I rarely go a month without hearing the question, “How in the world do you convince patients to pay $150/hour for Physical Therapy?” Another related comment goes something along the lines of, “Cash-pay patients??! But I struggle to get many of my patients just to be okay with paying their co-pay!” The mindset underlying these statements is quite upsetting to me. Why? I feel that the majority of Physical Therapists are guilty of the same thing the majority of the general population is: a significant undervaluation of physical therapy services.
Think about it … those of us who get good-great results for our patients, help them to move, exercise, and LIVE with less/no pain and dysfunction. We help people get back to lifting their grandchildren up for a hug, going for a run when that hadn’t been possible for months, and looking over their shoulder far enough to safely change lanes while driving! Is that not worth more than a $20 copay, 2-3 times per week for a month or two? Really!?
I understand that everything is relative, and there could be valid arguments and complaints about this post depending on individual circumstances, but I’m not trying to propose a payment formula that will work for all individuals, or argue about cash-pay vs insurance-pay; that’s not what this post is about.
I’m simply trying to draw attention to the widespread mindset that I see pervading our profession about the value of what we do. How in the world can we expect the general population to place a high level of value on our services, if we (on average) do not do so ourselves? I know that it makes all the difference in my own cash-based practice that I am fully confident in the difference my services make for my patients.
I really hope that my colleagues from all sides of this topic decide to chime in and voice their opinions below. Of course we have to make sure that our services are available for all. And of course not all people have the disposable income to be able to go out-of-network/cash-pay for PT treatment. Again, that’s outside of the topic I really want us to hone in on here. I want us to look at how we as members of the physical therapy profession view and quantify the value of the services we provide.
Why do we tend to minimize the value of physical therapy?
I trace a big part of this valuation issue back to “habituation.” I think that a great majority of Physical Therapists have simply never known anything different than the model in which someone can come to a nice clinic, spend an hour receiving care, and pay $10-20 as they walk out the door. When this is one’s reality throughout one’s professional life, it’s completely understandable for that person to develop the mindset that an hour of their time is only worth $10-20 to the consumer. So does that make this opinion and valuation correct? I would say “No!” It is simply “the norm” (at least at the time of this writing).
I would like to ask all those who have spent their careers in this type of scenario to really focus on that question. Yes, the insurance/Medicare systems will (hopefully) pay your practice much more than that $10-20, but do you think it’s okay that your patients view your services as “worth about $20 per hour”? I think even mediocre PT care is worth more than that, but maybe I’m just biased. (Okay, to play the devil’s advocate, if you’re seeing 4 patients at a time, counting repetitions all day and delegating most of your actual treatment to techs, then yes, that consumer is probably correct in valuing his time at the PT clinic at $20/hour.)
Everyone is screaming about insurance companies and Medicare paying us less than they should, but I think our fights in these areas are doomed as long as the majority of us mentally undervalue our own services.
Reconsidering our mindset about physical therapy
In my opinion, “mindset is everything” because even if you do everything else in your business correctly, but your mindset about your business and your value is not where it should be, you will still struggle to succeed. That’s why I dedicate an entire chapter to “mindset” in my Cash Practice Guidebook.
I think it is long overdue that we as a profession really evaluate the way we perceive our value, the way our patients value our services, and the value that the general public places on what we offer. How can we improve and increase the value that most people place on physical therapy? I have numerous ideas on this topic, and I’m sure many of you do as well, but I would like to begin with this statement:
It all must start with us. If we don’t view our services as highly valuable, speak about them in this way, and convey that value in everything we do, then our patients, the general public, and insurance companies/Medicare will not highly value us either.
So what do you think about all this? Do you think that PT services are undervalued by Physical Therapists themselves, and/or the general public? Let us know in the comments below, and give your opinion on what can be done about it. Share this post with your colleagues and get others involved in the discussion.
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Great post Jarod. Totally agree. I would also mention that physical therapist’s should also think of ourselves as replacing physician care for many high-volume caseloads.
Hospitals, particularly, are interested in replacing physician labor, valued at a median $165,000 for a family practicioner to 2-3 times that for specialty care.
Just as Jarod says, physical therapists need the proper mindset to replace physicians as the first, best provider of musculoskeletal care.
We already have the education. In some states we have ‘strong’ direct access while other states have ‘weak’ direct access (Florida has weak direct access).
Either way, physical therapists can be more assertive in establishing our scope of practice. The reason we aren’t, in my opinion, is that we are too dependant on the insurance ‘tit’ 🙂
Tim Richardson, PT
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Thanks for the input, Tim.
