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 results in more referrals for you. And in an increasingly value-driven healthcare market, these word-of-mouth referrals have become a cornerstone of keeping practices busy—and in business.

While bringing in new patients will always be crucial, things can get dicey for insurance-based clinics that rely on a revolving door of patients to keep their businesses afloat. In general, this strategy isn’t sustainable, which is why many practices are starting to jump on the cash-based wagon. But switching your practice from insurance-based to cash-based is a big step—and one that you may not be ready to make yet. So, what’s the solution?

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Breaking into Cash-Based

If your current business model requires you to see a lot of patients—and spend less time with each of them than you would like—just to stay financially healthy, then it’s time to broaden your horizons. Cash-based services can have an immediate effect on your revenue stream because they allow you to circumvent the insurance middleman. When you collect full payment at the time of service, you don’t have to wait on the insurance payer to reimburse you. Plus, you won’t have to deal with continually dwindling reimbursements—which means you may even increase your total net income. 

Perhaps even more importantly, tacking cash-based services onto your practice’s menu creates an opportunity for current patients to bring their business back to you long after discharge. Instead of sending patients out the door and hoping they’ll return to you for check-ins or additional therapy treatment (if they ever need such treatment), you can give them a reason to return to your practice by offering cash-based wellness services. And if those patients do end up needing additional therapy, you can bet your bottom dollar they’ll seek treatment from a provider they have an ongoing relationship with.

Researching the Facts

Before you take a running leap into the world of cash-based services, you first need to decide if it’s a justifiable move. You should start by researching the demographics of your area to get an accurate snapshot of who you can reasonably expect to pay out-of-pocket for your services. As WebPT’s Courtney Lefferts writes in this post, “don’t forget to take a look at the patients you currently treat (and have treated in the past). By starting your research close to home, you can get a better idea of what cash-pay services would generate the most interest for your clinic.”

Marketing for Wellness

Once you know who your target audience is, it’s time to spread the word. The idea is to stay connected to your current patients after discharge, so focus your marketing efforts on the niche groups you already treat in your practice. For example, if you see a significant number of diabetic patients, consider implementing services that cater directly to this demographic (e.g.,diabetic-specific exercise programs). Not only will these specialty services improve your patients’ wellbeing, but they’ll also help foster those patients’ loyalty when it comes to all wellness-related needs. Other cash-based services could include:

  • spa services such as massage and acupuncture,
  • weight loss programs,
  • fitness classes like yoga and pilates,
  • cardio training, and
  • nutrition consulting.

To help jumpstart your wellness offerings, focus on obtaining referrals from established fitness and wellness-based professionals. (Physician referrals often yield clients who expect insurance to cover their expenses.)

If you’re not sure which cash-based services to implement, start by taking a step back and shifting your practice’s mindset. Instead of thinking, “We need more clients to provide service to,” think, “We want to provide more services to gain lifelong clients.” Any programs you offer should be geared toward meeting the long-term needs of your client base. For instance, practices that see a high number of student athletes may find it beneficial to offer running evaluations, sports screenings, or performance improvement clinics, whereas clinics with a large Medicare population may want to implement wellness programs that focus on geriatric care and improving quality of life.


Maybe you’re not ready to make the jump to an entirely cash-based model just yet, and that’s okay! You don’t have to stop working with third-party payers to reap the benefits of offering cash-based services—namely, a steady, reliable revenue source. Better yet, you can create lasting relationships with your patients—and win their loyalty—by providing them with services that promote their all-around health. And no matter how you slice it, that’s a win-win.

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