I was invited to speak to the 5th semester students at my alma mater, University of St Augustine. In preparation, I put myself back at that point in my time at PT School and decided it would’ve been beneficial to hear about how to excel in the coming job interviews and negotiations. I mentioned that my practice is 100% Private Pay, and a funny thing happened … when we got to the Q&A, all of their questions revolved around cash-based PT!
Here is a video of the speech and Q&A.
It runs about 15 minutes and I cover a variety of topics including why I don’t think “job security” will equate to “salary security” for Physical Therapists in the future. It contains good info whether you’re a student, a practice owner, or a staff PT. If you know PT students or are associated with a PT school, please feel free to pass this video on to them.
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Great talk, as a fairly recent USA grad and new private practice owner I wish I would have got more info on this when I was in school. What recommendations do have for cash based business in a more rural lower socioeconomic area.
Thanks John Paul. Whether it’s an affluent area or a lower socioeconomic area, getting involved in the community and meeting people face-to-face in networking scenarios will help them make the jump away from utilizing insurance and going self-pay… and when finances make this jump even harder to take, then I think those activities take on an even greater importance.
You may also need to experiment with different pricing and treatment models to see what the people in your area are most comfortable with, but still allow you to make a good living. For example: maybe $100 for hour-sessions will scare people away, but $50 for 30 minute sessions is more acceptable to them … though the cost/minute is the same, changing the numbers they see can have huge effects on perception of actual expense. You may also want to look at adding complimentary services that people are interested in .. group fitness, yoga, pilates, etc.
And finally, I have patients drive from rural areas far outside of Austin to bring their children if that weekend’s football game is riding on their ability to play. People who seemingly don’t have much money are often willing to pay quite a lot out of pocket if it has to do with their child’s chance at playing their sport. So focus your marketing on youth and high school sports in your areas .. do injury prevention clinics for coaches and parents, go to games and meet people, etc.
These are just a few suggestions I’d have. Let me know how it goes!
Hi Jarod,
I’m a transitional DPT grad from USA and a graduate of FIU 1998 PT class. I truly enjoyed listening to your talk and have interest as well in giving back to future grads. I’ve had a prior joint ownership practice 2005-2008 and now involved with 2 partners in a new side venture. Myself and a few colleagues also inspire to be more involved in the political process for physical therapy autonomy. I admire your involvement.
What’s your thoughts on having a successful partnership practice?
How difficult is it to make a changing impact on legislation on a national level ie brand and copyright the name physical therapist/therapy to only be advertised by sole PT clinics/businesses and not by chiros or MD/DO?
I’d enjoy hearing your thoughts.
Matthew
Thanks for the comment and questions, Matthew.
My thoughts on a successful partnership practice come from what I’ve heard and learned from others, but Not from personal experience since I’ve never partnered in a practice. As I look to grow my practice in the future, partnership is certainly something I will consider as an option. In choosing a partner, I would suggest you know them extremely well first. Every possible change in personal and professional circumstances (and how those might affect everyone’s ability to contribute to the practice) need to be considered and accounted for in the written contracts you create. The only thing that never changes is that everything changes, so it’s really important you plan for all the possibilities up front.
As for your question on impacting legislation that would prevent MDs and Chiros from utilizing and marketing the term “Physical Therapy”… that’s a tough one. In general, it seems laws tend to change in favor of the group that has the most money to throw at it. For this reason, battling MDs and POPTS is always a an uphill one. From what I know of this subject, states have focused their efforts more at legislation which governs the activities of Physical Therapists rather than trying to police members of other fields… ie. making it illegal to work in POPTS, etc.
Whether it’s Medicare Caps, Direct Access, POPTS, or other issues, there’s no shortage of issues to fight for and get involved in as a PT.
Nicely done, Jarod. I think it is really important for us to reach students with information on developing a cash based practice. It is obvious from their questions that their interest is piqued, and I am sure you will receive follow up questions via email. Way to go!
Ann
Thanks Ann!
Jarod,
First, let me say I admire the work you’re doing with cash-pay education. I wish someone like you had been around 15 years ago when I started my private practice.