I wish Texas’ Direct Access was as “weak” as Florida’s! 😉
Great post, Jarod. As someone considering a DPT program who has been a PT patient at both cash-only and insurance-only practices, I will speak from the limited experience I have and make comparisons I think are fair from listening to friends’ stories.
I experienced one clinic in Austin where the doc only spent a couple minutes with me, and then the rest of the appt was with the PTA. I was paying cash and was very lucky to be able to afford several sessions to work some post-half-marathon hip pain, but it always felt like the doc was rushing me and I was paying a fair amount of money to do exercises I was also supposed to do at home. So, I can see how some practices can incite patients to think, “why would I spend $100 on this?” But I know that your practice, Jarod, is far from this. When the PT spends quality time with his/her patients, that really adds so much value to the services.
I also think PTs who undervalue their own services should really take a look at the holistic benefits of their practice. Like you said, Jarod, you are helping an athlete get back to what they love or a grandparent improve quality time with their grandchildren. It’s more than just strength and pain reduction, it’s life improvement, just like going to see a psychologist who can help you overcome anxiety and depression.
In a lot of circles, PT is not seen as a “luxury” because patients associate it with post-surgery rehab or a mandate after an accident. And that can be tricky for practitioners, I’m sure, because you don’t want to seem exclusive and prohibitive to someone who may not be able to afford a cash appointment — the same mentality often contributes to the stigma of going to see a psychologist. (A psychologist friend of mine markets her therapy practice as “taking care of the brain, an organ as important as your heart,” and another specializes in working with athletes who have performance anxiety and markets herself as a “life coach” to avoid the stigma. So I think the challenge must be, how can you convince people your practice is worth the money with alienating a whole community who might truly benefit from PT but can only afford it through insurance?
People will pay $100 for a massage which may never give them the benefits of PT (though of course some massage can be truly therapeutic) because of the relaxing, luxurious feel of going to a spa. So perhaps one thing PT’s can do is really focus on making sessions feel like a high-quality commodity. Making each patient feel cared for and listened to so that they will spread the good word and hopefully over time, the attitudes will adjust. Having more certifications, like manual therapy, massage, yoga, personal training, pilates, etc, (or offering those services through colleagues at your clinic) could also help. I know it isn’t possible for many practices, so just an idea.
I’ve also heard swapping sessions (like for a free dental whitening or new car battery or personal training session or whatever your friends can offer) can contribute to devaluation. I’ve been warned against it as a Pilates instructor. Any thoughts on that?
Looking forward to more comments – this is all great fodder as I get ready to take my prereqs and apply for DPT schools…
Thanks Karie! You sound like a successful cash-based private practice owner already and you haven’t even applied to PT school! We will be lucky and honored to have you among our ranks.
You made a lot of great points above, but I’d like to especially highlight your statement “So perhaps one thing PT’s can do is really focus on making sessions feel like a high-quality commodity.” Executing on this idea alone could make an enormous difference for a PT practice that struggles to convey the value of what they provide.
As for your question on service trades, I’ve done a bit of this with my mechanic and some graphic design professionals, and I haven’t felt that it devalued my services. However, I have learned that you need to make everything clear (in writing) about the parameters of the trade, and you should both utilize your full price/rate even if you are friends that would normally give one another at discount.
Yes, Yes, Yes, Yes!
Having a CashPT mindset is the golden ticket.
PT services are undervalued by both therapist, physicians and the public. Unfortunately we are only worth the co-pay to a majority of people, and really no one knows what we really do except hot packs, leg lifts and ultrasound.
I’ve also blogged about this and think that it is the cornerstone to a successful primary care physical therapy practice, not necessarily just a cash based practice.
When I was in school, I was already charging patients $85/hr as a highly trained massage therapist treating clients with chronic conditions who already had been to see physicians, physical therapist, chiropractors, etc. There was no way I was going to take a “pay cut” and work for someone else. As a student I had also treated a record 43 patients in one day! There was also not really anywhere else I could have been an employee where I live and treated patients in the way that I think is beneficial and valuable while earning a fair living for my services. The first thing I did out of school was to give myself a raise.
As Tim mentioned, considering ourselves as primary care providers is one of the Huge mindset shifts that I think is vital. To go along with this, is the use of the language we use when speaking to each other and our patients. We should not use the terms “Your Doctor” and “Docs” when talking about a physician or medical doctor, nor use the term “orders” or even “prescription” but instead say “physician’s referral” or “consultation”. We are a doctoring profession, and part of the mindset shift to be a primary care physical therapist is to talk about and think of ourselves as the primary provider of musculoskeletal care to our patients. Using the term “docs” or “your doctor” when talking to patients and other therapist disempowers us as practitioners. We can decide the best treatment for our patients.
