In a perfect world, health care wouldn’t need reform; patients would have access to quality, affordable care and providers would be paid well for their services without having to jump through onerous—and numerous—regulatory hoops to minimize the potential for fraud and abuse. But we don’t live in a perfect world, which is why patients and providers—including PTs, OTs, and SLPs—are understandably frustrated with the status quo. To gain a better understanding of the state of rehab therapy today—within the broader healthcare environment—my team and I conducted an industry-wide survey in which we asked thousands of rehab therapy professionals across a variety of settings, specialties, and geographic regions to answer questions about their practices as well as their motivations and frustrations.

The results were illuminating, although not entirely surprising. As we expected, survey respondents cited declining reimbursements and stringent government/payer regulations as two of their biggest concerns. As a result, many providers are exploring options to supplement their revenue stream—or replace it completely—with cash-based offerings. Unfortunately, though, doing so may be easier said than done, because Medicare rules for charging self-pay patients make it difficult for rehab therapists to treat Medicare patients on a cash basis. And for many rehab therapists, Medicare beneficiaries make up a large portion of their patient population, which means providers often have to choose between accepting extremely low reimbursements for their services or turning away patients who need their care. So, what’s a provider to do? Read on.

1. Understand the rules.

While most healthcare providers have the option to opt-out of Medicare—which essentially means they agree not to accept payment from Medicare, but rather will collect payment directly from the patient—physical therapists, occupational therapists, and speech language pathologists do not. If you’re thinking this sounds rather unfair, you’re right; it is. As far as I can tell, there’s absolutely no reason why other medical professions can accept cash-payments from patients with little restriction (as long as they follow the appropriate guidelines, of course) and we can’t—especially because so many Medicare beneficiaries could benefit from unobstructed access to rehab therapy services. I know when I was practicing, a lot of patients actually preferred to pay cash—but weren’t able to because of this relic of a rule. To learn more about the types of relationships therapy professionals can have with Medicare, check out this series of posts.

2. Advocate for change.

In 2013, Representative Tom Price introduced a bill in the House that would grant PTs the option to opt-out of Medicare, but unfortunately it’s seen little movement since. Sure, there’s a lot of red tape to cut through when it comes to changing anything having to do with Medicare, but ultimately, the responsibility for making this change—or any other, for that matter—falls on us. If we’re not willing to pick up the ball and run with it (i.e., fully advocate for regulatory change that would allow therapists greater flexibility in treating and receiving payment from all patients, including Medicare beneficiaries), then how can we possibly expect our representatives to score us a game-winning point? We can’t. That’s why there’s no better time to get involved than right now. Check out the APTA’s advocacy tools page to learn more about how you can use your voice to effect meaningful change. Then—as I recommended hereget your ticket for Ascend 2017, the ultimate business summit for rehab therapists. After all, we’re much more powerful when we’re united. And where better to unite than at a two-day conference designed specifically to advance the rehab therapy profession?

3. Explore the possibilities.

Now, just because the rules on accepting cash from Medicare beneficiaries are less than ideal, it doesn’t mean you don’t have options. In fact, rehab therapy professionals are absolutely allowed to accept cash from any patient—regardless of payer—for non-covered wellness services. That—in and of itself—should open up some possibilities for exploring successful cash-pay offerings to boost revenue and provide added value to your patients. Plus, establishing these types of service offerings can help you stay connected with your patients post-discharge to foster loyalty and ensure long-term care. Not sure where to begin? Consider the types of patients you frequently see, and determine which services they might benefit from most. Here are some ideas:

  • Fitness consultations and individual or small group classes (e.g., yoga, Pilates, or golf)
  • Gait training
  • Medically oriented gym (MOG) memberships
  • Aquatic therapy
  • Therapeutic massage
  • Craniosacral therapy
  • Nutrition and metabolic guidance

Cover your bases.

In some cases, you may want to provide these services yourself; but in others, it may make sense to partner with another healthcare provider—maybe even a physician—to round out your offerings. Either way, before you start a wellness program in your practice, please consult your state practice act, professional liability insurance (PLI) policy, and a healthcare attorney to ensure you’re in compliance with the rules that govern your geographic location.

4. Build relationships with patients.

Whether your patients are footing the bill themselves or splitting it with their insurance carrier, they’re essentially behaving like consumers—which is why demonstrating the value of your services is crucial to not only earn their business, but also generate word-of-mouth referrals. That’s where patient relationship management (PRM) comes into play. While very small clinics may be able to maintain consistent contact with their patients on a regular basis to keep them engaged in their care plan or wellness program, it can become challenging to scale that kind of communication without the use of technology. Good thing there’s software available that makes it easy for providers to automate engagement with patients at every point along the care journey, including after discharge.

Adopt PRM software.

With the right patient relationship management or patient engagement software, you can connect with current patients by sending them relevant blog articles and content to enhance their therapy experience, appointment reminders to ensure they’re making it to their sessions, and home-exercise program instructions to help optimize their progress—in other words, you can provide even more value, thus encouraging your patients to continue choosing (and paying) you as their provider. This type of software also makes it possible to reach out to lost patients to encourage them to schedule their next appointment as well as follow up with past patients to check on their progress, make yourself available for questions, and share information on new cash-based service offerings. Patient relationship management can be a big differentiator in generating new patients and keeping existing ones.


Looking for specific strategies to up your cash-pay game with Medicare and non-Medicare beneficiaries alike? Join us on Tuesday, August 29 for a free webinar in which cash-pay expert Jarod Carter and I will explain how PTs, OTs, and SLPs can go fully or partially out-of-network—thereby generating more revenue and better serving their patients. With reimbursements declining at such a steady rate—and the regulatory reform train showing no signs of stopping—you really can’t afford to miss it.