Cash-Paying Programs

Article from Impact Magazine, written by Harvey Schmiedeke, President:

Tired of declining reimbursements and insurance hassles? Cash-based programs can do more than eliminate paperwork and long delays in payment. They can add significantly to your bottom line, attract highly motivated patients for programs that are fun to deliver, and give your clinic a unique selling point to both the public and referral sources. Cash-based services range from simple services that you may already offer to programs that require significant outlay in time and money. They could, however, become the majority of your income. Here are some examples of specially focused programs that can be fine-tuned to add to practice income and might eventually develop into freestanding satellite programs all on their own:

Equipment, supplies, vitamin supplements, etc.: Every clinic supplies some of these items, but you’d be surprised how little they’re emphasized and how many practices let things like tubing and balls “walk” out the door without charging for them.

Sufficient care when insurance won’t cover: Because it is so difficult for most practice owners, let alone their staff, to ask for money, patients can have their treatment determined by what their insurance will pay for as opposed to what they actually need—full corrective care of the underlying cause and return to optimum function. Effective education is the key to getting treatment plan commitment and financial responsibility, regardless of insurance constraints.

Massage: Massage is one of the most common cash-based services in practices. Patients like it and will pay for it, and it adds to overall wellness and perceived value. About ten years ago, one practitioner saw her numbers drop significantly when another client cornered the market in her town. She set up a freestanding therapeutic massage company. It did quite well, offering massage on-site to executives of large corporations as a perk paid by their employers, and it developed referrals for her PT services.

Wellness and fitness programs: These run the gamut from simply allowing patients, for a fee, to exercise in the clinic gym to offering organized programs in Aquatics, Pilates, Yoga, Tai Chi, supervised exercise with massage, nutritional, and other programs. Potential clients are right in the clinic—you just need to educate them about the programs you offer and get their commitment to a program prior to discharge. Such programs keep clients active and referring friends and family.

Sports enhancement programs: Now we’re getting into programs that may mean an outlay in cash for specific training, equipment, designated staff, and facilities. The outlay can, however, be reasonable. For example, a golf performance enhancement program that features core strengthening can be done with existing balls and tubing. You may also want to hook up with a franchise and invest in swing analysis equipment if you’re looking at making this a major portion of your income. The same would hold true for speed training programs, sports-specific programs in soccer, jump schools for basketball, and marathon training programs.

Obesity programs: With the American Medical Association recently acknowledging that obesity is the number one preventable cause of death, there is a huge market for handling obesity. PTs, if they’re quick on their feet, can capture this market by offering standard treatment as well as testing, nutritional, motivational, weight-loss, and fitness support programs. Physicians know the stats and have to confront these patients daily. They see patients making futile efforts and even hurting themselves to lose and keep off the weight. They are very motivated to accept help from a health care colleague. That would be you. PT-specific obesity handling is gathering such momentum that training and licensing opportunities now exist.

Balance programs: Programs for balance, when handled correctly, can do well. Some of the best programs are done in conjunction with Audiologists for vestibular testing and support. It is a great synergy between the two professions as well as a significant and demanded niche market for referral sources.

The common denominator of many cash-based programs is that they appeal to a long-lived but aging baby-boomer population that (a) wants to remain healthy, and (b) has the disposable income. Look at the billions spent on fitness, supplements, and plastic surgery.

It’s a wave! So, why aren’t more PTs catching it? Many of us, frankly, have developed an insurance dependency and are terrified of the “S” word—“selling”. Sometimes we rationalize this fear with the fixed idea that people just aren’t “willing to pay for such services.” If the billions given annually to our competitors aren’t enough to convince you, let me close with a brief story…

About fifteen years ago, I had a client in a northern border town. Canada, as you know, has socialized health care. The large majority of my client’s patients were Canadians. They would go through the hassle of clearing customs, driving hours in some cases, to pay him $78 cash for treatment they could get in their own country. Why? Because he had a reputation for handling headaches, and they knew if they saw him they’d be seen now and they’d get better!

People pay for quality care—if you offer something that’s needed, ask for the money, and deliver what’s promised.

Here is the simple formula for a successful cash-based program:

  • Examine your own “core competencies” (what you do really well and have an interest in).
  • Survey the public and your referral sources to determine what cash-based programs they need and want related to your core competencies.
  • Design your program, including marketing. Determine what it will cost and how people can pay for it.
  • By hook or by crook, learn how to sell. Don’t like the word “selling”? Well then, call it“helping”, as it means the same thing. Professions such as Dental Specialists, Audiologists, and many others have had to learn to educate and motivate patients to commit to and pay for care.
  • Get the show on the road with public lectures, newsletters, and posters, and move lots of patients into you cash-based service.

Harvey Schmiedeke, the co-founder of Survival Strategies, Inc. and, specializing in PT Private Practice Solutions for over twenty years, has helped more than 4,000 clients and authored one of the nation’s most widely used manuals on new patient referral development.