We should not let 3rd party insurance reimbursement influence our decisions about what is best for the patient. There is also the value to a practice owner who knows that every patient they see brings in the same amount of money. I’ve seen patients with “better” reimbursement treated more and with extra care than patients who are not “worth” as much to the practice. That is really where a cash based practice allows for success, independence and freedom.
I think it all comes down to value, and how much do we value what we provide. A patient who is paying a $10 or $20 co-pay will only value you and your service that much. That’s less than dinner at most restaurants. Even a $50 co-pay is off the mark for the value of what we can offer. Charging the fair market value for physical therapy puts the responsibility back in the patient’s hand that they have to help heal themselves, they are not there to be fixed. I find that when my patients pay in full, they are more compliant with their home program, they have bought into my philosophy and program, they are incentivized to get better and often discharge themselves.
I could go on and on…:-) but I’ll stop there. thanks for the putting it all out there in an awesome and relevant post.
And Thank You, Aaron. Great input. Makes me want to find a wordpress plugin that allows you to give individual blog comments a “thumbs up”
Thanks. You too. If you find one let me know!
Of course, I could just pile on to the good vibes that this post will generate with the like minded PTs who read you Jarod. As many of you have already read, I wrote a post comparing and contrasting value among the physical therapy and personal training fields similarly to what Aaron points out above (http://sparkphysio.blogspot.com/2013/06/your-personal-trainer-is-more-valuable.html)
That said, I’ll point out the biggest barriers that I see to us all moving forward as the high-value practitioners that we are:
1. PT education continues to foster a subservient relationship to the ALL MIGHTY, ALL KNOWING physician. As we are all completely aware as I’m sure you all treat many physicians (as I do) they know far less than our education and the public gives them credit for.
2. The current “everyone must work in a PT MIll” model will ALWAYS be the norm and will continue to wreck the public’s idea about what PT is. Volume first, quality a distant second. What is a student PT to think when each of their affils is as an assistant traffic cop in a physical therapy factory? I recently did a national radio media tour where in two of the conversations I was challenged to answer questions about why “physical therapy doesn’t work”. I feel that I helped our colleagues by explaining the difference between PT settings and that “HUM job PT” is going the way of the dodo, but I’m not 100% sure that this is the case. Every PT going would practice in with the approach we all share but the setting they work and the way in which these clinics are reimbursed for their service drives the care that patients receive. It is no wonder why the public doesn’t value what we do; they are not seeing it!
3. Add more services to your physical therapy practice. The public may not yet know what ELSE a physical therapist is capable of helping them with. In PT Mills, regardless of how good the pro is at treatment or another ancillary yet related skill, the patient will never know it because of the truncated time they get with that PT.
The solutions as I see them are:
WRITE, READ and get in the conversation
and
take on students! this is a bit of a grass roots approach but every time we have another affiliation come through they leave our clinic refreshed and confident that they will be able to do the work they have dreamt of all their student-lives because clinics like ours exist.
Carlos
ps: Jarod, Aaron or anyone else: are you going to AAOMPT in October? I’d love to talk some more shop and work some strategy with each/all of you for the coming year. There is little I am more passionate about as reestablishing the standards for value in what we do and what the public should expect from PT.
I won’t be at AAOMPT but if you’re at the PPS Annual Conference, I’d love to meet up with you there.
You’re comment here was awesome and I agree 100% but there’s one sentence I feel we I should add a tag/modifier … [physicians] “know far less than our education and the public gives them credit for.” As a PT, I’m guessing you meant that the the non-orthopedic/PMR physicians know far less about the musculoskeletal system than PTs… I agree, but I think that statements like this need to delineate the specific parts of the MD population we are referring to and also the realm of the body/healthcare in which we are so well-trained.
Thanks again for taking the time to give such a detailed contribution.
Carlos,
Great thoughts. Love your passion! I will not be at AAOMPT this year, nor PPS. I am planning on going to PPS in 2014. Maybe we should try to have a CashPT session, luncheon, or even a separate cashPT retreat, where we can all get together, meet in person and share ideas.
I’m down with that! I’m sure we can come to an agreement as to the details if its something that more people would be interested in.
This is one of the top issues in our profession. A plumber charges more to look at your clogged sink in 15 minutes than a PT charges for a 1 hour eval.
Let me know what we can do to change this perception in the PT student. I think a lot of this starts in school and other than just explaining to them the value of our skill set what else might help?
