This post is an interview of Emily Wegmann MPT, OCS, co-owner of a successful cash-based PT clinic in North Carolina where they specialize in pelvic floor therapy.

Give us the background of your cash-based practice? What are the general logistics: setting type, treatment length, employees, rates, etc?

Niche Specialties like Pelvic PT can make Cash-based a realityWe are an out-patient physical therapy clinic with a specialty in pelvic floor therapy for both men and women located in Raleigh, NC.  We have one-hour appointments for initial evaluations and follow up treatment sessions.  We have a flat rate fee of $175 for evaluations and $125 for treatments and submit claims on behalf of our patients, who are then reimbursed by their insurance companies at the out of network rate.  In addition, we treat Medicare patients as non-participating providers.  We have a separate fee schedule for Medicare which is based on the physician fee schedule for North Carolina.  Medicare patients pay at time of service per CPT code rather than via a flat fee.  We submit the claims to Medicare on behalf of our patients and they are reimbursed directly by Medicare.

Presently the two owners are the sole practitioners, administrators, billing office and marketing team.

When you started your practice, did you immediately go 100% private-pay or did you start out as a fully or partially insurance-based practice?

Our initial business plan has been based on 100% fee for service, out of network, private practice.  We have not considered being contracted with insurance however, it does help that we submit claims to the insurance companies for our patients.

What was the biggest challenge you faced as you started your practice?

The biggest challenge has been educating patients about the out of network fee for service practice model.  Many people are confused about their insurance plans and are uneducated about their financial responsibilities for in-network vs. out of network insurance benefits.  In addition, they don’t often factor the amount they already would pay out of pocket via a copay for in-network services. We are pleased that approximately 50% of our referrals are actually scheduling. We had estimated in our budget that 1/3 of patients referred would schedule.  We have been pleasantly surprised!

What is the biggest ongoing challenge of running your cash practice?

Educating patients about the benefits of physical therapy in a cash based model.

How did/do you overcome these challenges?

We continue to market in a variety of ways; classic marketing to MDs and providers, community marketing via print and radio ads. We are beginning to explore social media via Facebook and Twitter. We find our biggest resource is our website.  Many people find us via internet searches.

How do you market to physicians (if you do)? More specifically, how do you explain your private pay model to them and ensure that they still send you patients?

We were well known in our community and had a strong physician referral base prior to starting our practice.  Since opening 6 months ago, we have focused on reintroducing providers to our new name, location, and practice model and we highlight all of the benefits of being out of network providers. Specifically, we have done lunches, flyers, thank you cards and other traditional marketing techniques. We make personal phone calls with our providers about the coordination of care and frequently refer patients to them as well as receive referrals from them. We have direct access in North Carolina so for many of our patients physical therapy is the first medical screen for their symptoms. As a result a referral to a medical practitioner may be necessary. We specifically ask potential referring providers that we meet about their specialties are so that we can refer them patients. We have found allies with private practice physicians who are facing the same competition that private practice PTs face with the growth of hospital owned specialty centers and satellites. The team approach has been working great for patient care and for our business.

What would be your best advice for someone who is considering starting/converting to a cash-pay practice?

Don’t undervalue your services! Do your research—determine your fees based on both the physicians fee schedule as well as what your local market will bear. Some regions will thrive with high fee schedules; others may not sustain a cash practice model at all based on market, regardless of the quality of the services offered. Find a good mentor and don’t reinvent the wheel. Use professional services to strengthen areas you feel are your biggest weakness. Find an excellent accountant and health care attorney- work your contacts to find people recommended by your circle. Get involved in your community- your friends, neighbors and colleagues- and previous patients- are your biggest referral sources. Lastly, don’t hesitate! Start today, it was the best move ever! Great quality care, great quality of life! Of course if you can, have the world’s best business partner, I do!

Carolina Pelvic Health Center, Inc.

Emily R. Wegmann, MPT, OCS

www.carolinapelvichealth.com

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If you have any questions for Emily, please post them in the comments below.

Interested in the cash-based private practice model?

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