The transition from an insurance-based model to a cash-based business can be daunting.
Many of us do it so that we can provide more individualized and hands-on care.
If that’s the case, where do PTAs and aides fit into this model? Well, it depends, but there can be a role depending on how you set things up.
To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 283: Using Physical Therapy Assistants and Aides in a Cash-Based Practice
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Show Notes
Transcript
Student:
Yeah, I’ll jump in. So we got Jason from California asking, “Hey guys, gals, I’m interested in opening my own cash based practice someday, and I’m curious as to what your opinion is on utilizing PTAs and PT aids in a practice. How much of the treatment session do you typically allocate to your aids?
Mike Reinold:
That I would say, from people coming from an insurance based model to a cash based model, that’s one of the first questions… I think we get asked that like 50% of the time with people when they come in with cash based questions. Right? So very common question, Jason, that you have. I guess. There’re a bunch of different models that you can do, that I think as you see best fit. You can do it both ways. I think it just has to apply a little bit. Right? So I don’t know. Len. Yeah. Why don’t you start? I mean we at Champion, I’ll be honest, we do not have physical therapy assistance or techs or aids.
Lenny Macrina:
Right.
Mike Reinold:
I think we have a different model for that. But I don’t know. Do you want to start with that Len? Your thoughts? I’m not against it.
Lenny Macrina:
Yeah.
Mike Reinold:
I just think our model… We just don’t need it.
Lenny Macrina:
Yeah. I mean, we’ve been open for almost eight years now and we’ve never hired one, a tech or a PTA. That doesn’t mean we won’t in the future, but we have no plans to. I guess, just because people are expecting to see the PT, and to work with us and pay in their own cash for the services that we provide. Whether it’s for a baseball injury, or gymnastics, and all that. I think we just value… I think they value their time with us and we don’t want to take away from that, where it gets diluted in our situation. So we’ve never really considered that or talked about it, because we want that person to come in, work with us independently, work with us completely, and have that experience and not have to… We’re not trying to overbook, and double book, and get more people in, because we want to get people in that are valuing our time. And we value their time. We want that perception to be that and we don’t want that diluted in any way. I guess. I don’t know if there is a better way.
Mike Reinold:
I think, it’s not that they value time and we value their time too. I think that is huge. You’re right. I think it’s also that we value our one-on-one time with them. And that’s one of the reasons why we went to a cash based model, is that we wanted to spend one-on-one time with our clients. So typically when you add an assistant to you, it’s to monetize the clinic more. Right?
Lenny Macrina:
Right.
Mike Reinold:
It’s not to help with that treatment session, because you don’t need help at that treatment session. It is purely from a business standpoint, to monetize. That’s not necessarily a bad thing. But I would keep that in mind, is that I think we built it this way because we wanted to spend one-on-one time with them as well. What do you think, Dan?
Dan Pope:
Yeah. I’m just going to piggyback off what you had said too, is that… And this is kind of one of the issues that I have, is that oftentimes I feel as though when a patient comes in, they want to spend more time with me. Then oftentimes, I want to spend more time with them too. So I’m a little bit weary of letting other people work with my patients. But the other thing I will say is that, I’ve worked with a lot of really really good aids in the past. Where the patients actually loved the aids, and they wanted to work with the aids, and when they started to work with the aids they had a better relationship than when they were working with just me.
Dan Pope:
So I could see… And we used the students, that’s kind of our help here. Oftentimes, the patients love their experience even more, because they like the extra staff, ancillary staff that’s around, not just necessarily like an aid per se. So I think that it probably could be worked in, in a way that’s beneficial for the patient experience. But I think, like Lenny’s saying, you really have to respect that person’s decision to go out of network and pay out of pocket, potentially, to be with a physical therapist.
Mike Reinold:
Yeah. I like that too. And look, this has nothing to do with skill, or intelligence, or qualifications. Right? I’ve worked with tons of physical therapy assistants, athletic trainers, people that would technically be in an assistant role at a physical therapy clinic, that are equally if not more skilled than a lot of physical therapists I know. So it’s not a skill or a knowledge based thing. This is purely just as a business model, what you decide to do.