Last thing is that a lot of PT’s suck, and by that I mean they are terrible, I wouldn’t send my worst enemy for treatment type of PT. These people run mills of patients through basic cookie cutter exercise and modality heavy protocols. they do not deserve $150 a visit, they deserve $30 a visit if that, so they do not apply to this conversation.
I guess one thing that can be done at the level of the PT school is to explain that a huge percentage of PT clinics out there are the “mill”-type clinics that provide crap treatment and perpetuate a low-value perception of PT among the public and our referring colleagues. Give them insight into how crappy life will seem when they are expected to see 3-5 patients per hour, all day long, every day (and then they get to do the paperwork). Present to them the idea that salary is not the only benchmark they should consider when looking at their job options … that a setting/clinic which encourages high quality care will also provide them with a higher quality of life, even if the salary doesn’t trump the mill/popts down the road.
I remember our professors talking to the class about POPTS and what they are doing to our profession. Whether it’s a POPTS, or a PT-owned “Mill,” the result is the same when it comes to this topic of delivered value, and value-perception among PTs, the public, and 3rd Party Payors.
“Last thing is that a lot of PT’s suck, and by that I mean they are terrible, I wouldn’t send my worst enemy for treatment type of PT.” – I’m so proud to call you a classmate! Thanks for contributing here, old friend. I hope it’s not long before I can make it out to ol’ St. Auggie again.
Jarod, great stuff. I would just add that we, as a profession, need to do a better job at promoting what “physical therapy” really means. Massage, personal training, etc all have a very clear descriptions. If you perceive value in that service, you are all set.
What is “physical therapy?”
I bet if we surveyed the public it wouldn’t be what we say “physical therapy” is to us. There is a general sense that you need to have a blow out injury or a major surgery to attend PT, which is the unpleasant thing you need to do afterward. The public doesn’t know that we can help them live better!
Who wouldn’t perceive value in that?
Thanks for the comment, Mike. Great point … it’s hard to value something you can’t accurately define, and we definitely seemed to be associated much more with post-surgery than anything else.
I couldn’t agree more that we undervalue ourselves as a profession. I feel one of the biggest problems is internal fighting and putting down. I have a DPT and work with people that have MPT and one co-worker that just retired that had a bachelors. Whenever anyone asks the difference they get all huffy and puffy that there is no difference. YES THERE IS! I went to school for 1 more year and took more classes. Do I think that makes me a better PT no, but it makes it seem like being a DPT has no value when we as a profession put it down in front of the patients. I think we should be called Doctor because we are and I think that would start to help and I know patients who have said that they have never been treated by a Doctor before. So the masters and bachelors need to get on board or get off the train and stop slowing down the progress of our own profession with internal bickering and back biting.
I think are schooling needs to push marketing to the community that we are Doctors and we are the musculoskeletal professionals. Most people I meet and know don’t even know truly what we do or that we are DPT’s.
I disagree that quality time is what makes me more valuable. I am valuable because of my education and that is the way we should think. I don’t think physicians say that they should only be valued if they provide quality care. They demand respect because of the knowledge and schooling they went through. It should be the same for us. Quality of care helps but should not determine my value.
Lastly, I don’t think we should be putting down our profession and telling others that there are a lot PT’s that suck. It puts down our eduction. They may suck but you don’t here lawyers and physicians go around knocking there own profession. They may think it but would not tell people that. I think we can help increase our value without telling the community that we have a lot of PT’s that suck.
I am glad you wrote about this I am passionate about it and wish they would make everyone get on board so we could all just write DPT behind our names and bring uniformity to our profession.
I hear some good agreement and some interesting counterpoints. I think Aaron may be onto something with a Value PT Symposium!! I am officially throwing my hat in the ring to help/lead organize it if people are interested.
Spring 2014: Washington, DC will be the venue. Who’s in?
I also wish we had uniformity across states with direct access and things like dry needling. Found out my state doesn’t allow it but others do makes no sense. I would be interested in doing DC idea.
Hi Jarod,
Thanks for posting this. I think that we ROUTINELY undervalue ourselves as a profession. TImes are a changing and the ACA has made it so. We have to offer #value to the consumer and it can come in all shapes and forms but it has to come. I will tell you the consumer is getting more savvy about their health care and what they have to pay, even though they do not show it. In the end, “You get what you pay for” rings so true and I often find myself saying that to patients who have come to me from another facility where they have gotten “sub-par” care. This is the model we have to supress and defeat.
