Re: Cash-based Question (Full Version)

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kenstack -> Re: Cash-based Question (June 7, 2006 2:48:00 PM)

I charge just $30 a session so the doctor(s) who trust me refer patients with no insurance or $30 and up co-pays.

I can't imagine charging $200 a session, that certainly seems as though you are taking advantage of the everyday person.

I certainly will raise the rate as I decide to become busier but i can't forsee higher than $50.00



FLAOrthoPT -> Re: Cash-based Question (June 7, 2006 4:30:00 PM)

30 a session?!?! wow are you short changin yourself. I am sorry you do not feel your time is more valuable than a nail technician, a massage therapists, an accupuncturist, a personal trainer, a barber, and I can go on and on.

good luck surviving-
Ben



TLB -> Re: Cash-based Question (June 8, 2006 6:44:00 AM)

[QUOTE] I certainly will raise the rate as I decide to become busier but i can't forsee higher than $50.00[/QUOTE]Ken,

Are you telling us your education/expertise and time is worth less than a massage therapist or personal trainer who regularly charges 60.00 and up per session? Maybe you should try and get licensed as one or the other as it would surely double your income. ;) j/k



SJBird55 -> Re: Cash-based Question (June 8, 2006 2:16:00 PM)

You know, Ken never stated the length of time for the session... $30 could be a decent amount - it just depends on the time he spends with the patient.

Before judging... it is best to instead ask questions to have a better grasp on the situation.

So, Ken, on average, how long are your sessions with patients?

Ummm, Ken... if a patient has a >$30 copay, technically, you should be charging them their copay, even if you don't believe that >$30 is reasonable. Technically, the patient is the one who agreed to a higher copay and is paying whatever premiums. The expectation is that copays are not written off or reduced by providers. I do believe that technically you could get yourself into a situation in which you have consequences for reducing copays. I may have misinterpreted your comment about >$30 copays though...



kenstack -> Re: Cash-based Question (June 8, 2006 4:02:00 PM)

Ohhh I'm taking a beating. I don't look at the clock on sessions - 30 to 60 minutes likely.

Physical therapy is not rocket science, although it is higher that a nail tech. Why so judgemental about other professions - are you better than others? That's an ugly attitude that I too have shared and try to break. Good barbers are hard to find anyways:) I just provide the 30$ service part-time on my own terms which is certainly more enjoyable that working for someone. I make some good money doing homecare per visit and some group situations i have with athletic teams. I would like to move up my services as my stability improves and the action grows based on the market. Supply and demand i suppose but I can't value P.T. at $200. What is a good therapist worth in utopia? who am i to say.

On a serious note: What kind of clientele pays for the higher priced service and how much will they pay? Are they wealthy? Are they chronic pain patients very frustrated? Post-op needs? Recommendations? So you can get $200 a session, that's great and unbelievable! WHat was the process whether it be though process or just a developing process where it was decided that was the rate? I think it's reasonable to rival co-pay amounts to begin and build up a bit before raising rates. At a certain dollar amount I will price myself out of a certain clientele, I'm just not sure what that amount is. It is difficult to rate the market and determine a not a fair price but one patients will pay.

anyways, I'm thinking about SJbird's post: Not really sure of the legalities on this. I do no insurance work and just accept cash only. I have a special rate with some athletic teams and a flat rate at private residences, a little more if distance is excessive. I can't imagine an insurance carrier enforcing that technicality unless I was doing some major business.



FLAOrthoPT -> Re: Cash-based Question (June 8, 2006 6:21:00 PM)

legally, if you accept medicare then you must have one set fee schedule that is for all....otherwise if you do private insurance then you must charge co-pays, failure to collect them or more appropriately, failure to charge them is against your contract with that insurance company and is tech. insurance fraud but more likely just gets you dropped from their plan. If you are chargin cash and no insurance involved, you can charge whatever you want. But the whole rocket science, I pride myself in being a guru in movement science, be it the motor control and motor learning and the anatomical and physiological and biomechanical aspects to movement and movement dysfunction. I think the 3 degrees and post professional APTA certifications and countless hours of coursework towards manual certifications are close to rocket science, in fact, I find physics easier to ecplain than trying to explain a scapular dyskinesia and its role in RTC pathologies to a patient. SO, yes I value my knowledge in muscular skeletal dysfunction and place it as high as any orthopedically trained professional be it a spinal surgeon or an osteopath when it comes to muscular skeletal pain and even in ruling out or claiming referral for non muscular skeletal causes of pain. SO, for that, correctly or incorrectly assessing, diagnosis, treatment strategy based on thorough evaluation, and offering a good progosis based on my findings, tied into the know how to recognize constituional symptoms that require immediate or non immediate medical attention all account for my price. Of course you environment regulates how much you can charge, and yes I have a very wealthy country club type clientelle at my finger tips in palm beach, but even still, people will pay just about anything that they value you at, so if you are the 10th person they have seen for a supposedly chronic problem but through your expertise you can help them get 100% better or even 50% better through your exclusive and unique knowledge unique to you and our profession, then there is almost no price that is too high...if you think of yourself as a glorified trainer or atc, then sure, you may not be worth much more than 50 an hour.

