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Re: How to start a small solo PT practice
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Re: How to start a small solo PT practice - April 4, 2005 4:45:00 PM
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Diane
Posts: 1491
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Thank you for opening a new board administrators.
:) ,
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Re: How to start a small solo PT practice - April 4, 2005 4:49:00 PM
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David Adamczyk
Posts: 292
Joined: March 14, 1999
From: Cleveland
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Ask and you shall receive! Enjoy. :)
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Re: How to start a small solo PT practice - April 5, 2005 2:29:00 AM
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Sebastian Asselbergs
Posts: 1105
Joined: September 29, 1999
From: Barrie, Canada
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Yeah, thanks, David.
Ben and Randy: regarding clients vs patients. If your state has a regulatory body like a College for protection of the patient of a physical therapist, you have to know that in most Colleges, ALL you do with other people is considered to fall under standards of practice. So, you may need to look at your state's regulatory and patient-protection set-up: do you have those - what are the standards - who controls that.
Here in Ontario, ANYthing I do with other people is subject to the College's standards. And NO it is not Big Brother (at least not in all aspects...)
Direct access, direct access, direct access - the three conerstones of true private PT practice!
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Mundi vult decipi
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Re: How to start a small solo PT practice - April 5, 2005 6:17:00 AM
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Randy Dixon
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Sebastian,
There are state boards and I suppose it may be helpful to look there. But I've never seen it addressed as far as what I'm talking about. If a PT coaches an athletic team, is he acting as a PT, if he gives advice or trains the team is it as a PT. How about working at a gym? Are you acting as a PT if you are not presenting yourself as a PT or what you are doing as "physical therapy"?
Obviously, true DA is the way to go.
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Re: How to start a small solo PT practice - April 5, 2005 8:32:00 AM
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Sebastian Asselbergs
Posts: 1105
Joined: September 29, 1999
From: Barrie, Canada
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Randy, when I'm coaching, I am not a PT, since coaching does not concern treatment. If I am training, it is still OK, since all a trianer should do is train....If I become a "treating" person (manual stretch, tape), I am automatically under the College's wings. Even if I do not present myself as a PT, I am still restricted by my college's standards when dealing with people in a potentially rehab or exercise environment. Their opinion is, IF you do not want to be designated as a PT and controlled - DO NOT keep your registration. If I want to do TCM and treat epilepsy and asthma and weightproblems, I will have to suspend my licence as PT, since my College will not allow me to do this as a PT - no matter what name and title I put up on my shingle....
Please remember - this is only in Ontario with its College and its direct access.
I am pretty satisfied with the strict regulations - it "forces" us to keep our noses clean in a way that goes beyond the requirements of the law. This helps in keeping direct access for the public safer.
Complex stuff in different states/provinces....
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Mundi vult decipi
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Re: How to start a small solo PT practice - August 29, 2005 8:46:00 PM
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webrehab
Posts: 24
Joined: January 31, 2002
From: San Diego
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Just a small addition, in California, there was a bill passed that allows PT's to provide for "non-patients" clients. SB 1485 allows PT's to provide fitness, prevention, and wellness interventions.
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David Straight, MPT, OCS
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Re: How to start a small solo PT practice - August 29, 2005 9:33:00 PM
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goodlooks58
Posts: 418
Joined: October 21, 2002
From: CA
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David: In Ca, we still do not have direct access. So wellness can be provided to "non-PT clients" but can we bill if someone came to a PT office without a referral?
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Re: How to start a small solo PT practice - October 25, 2005 3:21:00 AM
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webrehab
Posts: 24
Joined: January 31, 2002
From: San Diego
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I think that it is pretty clear that you can bill for patients that have a diagnosis but you don't need a referral for PT from the doctor. Whether the ins. company will pay is a totally separate issue and in my experience, many will not pay if the patient does not have a referral.
I would recommend checking out the CA PT board website and you can decide for yourself.
Here is a link: http://www.ptb.ca.gov/direct_access.pdf
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David Straight, MPT, OCS
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Re: How to start a small solo PT practice - January 23, 2006 12:54:00 PM
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twinliz
Posts: 4
Joined: January 22, 2006
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Hello,
I have been asked by a chiropractor and massage therapist to join their team as an adjunct to their facility. I would essentially be opening my own solo practice and just rent a room from them. Besides getting registered as a physical therapy facility, what other steps do I need to take? I live in Texas which has direct access, and I could also get referrals from the chiropractor. I'm concerned about dealing with insurance companies, and wonder if cash only patients can build a practice. The facility is in a wealthy neighborhood, and most of the clients pay up front for services. (The chiropractor does do some insurance however.) I'm very excited about this opportunity, but have no business experience. Please let me know if you have any info on this subject. I appreciate it!
