INTRO
For those of you who may be new to this site and new to who Move Pure Physiotherapy is, let me do a quick introduction. My name is Joseph Terry, DPT (Joe) and I am the founder/owner of Move Pure Physiotherapy (MPP). The mission of MPP is to provide more individualized, 1-on-1 care through a cash-based model which allows me to avoid the many limitations and stipulations placed on health care by insurance companies. As a result, each individual will be able to receive the specific care they need to recover in less time and with fewer visits. If you are interested in more details about my background please have a look at the About page on the website (movepurept.com).
"DON'T JUDGE A BOOK BY IT'S COVER"
At first glance paying $100-$170 dollars out of pocket for a physical therapy visit may seem like a lot. Especially when compared to being able to go right down the road to another clinic who will bill the insurance and only require a $30 copay. However, this can be very misleading. Without digging into the fine print and understanding the key differences this can lead to a misinformed decision resulting in unnecessary frustrations. In order to fully compare insurance-based and cash-based physical therapy models, it is important to take into consideration the principles that make these two approaches so different.
THE FINANCES
Let us first look specifically into comparing the two models from a financial standpoint starting with the insurance-based side. When a patient is referred to physical therapy often times the script will recommend 2-3 visits a week for an initial time frame of 4-6 weeks. Depending on the condition many times at the end of the initial script the therapist will re-evaluate the patient's status and request for an additional 4-6 weeks. Trust me, this is the average across most outpatient clinics and ultimately results in a minimum of 16 visits. Now factor in that the typical copay is around $30/visit, by the end of 8 weeks the total is $480 minimum. Obviously policies can vary drastically and this can lead to much larger or smaller numbers, but on the average this is a fair assumption if not on the lower end.
On the contrary, the cash-based model requires the patient to pay the entire charge for the service out of pocket. This is typically paid through cash, card, personal check, and in some cases a health savings account. At MPP the initial evaluation is $170 dollars which includes an in-depth assessment as well as treatment, usually an exercise program, and some form of manual if indicated. From here patients will schedule a follow up visit somewhere around 1-2 weeks out depending on the individual's needs. The follow up visit is usually $100 and will include updated exercises and manual if indicated. This may continue for another 1-4 times (4 being the high end), with the subsequent visits being spaced further apart to allow for improved long term results. The outcome of this is around a total of $570 (1 evaluation and 4 follow ups). Based strictly off of up front monetary expenditure the difference ends up being $90 between the two different approaches.
Although MPP does not directly bill the insurance company, each patient will be provided with a superbill that includes the necessary information for the individual to submit a claim. Most insurance policies have an "out-of-network" policy which allows for reimbursement for services the patient pays for out of pocket. Reimbursement rates will vary between policies and services billed, and most of the time will not reimburse the full amount paid. However, this also holds true for when clinics bill insurances directly themselves. Just understand that even though MPP does not go through insurance companies directly, there is still a good chance of partial reimbursement when the individual submits a claim.
QUALITY OF CARE
Based off of the previous section one might argue that not only is the insurance-based model cheaper, but it also allows for more visits at that price. Once again, at face value this may seem like the obvious choice to get more from the money spent. However, quantity is not always indicative of quality or better outcomes. In fact, this is where I believe the focus of comparing the two models should be. Providing higher quality care is what ultimately leads to better results. This is where the cash-based approach shines, and ultimately separates itself from the standard model.
During the initial evaluation at an insurance-based clinic each patient will be individually assessed by a physical therapist. These evaluations typically last 45-60 minutes and may or may not (most cases not) include a list of exercises and/or form of treatment. Most outpatient clinics have both evaluating PTs and treating PTAs which results in patients often times being seen by multiple therapists over the course of the treatment plan. On top of that, most clinics have each therapists treating 2-3 patients at a time resulting in only around 15 minutes of actual 1-on-1 time throughout a 60 minute session. The remaining 45 minutes consists of the patient being instructed through a series of repetitive exercises, most of which could be done at home. There is some value in having accountability to ensure the exercises are getting done and done correctly, however, I would argue that such accountability likely sets patients up for failure once their time at therapy stops.
At MPP each patient initially comes in for an evaluation performed by me, Joe. These initial appointments are scheduled for 75 minute blocks to allow for the necessary paper work to be filled out prior to the assessment. Throughout the assessment I find it crucial that the patient is provided with extensive education to set a foundational understanding of the nature of their injury/condition. This lays the ground work for them to take responsibility and to be equipped in managing their rehab. After the assessment aspect of the first visit is done I educate, demonstrate, and have the individual go through the list of exercises I send them home with. Along with the exercise program, these initial sessions often include a form of hands-on treatment to address significant restrictions and/or pain. Follow up sessions, whether it be a 30 minute exercise progression, a 30 minute manual treatment, or a 45 minute combination session are conducted in a 1-on-1 setting allowing for complete focus on the individual in front of me. There is no wondering of who the therapist will be or disappointment with lack of attention. I guarantee that each visit will be with me and with my full attention.
AVAILABILITY AND CONVENIENCE
The last comparison I would like to make is in the amount of access patients have to the therapists of a standard clinic and the access they have with me. Outpatient clinics generally operate on a set schedule in the ball park of Monday-Friday, 8am-5pm. Therapists at these clinics also do not give out personal contact details for after hour or weekend events/emergencies. This is completely understandable in this setting as it could lead to a host of problems for both parties. The massive volume of patients that come through these places would make it completely unmanageable and unreasonable to expect consistency on the therapists' behalf. That's another way in which the cash-based model allows for more follow-through and extended care beyond the clinic.
As of right now my availability for patient care is Monday-Friday 7am-8pm and Saturday 7am-1pm. This allows for flexible scheduling on both my and the patient's part. MPP does not operate as a drop-in clinic, therefore scheduling an appointment is necessary in order to be seen. Also, at this time it is not my sole source of income and thus requires a little planning around my schedule. By opening up these hours it allows for more options to find a time good for both the patient and I. Along with the flexible schedule MPP offers the ability to schedule an appointment at the patient's home or local gym for their convenience. Within a reasonable radius, this service is without any additional charges. Finally, each patient that comes through MPP with be provided with the business email and phone number, both of which are able to reach me even after hours in case of any pressing concern. I see it as a privilege to help others with their physical concerns when they come to me trusting I can help them, and I strive to facilitate the best care possible through being available.
Ultimately each person has to make a decision on what they believe is in their best interest. This article is not meant to persuade everyone to come to MPP instead of the many other physical therapy clinics around. Nor is it to say that MPP is the only place to receive good care. My intention in writing this is to provide insight into another option for treatment so that each individual can be better equipped to make an informed decision for their specific needs. If MPP seems like a good fit feel free to contact me at anytime and I'd be happy to discuss any questions or concerns. Thanks for taking the time to read this and I hope it was of some value.
Joseph Terry, DPT
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