my 2 cents

Ben Galin, PT, DPT, OCS



kenstack -> Re: Cash-based Question (June 9, 2006 3:09:00 AM)

I can certainly respect that opinion. I like the position of a primary care therapist directing a patient's care to other professionals as needed. That is what direct access has earned those of us skilled enough to provide this service.

I'd like to see patients initially and direct their care rather than having a physician refer me patients flipping the script a bit on how we get our patients. People are so hungry for information on what their condition is and how to manage it or abolish it and PTs satisfy that need best I believe.



bhenchodh -> Re: Cash-based Question (June 9, 2006 6:58:00 AM)

Going back to the process of how to come up with rates...we polled over 50 clinics surrounding our location. We polled Medicare accepting clinics only, because their fee schedule is our competition, as we need to be competitively priced. Also we looked at the UCR rates of our geographical location. So maybe local rates in NC are lower that NJ. Anyhow, after much research we came up with our figures. Maybe when you all have some extra time, call up your local Kessler, Novacare, local hospital outpatient rehab clinic, or a famous clinic that covers your niche (thus your closest competition, and you all should know who your competition is) and ask them their fee schedule. Pretend that you are a patient. Even periodically updating your data will give you some insight on changing trends.



bhenchodh -> Re: Cash-based Question (June 9, 2006 7:11:00 AM)

As for the patients you cannot afford. We have a system in place similar to when a MSW does financial eval for a patient. We document everything including financial needs. You can't just provide free or discounted care for one patient and not for another. You have to have a process in place so that in future you don't get sued for providing free care to one and not to another. In that case why not free care for all? As I said our collections is not aggressive but we make sure every patient knows what is the value of the care they are receiving. Every patient-in- need's situation is evaluated. Our value is in our work, and functional outcomes. And that is what really dictates how much we get at the end of the day. If you are truly good and have good outcomes then don't hesitate to charge for them. You might be pleasantly surprised. I had patients that only gave me 20 bucks for a visit, and one got free care. But we have documentation to prove that the reimbursement was justified.



kenstack -> Re: Cash-based Question (June 9, 2006 2:28:00 PM)

That's what I wanted to hear AHAHawkins. It is true in NC I could easily price myself out of my clients. Raleigh,NC traffic is an issue as many southeast states are being more congested and a drive across town can now take 30-40 minutes. I was planning on updating my rates annually as I assess and reassess my success from the past year.

The market really dictates my price, not my perceived value as I would price myself out of a lot of business and lost opportunities in the past year.



SJBird55 -> Re: Cash-based Question (June 9, 2006 3:36:00 PM)

Ken, if you aren't participating with insurance companies and don't have contracts with any insurance companies and don't bill insurance companies for services, then, you are just fine in deciding to charge $30/session. I misinterpreted your post and thought you reduced the copays to $30 even if the copays were higher. In my opinion, you are perfectly fine and you aren't doing anything illegal since you aren't billing any services to insurance companies. Kudos to you.

Ken, what you might want to do is take a look at Medicare's fee schedule for your location. Set your rates just a little bit higher to capture your drive time/gas and you might be pleasantly surprised. If you are charging $30/session for 30-60 minutes, I believe you could probably be charging a bit more. Granted though, it does depend on the financial situation of the patients you are treating. We're all different and all have different financial needs/personal goals/lifestyles. If you're happy with what you are charging, that's all that matters.



kenstack -> Re: Cash-based Question (June 11, 2006 6:02:00 PM)

I'd loose all my business at too high a session charge but I am constantly re-evaluating my situation including getting on board with medicare.



TexasOrtho -> RE: Re: Cash-based Question (February 9, 2008 11:07:15 PM)

I am totally resurrecting this thread.  It is very good.  I was imagining a cash-based model and $30 per visit kept creeping into my head.  I can't see why everyone was kicking Ken's butt on this.

If I look closely at my practice patterns which is about 15% modalities, 50% therex and 35% manual, I could see how this could possibly work.  Maybe I am missing something, but Ken may be on to something.