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Re: How to start a small solo PT practice - January 24, 2006 8:56:00 AM
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Diane
Posts: 1491
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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Elizabeth, just be very clean with your boundaries, so that the relationship is only about renting the room and ends there. Crossover with patients is a bit murky. I wouldn't be too worried about the MT, but be sure the chiro isn't able to wrap his tentacles- oops, I mean, isn't able to take some sort of financial advantage of your being there (like being able to bill and collect money somehow for PT services). I recommend developing and maintaining a very high index of suspicion with chiro in general... they'd love to make PTs their domesticated livestock. Don't give 'em any space for that.
I share an office and a receptionist with a naturopath. She and I are cordial, but I refused from day one to operate my practice under her auspices. Technically it's illegal in any case (I think) in BC for anyone who is a PT to work for anyone who isn't. Not that I wanted to anyway. She's strictly a "roomate" with her own treatment room.
We have a joint account into which we each put an equal amount to cover office costs; my practice is totally separate, though: I keep my own book, have my own name/phone #, do my own banking/pamphlets/ farm out my own bookkeeping/accounting to someone I trust.. cleanly separate. We do share a sandwich sign outside, (with our separate phone numbers on it) but that's it! Her patients are hers and mine are mine. I don't refer to her, but if one of my patients wants to see her, that's up to them. She has sent me a few of her patients, and some of her patients have decided to see me on their own. Both of us have non-insurance cash practices.
It sounds like you'd be fine starting a cash only practice where you are, in that you have direct access and if the sort of public around you are already cash payers. The insurers would just waste your life making you chase after them. People like to pay cash when it is associated with greater choice. You don't need to have huge business skills, just keep things simple. Stay on top of your own banking. Farm out the technical stuff if you hate it, like bookkeeping/accounting (there are people who love to do that sort of thing so much that it's their life!).
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Re: How to start a small solo PT practice - January 24, 2006 10:28:00 AM
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twinliz
Posts: 4
Joined: January 22, 2006
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Diane,
Thank you for your info. Yes, I basically would be just renting a room from them and having my own practice. We would share a sign, front office, and billing equipment but that's it. However, I would be getting some referrals from the chiro and massage therapist. Do you see this as a problem? Also, I don't want to have to deal with insurance companies, which is why I want to to a cash based business. Currently, the chiro and MT are this way and have no problem.
Also, do you have any average charges for certain tretaments and modalites in OP clinics (ie. ultrasound, interferential, manual therapy, joint mobs, ther exs, etc)? I have worked with Medicare and insurance companies so long that I don't know what the average charge is now. Or is there a resource to find this out? I know most PT's charge by units for treatment, but it would be helpful to know some specifics.
Thank you so much for all your replies and information. Your previous posts have been very helpful. Thank you and to anyone in advance for their comments.
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Re: How to start a small solo PT practice - January 24, 2006 10:47:00 AM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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Check out Start Laws. Renting a room from a referring doc could be iffy. The chiro in this case would have a direct financial interest in referring you patients (so you keep paying the rent).
I dont know all of the specifics, but consulting a lawyer would be worth it in this case.
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Re: How to start a small solo PT practice - January 24, 2006 2:17:00 PM
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Diane
Posts: 1491
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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[QUOTE]I would be getting some referrals from the chiro and massage therapist. Do you see this as a problem?[/QUOTE]Not a problem as long as there are no icky strings attached/ counter-referrals are not expected. Maybe drbuddy is right, you should have a contract, signed with witnesses.
[QUOTE] don't want to have to deal with insurance companies, which is why I want to to a cash based business[/QUOTE]MUCH easier to cope with.
About all the other stuff, modalities, charges etc. I don't have the foggiest. I don't use modalities. I sell my time, hands-on ingenuity, and consulting expertise, the last two nested within the first one. How much you can charge will depend on the social conditions around you. Probably best to ask around your own neighbourhood.
You are saving yourself mucho headaches by opening your own small practice. Good luck!
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Re: How to start a small solo PT practice - January 25, 2006 1:07:00 PM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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Geeze, check my last post. That should read "Stark Laws".
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Re: How to start a small solo PT practice - January 25, 2006 1:58:00 PM
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twinliz
Posts: 4
Joined: January 22, 2006
Status: offline
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drbuddy,
Don't worry, I knew what you meant. Thanks!