Getting the word out about PT and how we show value is paramount to our survival. The consumer has to understand that PT is not about e-stim and the leg press !! I did a 3 week course last year in Canada and the physios there do not have this problem. As a matter of fact, they have a wait list for their cash services!! Go figure…
It’s all about priorities. If you #value your health, you #value your physio. Period end of report.
Sorry I did not get a chance to meet you in Vegas last year but New Orleans is looking good. We will definitely meet in November!
Erica
Thanks for input, Erica. I’ll be speaking at the PPS conference this year, so I hope to see you there!
Great topic. I just opened my Cash PT and Wellness business last week. Exciting times. What are some talking points to those patients who say. “I can just go get a quick adjustment for 25 dollars”. Obviously I don’t want to bad mouth the chiro model but this bugs the heck out of me. Have you guys had good success convincing those patients to try sessions with you?
Thanks for your feedback
You don’t have to bad mouth chiros but if you simply point out the literature re: acute benefit and lack of long term efficacy of treatment that is solely hvla manip then your argument to those clients is simple. Chiros have been making their living by openly bad,outgoing PT and fighting every step of the way to limit our scope and expand their own. I don’t see any problem telling the public the truth about these scam artists but usually choose the evidence based arguments.
I don’t hear that statement too often but when I do, I explain a few things:
1) my treatments are not “quick” and therefore I get a great deal done in each session. As compared to a “quick” adjustment which they tend to recommend every week or two FOR LIFE … add up the overall financial and time cost of that approach and there’s a very clear winner when our goal is to get them better and no longer in need of regular treatment.
2) I explain the neurophysiology of the joint cavitation, how it causes a temporary reflexive muscle relaxation, does not actually (in most cases) “re-adjust” the position of anything, but releases endorphins and can even cause instability if the manipulation is not focused on the tight joints only.
3) I explain that I too utilize chiropractic treatments but only go to those with a model like mine … get the patient better as fast as possible and then send them on their way with the tools to maintain the improvement on their own whenever possible.
I love every one of you!! I work in a holistic model and need this refreshment every now and then from my friends off the yoga therapy mat. I Just shared this post with Private practice owners group on Linked in because that forum has many “surviving ” . I just wanted to acknowledge that It is not easy to be the one that consistently needs to forge new paths . It can be downright frustrating ( which we see in these comments) but when you see the prize it is impossible to do it any other way and I want to support you. So in my @yogadocnc words I say ” stop being so distracted, see your potential and go with the flow of the times and for anyone actually reading unable to evidence base my words: “Dr. Lisa Holland send you hope that your very inflexible and stable mindset learns to use your titles better, expand , circulate and mobilize your options.”
Thanks so much for sharing this post with the Linked In group, and for your kind words here.
I have been practicing PT for 37 years now and I think I am very good at what I do. I own my own clinic and have not considered closing the doors. So I neither undervalue myself as a PT nor undervalue my profession. In fact, my daughter wants to go to PT school…so I clearly am invested in this “thread”.
What do you all think about leveling the playing field for all PT’s by stopping 3rd party reimbursement all together except for maybe in patient hospitalizations? (6 visits whether you need them or not)
With health insurance that looks more like major medical coverage, Insurance premiums would (should) go down and patients, once they leave the hospital (if needed), will have to find the PT that gives the best service, the best value and the best care. In my mind that weeds out the “mill” PT offices. This allows a free market to dictate where patients go for their care. However, that puts us in competition with those that don’t accept insurance reimbursements. I say “bring it on”.
I am just trying to think outside the box as I agree, reimbursement will only go down…so let’s help the insurance companies and their customers out and make it an option (rider?). If I were an insurance company, I would increase premiums for skiiers, extreme athletes…etc
Where I live we have a very healthy population of active people doing perhaps excessive and dangerous activities. Many are young and don’t carry insurance, so when they get hurt they see CMT’s and personal trainers without question. What the injured party pays their health care providers is much more than an insurance company would reimburse me as a professional. I want to be that “go to” person when a young athlete without insurance needs help. I want to tap that market. I believe I offer a better product!
Would love your thoughts!
Kristie
Hi Kristie,
I am all about knocking out 3rd party reimbursement! That would level the playing field, for sure. I think with such high deductibles on out of network benefits, we are becoming a cash practice field by default. The consumer has to understand that the insurance company will not cover everything-and there are people who believe that. But the overwhelming majority still believe that their insurance will and should cover everything and will not pay a plug nickel for their care-that is NOT my ideal customer avatar nor should it be anybody’s who wants to generate a cash based business. That is mindset that will not deviate.