(he said two years after the last post on the thread)



goodlooks58 -> RE: Re: Cash-based Question (February 10, 2008 4:57:57 AM)

FlaPt: You must be truly in affluent neighborhood. In CA right or poor, pts. feel that even paying a copay is too much money, and that the medical professionals are just making too much money. These same people would easily drop $100 on a mediocre restaurant on food but for copays and deductibles, they shiver...



TexasOrtho -> RE: Re: Cash-based Question (February 10, 2008 12:09:30 PM)

Regarding an earlier post.  What you charge is not simply a matter of what you think you are worth.  I think my time is well worth $200 an hour. If that's what I ask for in a small suburban community near Houston, I'm not likely to get much business through the door at all.

The market challenge would be to provide value with a combination of pricing and service.  It doesn't matter if I've got the cure for HNP stored in my two hands.  If people can't afford it, what good does it do them?  The point is that if $30 gets people in the door, it would be a whole lot wiser strategy than the therapist who values himself more than he values his patients' needs. 



goodlooks58 -> RE: Re: Cash-based Question (February 10, 2008 10:03:01 PM)

Well, if you want to get philosophical..healthcare should be given free as there is no way we can allot a price on someone feeling better. Someone living with pain for years with reduced mobility and now they can move around freely is priceless. So $200 versus $30 per hour is soemthing just made up. Unfortunately we are in a "business" of providing healthcare per the Blues and United Cares of the world so how do we live with that? When we look at someone in the eye is'nt it our moral and ethical duty to show compasion and care for that person?



TexasOrtho -> RE: Re: Cash-based Question (February 10, 2008 11:06:10 PM)

I don't think I was being philosophical.  In fact, quite the opposite.  I am looking at what the market in my area would support.  I certainly wasn't trying to steer the conversation into a debate on healthcare as a right etc...

The point I was making is that what you charge isn't a measure of your self-esteem or what you think of your services.  It is a measure of what you think the market will allow you to operate a successful business. If I can run a profitable business at $30 per visit and not deal with third-party reimbursement, a very large person would need to sit on me to hold me back. 

So in a way I was getting economical.[:D] 



goodlooks58 -> RE: Re: Cash-based Question (February 10, 2008 11:24:00 PM)

In order to live on $30 per visit we will have to eliminate billing and ins.cos. and go back to cash per visit as it is in every other part of the world including emerging Asian countries. How practical is that for our American thinking? My patient brought in her EOB from a local hospital for her 5 days stay in the hospital for a routine THR: Hospital stay alone without MD or Anesthsiologist: Atena paid: $87000. Her daughter had to have an emergency C-Section with the child born premature with neonatal care for 30 days: Aetna paid: $495000. Now if I were the CEO of Aetna I would seriously consider outsourcing big ticket items like the above mentioned to India or Thailand and save 80% of the cost. I just talked to a PT from India: PT visit is paid by the patient (cash only) from $6.25 to $10.20 and here the PT does home visits......



SJBird55 -> RE: Re: Cash-based Question (February 21, 2008 9:12:48 PM)

Actually... think about this... if one doesn't participate with insurance companies, all the headaches revolving around them disappear... all the crappy rules and regulations disappear... the watching of the clock disappears... the one-on-one vs group crap goes away... overkill documentation to either support your services and keep you in good graces goes away.... Your role becomes entirely focused on the client; the client's needs and risk management.  Your only "rules" are your state practice act.  You only need your state practice act to define supervision and supportive staff.  Life would be SOO much more simple.  All the variables that truly limit our business opportunity and ability to generate revenue are gone when one does not participate.  One day I'd like to go that route... one day. 



cowboybuboy -> RE: Cash-based Question (February 21, 2008 10:03:42 PM)

If you're doing home health on your own, you should be charging at least $75. Considering the time and misc expenses included. But if you contract with home health agencies, you'd get $75-100/visit doing the same thing. Hope you'll consider this and some other posts in the forum. What you're doing is really hard to sustain. Plus, people in the area might think that every therapist are doing the same and would not value the profession anymore. They might even call us "cheap physical trainer" for giving them a very low rate. Look what happened to Anodyne. Medicare wouldn't reimburse it since they market their infrareds in the beginning to the general public, now Medicare does not consider it skilled anymore. If the majority thinks that there are PTs out there that would charge less, and insurance companies might think the same. So, I hope you'd consider some of the posts here. We're able to graduate and got licensed because we're the best. A lot of wannabe PTs went to other disciplines just because they didn't pass or was not admitted due to poor GPAs. Hope you'll realize how important you are and add value to your practice. Just a constructive criticism.



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