A few weeks ago, I was making the rounds at a party, sampling—okay, more like scarfing—all of the hors d'oeuvres and stopping along the way to chit-chat with fellow partygoers. Among our topics of conversation: cheese, football, cheese, running, and physical therapy. So, how did we get from provolone to PT? Well, in between mouthfuls of smoked gouda and crackers, I asked a new acquaintance—we’ll call him Ted—about his hobbies. “Actually, I’ve gotten into those Spartan adventure races,” he said. “But lately, it’s been kind of touch-and-go because I’ve got this knee thing from my high school football days.”

Of course, I immediately saw this as an opportunity to tout the benefits of physical therapy. Ted seemed confused; after all, this was an injury he suffered more than a decade ago, and it’s not like it bothered him all the time—just when he exercised. “Oh,” I said in between chomps of cheddar-covered nachos. “Well, then you should definitely look into a PT-oriented fitness program. They can help you create a workout routine that will get you into shape without causing pain—or reinjury.”

His reaction to my suggestion fell somewhere in between surprise and bewilderment. Because like most consumers, he was totally unaware that such services existed. The thing is, there are thousands of people out there just like Ted—people who are looking to start (and actually stick with) a regular fitness routine, but who are dealing with circumstances that require a bit of extra attention.

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The Emerging Cash-Pay Market

Some PT clinics already are capitalizing on the market for cash-based wellness services—things like post-injury exercise programs, fitness consultations, group fitness classes, aquatic therapy sessions, and medically-oriented gym memberships. And in the current environment of declining reimbursements from third-party payers, adding cash-pay options to your practice’s current menu of services isn’t only smart—it might just be necessary to secure your survival. As physical therapist and PTPN co-founder Michael Weinper suggests in this Today in PT article, “Cash-based, extra services beyond physical therapy should be at least 20% of a clinic’s overall revenue in today’s business climate.” However, that ratio is a far cry from reality. As the article goes on to report, “Today, only about one in four clinics offer such services.”

Thanks to the proliferation of pro-PT direct access laws, physical therapy practices have a great deal of opportunity on the cash-based front. In addition to add-on, “à la carte” cash-pay services such as deep tissue massage or strength and balance training, therapists can fill niche demands with entire programs directed at specific subsets of people. For example, Pinnacle Physical Therapy in Angels Camp, California, teams up with a crew of local golf pros to run a golf fitness program. According to Pinnacle’s website, “This program is designed specifically to address the unique needs of each individual and combines physical assessment and training drills with swing video assessment and instruction. It is the perfect fit to prevent injuries, improve play and enhance one’s enjoyment of their golf game.”

Preparing Your Clinic for Cash-Pay

For those considering dipping a toe in the cash-pay pool, the next logical question often is, “What equipment do I need?” Luckily, you don’t have to break the bank to equip your clinic for cash-based business. In fact, depending on the types of programs or services you offer, you might not need any additional equipment at all. Here are some examples to get your creative wheels turning and help you decide what kind of cash-pay therapy options best fit your clinic’s budgetary and environmental constraints:

Little to No Upfront Investment

If you’re ready to explore the cash-pay world—but not quite ready to invest any of your current revenue—then think about the types of services you could provide with the equipment and space you already have. For example, if you’ve got a treadmill, you could offer gait analysis for runners (which, according to this Wall Street Journal article, is all the rage right now).

Alternatively, you could develop a partnership with a business or organization that has the equipment or facilities you need to provide the services you have in mind—much like Pinnacle did with its golf program. If you’d like to offer strength training services, perhaps you could partner with a local gym. Or, if you’re interested in providing aquatic therapy—but can’t afford to install a therapeutic pool—team up with a community aquatics center.

Some Upfront Investment

If you’re willing to put up a little of your own cash to get the cash-pay ball rolling, think about investing in something that will truly set your clinic apart from the rest. As physical therapist and practice owner Jason Waz says in the Today in PT article, “I’m always looking at finding out what other PT offices don’t have—find ways of setting yourself apart.” To continue with the running theme, an example might be purchasing—or leasing—an innovative piece of equipment such as an anti-gravity treadmill and using it as the centerpiece of a cash-pay training program for runners who are injured or recovering from injury.

If you’re looking for something even less expensive, think about starting a stretching/light exercise class for seniors, postpartum mothers, or people with fibromyalgia. You could provide such programs with nothing more than a few sets of exercise mats and resistance bands.

Considerable Upfront Investment

If you’re comfortable with making a more significant financial commitment to jumpstarting a cash-pay program in your practice, think about what will give you the most bang for your buck. If you think selling medically-oriented gym memberships would be a viable venture in your area, then you should consider investing in gym space and equipment—or expanding the gym facility you currently have. Another highly marketable service: aquatic therapy conducted in a therapeutic pool. As this ADVANCE for Physical Therapy article explains, “It’s no secret that a therapy pool is an investment, so it’s critical to sit down and take a good look at the numbers, including all aspects of revenue generation and expenses.” However, while there is certainly a degree of risk involved, the article goes on to emphasize the long-term benefits of adding a service like aquatic therapy to your clinic’s wellness offerings: “...aquatic therapy becomes a unique selling point and a competitive advantage in recruiting new patient referrals.”


No matter your budget, introducing cash-pay services in your clinic could have a big impact on your bottom line—and your ability to compete in today’s healthcare landscape. Does your business model include any cash-based elements? If so, have they proven profitable? Share your thoughts in the comment section below.

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