Abby Sims

Today’s blog post comes from Abby Sims, MS, PT, a professional blogger and creator of FitScreen™ ( in Seattle, Washington and NYC. Check out Abby’s full bio here. You can also follow her on Twitter @abcsims and subscribe to her blog here.

The evolving healthcare environment continues to challenge the adaptability of provider business models. Not only are physical therapists tasked with staying abreast of new developments in the field and expanding our clinical repertoires, we have also, understandably, been asked to place greater emphasis on functional outcomes. In doing so, we’ve had to embrace new methods of documentation, reporting, and coding, while our governing body develops more avenues for research to provide the necessary insight and further justify the care we provide. In order to acclimate to the limitations placed on therapy reimbursements—the ceilings placed on revenue per visit or visits per patient—therapists have had no choice but to manage care differently. Another option is to innovate and generate entirely new revenue streams—cash-based revenue streams.

The media’s focus on wellness, healthy living, and fitness places a spotlight on prevention, and PTs are perfectly positioned to lead by expanding and better marketing our menu of services. The concept of physical therapists providing primary care isn’t new, though perhaps its appeal or the necessity to get on board has been invigorated. Some specialists have been performing functional capacity evaluations in the workplace for years and provide ergonomic training to minimize the time lost due to injury. Others offer personal training in their therapy clinics, a logical way to increase the bottom line. Programs like the one discussed here—FitScreen—are yet another option.

Way back in 1983 I developed an assessment that physical therapists performed for all new clients at New York’s Sports Training Institute (STI). Though now long since dissolved, STI pioneered the concept of one-to-one fitness in the mid-70s. The Institute personalized clients’ fitness programs addressing any weaknesses or strength imbalances they might have, while taking into consideration any musculoskeletal issues that were identified. FitScreen is a more comprehensive version of this assessment—one that incorporates balance, movement, and functional testing—while continuing to evaluate flexibility, strength, and range of motion as well as perform an expansive number of special tests to detect a predisposition to injury or the presence of a problem.

Curious as to who would constitute your market base? Actually, just about everyone. A program like FitScreen is ideal for the person just embarking on a fitness program, especially one with underlying medical conditions. Those who may be fearful of exercise or are unsure of how to proceed safely are perfect candidates. Working in cooperation with internal medicine physicians and family practitioners to address concerns about blood pressure, cholesterol, diabetes, and other risk factors also enables PTs to benefit from ancillary referrals for traditional treatment. 

A second demographic ripe for intervention is the client who has completed PT (or faces discharge regardless) and is mainstreaming into a broader fitness program. We aren’t always able to progress patients through end-stage care as we did in the old days, restoring or even improving upon their pre-injury level of function. Turning them loose without all the tools to manage their self-care—beyond those specific to the injury treated—may be a precursor to recurrence or to new injuries.

Clients who may be gearing up for an event, particularly one they may not have participated in prior—such as a marathon—form the third group that benefits from comprehensive PT assessments. Preventing the overuse injuries that often occur with dedicated training is crucial to successful performance. Marketing preventive services to runners’ clubs, dancers/performers, or athletes is a natural extension of what we already do. Those whose livelihood, or avenue for serious competition, depends on a body in balance are most appreciative of the effort to achieve and maintain this balance while challenging their limits. 

Lastly, those who fly solo—in the gym or at home—or those who work with personal trainers, comprise the fourth group who will benefit from your expertise. The rudimentary fitness assessments performed in some fitness centers are generally only a minor upgrade from programs that provide no assessment at all. The spectrum of knowledge and ability displayed by personal trainers is also a broad one, and those who work out alone often lack an understanding of what to do or how to do it (just look around any gym—it is cringe-inducing). The best way to ensure that fitness programs will meet clients’ fitness goals and needs rather than cause overuse injuries is to establish each individual’s baseline and provide recommendations for care as well as clarify contraindications. This presents an opportunity to educate our clients as well as other professionals in the process. Establishing cross-referral relationships with trainers can be a welcome addition to your practice while allowing you to handpick those who will provide your clients with a safe fitness experience. Of course this also holds true for professionals instructing other types of exercise programs such as Pilates, yoga, or martial arts. 

So, what does a comprehensive fitness screening entail? As an example, the FitScreen program begins with the completion—pre-exam—of a thorough history form that includes discussion of goals, concerns, lifestyle, and functional demands. The assessment that follows—which takes a minimum of two hours—is the focus of the program. A detailed report is subsequently generated, providing both the client as well as his or her medical/fitness team with all findings and recommendations. A follow-up session is scheduled for the physical therapist to review the results with the client, and if the client chooses, his or her personal trainer can be invited to attend. The purpose of this session is solely educational (with some demonstration), and to stress the importance of safe and personalized exercise progressions. Additional sessions are optional but may be scheduled in order for the PT to provide further guidance, perform selective re-testing, monitor progress or modify exercise progressions should a client desire. 

From a billing perspective, FitScreen is a cash-based service. Bill your clients directly, and encourage those with out-of-network benefits to submit invoices to their carrier for possible reimbursement. It may be advantageous for these clients to attach a prescription for physical therapy that lists any applicable diagnoses as well as instructions to “Evaluate and Treat."