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Re: How to start a small solo PT practice - January 25, 2006 3:59:00 PM
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Diane
Posts: 1491
Joined: March 9, 2001
From: Vancouver, B.C., Canada
Status: offline
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Elizabeth,
Cautionary tale from Brett, from a thread called " PT working for a chiropractor" in Open Forum.
[QUOTE]i may be able to shed some light on this topic from the perspective of a PT who actually worked for a couple of chiropractors...for a few months at least. colorado springs was a tough market at the time and they were offering good pay and good benefits. at the interview i was told that the PT clinic would be run my way and they were just a referral source; the patients could be treated as i saw fit. come to find out that meant as long as i saw fit to make sure everyone received US and/or ES andor Ionto and/or traction.
i did do my own marketing to outside docs and treated them my own way. but close to 70% of referrals came from in house. keep in mind that i really liked the two chiros and learned quite a bit from them. they just viewed me as a way to increase their billing. i was also reprimanded a few times for discharging patients that hadn't progressed and was told that i couldn't discharge patients until they (the chiros) thought they were ready...sometimes not until after 30 visits.
it was a tough situation and one in which i was definately not comfortable. perhaps it could work differently if the PT and chiro have equal ownership.[/QUOTE]
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Re: How to start a small solo PT practice - April 2, 2006 6:42:00 AM
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rwillcott
Posts: 352
Joined: March 20, 2006
From: Canada
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Diane,
I'm a PT in Canada as well. Where I live PT is considered a direct access Profession. However, in order for private insurance plans to pay for PT they must have a doctor's referral. Is this different in BC? Also, you mentioned that you are able to generate enough business through direct access. Do you mean patients that are paying out of pocket?
Another question that I have is regarding a recent change in billing by a private insurance company. Up until this week the clinic could direct bill the insurance company for PT services. That way the patient would only pay 20% and we would bill the insurance company the 80% at the end of the month. Now the patient has to submit their receipts for PT in order to get reimbursed. I'm finding patients are reluctant to pay the money out of pocket since it can be expensive and some patients don't have enough money to pay up front. Do you have any suggestions as to how to remedy this?
Finally, I'm finding that the CPA does not do enough to educate the public about our profession. I have patients who have no clue what a Physiotherapist does! It can be very frustrating as you can imagine. I find that Massage Therapsits have worked hard to promote themselves and many people choose to see them before even considering PT.
I know these are a lot of questions but I would really like to know your thoughts and suggestions as well as everyone elses.
Rob
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Re: How to start a small solo PT practice - April 20, 2006 7:41:00 PM
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dfjpt
Posts: 238
Joined: April 9, 2006
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Hi Rob,
In BC we definitely do not need a referral. In 1994 the category of "chartered" physiotherapist (which required a referral), and "registered" (which didn't) were collapsed together and everyone was designated "registered."
[QUOTE]in order for private insurance plans to pay for PT they must have a doctor's referral. Is this different in BC? [/QUOTE]I think it depends on the insurer. I don't know much about it because I chose to go cash only when PT got delisted from the provincial health care plan in 2000, along with everyone else except MDs.
[QUOTE]Do you mean patients that are paying out of pocket? [/QUOTE]That's what I mean. They get a receipt for every treatment and can submit those for whatever reimbursement they can get.
[QUOTE]Up until this week the clinic could direct bill the insurance company for PT services. That way the patient would only pay 20% and we would bill the insurance company the 80% at the end of the month. Now the patient has to submit their receipts for PT in order to get reimbursed. I'm finding patients are reluctant to pay the money out of pocket since it can be expensive and some patients don't have enough money to pay up front. Do you have any suggestions as to how to remedy this? [/QUOTE]Not really. I don't know your province or your conditions or what sort of care you offer.
[QUOTE]I'm finding that the CPA does not do enough to educate the public about our profession. I have patients who have no clue what a Physiotherapist does! It can be very frustrating as you can imagine. I find that Massage Therapsits have worked hard to promote themselves and many people choose to see them before even considering PT. [/QUOTE]CPA's job is to keep it all together nationally and at federal political levels. The provincial organizations/branches are the ones who promote and publicize. In BC we have TV ads. I'm now on a committee (communications advisory group) that helps the PABC. Really it's the job of every single PT to do a good job promoting PT by educating, informing, and doing a great job with patients. My experience is that the massage therapists in my city are a very good referral source. You don't have to market to them, just treat a few and treat them well/successfully, and before you know it they'll send you all their tough cases.
Feel free to PM me if you have more questions. :)
Diane
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