Practice Experience Podcast: Clinic Leadership: Employee Benefits and Impact, Part 2

Rehab therapists are feeling the effects of a new benefits landscape on two fronts: as employees or employers and as providers for patients who may be struggling with the greater out-of-pocket costs for their care.  As insurance companies put more of the cost of care on patients, clinic leaders now have to navigate how to offer their staff what they need while figuring out how to keep patients coming back—and making ends meet. 

In part two of their conversation on the Practice Experience Podcast, host Dr. Heidi Jannenga, PT, DPT, ATC, Co-Founder and Chief Clinical Officer at WebPT, talks with Dr. Larry Benz, Founder at Confluent, and Dr. Brian Adams, Owner at Adams Sports Medicine, about how changing benefits are impacting patient behaviors, how many clinics are shifting away from the strictly insurance-only business model, and how providers can balance their patient engagement responsibilities with all the other administrative tasks on their plate.

On patients moving away from insurance for their care

Larry: And the trends have changed a little bit. I would actually say things are a little bit better than they were two years ago because their costs have come to a point where, at a certain copay dollar amount or a certain deductible, people are opting out. And then as you well know, a lot of folks have choices on what their deductible is going to be. I view this as the retail consumer side of healthcare.

On creating value for patients

Larry: We lobbied aggressively to get our copay legislation the same as a primary care physician. It couldn't be any higher. So we do have, at least in the state of Kentucky, that advantage. You cannot charge a copay for PT higher than you would for a primary care physician. So that has kept it in the $10 to $30 range. I like that in a sense because it makes your accounts receivable less.

And it's a proxy for your service and the value you bring. People are paying $20-$30 to get a burger at lunch right now. They're paying that kind of money for all kinds of consumer-oriented things, especially given inflation over the past three years. And so if they're not willing, and if it does end up exhibiting by lower visits, then that tells you something about your organization.

On Adams Sports Medicine’s evolution to an insurance/cash-pay mix

Heidi: Brian, I know that within your practice, you've shifted away from this more traditional insurance-heavy model to a 60-40 insurance to cash model. So, maybe talk a little bit about why this transition has happened within your clinic.

Brian: That 60-40 model has kind of evolved over time. You know, in the beginning, as any initial startup, unless you start off with the intention of being cash only, which does seem to be a little bit more of an uptick of clinicians doing that these days. I was all in on insurance to wrangle in as many contracts as I could to limit barriers to access, to get as many patients to be able to walk through the door, to see me, and to utilize our services.

It was always frustrating when I had friends or people that I knew that were like, “Hey, I have this insurance.” I'm like, I'm not contracted with that insurance. Then, they choose to utilize that insurance benefit elsewhere. I would say, having done this for 13 years, it's that 60-40 model…over the course of time, we've slowly paired back some of the payers that just frankly weren't paying.

On creating excitement for PT services 

Brian: The trick is, and what clinicians and clinics need to do is really deliver a product that people are excited to pay for…If you walk into a store and people are really being pushy and selling a product that maybe you're half interested in, it's a little bit different than walking into, let's say, a Lululemon or something like that where you're really there to buy something, you're excited about it, and you're excited to have it. So, at the end of the day, the quality of the product that we're putting out and the experience that the athletes and the patients coming in here get makes them excited and makes them less concerned about the cost.

Larry: No, you're exactly right. The mantra that we promote is you want every patient leaving that particular day having felt cared for, listened to, and engaged in the process. And that's sort of the litmus test of whether or not you're doing your job.

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