Having said that, identifying your ideal customer and wrapping your head around that mindset and BEING your ideal customer will help you attract your ideal customer. That “go to” person who is an expert in their field-my mind is going down the same route as yours!
When you become your ideal customer, you will tap into that market without thinking.
I think that insurance premiums will be going up actually as more people access the exchanges-I may have to go there myself for my personal coverage as 2 insurance companies that I have had previously have already dumped the small business market here in NY. Who gave them the right to do this? My revenge is to NOT TAKE insurance and be the best PT you can be. Sorry, for the lengthy post but I can be a bit wordy when I am passionate about something!
Erica
Don’t apologize! That was great stuff! You clearly understand a lot about proper mindset, and I appreciate you passing that on here. Having an image and knowing the characteristics of your ideal customer/patient is hugely important and I’m glad that you brought it up. When it comes to conveying the value of physical therapy, certain people will be very open and “teachable,” while others simply never will be; and you shouldn’t spend too much energy trying to change the mindset of that type of person.
I think it would make for a very interesting situation if PT is a whole was not covered by third party reimbursement, but I don’t think logistically it could ever fully go in that direction. And I don’t know that it really should either… I think some level of coverage is important for those who end up with long-term chronic issues, and an inability to pay much out-of-pocket.
But as for your young athlete population, you can most definitely tap into that market and become a “go to” practitioner. Here is one idea to start with: Pick a sport/activity you are especially interested in, and/or know creates injuries you enjoy treating and have a lot of success with, and start offering injury-prevention clinics for groups of people in that sport/activity.
Great post Jarod!
My 2 cents: Keep focusing on quality and word of mouth is the best marketing you will ever get and the word will spread but… will do so slowly (and steadily). The PT mill and POPTS can keep doing what they are doing as far as I am concerned…it keeps me in business because it makes me different! People are willing to pay out of pocket when they realize they get what they pay for with the “free or nearly free” model and many times the “free” model ends up costing more in the long run (complications, additional surgeries, lost time from work/sport, etc…)
It does frustrate me that the PT mills ultimately devalue our profession because of the lack of quality and time spent using brianless modalities but that is a fight you have in many professions.
My dad was a custom homebuilder for many years. He had it figured out that he would rather build fewer #s of houses and focus on quality than become a cookie cutter home building factory…can tell you details about houses he built and the families he built them for years later. He also was smart enough to know that the customers for each were different and didn’t try to compete on the same grounds. Don’t think that is much different with mill PT vs us in cash and/or private practice.
Julie
I completely agree with Jarod. I’m not a PT. I am an engineer and I see this same issue within my field. It’s up to the professional practitioners to somewhat come together and start demanding their full value. As long as the majority is willing to accept the under-valued compensation, it will undercut the rest of the market. I’ve seen the cost of almost everything go up (food, clothes, gas, rent, entertainment) over past 10 yrs, yet avg incomes have stayed the same. As long as the majority caves and under-values their own service by accepting low pay, PTs only have themselves to blame.
You PTs are lucky in that you have a skill that allows for the possibility to work for yourselves and set your rates where they should be. You should take advantage of this.
As an engineer it is very difficult to run your own practice due projects requiring a large team of engineers requiring guaranteed pay upfront. You’re lucky to get $50 an hr with many years of experience, even though the expertise provided is likely worth $100 to $200 an hr.
Also, I’ve been looking for a foundation repair service to inspect a home before I close on it. They want $250 guaranteed just to show up an inspect. They generally don’t have specialized academic training, yet they command much more than most engineers will earn hourly or PTs for that matter.
Don’t be afraid to command what you’re worth. After all, how can you expect to exist in the future to help people if you’re not commanding enough to make it worth your while?
Extremely well put, Shane. Thanks so much for contributing.
People will not pay a stated fee if they do not understand the potential benefit. No one here can blame them. We all can educate our patients and, by word-of-mouth, spread the word of the benefit of PT. At this rate we should have everyone educated by 2050. Lol
This lack of understanding of physical therapy’s benefit must fall upon our association if we hope to sway the population anytime soon. Anytime someone has a terribly misguided understanding of physical therapy, I detail it in a quick email and send it to the APTA president.
These encounters happened to all of us weekly and the APTA should be informed in hopes they may take action to educate the public.
This will take forever without a concerted effort.
Great Post Jarod!
I currently work in a third party/Medicare system and am working towards opening my own Cash based PT clinic. I completely agree with Mike Reinold that the community has no idea what physical therapy is, or how it can benefit them. We should be the primary care practitioner for musculoskeletal disorders – I almost wish our title would change from Physical Therapist to Musculoskeletal Experts. But how do we show the value of therapy or get the message across that we should be the “go to” clinician for musculoskeletal pain?