Lenny Macrina:
Right.
Mike Reinold:
I think that’s a really good point. I think there’s… We talk about monetizing. Right? So the reason why you would have somebody assist you, is so that way you can book two people at once. Right? Otherwise, you wouldn’t need people. So that is one reason why you do that.
Mike Reinold:
You could argue, that starts getting away from the point that you actually went cash based to get out of the insurance model, so that way you didn’t have to overbook yourself. But there is one other thing that you could potentially use an aid for, that Dan kind of alluded to a little bit here. It’s not to monetize more, but it’s because people want to see you more. Right? So you have more people that want to see you than you can handle. What you do is, you say like, “Look, we have a team approach here. I’ll do the evaluation, and then we’re going to work together.” We’re all side by side. We kind of do that at Champion, to an extent sometimes. Right? But look, “We’re a team here. These are my partners that help me with this.”
Mike Reinold:
But it’s because you have more people that want to benefit from your services than you can personally handle. Right? So you would get assistance for that reason, so that way then you can get your hands on more people. Even though, it might not be one-on-one time. And when you think of it that way, from that lens, to me I think that’s like… I don’t want to say more ethical. That’s not really it. But I think that fits your core values more, of why you would want to hire an assistant or somebody to help you, is because you’re trying to help more people. Not that you’re trying to squeeze more people and to make more money. Right? If you went cash based, I don’t think you’re trying to make more money. Right? Because it’s not the most lucrative and profitable way to do PT, believe it or not. It’s because you value the care over the money a little bit. But anyway, anybody else have anything they wanted to share on that? Lisa, do you have something?
Lisa Lowe:
Yeah, just quick. I guess, as I’m rereading and rereading this question… Because it’s like… Okay. In the very beginning of trying to open your own cash based… I don’t know. It just makes me uncomfortable to think that you’re just going to be hiring somebody else to do the work that you’re so passionate to go in and do. Then I feel like, maybe that’s a three or four years down the line kind of question, potentially for all the reasons that we’ve already talked about. If maybe now you’re getting busier and people want your time, and you don’t have as much of it as they want. That kind of thing. I feel like, thinking of hiring those helping hands when you’re first starting out, it’s just like… I don’t know. They want to see you. Let them see you.
Mike Reinold:
I like it too. You expect to be packed on day one. Congrats. That’s great. That’s a lot of self confidence. That’s good. [crosstalk 00:08:19] Yeah. I mean, we didn’t feel that way about ourselves here. But yeah. Honestly my guess is… Speaking to Jason specifically, because he asked the question. Yeah. My guess is, that’s just what people think is the normal model in physical therapy, and that’s one of those first chains you got to break. That maybe we’re not restricted to having to do it that way. I don’t know. I mean, I would be really sad if I didn’t work with all the people I work with. Right? It’s about the relationships you build. In cash based, you end up being a little bit more “conseilleur” based. Right?
Mike Reinold:
A little bit more attentive to all their needs. On and off the field, but in and out of the clinic, is probably a better phrase to use with that. You really help these people, you become their person that helps them navigate through their health and their fitness stuff. So I think it would be interesting to do that. But I don’t know. Lots to consider Jason. I think you can structure this in ways, that’ll be helpful. If you bring in the right people, I don’t think it necessarily matters what their titles are, or their designations, or their degrees to an extent. If you bring in the right people in the right system, that ultimately ends up in people getting an exceptional service. I think that’s the key to it. So good luck, Jason. Hopefully your transition goes really well. If you have a question like that, some more career business advice or anything related to PT, sports, performance, fitness, head to mikereinold.com. Click on that podcast link and be sure to listen to more episodes. Apple Podcast, Spotify, whatever you listen to podcasts on. Please subscribe, so you can hear future episodes. Thanks so much.
