The Anatomy of a Physical Therapy Cash Practice

Cash-Based Physical Therapy in Practice

Aaron LeBauer PT, DPT, LMBT

Aaron LeBauer PT, DPT, LMBT

Hello.  Welcome to my new website and blog dedicated to building, growing and starting a 100% Physical Therapy Cash Based Practice.  My name is Dr. Aaron LeBauer and I am a physical therapist in Greensboro, NC.  I am a Doctor of Physical Therapy, Licensed Massage & Bodywork Therapist and Myofascial Release specialist.  I have had a 100% cash practice since the day I graduated from PT school in 2008.  All of my professors and any other physical therapist I told about my plan simply looked at me like I was crazy, or with disbelief.  I had owned my own massage therapy practice for 10 years, specializing in chronic pain and injuries prior to entering PT school, so the transition was a bit different than starting from scratch, but I definitely faced some unforeseen challenges in my new role as a physical therapist.

My CashPT Schedule

I work 5 days a week, treat patients on 4 half days and 1 full day each week.  I schedule my patients on the hour, each visit is about 30-45 min of hands-on treatment, with 5-15 min of teaching exercise or self-treatment techniques the patient will complete at home.  I finish treatment sessions at quarter to the next hour to leave time for payment, rescheduling and changing the room. The average patient in my clinic comes in for treatment once a week for 5-8 visits. I give each of my patients a receipt with all the information they need to submit the claim themselves.

LeBauer Physical Therapy in Greensboro NC

LeBauer Physical Therapy in Greensboro, NC

Creating Freedom in Practice

I set up my business this way because it allows me to spend quality time with each patient using my hands for treatment, providing each patient with the best experience tailored to their needs which they can receive while not allowing the insurance company or 3rd party payor to dictate or influence the treatments I provide or the time I spend with the patient.  The process an individual has to go through to submit a claim is much more simple and straightforward than 3rd party billing. I feel that processing insurance claims, and even filing on behalf of patients, would greatly increase the workload, require additional support staff and reduce my desire for a low overhead footprint without adding any value to the patient.

Who Are My Patients?

My patient demographic is varied, and while I treat some children and students, a majority are professionals, though most are not extremely wealthy and upper class. The common thread with my patients is that they value high quality personalized care and they value their bodies and personal health. Most of my patients have not had success or resolution of their problems with traditional treatments, medications, surgery and even physical therapy.

A Low Overhead Practice

One of the other goals in my business is also to maintain a low overhead so I can choose whom I work with and when I work. It also keeps my life simple so I can spend more time with my family, exercising and have balance in my life. We spent 5 years in a small 2 room studio and now have a small clinic with 3 private treatment rooms, waiting room, bathroom, front desk area, no exercise equipment or anything that plugs into the wall, aside from my lamp and stereo. I use my hands and provide a treatment and skill set that no one else in town can offer.  My wife, Andra, who has her own clientele providing therapeutic massage and private yoga instruction, uses one of the treatment rooms.  The other treatment room is rented by a chiropractor that specializes in soft tissue treatment as his satellite office.

Primary Care Private Pay Physical Therapy

Primary Care Physical Therapy

My other goal is to be a primary care health care provider of musculoskeletal issues, and the consumer of my services is the patient, not the physician across town.  This is why I market directly to the consumer and patients. However, I do not spend wads of cash on typical or traditional (brand) marketing and advertisements (This does not work), nor do I buy lunch for the physician’s whole office just to get 5 minutes of their time. That should be reserved for big pharma. 🙂 and is similar to paying for a referral in my view. I am their colleague so why should I beg them for referrals?  Internal marketing; asking my current patients to refer their friends, family and co-workers is my number one source of new patients, and close behind is the internet and specifically Google search.

Give to Get & Provide Exceptional Value

Writing articles for a local publication, optimizing your website and blog so people can find you online and offering people something of value (like our knowledge written out in a how to guide) rather than asking for handouts is the approach I find most successful.

In this blog I will share some of these strategies and tips, what has worked for me and what has not.  If you are thinking about starting a small cash based or fee-for-service physical therapy private practice or even a more traditional model, the information, how to articles, guides and marketing secrets in my upcoming digital products and online trainings will be some of the most important information you will ever read.