I believe it is on us as therapist to break out of the insurance model and move to a cash-based system that allows us to spend more quality time with our patients. No matter how good of a PT you are, if you have 5-6 patients in the clinic every hour, you will not provide your best care to these patients. The model is flawed! And we rely on support staff to help us, but they are less qualified and are unable to provide the quality/effective care that we can provide as doctors of physical therapy. If we focus on a model that puts value on the patient, provides excellent care, and demonstrates that effectiveness of good therapy treatment; then we are headed in the right direction. If we continue to dwell in a model that inherently does not allow the therapist an opportunity to provide the best quality care, than our profession forever will be known as “those exercises guys that make me hurt (non valued persona)” and not the “doctor I go to for musculoskeletal pain”.
Well put!!
Hi Everyone!
I can’t thank each of you individually….so as a Group…Thank You…because I found “value” in ALL of your comments…in some way. We do have to chart some new waters…as we have “grown up” in an Insurance Driven World from the beginning of our careers…and it progressively worsens….and I believe will continue to do so.
I think “providing value” and placing a “price tag” on that value is (and will be as time progresses) a tricky task. At the end of the day, the perception of value is in the hands of each and every patient….and I really believe we have to be Creative with how care is provided AND “How” the cost of our care is delivered.
Truthfully, I don’t know that the average American could afford what we may think our services are truly worth….if we are basing it on an hourly scale….unless……we get CREATIVE. With the way the traditional therapy model works…2-3x/week x 4-6 weeks….not too many could afford what we are worth hourly (although many don’t need that frequency or total visits)..just as most couldn’t afford an Orthopedic Surgeon Consult 2-3x/week x 4-6 weeks. But because we are reimbursed so little (and dwindling) it makes it so difficult to operate.
Self Pay Practices would be so prevalent, but Practices are clinching on to the insurance based practice because it is “the norm” and “the volume” is there, which to some extent, secures their existence (at least in the short term). And of course there are hesitations because of the very fact that consumers can’t even afford the $20 Copay…..and ESPECIALLY the $40 and $50 copays. Of course, no one will pay for a service of which they see little value…but it is a reality that even with exceptional value…MANY people just can’t afford it. I know many of you are in geographical areas where your avg. per visit reimbursement is $85-$95……I own 3 practices and our average is $49-51/visit….Some copays are $40 and we get the remaining “$2.00” from the insurance. All in all…..we are being squeezed so much…..and most of us want off the crazy train…….but we also don’t want to lose our livelihoods as we know them. So, for me? I’m thinking less about (although I value the thought process) my hourly rate and more about…How can I deliver what I, and more importantly, the patient considers to be a life changing, value driven experience….BUT make it realistic and affordable for the patient….and economically feasible for the business….tricky…..but I have a very Unique Business Model (that I am working on right now) as I plan to launch a cash based practice. So, I think we need to consider hourly rate….but……we need to “package” our offerings VERY creatively……and “Prove” our value through our actions and outcomes.
So here’s to “getting off the crazy train” …and Best of Success to all of you….and to Jarod for initiating such necessary discussions
Sincerely
Dr. Joe, PT, DPT, OCS
Thanks for the comment, Joe.
Wow, $50 avg reimbursement?! You are definitely in a tricky situation and I’m glad to hear you are really looking into the transition to private-pay. You raise some very good points, that even if you’re delivering a high value service, much of the population simply will not be able to afford many high-dollar cash-pay visits. I don’t want what I’m about to write to be taken the wrong way, but I feel I can say it because no matter how bad the reimbursement scenario gets, there will always be plenty of MC/Insurance-based PT options for consumers who cannot or choose not to visit an private-pay PT clinic. I want you to keep in mind as you make this transition, that you will no longer be marketing to the exact same group of prospective patients that you have up to this point. I’m not saying you’ll need to market only to the affluent… I’m saying you’ll need to market to those with the mindset of being happy to pay more to receive higher quality service (in many cases, this has less to do with income than you would expect). The way you speak and write (online) about your services and present them to the general public should be done so in a way to attract those with this mindset, and possibly even appear unattractive to those with the opposite mindset (that PT should simply always be covered by insurance, and is never worth more than a $20 copay). Here is an example (on my clinic’s website) of what I mean by that: http://www.carterpt.com/rates/ . Like you mention above, there is a lot of room, and Need, to be creative with pricing and service delivery models … especially if you are in an area where you feel the above-mentioned high-value mindset is sparse.
