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  • Writer's picturePhysical Therapy International Service

Cash based practices

By Rachel Luzer, Aiyannah Wilson, and Chiamaka Obidigbo

What is it?

Physical therapy clinics have many restrictions when involving insurance companies and individual plans that serve to reimburse therapists for their work. Although not new, cash- based practices have become more popular and create a level of accessibility for more patients to be treated without the restriction of a third-party. Cash- based practice is a practice that accepts cash, card or check payments. Additionally cash-based practices may accept Flexible Spending Accounts, Health Saving Accounts, or Health Reimbursement Accounts. Despite a service being cash-based for a patient, if insurance is present, certain insurance companies will pay for “out of network” or not partnered services.

How does it run?

Cash-based services can differ depending on insurance, provider, and service provided. Different Insurance companies have different restrictions and reimbursement methods that should be reviewed before developing a contract. Cash- based services allow for flexibility in payment and service type to achieve the patient’s long-term theraputic goal. Many types of physical therapy clinics are beginning to support this method of reimbursement such as Pelvic Health, Skilled Nursing Facilities, Vestibular Care, and Neurologic Rehabilitation. Many patients within these settings are attending group programs, home-care, and long-term care support and with the cash-based payment method, these services are more easily accessible and help to support patients' quality of life in any setting.

Cash Based Practice Pros

Administrating a cash based clinic allows for Physical Therapists to provide any service to their patients within their line of practice while gaining financial control. Physical Therapists have the opportunity to discuss a summary of treatments for the patient and provide pricing upfront. This allows therapists a great deal of financial stability being able to receive their money right away and avoid the waiting period for payments. Providing a cash based clinic opens the door to providing more services such as health screenings and cryotherapy for patients. This opportunity allows for physical therapists to compete at more of a competitive level providing quality care for patients on a more one on one level and not being limited to a certain amount of visits.

Cash Based Practice Cons

With the good, comes a few challenges. The biggest challenge is being able to hold on to as many patients while trying to attract more patients. Because therapists are able to charge for their time, prices are set at a premium price, which doesn’t favor the low to middle income families. This is where things get tricky, providing cash based practices means high quality care at a high price. Everyone has the right to quality care but because the prices aren’t feasible for most this limits patients from that one on one care that they may need from their therapist. This now becomes a debate on health inequities, patients aren’t provided equal care based on their income. In this the debate lies on the therapist is It more important to focus on the money or the care of the patients.

Strategies to have a successful cash based practice

The best thing about having a cash based practice is that as a healthcare provider you are still able to render the best possible care, free from any obstructions or complications from the insurance companies and declined reimbursement rates. Although ideally a cash based practice sounds superb because you’ll get more for each hour of care, the core success is to have an adequate flow of patients who are willing to pay out of pocket. One main strategy in having a successful cash based practice is to specialize in superior skills such as sports, cardiovascular, neurology, pediatrics, vestibular care, pelvic health and/ or geriatrics. These top specialties may not be covered in most common insurances so if your practice can offer top notch services at a flat rate more customers will be willing to pay if their insurance will not cover it. Another important factor in having a successful cash based practice is being flexible with individuals. It’s important to have multiple sources of payments such as cash, check, or instant transfers. In addition to this flexible payment method it is also helpful to have payment plans as an option for those who are seeking services but may not have enough to pay everything up front. Another way to be more creative with cash based is to offer services that most are not used to covered by insurance companies such as educational workshops, these help build a community within your clinic. Group classes can also be offered which can help reduce the cash based cost out of pocket and finally offering online services such as telehealth that can be covered out of pocket giving more convenience to the individual.

Future prediction of cash based practice in the future

The field of Physical Therapy is an ever growing and booming industry within healthcare. According to the U.S Bureau of labor statistics the occupational outlook of physical therapy is to grow by 17% from 2021 to 2031 which is a much faster average rate than other occupations. With the job rates increasing year after year it opens a whole network of working Physical therapists available to not only work at more clinics but to also be entrepreneurs for their own clinics which can also be cash based. Cash based practices are now heading to be one of the top 4 trends being revealed within the 2021 State of Rehab Therapy Report. The report shows a trend of diversified revenue which included a lot of cash based practices. As physical therapy clinics continue to open at a 2.2% increased trend a lot of them are now offering cash based options as we progress in the future.


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