The Pros and Cons of Concierge Models for Physical Therapy Practices

By now, you’ve probably heard about the latest trend in physical therapy practice models: concierge-based clinics. For many practice owners—or future practice owners—the idea of spending as much time as you need with each patient and offering a completely holistic approach to care sounds like a dream. After all, concierge physical therapists have complete freedom to treat their patients as they see fit—without having to cut corners or remain at the mercy of insurance payers. But can that dream be a reality for PTs, or is it all hype? Check out the list below for some pros and cons of providing concierge-based physical therapy services:

The Pros

You’re not restricted to 30-minute appointment slots.

Most physical therapists are familiar with the struggle to devote adequate one-on-one time to each patient. During a recent webinar with Castle Connolly Private Health Partners, LLC, Paul Knoepflmacher, MD, who owns Knoepflmacher CCPHP, explained how concierge models allow providers to use the full scope of their knowledge and devote the time necessary to treat each patient to the best of their ability: “There are days when I might have a two-hour visit” because concierge health care lifts the pressure of cramming as many patients as possible into an eight-hour day, he noted. Knoepflmacher went on to say that “there’s a level of comfort when it comes to scheduling patients for as long as I need.”

You develop unparalleled rapport with patients.

When you practice in a concierge clinic, patients can come to you for anything and everything. As a result, concierge providers get a full picture of their patients’ health—not just one piece of it—which creates a high level of trust. When you’re familiar with the full breadth of your patients’ circumstances, you become a reliable advisor, advocate, and resource.

According to Dean McElwain, president, chief operating officer (COO), and co-founder of Castle Connolly, “It’s about the experience of the kind of environment you receive your care in. You can connect with patients any time, and you can set appointments for the next day” as opposed to waiting weeks—or in some cases, months—to get in. During the COVID-19 pandemic, McElwain says the wellness experience at CCPHP partner practices has been very meaningful for patients who can’t access a gym or who have struggled to deal with the stress of the pandemic.

You can offer a highly customized experience.

During the above-mentioned webinar, Kim Parks, MD, the owner of Synergy Private Health, explained how the freedom of a concierge-based model allowed her to fill an outpatient care gap in her community and focus her practice on wellness, nutrition, and stress management.

Synergy Private Health has a stress management room and an onsite kitchen where patients can drop by for cooking classes. Parks says this has been incredibly beneficial for her patients during the coronavirus pandemic, as it “created an opportunity [for patients] to start doing cooking classes online” and connect socially. Her practice even hosted several town hall-style sessions to answer patient questions and alleviate anxieties over COVID-19. According to Parks, “those were some of the highest-attended programs our practice put out.”

Revenue is more stable—even in times of economic downturn.

Another benefit to using a concierge model in your physical therapy practice is the financial predictability—and the peace of mind that stability brings along with it. Instead of relying on insurance payers to reimburse your practice in a timely manner, a significant portion of your income comes from regular membership fees, which means you can better budget for expenses. Both Parks and Knoepflmacher spoke to the financial security that the concierge practice model has lent their practices during the COVID-19 pandemic, noting that it alleviated a lot of their anxiety over financials during lockdown.

There’s less burnout.

All of the above create one massive benefit for concierge PTs: a real solution to burnout. You’ve likely heard the term “moral injury” floating around, which—as this article from Stat News explains—refers to “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”

Within the context of physical therapy, moral injury may refer to a PT’s inability to provide adequate care due to payer restrictions, constraints on appointment length, and other common obstacles. But, according to Knoepflmacher, this issue is virtually eradicated with a concierge-based approach.

The Cons

Making the switch can be stressful.

Do you feel like the above-mentioned benefits make a concierge-based practice sound too good to be true? You’re not alone. After all, flipping your entire practice model can be a major challenge. “The most stressful time was the transition from a traditional practice to a concierge practice,” Knoepflmacher explained. A great solution to this problem is partnering with an entity that can offer you expertise and guidance as you make the shift—as well as reassure you along the way. This could either mean hiring a consultant or partnering with an existing group of concierge practices.

Not every patient is willing to pay membership fees.

While many patients enjoy the benefits of paying one upfront fee for basically unlimited access to health services, the concept can be a tough sell for some. However, concierge patients often end up spending less overall than they would with a traditional provider. If that’s not enough to convince patients to give concierge a try, you can offer an alternative pricing structure to patients who aren’t comfortable with the typical membership fee.

According to McElwain, some practices offer an annual subscription rate that can be adjusted per patient. At Knoepflrmacher’s practice, he was able to grandfather in many of his longtime patients at a discounted rate or offer adjusted rates based on a patient’s circumstances. Park, on the other hand, wanted to be able to widely serve patients who couldn’t otherwise afford her fees, so she set up a service option specifically for those who use insurance—and occasionally sees some patients pro bono.

The Medicare Dilemma

Medicare presents concierge practices with another major payment issue, because patients who wish to obtain cash-based concierge services are legally barred from paying out-of-pocket for Medicare-covered services. So, if you wish to serve the Medicare population, then you’ll still need to be credentialed with Medicare, and you’ll want to learn the ins and outs of providing cash-pay services to Medicare beneficiaries.

For more information on serving Medicare patients on a cash-pay basis, check out this article from the WebPT Blog.

Patients sometimes face additional out-of-pocket costs.

While membership fees cover a large number of services, there are bound to be some outliers—and patients may feel blindsided by those extra costs. For this reason, it’s crucial to inform new patients of any additional expenses they may incur before you provide services that aren’t covered by the membership fee.

Knoepflmacher’s practice provides a list of services that aren’t covered by the concierge fee, which patients can then submit to their insurance for reimbursement. Additionally, many concierge-based providers are credentialed with insurance payers. If you’re one of them, then you should do your best to be totally transparent about which insurances you’re credentialed with—whether that’s by providing a payer list during a patient’s initial consultation or posting it on your website.

So, there you have it: the upsides and downsides of concierge-based physical therapy. Have questions about concierge services? Leave them in the comment section below, and we’ll do our best to find you an answer.