Thanks and I look forward to your thoughts, personal experience and feedback.
Aaron LeBauer PT, DPT, LMBT

 

If you are considering starting a cash-based practice and want the step-by-step guide on how to get started and grow your clinic, or you have recently started and are still struggling to get new patients in the door, then my online coaching program, The CashPT Blueprint, may be exactly what you are looking for to help you avoid the mistakes I’ve made, acquire new patients and to create the practice of your dreams.

CashPT Blueprint Cash Based Pay Physical Occupational Therapy

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About The Author

Aaron LeBauer

Aaron LeBauer PT, DPT, LMBT started a 100% cash based physical therapy practice right after graduation. He enjoys sharing his experiences in private practice and helping other therapists find freedom in practice.

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27 Comments

  • Jessica

    Reply Reply June 17, 2013

    Our philosophies on work-life balance really resonate with one another. My husband and I own a very small private PT practice, and by utilizing some simliar concepts, we have been successful too! Thank you for sharing!

    • Aaron LeBauer

      Reply Reply June 17, 2013

      Jessica,
      Thanks for your comment. It’s always nice, and validating for both parties as it’s common to be isolated in our practices, to connect with other therapists who share similar ideas about work, patient care, life. Stay in touch.
      Aaron

  • Lara DPT

    Reply Reply August 2, 2013

    Wow, all of this resonates so much with me. I started my private practice soon out of PT school (though I have degrees and experience in related field of Health and Exercise Science, thus lots of time working with people). Like you, work-life balance is vital to me, in order to remain a highly competitive runner, as well as have time for relationships. I do think patients appreciate the time and attention given in this one-on-one format. And I have considered beginning to bill insurance, but all along my fear is it will take away from both my patient time and my personal time. Thank you so much for sharing your experience. My biggest challenge and pitfall is self-doubt. Questions that I have regarding my own practice include: what to charge (I have a feeling I am under-charging since I’m afraid pts won’t come in to pay cash); Also, I use QuickBooks but how did you customize your receipt to include codes, IDs, etc for superbill? This would be much easier and more formal than my hand-written form, I think. Lastly, I earned my MS from Wake Forest U., so it’s fun to think back to Greensboro and that area- it’s really great!

    Thank you,
    Lara

  • Aaron LeBauer

    Reply Reply August 3, 2013

    Thanks Lara! It’s so awesome to connect with other therapists who have very similar practices, stories and philosophies. What a great coincidence that you spent time over here during school.
    Don’t doubt yourself. It’s one of the hardest aspects to overcome, especially as a solo practitioner. I also have had trouble with this too. Just remember, that your patients would not come in and pay you money if they didn’t value you and your service. You do need to charge what you feel you are worth, just make sure you are not undervaluing yourself, your education and the way you make patients feel at the end of their visit.
    I can comment and help more about the QuickBooks receipt customization at another time, but it was somewhat simple once I found the manage templates button, but not intuitive like it should be. A bit depends on your version of QuickBooks. I even was able to scan in my signature. I can help you with it in person if you would like.

  • Heidi

    Reply Reply August 9, 2013

    This is very informative. I appreciate all the input you have provided for those therapists looking to transition. I have heard various parts of the information you provided from other MFR professionals but you put it together beautifully. Thanks again! Heidi

    • Aaron LeBauer

      Reply Reply August 9, 2013

      Heidi,
      Thanks, I appreciate your comments and feedback.
      Aaron

  • Kristen K Glancey PT

    Reply Reply August 15, 2013

    Hi Aaron,

    I appreciate your insight. I have a BS in PT, so will still need a prescription & have to get approval for visit numbers as well even if I open a cash practice correct? I have so many questions. I am trying to center & focus just as John has taught us.

