While hybrid care has been a growing trend for years, the pandemic accelerated our understanding of just how well it could work in practice. Not only did telehealth prove invaluable in bridging the gap between patients and their providers, it was something that patients of all ages embraced, recognizing that additional flexibility helped them better meet their treatment goals.
As rehab therapists, we must adapt to this changing world of patient expectations for healthcare providers. While hybrid care is usually talked about in reference to treatment options, it’s also worth considering a mixed approach to payment models as its own kind of “hybrid”—one that can also better serve and meet the needs of a more diverse population of patients. Melding both models can help us to meet those needs—and to address the shortcomings in our current system.
Traditional models are falling short.
The traditional healthcare model is still the preferred option for most patients, who are more comfortable with in-person provider visits and are reliant upon their health insurance to cover a (dwindling) portion of the costs. But as healthcare evolves with better technology and increasing out of pocket expenses, a growing number are looking for more options from their providers.
In-person care is still a required function for many types of providers, including physical, occupational and speech-language pathologists, but it’s no longer a necessity for every appointment. Work schedules and mobility issues can be barriers to in-person care, and many don’t complete their plans of care as a result. And while most patients rely on their insurance to pay for rehab therapy services, there are some who are looking for care beyond what third-party payers are willing to authorize—and are ready to pay out of pocket to get it.
Until there are more changes to care pathways, we can’t move too far away from the current model that’s serving so many patients—but we can start to adopt things like telehealth, remote therapeutic monitoring (RTM), and cash-pay services to reach a greater number of people who aren’t having their needs met under our current system.
Why hybrid models make sense.
Rehab therapists must look toward new ways of operating that blend the best of all options to create a model that meets the demands of modern patients without leaving certain populations out in the cold. A hybrid model provides that flexibility while also helping therapists and clinics become more effective, efficient, and profitable to boot.
It fits within the three pillars of evidence-based practice.
As clinicians, we ultimately strive towards evidence-based practice in our care. The APTA defines the elements of evidence-based care as:
- The best available evidence;
- A clinician’s knowledge and skill; and
- A patient’s wants and needs.
Fortunately, this new hybrid model manages to check off all three boxes.
We have strong evidence that remote care leads to improved engagement, which in turn leads to improved outcomes. And with RTM, it’s easier to collect the evidence that demonstrates the efficacy of remote care.
Adopting cash-pay options can help to free both providers and patients from restrictive insurance coverage. Rehab therapists know how to best meet the needs of their patients and help them reach their treatment goals; in turn, patients ultimately know what they want from their providers. Unfortunately, third-party payers aren’t always as in tune with the wants and needs of patients or clinicians. Utilizing cash-pay or even out-of-network options can help put more of the care decision-making process in the hands of you and the patient. It also opens you up to more patients and increases your reach in the community.
While there’s a perception that cash-pay services are only for the wealthy, rising deductibles have pushed more patients to consider cash-pay as an option for their medical care than ever before. Adding a cash-pay fee schedule to your business model is a must have in any PT private practice today. And offering cash-pay and concierge services can be a competitive advantage over other clinics in your area that may still be operating under the traditional insurance-only model.
It’s more profitable.
With reimbursement cuts, clinicians treating in-network patients are struggling to maintain their profit margins, with most forced to decrease patient visit time and increase patient volume to meet revenue targets. Adding in the cash-pay option allows therapists to adhere to a set self- administered fee schedule for services. Plus, the elimination of some of the administrative burden on the front office for insurance reimbursement claims.
In setting a cash-based fee schedule, consider a bundled approach with a set amount for a period of time versus the á la carte model that insurances have been adhering to for too long. The bundled time-based model allows for trying new modalities or treatment options without the perceived nickel and diming for treatment plan changes.
And with telehealth poised to remain an available service for rehab therapists through at least 2024, RTM is a viable alternative revenue stream for clinicians while also improving their patient care. Not only are you improving your patient care, you’re providing a significant boost to your revenue when using RTM with patients who benefit from additional touchpoints.
How to implement hybrid models in your practice.
Introducing a model that embraces remote care and cash-pay services alongside your traditional treatment options isn’t as easy as setting up some technology and drafting a fee schedule for your new services. There are some compliance and billing issues that you must solve before getting your new hybrid practice running smoothly.
Having separate tax IDs for insurance and cash-pay patients is best practice.
Trying to balance compliance regulations for private insurance and Medicare patients alongside a new cash-pay schedule can make adherence a bit tricky. To make it work, it’s recommended to set up a separate tax ID for your cash-pay services to avoid any compliance issues.
