April 30, 2018

5 Links in a Cash PT’s Pain Chain

Just like a Whack-a-Mole

As PTs, we deal with other people’s pain points every day. We put so much effort into bringing positivity, hope, and a plan (of care) to others. So, when PtEverywhere asked me to create a blog entry for them, I thought it was finally time to talk about my pain points. What are the five links in our “chain of pain” as out-of-network physical therapists?


“Whack-a-Mole” was my favorite game as a kid. For 25 cents, we could channel all of our energy and focus, and let out some serious tension from a long day at school or on the playground. Hovering over the machine, I was ready for whatever and wherever something popped up next.

Fast forward to today. I just started my 20th year as a physio and I am quickly realizing that my career as a Cash-Based PT is a lot like that popular arcade game. As soon as I take care of one problem, another problem is sure to pop up…


1. “You’re being demoted”

A lot of time and money were invested into my education. A lot of sweat and tears were poured into opening my own practice. That’s why it was so crushing.


Every year, insurance companies wrote a new section in MY company policy. They told me how long, how often, and what treatments I am allowed to provide for my patients. I was bending over backwards to provide a substandard quality of care; it was painful to see so many patients walk out of my doors with the same struggles that they brought into our first visit.

It was equally painful to discover that (although my professional skills, knowledge, and experience were increasing) my pay was decreasing. I was tired of worrying about this downward trend of insurance reimbursements. I was done with taking pay cuts each year, despite truly delivering a better product.

So, I cut the cord. No more insurance contracts.

2. “You’re on your own”

School prepared us to help the person sitting in front of us. But, how does that person get there?


No insurance contracts. No Medicare patients. I’m not buying lunches for physicians so they will send me patients. I needed to figure it out..

I want my patients to pay 3 times more per visit than they would at an in-network practice; so, at minimum I knew I needed to deliver at least 3 times the value.

Knowing this, it was obvious. Our most valuable resource is (drum roll, please)… Time.

My clinic. My rules. That means I see every patient in a one-on-one setting for 45 minutes to an hour. I take the time to hear their story, to truly understand their pain, and to thoughtfully provide a personalized plan of care.

So, I committed to my unique selling proposition (USP). Make more time for patients.


3. “You’re running out of time”

I know it. My patients know it. There are cheaper options than my practice for “physical therapy”.


Luckily, we are not selling “physical therapy”. We are selling a unique treatment experience that gets people back to doing what they love doing.

I love seeing the results from our standard of care, but this requires a significant time commitment. I also love my time – with my family, at my home, and vacationing.

For that reason, I made the decision to implement a software that saves my time by helping us manage the treatment process from start to finish. I learned quickly that piecing together a scheduling system, an EMR, and an HEP app, while creating my own superbills, takes hours upon hours each week. And I end up repeating data entries throughout these disparate systems.

So, I chose to amplify and simplify my software partner. PtEverywhere gives me more tools, in one place.

4. “Your new patients look a lot like your old patients”

We have the education, the experience, and now – the software system to provide a level of treatment better than ever. We have the environment where patients are making greater time commitments and financial commitments than they would with in-network physical therapy.


For these reasons, I was surprised to experience many of the same problems we had before creating our cash-based clinic. Patients forgot their appointments, which cost me valuable time and money. Patients ignored their home exercise programs, which delayed or prevented them from reaching their goals. And we had little to no idea what patients were doing in between visits, so there were problems and workload issues that I was unable to effectively address.

We saw these issues steadily decrease shortly after I accepted the fact that the patients are not solely to blame. It is my job to confidently set expectations for patients throughout each stage of their treatment. It is my job to gain and build my patients’ trust. It is my job to automate tasks and promote effective communication.

So, I created systems to maximize my resources and I stopped making excuses. PtEverywhere does more than I realized. And I can do more than I thought I could.


5. “Your patients are telling everyone about you”

We built systems to attract new patients and to guide our operations. We opened communication channels to instill trust and create rapport.


Now, we are domain experts for movement and pain relief. We have countless success stories of patients overcoming the odds and truly changing their lives. My patients are returning in droves, and they’re bringing their family and friends with them!

That’s not painful at all? Well… until now. I need to hire and I need to find a bigger space.

So, I celebrated the growth of my practice. The late hip hop artist, Christopher Wallace, warned me about the sixth link in my pain chain: “More Money, More Problems.”