Why I’ve decided to have a cash-based practice?

One of the hotly debated topics in the news these days is centered around insurance and the cost to keep our society healthy. There is a growing movement towards cash based practices. Why has this movement occurred? Reimbursement rates from insurances make it hard to run profitable practices while providing quality care.

In school, I worked at practices where almost every patient got heat, electrical stimulation, ultrasound and ice. Did these modalities hurt the patients? No. Did every patient need these modalities? No. So why were we focusing on providing these modalities to almost all patients that walked through the doors? Simple, they allowed us to check off more billing codes to help increase the amount of money we were being reimbursed. On one clinical rotation in grad school, I was chastised for providing too much “hands on” care for a patient because it was not a good use of my billable time regardless if it was benefiting my patient. The amount the practice was reimbursed for this much-needed manual physical therapy was not worth mine or the practice’s time. Does this seem like we are doing right by our patients? Not to me.

The price each family pays for health care these days is almost unfathomable, especially when you consider the high deductibles you must reach before you start to see any money back. Copayments seem to be getting higher and higher. I’ve seen copayments as high as $60/visit. If you’re going to a conventional, in-network PT practice, you might be seeing your therapist 3 times a week. That’s $180 a week for maybe 45 min of hands on work done!

For these reasons, I opened a cash-based practice. When insurance does not dictate my plan of care, I am able to provide hour long one-on-one treatments that are heavily focused on manual work. I can take my time to mobilize the soft tissues, joints, nerves and viscera to free your body for more uninhibited movement. I’m able to use manual contacts to facilitate your muscles to fire properly rather than have you perform exercises in a gym where you might be just feeding into old, inefficient patterns of movement. I don’t feel rushed by the clock so I can take the time to listen to you and your concerns. Countless times I have discovered the reason for a patient’s chronic pain during these conversations. My mind is 100% focused on getting you better and focusing on what your body needs. I’m afforded the time to investigate your injury and discover what’s causing the breakdown and fix it.

While the price might be produce a little sticker shock at first, people come in a realize the quality of care they are receiving far exceeds the cost. I usually see patients once a week, occasionally twice but only for a short period of time before going down to once a week. When people weigh out the cost of going to an in-network practice and how often they would have to go to get the same hands on time, they find it is a better option for them. An added service we provide our patients is submission to your insurance company on your behalf so the cost of the treatments go towards your out of network deductibles (if you have OON benefits). Depending on your plan, you will receive money back from the insurance company directly.

I got into physical therapy to have a positive impact on people’s quality of life. The best way I know how is by providing the plan of care I think is most beneficial for a fast and lasting recovery. I do not believe it should be the insurance companies determining this for

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