Thursday, May 30, 2013

Why Cash Practice Physical Therapy May Be Better for You: And why it may even be LESS expensive than your in-network PT Mill!

There is a new trend in physical therapy designed to shift the balance of power back toward caregivers and patients. It's called the "Cash Practice Movement". Here we'll discuss how this not only empowers you, the client, to make the best decision for your physical health but also liberates skilled physical therapists EVERYWHERE from the handcuffs of the PT Mill and the constraints of a third party payment system.

PT Mill (noun): a rehab clinic setting where patients are numbers and simply shuffled along from one area of the clinic to another, most of the time by unskilled technicians and/or without any supervision.
The physical therapist in this setting becomes adept at managing traffic and less so at treating their clients effectively.

This business model for medical care is not a new one. Professionals in the fields of dentistry, specialty medicine and even surgery have begun to operate this way. All in the name of PATIENT SATISFACTION and doing what is NEEDED not just what is easy to document so the doc doesn't get left eating the cost! After all, when did the objective of medical care shift from getting completely better to 'how cheaply you could be cared for'?  

In a cash practice maximum accessibility and value are stressed. Have a question for the doctor? They will answer it thoroughly. Need some extra hands on care? They will be excited to give it to you. Valuable patient education and teamwork are hallmarks of cash practices. And another great bonus: ALL of this great treatment and you are still 100% entitled to reimbursement by your health insurance provider.

Almost all of us who have health insurance have out-of-network benefits. Knowing your out-of-network coverage, your total out of pocket maximums and deductibles should be the main points of your health coverage that you keep at top of mind. If you know this info you're doing what is needed to stay in the driver's seat of your care

In a blog post that came across my desk recently, an MD colleague of ours eloquently wrote about 'what would happen if a restaurant were operated in the same manner as a medical practice'. This piece is ESSENTIAL reading for anyone who is looking to be their own best health care advocate.

With greater volumes of clients comes less attention to any one client. This isn't a value statement; this is math.

Clinicians working in a cash practice STUFF AS MUCH TREATMENT AS POSSIBLE into each visit. The 'PT Mill' employs a different strategy: to be judicious about the amount of time that is spent with any one patient so that the clinic can bill your insurance company for many different units/CODES (the special language of health insurance billing).

In a conversation that our office administrator recently had with an insurance company, she was actually advised to, "make sure that she and the our therapists were aware about each clients' treatment allowances". That, "each client is only WORTH what that insurance company dictates they are WORTH", and that, "if that client needs 30 minutes of intensive hands on care, but we had been told they would only be allowed to bill for 20 minutes, just don't treat them for that extra time" (read: unnecessary time according to a pencil pusher behind a desk with NO medical background). This is the best example I've ever heard of an attempt at third-party-dictated-care.

No offense to pencil pushers the world over, but this group of people are different; they are SUPPOSED to be on your side!! They are most certainly not. I, like our office administrator and I'm sure YOU, am APPALLED at this. This is not the reason that any of us went into the physical therapy field and until the premium-paying-public truly understands that this is going on behind the scenes, less valuable and less effective care will continue to be the norm.WE, the physical therapists, the physicians, the surgeons; WE are in your corner. We want what's best for each of our clients and those of us who operate as fee-for-service professionals are the ones who will always be able to provide our clients with THE CARE YOU NEED.

As it turns out, our clients are great advocates for themselves AND for rehab practices like ours! Little excites us more than to keep the friends and family of our clients pain free and moving well. In an email to a friend, one of our clients laid this info out: 

In-Network provider:
  • $30.00 / 60 min visit, with approximately 15 min contact time with PT provider. 
  • I would go 3x/week totaling approximately 180 min of my time, and 45 min of contact time with PT provider.
  • Total out of pocket expense: $90.00
  • Treatment: several months
  • Results: no improvement.
SPARK Physiotherapy (out-of-network provider):
  • $125.00 / 60 min visit, with approximately 60 min contact time with PT provider.
  • I would go 1x/week totaling approximately 60 min of my time, and 60 min of contact time with PT provider.
  • Total out of pocket expense: $125.00, less 50% of the maximum allowable reimbursement from my insurance, totaling about $95.00 out of pocket.
  • Treatment: 2 months
  • Results: significant improvement and return to normal activities.
Ours are the clients who expect more than just good enough. They seek high quality care but with the reassurance that they will receive the reimbursement they are entitled to because we go through the trouble of billing that person’s insurance on their behalf.
All physical therapists and clinics are not created equal. I am teaming up with colleagues across the country who are emphatic about this. People who go to physical therapy clinics that bill every insurance company under then sun don’t realize that they’re getting higher volume/lower quality care. PTs working in PT Mills always have good intentions, but there is no way to learn your patients' complete story when you have only 15 minutes with them and maybe 2, 3, or even 4 patients waiting to be seen at the same time.
Regardless of the skill level of the therapist, it is impossible to deliver the quality that we deliver because of the amount of time and effort we expend on each individual. The extra effort spent with hands on, with eyes on and providing detailed education translates into clients who get better faster and with a more valued experience. If more people knew that there is another option, they would likely think twice before accepting care in a 'mill'. I'm excited to say that we are helping lead the initiative to reestablish the concept of VALUE in physical therapy.
In a recent article in Forbes magazine, this trend is analyzed and appears to be in line
with the way more consumers would like to be treated.
The term cash practice may scare off some people because they believe it must be more expensive. Simply put, at a cash practice you will pay for high-level care and get the best result possible. In many of these clinics they will assist you in billing your insurance company for reimbursement. Out of pocket expense is comparable, but the quality of care is much greater.
There are cash practices out there. We are always updating our own referral network here at SPARK Physiotherapy. If you are looking for a cash practice outside of the Northern Virginia area, we want to hear from you.

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. In addition he holds a Master's Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. The concept of 'all the way well' in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is.

Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, power lifting and adventure races. He is an advocate for his patients, clients and his fellow PT colleagues. He can be reached at


  1. Nice post! Physical activity may be the closest thing we have to the ‘fountain of youth.’ Yet it’s a fact of life that health and mobility concerns often arise as we grow older. The good news is that we can keep many of these concerns at bay through regular physical activity.

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  2. Thanks for the comment! You are absolutely right.

    Through insights like yours and the compilation of the best manual medicine team we can all move better and live happier lives.


  3. Great and detailed post, liked the facepalm part !

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  5. I really related to your question that asked when were we more concerned about how cheap we could be cared for versus getting better completely. I like that physical therapy is moving in a direction that satisfies the customer completely. I think more professionals could focus on that. Our health should be a top priority!

  6. I agree with you completely, Angela! We should be more concerned about making sure people are better versus how much we pay or get paid. You will spend less money over time if you are returned to full health as soon as possible. Satisfied customers will keep coming back if they had the right care.