How Self-Pay Patients Have Made Me a More Effective Clinician
If I have to see a patient with an ankle sprain for more than 4-5 visits, I start to get nervous. Why? Because my patients pay $120 out-of-pocket for each one-hour session, and they expect to get better very quickly with that kind of expense; and the same expectations exist for just about any fairly recent non-surgical injury.
Aside from avoiding the hassles of Medicare and Insurance reimbursement, cash-pay patients can have another positive impact on your practice. In many ways their presence both requires and leads you to become a better clinician. The ways in which this occurs are numerous, but I will expand on a few of them below.
Self-Pay Patients Are More Motivated
Whether you have an entirely fee-for-service clinic like mine, or just see a few private-pay patients here and there, you will likely notice a distinct difference between them and insurance-utilizing patients. On average, they tend to be more motivated to get better quickly and are more compliant with their home program. When they are paying 3-5 times more than a co-pay for each session, there is an inherent financial motivation to minimize the amount of needed treatments. I could be wrong, but if you were to grow the private-pay portion of your patient population, I imagine you would start to see faster and better outcomes solely for the above reason. Another positive side effect of this is that when the majority of your patients are highly motivated and compliant, it makes your job more enjoyable and rewarding.
[Editor note – I agree with this 100%. This is also probably a big factor in the recent study that was published reporting that direct-access physical therapy produced better results with fewer visits. Patients that choose to go to PT are going to be the most motivated.
More Hands On Time Means Better Patient Satisfaction
There are a variety of approaches to treatment and scheduling in the cash-based practices that I know of, but in general they all seem to provide more than average one-on-one time with each patient. There is also less (or no) utilization of techs or PTAs, and often modalities are not used either. In these situations, the added one-on-one time with the PT is another reason why clinical outcomes tend to be better with self-pay patients.
This is what compels the majority of my patients to forgo using insurance and pay up front for my treatments. My focus in the clinic is primarily on Manual Therapy and anything else that the patient can’t reproduce on their own time (I should also note that I don’t see a lot of post-surgical rehab patients, but see plenty that are trying to avoid surgery).
Trust me, you can get a lot done in 60 minutes of individualized treatment, and it’s quite luxurious for you as the Physical Therapist as well. In a normal clinic you may only have time for a few Manual techniques and some Therex before it’s time to move to the next patient. With a full hour available, if the first couple things I try don’t make an immediate and significant difference, I can keep trying new approaches and techniques.
For this reason, it’s rare that a patient leaves my office without having some type of significant improvement in their symptoms/movement. Simply put, if all else is equal in terms of clinical skills, the PT who spends an hour with each patient is going to produce more results per session than the PT who races from one to the next every 15-30 minutes.
Motivation to Improve My Skills
Returning to the first paragraph, one of the biggest motivating factors for me to always improve my skills is the pressure of higher expectations from my patients. Most self-pay patients will be paying out-of-pocket in hopes that fewer total visits will be needed. I’m not saying patients in a traditional PT clinic don’t expect you to do a great job; but I’ve worked in both insurance-based and cash-based settings and I assure you that the expectations are not quite the same.
To live up to this (especially as a fairly young PT), you tend to go beyond just the requisite CEU hours and continually seek out new information to improve your skills. If you’re a subscriber to Mike Reinold’s website and newsletter, you’re already displaying this type of drive to be better.
After all, if self-pay patients can get similar results by going to the insurance-based PT down the road, why in the world would they pay top dollar to see you?
My Patients are My Biggest Referral Source
This pressure to perform does not just stem from patient expectations, but also the nature of how referral sources shift in a cash-based practice. At least in my experience (and the experience of other private-pay PTs I know), a cash practice relies on word-of-mouth to produce new patients much more than it relies on Physicians. The reason why is beyond the scope of this article but is explained in more detail here if you’re interested.
In no way am I saying that every patient doesn’t count in a traditional PT clinic; but when your primary referral source becomes the patients themselves rather than physicians, you tend to go that extra mile for each individual on a more regular basis. If you disagree, please think of the times when you’ve had a referring physician come to you for treatment. Now imagine that every one of your patients was a referring physician. Interesting concept isn’t it?
About the Author
Jarod Carter, PT, DPT, MTC is a private practice owner in Austin, TX. Jarod has formed a successful cash-based physical therapy practice and now has a website to help others do the same. Check out his site for more information on cash-based physical therapy.