When I present the above idea, some PTs get upset about the suggestion of switching into a business model that is “alienating” patients that formerly used their services. To this I say, as a business owner, you have a duty to your employees, yourself (your family), and to your community to remain profitable and keep your doors open… and at $50/visit avg reimbursement, that’s just not sustainable long-term.
We will all be interested to hear how this transition goes for your clinics, and wish you the best. Feel free to join our forum/group at LinkedIn and post questions/comments along the way:
http://www.linkedin.com/groups?home=&gid=4934547
Thanks again, and best of luck!
As I am growing my cash pay practice here in San Diego, my frustration lies in comments from prospective clients and/or other small business owners along the lines of “well our employee teaches yoga so we go to her” or “I hurt my back so I am going to see a yoga instructor”. It kills me. I try to explain, but for many folks here in north county SD, it’s as if the yoga instructor is more qualified to help with rehab, despite many yoga instructors having approx 200-1000 hours of education (a far cry from a clinical doctorate/ DPT). Argh!
I have tried to bend this around (no pun intended) to figure out a way to integrate PT and yoga.. I am hoping that people can learn that PT can be as effective, more customized, and more valuable then a group yoga class. Yet, rather then fighting the concept I am toying with doing customized PT stretching classes for small groups that would help satisfy this yoga desire of the residents of SD. Perhaps an “extension sensitive/ flexion biased” type back stretch/stab class that is yoga driven. Or hip and ankle stability class and classify it as yoga-inspired (tree pose/ SLS..throw in a dynadisc…)..
Anyone had any luck with these type of classes creating clientele for their normal one on one cash based clients?
I haven’t myself but I know of a practice at which all the practitioners are very into the John Barnes MFR approach, and they have a great “myofascial stretching” class that many of their patients take in addition to their actual PT treatments. If there is a need/desire for something related to “Yoga” in your area, fill it! Use the term “Yoga” in the class description, and don’t worry about using that term since they have no problem saying that they “help with back pain” and other injuries they have no education in evaluating or diagnosing.
On a related note, try not to get too worked up about the mindset of those who feel Yoga instructors (or Pilates, or whatever) are more qualified than us. Just quickly explain that their education requirements pale in comparison, and let your results do most of the talking. It’s kinda like trying to convince everyone in the general public that cash-based PT is “worth it.” Our target market are not those who need a lot of convincing, and you will only frustrate yourself if you get caught up in trying to change the mindset of Yoga lovers. Just utilize the craze to your advantage and create one of the programs you mentioned. You might find that you love “Yoga” too when it starts to pile money in the bank account 🙂
Shane,
Congratulations on your new practice!
I hear you on that issue. It’s fairly common. As Jarod said, don’t let it effect you and you just have to get over it. I know I can not convince someone that they should be coming to see me for therapy if their belief is their yoga class, physician, chiropractor, vitamin, etc will heal them. The people who you serve will find you because of your value and quality of service.
My wife and I taught a very successful Yoga for Back pain workshop about a month ago at a local yoga studio. We made some money from the class fee that paid for lunch and a babysitter 😉 but more importantly formed a much stronger relationship with the owner, teachers and students at the studio. They have already asked us to do it again.
My thoughts are, make it a point to get to know the yoga instructors and get in their network. Take their classes and introduce yourself. Once you get to know them, offer to teach a seminar at some of the larger studios just yoga teachers on how to identify certain injuries, modify poses to accommodate common injuries/pain conditions & contraindications, techniques & tips for them to teach their students to use when they are injured. Another idea is to teach a Yoga workshop with a teacher you click with, etc The yoga teachers will then begin to defer difficult questions to you and refer students to your practice when they have an injury that is not improving or ask the teacher for their recommendation for a therapist .
Yoga instructors are one of my largest referral networks. Good luck.
Thanks guys, great ideas and thanks for the encouragement.. Going to get my Prana on later this weekend 😉
I tend to think the market should set the value. If there is demand, then the price is naturally set at a product’s value. If I need the service of a good attorney, I have to pay what she demands. In healthcare, prices are artificially set. The ‘value’ is set from on-high and PT is highly under represented and, in my opinion, tends to kowtow to referring sources. That would be one thing except that, in Texas, we are handcuffed by legislation that won’t allow us to see someone without a referring sources blessing. I don’t think PTs undervalue our services, I just think it becomes an echo chamber among we insiders (compounded by the fact that many volume-based clinics don’t provide much value IMO, making the profession look bad and reducing perceived value of the potential of PT).
Congratulations on your new practice!