Do you conduct PT assessments as a primary care service in your practice? What are your experiences with cash-based services?

Interested in adding telehealth and wellness services to your practice?

Download our free guide to learn how.

Please enable JavaScript to submit form.
Billing - Regular BannerBilling - Small Banner
  • Dipping a Toe into the Out-of-Network Waters: The ActivCore Model Image

    articleJan 6, 2016 | 9 min. read

    Dipping a Toe into the Out-of-Network Waters: The ActivCore Model

    As regulations intensify, reimbursements dwindle, and patients take greater control of their health care, interest in cash-pay services and cash-based practice models has increased, especially among physical therapists. For years, we here at WebPT have kept a pulse on the cash trend, sharing hard-hitting pieces by Ann Wendel and Jarod Carter. Recently, we discovered a new out-of-network model—one that’s complementary to the in-network model most practices already have. This setup allows providers to dip their proverbial toes …

  • Future-Proofing Your Practice: Diversifying Revenue Streams Image

    downloadJan 7, 2016

    Future-Proofing Your Practice: Diversifying Revenue Streams

    What does it take to future-proof your practice? In this guide, we’ll talk about how you can incorporate health and wellness services to diversify your practice’s revenue streams and boost your bottom line. Ready to prepare your practice for the age of payment reform? Enter your email address below to download Future-Proofing Your Practice, Volume 3.

  • articleSep 8, 2011 | 3 min. read

    Can a medically oriented gym increase revenue for your clinic?

    Increasing Clinic Revenue Declining Reimbursement for Physical Therapy is a huge issue facing the rehab community. While our professional organizations work to defend our work and reform the insurance industry, many private practices are wondering how they can bridge the gap . Often times, this means seeing more patients in the same amount of time. Providers are faced with the often-difficult decision sacrificing on quality of care or finding other methods of increasing revenues. Medically Oriented Gym …

  • articleApr 18, 2012 | 4 min. read

    An Additional Source of Income for Private Practices: Nutrition Supplement Products

    Steve Messineo, PT, DPT and Owner of All-Access Physical Therapy Inc . contributed this blog post today. Steve (a WebPT Member) started this discussion about nutritional supplements in a Linkedin Group and we asked him to dive deeper in a blog post for the rest of us!  Steve has been practicing in an outpatient orthopedic setting since 1998. Thanks Steve for sharing your perspective.  Three years ago, my business partner and I decided it would be a …

  • Direct Access in Action: Jennifer Gamboa of Body Dynamics, Inc. Image

    articleOct 27, 2014 | 5 min. read

    Direct Access in Action: Jennifer Gamboa of Body Dynamics, Inc.

    In many cases, the old retail axiom “you get what you pay for” holds true within the healthcare market as well—and that is precisely why Jennifer Gamboa, DPT, OCS, MTC, and president of Body Dynamics, Inc. , believes that more physical therapy practices should be looking beyond the third-party payer game as they develop their business models. The way Jennifer sees it, declining reimbursement rates not only threaten the survival of private practice physical therapy clinics, but …

  • The Simple Key To Making More Money Image

    articleJun 17, 2015 | 2 min. read

    The Simple Key To Making More Money

    In this first video of a three-part series, PT and entrepreneurial consultant Jamey Schrier explains why the simple act of measuring your clinic’s business metrics will help improve your bottom line. Want to know more? Watch the video or read Jamey’s description below: Do you hate the money aspect of owning your practice—the constant worry of whether you’re making a profit or hitting your targets? Well, what if I told you that just one small change in …

  • Get Wellness: How to Boost Your Therapy Practice’s Revenue with Cash-Based Services Image

    articleJun 14, 2017 | 5 min. read

    Get Wellness: How to Boost Your Therapy Practice’s Revenue with Cash-Based Services

    There’s a pesky rumor flying around the healthcare industry: the more successful your treatment plans, the less business you receive from your existing patients. When you get down to it, the prime directive for most rehab therapists is to improve the health of the patient until he or she no longer requires therapy. And from the patient’s perspective, the quicker his or her health improves, the happier he or she will be with your service—and that often …

  • Medicare and Cash-Pay PT Services, Part 3: Maintenance Care and Self-Payment Image

    articleDec 17, 2015 | 5 min. read

    Medicare and Cash-Pay PT Services, Part 3: Maintenance Care and Self-Payment

    Based on the first two articles (which you can read here and here ) in this series, we now know there are two key factors that determine when you can accept private payment from a Medicare beneficiary: Your/your clinic’s provider relationship with Medicare Whether the service is “covered” by Medicare We ended the last article with a detailed discussion of medical necessity, which leads us to the final step in determining when a service is covered. Maintenance …

  • Cashing In on Private Pay: The PT's Guide to Going Out-of-Network Image

    webinarJul 27, 2017

    Cashing In on Private Pay: The PT's Guide to Going Out-of-Network

    For many rehab therapists, submitting a claim to a third-party payer feels a lot like pulling the lever on a slot machine. You never know for sure what you’re gonna get—and most of the time, it’s less than you’d hoped for. With seemingly ever-increasing regulations—and constantly shrinking reimbursements—it’s no wonder so many PTs, OTs, and SLPs feel like the financial odds are stacked against them. [video://] As a result, more and more rehab therapy providers are trying …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.