Concierge physical therapy

Concierge physical therapy, Conciergept

Concierge physical therapy is one of the latest options available to physical therapists looking to work outside of a traditional office setting. As the landscape of healthcare continues to evolve, many physical therapists and consumers of physical therapy services are looking for alternative models of practice. Contracting with insurance companies is no longer the only way for clinicians to practice in an outpatient setting. In fact, many of their clients are recognizing the benefits of paying for their services out of pocket. Concierge physical therapy is one example of an alternative practice model that has gained popularity. 

What is concierge physical therapy?

The term concierge is used to describe services provided to clients in a personalized and individualized manner. In the realm of rehabilitation, concierge physical therapy refers to a subset of outpatient practitioners that are providing cash-based and highly customized physical therapy service, often in their patients’ homes and communities. Concierge clinicians set their own prices for evaluations, treatments, group sessions, wellness visits and so forth and clients are charged a cash-pay rate. Clinicians may choose to bill their clients for individual sessions or may develop treatment or even subscription packages. 

These physical therapists are not in-network with insurance plans and receive payment directly from their clients. If asked, however, most will provide an itemized invoice with relevant CPT and ICD-10 codes so that their clients can submit it to their insurance. Concierge physical therapy can be a solution to many of the challenges facing the physical therapy industry today but there are some downsides to consider as well.

What problems does concierge physical therapy aim to solve?

Traditional insurance-based physical therapy is an excellent option for many providers and clients as it can increase access to physical therapy services at an affordable price. There are some challenges inherent to the insurance-based practice model, however, that concierge physical therapy aims to address. 

Benefit limits: Insurance plans determine how much physical therapy beneficiaries can utilize per year.  Some plans cover any PT services that are deemed medically-necessary while others dictate a set amount of available visits per year without regard to medical necessity of further visits. Concierge physical therapy allows clients to access as many physical therapy services as necessary. As a provider, you should continue to use clinical judgment to determine an appropriate plan of care, but clients do not have to worry that they will not be able to fully rehab their injuries or return later in the year if needed. 

Limited pool of providers: When utilizing in-network insurance benefits for physical therapy services, clients are limited to the pool of providers that are contracted with their plan. In some cases the pool may be very large while in others, quite small. Concierge physical therapy gives clients the right to select a provider based on other important characteristics outside of in-network status such as location, hours of availability and areas of expertise. 

Limited 1:1 time with clients: While some insurance-based physical therapists are lucky enough to practice in a setting that allows 45-60 minute, 1:1 appointments, many do not. In the case of a high volume clinic where therapists work directly with their clients for 15-20 min and then utilize a tech or rehab aide for the remainder of the appointment, concierge physical therapy can be a welcomed change. Because of the nature of concierge physical therapy, therapists can dictate the length of their sessions and clients benefit from more 1:1 time with the expert. This can lead to better client satisfaction and better patient outcomes. 

In this model of care clients have more on-demand access to their therapist, can expect great continuity of care and get to experience the benefits of working with their therapist outside of the 4 walls of a clinic. Therapists can customize their plans to the layout of a clients home and meet them in the community where they can individualize their assessment and treatments for the clients favorite activities. 

Unpredictable service costs: Reimbursement rates for physical therapy services are based in large part on contracted rates with an insurance company. This rate can vary based on a number of factors. Different CPT codes are reimbursed at different rates and this impacts the number of clients a clinic needs to service per day or per hour in order to remain profitable. Because concierge physical therapists set their own rates, the cost of physical therapy services becomes transparent and predictable. Clients know what they will be paying up front and clinicians can perform more accurate financial predictions throughout the year.

Are there any downsides or challenges for providers or clients?

As discussed above, there are many benefits to practicing as or working with concierge physical therapists but there are also some downsides to consider: 

Legal responsibility: As a provider of concierge physical therapy services, you will be responsible for understanding the laws and regulations for practicing in your state. One topic to consider carefully before opening a concierge practice is the level of direct access available in your state. Similarly, documentation is still an essential part of practicing within a concierge model despite the lack of an insurance company looking for justification of medical necessity. 

Medicare limitations: Medicare has strict restrictions on the direct collection of payment for services covered by the health plan. Since physical therapy is a covered service under Medicare, physical therapists cannot collect cash payment from any clients with Medicare in exchange for providing physical therapy. They can, however, collect a cash payment from a Medicare beneficiary for wellness services. If you are practicing in an area with a high volume of Medicare clients, it is essential that you understand how the definitions of physical therapy and wellness differ as this may play a role in where you want to locate your practice. 

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Not all clients can afford concierge services: Because practitioners can set their own rates, concierge services can be considered expensive by some. This is not to say that the prices are unreasonable, but while concierge physical therapists provide highly individualized and skilled services, many individuals rely heavily on the coverage of their health insurance and paying out-of-pocket may be impossible. This brings up issues around equity and equality in healthcare that continue to be a topic of conversation amongst rehab professionals. It is important that the community has access to expert clinicians regardless of their financial means.

Running a business: In most cases concierge physical therapists are business owners. If you are accustomed to working for an outpatient clinic, there may be a lot to learn about opening a physical therapy business and running it successfully. So while you may need to look for recommendations on the best lawyers, accountants and marketing professionals, Theraplatform has you covered when it comes to practice management and EHR/EMR software. 

TheraPlatform, a practice management, teletherapy and EHR all-in-software for therapists can help PTs manage their businesses by automating administrative tasks like scheduling, documentation, billing and more. They also offer a free, 30-day trial with no credit card required. 

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