Second, I think there is another interpretation to downward reimbursement spiral that ALL healthcare professionals face. You ask, at 2:40, “Does job security equate to salary security?”
True, physical therapists practicing traditional physical therapy may see declining salaries.
But, many hospital systems transitioning towards Medicare Accountable Care Organizations (ACOs) are trying to find primary care professionals who can treat patients WITHOUT expensive imaging (MRI), specialty referrals and surgeries.
The median primary care physicians’ salary is $165,000. Hospitals are slotting nurses, and physicians’ assistants into primary care roles to save money. But, nurses and PA’s are not especially well-trained for time-consuming musculoskeletal injuries.
Physical therapists are well-trained in these skills as well as the primary care screening skills that enable us so see direct access populations safely.
Anthony Delitto said at APTA Tampa 2012 that “the value of physical therapy is in the downstream savings, NOT in the improved functional outcomes”.
There’s a lot of room between what I pay my therapists in Tampa (~$75,000 with benefits) and what primary care physicians are making.
The trick will be convincing the therapists themselves, the hospital administrators, physicians and the public that physical therapists can fill these primary care roles.
Thanks for all that you do,
Tim Richardson, PT
Tim,
You leave the best comments! Thank you for bringing this possible upward earning potential to our attention. At times like these, and what seems to be on the way, it’s so nice to hear something positive about the salaries of Physical Therapists. If possible, please check back and update us on this topic and how you see it progressing. In the meantime, what advice would you give to PTs looking to capitalize on this potential opportunity within the hospital systems?
And for those visitors who haven’t seen it yet, I encourage you to check out Tim’s website: http://www.PhysicalTherapyDiagnosis.com
Here’s Delitto’s presentation from Tampa:
http://ptjournal.apta.org/content/92/8/1078/suppl/DC1
Great Talk. As far as I have researched, PT’s in California are able to see patients for cash without a referral. A referral is required for insurance billing. Any different information you have on this matter?
Medicare seems so contradictory in that they have implemented a therapy cap but from other things you have said, Medicare does not want us to accept cash from beneficiaries? Any thoughts
Last, Is it possible to get out of Medicare but still be a participating provider for Privates like BC and BS and bill them?
Thanks for the questions Larry.
1. I can’t speak for Califonria PTs, but I do know that in Texas we have to have a referral regardless of whether or not insurance is being billed. Your State Practice Act should pretty clearly outline your rules on this topic.
2. Yes, it is a messed up system to say the least. However, if you have been treating a beneficiary and they reach the cap (and don’t qualify for an exception), you can then continue treatment with them on a self-pay basis. See this post for details.
3. Yes, there are many clinics that do not participate with Medicare but are in-network with private insurance companies.
Thank you, in your mind Jarod, what is the advantage to being a non par with Medicare?
The primary advantage is that it’s the only way you can collect upfront self-payment from MC beneficiaries (up to %115 of the MC fee schedule) for covered services. But you still have to send in claims to MC and deal with denials and all the other hoops they make you jump through; and what you actually get paid is not all that much more than if you are a participating provider.
Another question, Is it ethical for a PT, for example for a Par Provider with Medicare, to pre-screen their referrals prior to agreeing to taking them on as a patient? Specialist surgeons and ortho’s seem to do it all the time. They review the Med History and questionaires and diagnostics and then make a decision whether they will take a patient or not. If Docs can do it, can PT’s also do it. Or… do you have to be cash based only to do this. Or not?
I can’t speak directly to the legalities of the situation, but as far as the ethics of it … that would depend on the reasoning behind screening and potentially turning away certain prospective patients. If you don’t think your services will be of help to the person, I would say it was unethical to accept them as a patient; which is what I often feel orthopedic surgeons are doing when they turn away patients. Of course there are probably reasons for turning away patients that would be considered ethical by all.
Larry,
In CA we do have to have a medical diagnosis to treat a patient, self-pay or not. We just lost that major battle when SB 924 failed to make it a few weeks ago. If you are providing wellness services you do not need a referral. There’s always been a bit of a debate about how “old” the medical diagnosis can be (i.e. if someone was diagnosed with DDD 5 years ago can that be a valid diagnosis for current treatment).