The “Coming of Age” of Cash-Based Practices

Once upon a time, the story of cash-based rehab practices sounded a bit like a fairytale. Imagine you are a solo entrepreneur with a fancy brick-and-mortar clinic, charging top dollar to treat only celebrities and professional athletes. You’re making well over $100K, don’t have to deal with the red tape of the healthcare industry, and finally have autonomy over your career. 

While this does sound like a dream, for many years, cash-based practices have had a stigma of being unscalable, inequitable, and often unapproachable for the everyday PT or business owner. Recently, thanks to thought leaders and entrepreneurs in the space (and to WebPT for giving us a platform to educate the public), cash-based practices have made significant headway in solidifying our place in this industry. 

Today, let’s talk about the “coming of age” of cash-based practice and how these services can impact the health of our society far past what was once thought. 

Who is seeking cash-based services?

While the truth is that many clients of cash-based practices are affluent individuals, the tide is shifting. In this blog, we’ll get into how to structure alternative care delivery models to improve accessibility to care, and we’ll go into more detail about how to craft payment models to further achieve this goal in a follow-up blog. First, let’s explore the impact that cash-based settings can have on various populations. 

PT Settings Embracing Cash Pay

The most common question we receive about cash-based services is whether we see this model being successful outside of orthopedics and sports. The answer is a resounding yes! The ability to move is a fundamental human need, regardless of whether you’ve had a knee replacement, delivered a child, or have advanced Parkinson’s disease. At the heart of cash-based practices is the freedom to get creative with how you deliver care. 

That said, here are some new PT settings we at MovementX are seeing embrace cash-based practice—and why they’re a good option for their specific patient demographics.

• Pelvic Health: Imagine you’re a new parent, or a long-time parent juggling a thousand responsibilities. Getting to a traditional clinic can be really, really difficult. Cash-based services, however, allow for in-home care, group wellness programs, or are capable of operating from a gynecologist’s or pediatrician’s office to help ease the burden of accessing care. 
• Skilled Nursing Facilities (SNFs): The work rehab clinicians do in SNFs is foundational to helping patients return to their normal life. Unfortunately, these facilities are often understaffed and overbooked. We’ve seen a large uptick in families hiring private rehab staff to come into SNFs (with the facility’s permission of course, which we’ve always obtained) to add an extra layer of support. 
• Vestibular Care: I’ve only had one vestibular episode in my life, and it was incredibly heart-rending to witness. I can’t imagine the anxiety that patients must have felt driving through traffic to a clinic or having to keep it together in the waiting room. Thus, being able to provide high-value services to patients in the comfort of their own home cannot be understated, which is why this is a large patient population to market to. 
• Neurologic Rehab: Most neurologic conditions aren’t resolved after a short-term stint of rehab—they are often lifelong afflictions that patients must learn and re-learn to live with as their disease process continues to evolve. With the advantage of offering flexible payment models, rehab professionals can play a huge role in the ongoing wellness and quality of life of this particular patient population. My favorite story from a MovementX physical therapist involves them helping a neuro patient learn how to ride the city bus for the first time after a stroke! 

What are some ways cash PTs can deliver their services? 

From traditional rehabilitation to supplemental wellness services, cash-based PTs have endless opportunities to target their ideal patient population. Better yet, with the cash model, you don’t have to follow the strict fee-for-service model of counting units (that is of course, unless you are submitting superbills—which is a topic for another blog post). Below are some ways you can get creative with how you actually deliver care. 

Educational Workshops

Partner with a local business or allied health provider to provide education to your community. Whether the topic is the benefit of exercise for diabetes, how to prevent low back pain, or how to prepare for heart surgery, rehab professionals can play a tremendous role in population health. 

Workshops are often utilized as a marketing tool for clinics to target potential paying patients. Consider flipping the script and rather than providing free education in the hopes that someone will book a session with you, put a price point on your workshop (whatever is reasonable for your preferred population) and define these workshops as a separate line of business. 

Everyone wins here. You build community relationships, you collaborate with a referral partner, patients gain access to high-quality education at a low price point, and you develop a new revenue stream. 

Group Classes

In our practice, we’ve seen PTs across the nation achieve incredible success with small, semi-private group classes. These classes can be targeted towards performance enhancement, such as helping dancers build strength or helping patients prepare for an Ironman Triathlon (both of which are real classes we host). These classes can also be focused on more traditional rehabilitation for those with pain, injury, or functional limitations. The intimate setting of working with other people will encourage compliance, community building, and more optimistic views on goal achievement! 

Online and Asynchronous Services

Personal trainers have been utilizing asynchronous forms of exercise instruction for years, and finally (many thanks to COVID), the rehab industry is starting to catch up. The options are endless, but a few examples are below. 

1. Telehealth: This is the easiest and most obvious route to take when expanding your online cash offerings. By now, we’ve all developed strong opinions on the pros and cons of telehealth so we won’t hammer it home in this article.
2. Virtual Programming: PTs spend countless hours designing and creating HEPs for patients, and this goes predominantly unreimbursed in the insurance-based world. In the cash world, however, virtual programming offers immense value to patients and can be delivered at a low price point. Consider those patients who may not need an expensive one-on-one session, but instead need a quick check in and an update to their program. Offering this service separates your earning potential from your hourly time. You can manage many virtual programs at once, but only so many face-to-face patient hours. The best news? All you need is a spreadsheet (or one of the hundreds of software programs that can assist you). 
3. Resource Libraries: Rehab professionals put a lot of emphasis on education. We spend hours creating educational resources for our referral partners and our patients (queue the gigs of video on your phone of you demonstrating exercises). What we don’t do is take the time to put these educational resources into a format that is accessible to the general public, let alone build this into a product that you can sell. No need to run out and build an app (although many entrepreneurs are doing just this), but consider ways you can put an accessible price point on and spread awareness around your educational materials.

Well, there you have it—an assortment of ways cash-based PTs can expand their services to reach more populations. The biggest takeaway here is to challenge yourself to get creative with the many innovative models of care delivery that exist, stay open-minded about to whom and where cash services can be offered, and stay tuned for more information on designing payment models for care accessibility. 

I am endlessly optimistic that the days of ritzy, glitzy cash-based services are over, and that this model of care can help accelerate innovation, improve the health of society, and elevate our profession.