Software in Cash-Based Practice, Part 1: Setting Up for Patient Care

Last month we wrapped up our three-part compliance in cash-based practice series. Now that you’ve got a thorough understanding of the healthcare rules and regulations that surround your practice, have registered your business entity to maximize liability protection, and have figured out how to protect your patients’ data, you’re ready to open shop! 

Naturally, the next question you’re likely asking yourself is exactly what kind of software you need to run your day-to-day operations. At MovementX, we’ve spent years developing an internal software designed specifically for our cash-based PTs and have learned the ins and outs of what is needed from technology to be successful in this model. While there are endless software options for you to utilize (take WebPT for example), this blog won’t focus on any one brand. Instead, we’ll outline all the facets of technology you need for cash-based practice management. 

Today, we’ll start with software that can streamline and strengthen patient care. Stay tuned, however, as we’ll cover software for billing and practice administration in future blog posts.

Software for Patient Care

The components of a patient care that require software support include: 

• Patient Intake 
• Scheduling 
• Documentation  
• Messaging
• HEP

Before we dive into each of these, I’d like to stress that the most important part of setting up your patient software is HIPAA compliance. Before you make a purchase, seek to understand the security policies of any software you’re looking into—like whether it’s HIPAA compliant or offers a Business Associate Agreement (BAA). Okay, onto the good stuff!

Patient Intake

If you decide to move forward with a software that has a patient-facing portal, you’ll want to evaluate what kind of patient registration process exists. An automated patient intake tool can help you collect patient demographics, contact information, medical history, affiliated documents, and liability waivers with very little effort on your part. Aspects of patient intake to account for include: 

• Release of liability waiver
• Consent to treat waiver
• Privacy practices notice
• Payment and cancellation policies

You may also elect to have your patients participate in this process manually, but a software can streamline your operations and decrease your administrative burden. Regardless of how you set up your patient intake, I suggest consulting a healthcare attorney to make sure all your bases are covered when it comes to the appropriate waivers. 

Scheduling

Your scheduling needs may vary considerably depending on whether you are practicing in a mobile manner, out of a clinic, or some combination of the two. Our cash-based providers at MovementX who are practicing in mobile model typically do not offer a patient-facing scheduling option. This allows them to maintain full control of their schedule and optimize drive time by determining where in town they will be at any given time. 

On the other hand, for our cash-based providers that operate in a brick-and-mortar setting, utilizing a patient-facing scheduling system can be a great way to decrease the administrative burden of managing a schedule and provides patients autonomy to decide when they’ll be seen. Regardless of how you plan to operate, make sure the software you’re purchasing fits your needs. 

Documentation

When practicing in the cash-based model, it’s no surprise that documentation requirements are far less burdensome than your traditional insurance-based model. However, there are many reasons to optimize your documentation practices in this model, considering that: 

1. Writing as thorough of a note as possible is crucial to ensure your care is defensible in case of a lawsuit.
2. Proper documentation is an essential component of quality of care when coordinating with referral sources and serving as a historian for the patient. 
3. You’ll have to make sure your documentation justifies your services—and that skilled care was necessary—should your patient have to submit for reimbursement from their insurance. 

At a bare minimum, be sure that the following are included in your documentation system: 

• Full patient demographics on every page
• Date of service
• Long-term goals (although short-term goals are also required for some insurance companies) 
• ICD-10 codes (for diagnostic purposes) 
• SOAP notes
• Timestamps and signatures 

Download our Defensible Documentation Toolkit—and ensure your documentation is thorough enough to withstand scrutiny.

Patient Messaging 

As most cash-based practices start with a solo physical therapist—typically without any administrative support—it’s important for you to have HIPAA compliant technology that allows you to seamlessly coordinate care with your patients. How you elect to communicate with your patients may vary widely pending on your preferences and the subject matter at hand. Here are a few options to consider:

• Platform messaging: Many EMRs or patient platforms have in-house messaging systems for patient-clinician correspondence. This is likely the most secure form of written communication, but not always the most convenient or fastest form of communication for either party. 
• Email: Email is a default communication preferred by most in our society, and patients are no different. If you elect to utilize email with your patients, make sure you sign a BAA with your email provider, receive consent from the patient to use this medium of communication, and avoid as much personal information and document exchange as possible. Additionally, go above and beyond to set up your email security features to avoid phishing or ransom scams. 
• Phone: As far as HIPAA is concerned, phone calls are the preferred method for most patients. If you prefer not to utilize your personal phone number for business, Google Voice offers a free local area code for all businesses that will integrate with your current phone line. If you don’t have administrative support (or even if you do), be sure to optimize your voicemail with specific instructions for patients and referral sources to avoid losing any leads. If your patient care schedule makes answering the phone or returning calls impossible, you may consider a virtual assistant or phone forwarding service. 
• Text: Many patients default to texting once you’ve developed a personal relationship with them. To play it safe, however, avoid texting with your patients when it comes to clinical content altogether. If you use text messaging to coordinate your schedule, make sure the patient has consented to this form of communication and is aware of the security risks associated with it.

Home Exercise Programs

The world of home exercise programs (HEPs) is vast and constantly changing. To make matters more complex, every individual clinician has a personal treatment style that impacts what software is the best fit. Oftentimes, you’ll find that larger EMR systems integrate with third party or in-house home exercise programs to offer an all-in-one package. Before committing, though, ask if you can trial the HEP software. You may prefer to invest in a separate program that is more fit to your needs. After all, convenience shouldn’t always come above quality with this specific subset of patient care software. 

Questions To Ask Yourself

While evaluating all the technology options for patient care, don’t forget to ask yourself the following questions: 

1. What lends to the least administrative burden for me (as a clinician and business owner)? Determine if switching between multiple software will become a burden, what tasks are automated vs. manual, and if there are too many or too few bells and whistles. 
2. What type of overhead can I afford? Look at the cost of all your software combined and determine what level of overhead is most viable for you. Consider starting with a lower tier software as you get your feet under you, and working your way up to a more integrated or complex software as you gain a better understanding of your margins. 
3. Does the software fit my model of care? Your needs may change whether you are:
   • Working in a mobile setting or a clinic 
   • Providing all cash-based services or billing out-of-network
   • In solo practice or have multiple clinicians and/or administrative staff support 
4. What experience does the patient have when interacting with my software operations? This perhaps is the most important component of evaluating your software needs. Consider what your patients will have to do to get set up with you for care. How can your software help them engage maximally in the care experience? This may vary pending on the age and demographic of your caseload! 

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There you have it—a look at the types of software that can help you elevate patient care in your cash-pay practice. If you have any questions about what we covered here, feel free to drop them in the comment section below and we’ll do our best to answer them. And be sure to keep an eye out for future blog posts that cover software for billing and practice administration.