So how would it work in practice? Your established business entity would remain as a participating provider with Medicare and stay in-network with insurers, handling all of the traditional insured patients. Your second entity, then, would be a non-participating provider with Medicare and out-of-network with other payers—allowing you to offer cash-pay services to patients. (I will touch on the intricacies of providing cash-based services to Medicare patients later in this article.) By setting up separate practice areas in your clinic, you’re minimizing any potential liability issues.
If you’re going to offer both cash-pay and insurance services, best practice suggests that there must be separate space dedicated to each specific tax ID—which means finding a space solely for your cash-pay services adjacent to your existing location where traditional insurance-based (non-Medicare) patients are seen. As MEG Business Management Founder and CEO Brian Gallagher, PT, lays out in this blog post, separate facilities working together as one practice allows you to leverage economies of scale when it comes to front desk and billing operations while still staying compliant.
Your staff will need additional training.
With any implementation of new practices and systems, training and communication of expectations is required. If new payment options are offered, the front office staff must understand the different policies for cash pay vs traditional insurance patients:
- How and when to collect payments for each type of service;
- Which forms of payment your clinic accepts;
- The right paperwork to provide cash-pay patients who want to bill their insurance; and
- Your clinic’s policy for missed appointments.
It’s also worth offering a refresher on how you can and can’t deal with Medicare patients when it comes to cash services. Here’s a quick overview:
- If you’re seeing Medicare patients under as a participating provider, you can’t then accept cash for physical therapy services that are covered under Medicare.
- An ABN form is required to provide Medicare non-covered services under a cash pay option.
- As a non-participating provider, you can opt not to accept assignment for certain services, but in those instances, you still can’t bill a Medicare patient for those services beyond the “limiting charge” set forth by CMS in the Medicare fee schedule.
- If you have no contractual relationship, you can’t see Medicare patients for any services covered by Medicare; however, because Medicare doesn’t cover wellness services, you can provide those to patients on a cash-pay basis.
- Patients can come to you for cash-based services only without divulging that they have insurance. However, if you become aware that the patient is covered by Medicare, the above rules still apply. The penalties can be steep for not adhering to the rules.
Building out a fee schedule can be a tall task in implementing cash-pay services in your clinic. If you’re looking for somewhere to start, keep an eye on this space, as WebPT Senior Vice President of Member Value and resident billing expert John Wallace, PT, MS, will be covering that topic in a blog later this month.
Likewise, clinicians starting virtual visits in a practice may need some guidance on how to use telehealth software and RTM software effectively—as well as how to properly bill for each of those services. (If you’d like a helpful guide for RTM specifically, check out this example RTM billing scenario.)
If you’re considering providing virtual care services to offer therapists some additional flexibility in their schedules, you and your team might need a bit of training on best practices to make it work effectively and compliantly. For a start, staff members will need a quiet room with a dedicated computer and monitor in your home. Fortunately, the technology you need for telehealth and RTM shouldn’t take up much more than some space on your desktop, but reviewing the privacy rules for an at-home set up will be an important addition to an employee manual.
Create unique marketing campaigns for cash-pay and insurance patients.
Now that you have operations to take on cash-pay patients in place, it’s time to get patients in the door. Using a one-size-fits-all approach to marketing isn’t going to work. With any marketing exercise, the first step is to take stock of your current patients and determine the new audience you’re targeting. Assessing the demographic breakdown of potential patients surrounding your clinic’s location as well as the potential interest in remote care is vital information to have in creating a marketing plan. A lot of things have changed post-pandemic, including the expanded age range of those patients seeking virtual care; as WebPT and Clinicient’s PT Patient Experience Report found, older patients are more willing to accept and even embrace technology than we give them credit for.
Direct access now plays a major role in marketing for rehab clinics as well. With the ability to offer your services directly to patients with the need for a physician referral, a review of your clinic’s value proposition, which is to say the benefits of rehab therapy services in general, and cash-pay services is key. Successful marketing starts with tailoring your message to a specific audience within your larger patient pool. To craft the right message for the right group, start with asking:
- Why do these patients need therapy or wellness services?
- Why would they seek out your clinic in particular?
- What sets you apart from your competition?
It is also critical for patients to easily find your practice listed at the top of the search results when patients are using the internet to seek out rehab therapy services. If you want to start ranking for those website and blog post keywords, check out our recent guide on increasing your clinic’s visibility online.
It’s an overused cliché in business and just about everywhere else, but each challenge presents its own unique opportunity. Decreasing rates from third-party payers, new patient-centered technology, and changing patient demands all offer the chance for rehab therapists to rethink what they’re currently doing and embrace a hybridized treatment and billing approach that works better for both clinicians and patients alike.
