Why Cash-based PT?
A common barrier to someone seeking care at Goodman Performance Therapy (GPT) is “If I’m not using my insurance for physical therapy services, then I’m wasting my money. “ There are several factors to consider when providing this answer.
To understand cost, lets look at some definitions of your insurance plan.
Deductible - amount of money paid for covered healthcare services each year until health benefits take effect.
Co-insurance - a percentage of a healthcare services you pay AFTER your deductible has been met.
Maximum out-of-pocket - the maximum amount of money that you have to pay for healthcare services in a plan year (deductible + co-insurance).
Copays - a flat fee you pay at the time of a healthcare service (office visit for example).
I recently heard a patient say “Do you know how much physical therapy costs?” when looking into treatment at another local clinic. I think the simple answer is no, most people don’t realize the true cost of receiving physical therapy. Charges for PT are based on units, which in simple terms describe what is being performed (i.e. Therapeutic exercise, Manual therapy), and are roughly billed for every 15 minutes that this procedure is performed. So for a 45 minutes appointment, typically 3 units will be billed and if you end your session with ice and electrical stimulation this adds another unit. At some clinics, the charges can be over $150 PER UNIT! So for your one visit, the clinic may be submitting over $600 charge to your insurance company, if not higher based on how long you are there. The twist that complicates medical billing is the negotiated rates that the insurance company has with the companies providing the services. That $600 charge will be negotiated down by a contracted rate. This rate varies by insurance company and is specific to companies providing the services. It is also not usually known until you receive a statement in the mail asking for payment. Unfortunately, these statements are delayed and you could receive all or most of your treatment before the insurance company is even billed. Your statement may come months after you finish your care. So what does this mean? Often, unfortunately this means a SURPRISE BILL. Most companies will ask for a prepayment toward these charges based on an estimate. For someone that hasn’t met their deductible/out of pocket, this prepayment per visit can be $300. Alternatively, in a cash-based PT clinic, the charge for the visit is paid prior to the treatment and there is no worry about a surprise bill afterwards.
When working in a traditional PT clinic, a therapist is often torn between doing what’s right for the patient from a treatment perspective and meeting productivity standards set by the employer. These productivity standards are typically a set number of units the therapist is supposed to bill each patient, a total number of units per hours worked in a day, or a combination of both. Productivity is often linked to performance reviews, bonuses, and staffing decisions for the clinic. So if the therapist dosen’t want to have a sit down meeting with their boss, wants to get a bonus, or wants to keep layoffs from occurring they are pressured to get your units in a day.
Another cost consideration is the physician visit. Ohio is a “direct access” state, which means patients can seek the care from a physical therapist without a physician prescription (you don’t need to see your doctor before going to PT!). However, most insurance companies require you to have a prescription from a physician before paying for PT services. In a cash-based system, you aren’t required to see a physician prior to scheduling PT. When seeing a skilled PT directly, the therapist has the skills to determine if treatment is warranted or a physician is needed for possible medication intervention, advanced imaging, or other treatment options. Physicians are crucial in your health care, but for simple orthopedic concerns starting directly in PT can save you time and money.
Quality of Care
Despite the high charges being submitted, the reimbursement rate for those services by insurance companies is reducing. It takes more patients to meet profit margins and cover the costs of running and staffing the clinic. As more patients are forced to be seen by the same number of therapists, it often results in double and triple booking of appointments. Multiple patients for the therapist to manage at the same time equals less one-on-one time for you. Clinics either expect the therapist to run around barking orders or they use aides (individuals without a physical therapy degree) using preset programs directed by the therapist. In either case, the therapist doesn’t have time to invest completely in your care and often this means a “cookie cutter” treatment involving the most common exercises to treat a particular body region. These exercises are often performed with little supervision regarding form or response. In my opinion, this is helping ruin the perception of PT by the public, if you wanted a "cookie-cutter" treatment, you can find a youTube video giving you common exercises for "knee pain."
Number of visits
A standard PT prescription from a physician reads 2-3x/week for 4 weeks (or longer). In this traditional system, you can understand why multiple times per week may be needed when you may only be getting 15-20 minutes of one-on-one care in a 45-minute treatment session. Less personal attention will likely result in a longer time frame to get the results you desire! In my cash-based clinic, you are seen one-on-one and the number of visits is reduced as a result of this quality of care. Reducing the number of visits required to reach your goals, means less time away from work, family, and travel time to a clinic. The visit reduction is often a point overlooked when considering a cash-based PT clinic. For patients who have a $40-50 dollar co-pay or higher (instead of a high deductible plan), receiving care at a cash-based PT clinic 1x/week compared to 3x/week at a traditional PT clinic can be very similar in cost. So to the points already stated, would you rather receive high quality one-on-one treatment at a cash-based PT clinic 1x/week or be treated in a clinic where you are one of multiple patients the therapist is treating and you need to come more times per week?
Many insurance companies are moving to authorizations and pre-certifications in order to have treatment. Often, these tasks are performed behind the scenes by the organization performing the treatments by either the billing department, registration staff, or the therapists. Most often, the initial assessment is performed and this information is faxed along with information regarding the patient (name, date of birth, insurance policy #, etc.), to the insurance company. The information regarding your condition is reviewed and either a number of visits or a date range is approved for care. For example, this may be "6 visits are approved", "all visits are approved until a specific date", or a combination of both. When those 6 visits have been used or you are nearing the end of the approval date, the insurance company requires a full re-assessment of the patient and another form is faxed for additional approval. What does this mean for you? The time in that visit that the therapist had to treat you is now spent performing measurements and assessments that will unlikely change your treatment plan. And guess what? That time is being billed for! Furthermore, insurance companies often have policies restricting which treatments they will cover. This takes the power of treatment selection away from the therapist and places it on a group of policy makers at the insurance company. Do you trust your insurance company has your best interest in mind? Or do you think they are interested in saving money they have to pay or limiting beneficial care?
Another detail with insurance plans to keep in mind: In 2018, 65% of major companies are offering high-deductible plans (HDP) as an option and 35% of employees selecting that HDP and paying less in premiums. link If you have selected a HDP, this means you pay a large out of pocket amount prior to insurance beginning to pay for medical costs at all. Often, unless you always meet your deductible or have complex medical issues, the cost of receiving therapy at a cash-based clinic is much lower than receiving care at a traditional clinic when paying to meet your deductible.
So why cash-based PT at Goodman Performance Therapy?
-Higher quality of care by receiving one-on-one treatment for your entire visit
-Often leads to fewer overall visits
-Unless you have great insurance or a lot of medical problems where you will meet your out of pocket maximum, it will likely save you money
-No restrictions by insurance companies! At GPT, the best course of action and number of treatments are determined by need and the results you feel you are receiving each visit.
-Removes productivity pressures on therapists in traditional clinics and puts the focus on your care!
-Get access to personal cellphone number and email for improvement in care (no waiting until your next visit to ask a question, I’m a text/email/call away!)
Ryan Goodman is owner of Goodman Performance Therapy LLC and the Team Physical Therapist for the Columbus Blue Jackets with experience in Orthopedic and Sports Medicine Injuries.