It’s no secret that our healthcare model is a bit broken. Patients often have to wait weeks or months to gain access to providers—long enough for conditions to move from acute to chronic. The good news is that there are plenty of alternative practice models clinicians are adopting in order to meet patients’ demands for high-quality, convenient care. Concierge medicine is one of those models; it’s becoming very popular in the general healthcare space, and it’s even making its way into the physical therapy arena. If you’re wondering what, exactly, concierge medicine is (and how it works in PT), then you’re in the right place! Let’s delve into the wonderful world of concierge physical therapy.
What is concierge medicine?
Before we get into the specifics of concierge physical therapy, let’s discuss the basics of concierge medicine. Essentially, it’s a cash-based healthcare model involving customized delivery and payment methods. The most popular type of concierge model features subscription-based pricing, meaning that in exchange for paying a monthly or annual fee, patients receive unlimited access to a provider’s services.
Another somewhat common option is to offer package deals, kind of like the ones you’d see at a yoga studio or rock climbing gym. For example, a clinician might offer five or 10 visits for a set price, rather than an unlimited subscription package. Savvy providers will often construct packages around commonly seen conditions.
Where does concierge physical therapy fit in?
Concierge PT is similar to traditional concierge medicine in that depending on the provider, patients can join practices as subscription-based members or opt to pay for special packages. Similarly, it’s up to the physical therapist who runs the concierge practice to decide on a business/payment structure. A sports physical therapist might offer a special 15-visit ACL recovery package for patients rehabbing after ACL reconstruction surgery. A PT who specializes in geriatrics, on the other hand, might encourage a patient with multiple chronic medical conditions to attend therapy on a subscription basis.
What are the benefits of running a concierge physical therapy practice?
The growth of the concierge trend is due in large part to the many benefits if affords providers and patients alike.
One of the obvious reasons providers opt for a subscription model is that it’s often more profitable than a traditional setup. By eliminating insurance companies from the mix, concierge physical therapy rates can be whatever the markets support. Compared to a traditional cash-based practice model, a subscription-based model also offers a more reliable income stream.
Providers can also choose to offer hours that accommodate their specific patient populations. Young parents, adolescents, busy professionals, and older adults all might have very different appointment time preferences, and a concierge model enables the clinician to run the business around target patients’ schedules.
Concierge PTs can also incorporate group treatment sessions into their programs to encourage camaraderie and community healing—or offer wellness services to ensure healthier patients still feel they’re getting their money’s worth.
Dr. Elizabeth Brewer, PT, DPT, founder of Elizabeth Brewer Physical Therapy, chose a concierge mobile therapy model because she wanted to create more convenient option for active adults in the Hampton Roads, VA area. Many of Dr. Brewer’s patients are constantly going to doctor’s appointments for pain relief—and are looking for a way to avoid injections and surgeries. She noticed that these types of patients tend to forego PT because they feel it’s too inconvenient to attend on top of their other appointments. By taking her practice on the road and providing several payment options—she offers five-, eight-, and 12-visit packages—Dr. Brewer eliminates the perceived barriers that might otherwise keep her patients from receiving therapy.
Furthermore, as WebPT’s Kylie McKee pointed out in a recent blog post, these types of concierge setups are great for the PT profession on the whole, as they “help foster the perception of PTs as primary care providers.”
There are numerous benefits to patients who sign up for concierge PT. For instance, if a patient wants PT intervention in preparation for an upcoming surgery, insurance may or may not cover those prehabilitation (sometimes called prehab) services. Concierge PT eliminates the stress of worrying about insurance coverage, enabling patients to receive all sorts of pre-op interventions—including strengthening, bed mobility exercises, patient education, and environmental preparations.
Plus, concierge models often enable patients to schedule appointments at favorable treatment times, and those patients typically receive:
- 100% one-on-one care,
- Treatment sessions long enough to see results quickly,
- Easy scheduling, and
- The ability to quickly reach providers with questions.
This model is especially appealing for patients who enjoy on-demand care—as well as those who have become frustrated by insurance-based limitations or have conditions that frequently require new prescriptions to address new body parts. For those with high-deductible insurance plans or plans with very little PT coverage, concierge services can sometimes wind up costing the same or—in a handful of cases—even less than going through insurance.
And, for patients like the ones who see Dr. Brewer, the luxury of a mobile therapist meeting them at their own homes is priceless. Not only is the care attentive and private, but it also eliminates the need for them to make the (sometimes painful) commute to attend PT at a traditional clinic.
What are the drawbacks to concierge and subscription-based PT?
As appealing as concierge PT is, there are some drawbacks.
Increased Patient Dependance
PTs have always struggled to find a healthy balance between encouraging patients to see us when they need us, and empowering those patients to take control of their own well-being. In a recent blog post on The Manual Therapist, Dr. Aaron LeBauer, PT, DPT, LMPT, RYT, makes the argument that subscription-based models can inadvertently cause patients to become more reliant on PTs, rather than leading those patients to take their health into their own hands. He recommends carefully wording your value proposition to lean away from touting unlimited treatment, instead highlighting perks like:
- Preferred appointment times;
- Increased access to clinicians;
- Annual checkups (or quarterly screens); and
- Additional specific items that would likely never be covered by insurance, such as free group classes and performance enhancement programs.
He also points out that knowing your state’s practice act is key to ensuring that you practice legally. While all 50 states do offer some degree of direct access to PTs, certain states are more lax about physician referrals than others, and different states have different rules about PTs providing wellness services.
For instance, many states require that PTs receive authorization or certification by an MD before beginning a course of treatment, but because wellness services do not require physician sign-offs, a subscription model can create some dangerous blurring of lines. LeBauer points out that if your state has limited or restricted direct access, you’re responsible for staying on top of obtaining physician signatures as the state dictates. He even suggests working in partnership with a physician who “believes in your philosophy and who is actually hungry for new patients.” He believes this is a win-win setup that can eliminate some of the hassles a subscription model would cause in those limited-access states.
Another consideration to keep in mind is that cash-based practice models can be particularly inhibitive to providers who contract with Medicare. Because Medicare prohibits providers for collecting cash for medically necessary covered services, an unlimited or subscription-based model could inadvertently land clinicians in legal hot water if they aren’t paying attention to what’s covered—and what’s not.
Clearly, concierge PT is growing quickly, and it has benefits beyond those affecting providers and patients alone. When patients no longer worry about long wait times or high copays, they are more likely to seek care early—when they first notice a problem. This not only saves tons of money on more invasive treatments down the line, but also spares patients from a lot of unnecessary suffering.
Do you practice in a concierge model? Do you know someone who does? Please let us know in the comment section below.