    Thanks,
    Kristen Glancey PT
    MFR 1, Unwinding, Myofascial Pelvis, & soon Women’s Health
    TN Pelvic Health & MFR Wellness Center
    Arlington , TN

    • Aaron LeBauer

      Reply Reply August 15, 2013

      Kristen,
      Thanks for your question. You need to check with your state practice act to be 100% certain, but with a quick Google search I found that Tennessee has unrestricted Direct Access and that with Bachelors degree you need 3 years of experience and to take a board approved 15 hour physical therapy screening course to see patients without a referral. https://health.state.tn.us/boards/PT/PDFs/PT_DirAccPolicy.pdf
      You shouldn’t need to get prior approval from your patient’s insurance providers, but that is a great question for the patient to ask when they call and one that I have on the “Insurance Benefits Worksheet” that I provide to patients who have questions about their benefits. I evaluate and treat all patients without prior approval from their insurance provider and it has not been an issue here in NC. In general patients who come to see you are not doing so because their insurance covers the treatment, but because of the awesome treatment and value you provide.

  • Trent

    Reply Reply February 25, 2014

    “All of my professors and any other physical therapist I told about my plan simply looked at me like I was crazy, or with disbelief.”

    I smiled after reading this… I am currently in a DPT program and have aspirations to create something much like you have with your practice. I receive the same reaction from folks when I tell them my “vision.” I look forward to digging more into your website as well as connecting with you via social media.

    • Aaron LeBauer

      Reply Reply February 25, 2014

      Trent,
      Thanks for visiting my blog and thanks for your comment. I’m happy that resonated with you. It was quite frustrating for me to always come up against resistance. Keep you head up and pressing forward with your vision and goals. You’ll find others who value the same.
      I hope you enjoy and learn a lot from the blog posts and let me know if there is anything I can do to help.
      aaron

  • Janet Colonghi

    Reply Reply March 29, 2014

    The key thing I heard you say is that you work in an affluent area. That fact makes all the difference! Many people cannot afford copays. What is your fee, if you dont mind me asking and do you offer a sliding scale? Thank you for the info, I can dream….

    Janet

    • Aaron LeBauer

      Reply Reply March 31, 2014

      Janet,
      Thanks for visiting my blog and for your comment. I do not work in or next to the most affluent areas of town, though I’m not isolated from these areas either. Our office is just off of one of the main roads in town, near the university. I have many patients who I would not describe as “wealthy, affluent, etc.” You are right, people can not afford co-pays. Who can justify paying $50 to go workout on a bicycle and get hooked up to an e-stim and practice leg lifts and squats when a membership at Planet Fitness is $10/month?

      My office is in a convenient location that is safe and comfortable for patients. They are the type of people who value their health, what I have to offer and who want to participate in their healing. I will occasionally offer a discount to patient who inquire and on a case-by-case basis. In these situcations I typically ask for payment upfront, however I believe that discounts can devalue our service and are not straightforward for people who are submitting claims to their insurance provider.
      I have a standard charge for the initial evaluation and treatment session and you can learn more about my payment policies at my LeBauer Physical Therapy practice website. You can always dream and with action your dreams can come true…. 😉

  • Chase

    Reply Reply May 14, 2014

    I just stumbled across your blog today and I am very impressed with what I have read so far. I am a chiropractor/nutritionist that runs an all cash practice as well. Going through school everyone [professors, doctors, students,etc] all told me that it would not be possible. 5 years later we are still kicking strong. I am able to spend time with my family, give patients the care they need/deserve, and make a great living at the same time. Having a practice where the patient is responsible for their health, both physically, and financially increases compliance, and really makes it more enjoyable. I look forward to reading through some of your posts, and looking for ways that I can build on what I am doing so far. Keep up the good work!

    • Aaron LeBauer

      Reply Reply June 12, 2014

      Chase,
      Thank you so much for your comment. I’m sorry it too me so long to respond. You comment was hidden below a pile of spam comments :-).
      anyway, it’s great to hear that you are so successful, living your life to it’s fullest, doing right by your patients and your family.
      I completely agree with you regarding patient responsibility, by empowering our patients to care for themselves, we create satisfied customers who will no only do their work outside of their therapy sessions but tell others about their experience in our practice.
      thanks again for your compliments and comments. It’s always great to know other healing practitioners that are on the same path.
      Aaron

  • Tom

    Reply Reply May 4, 2015

    I just wanted to complement you on what a great thing it looks like you have going on. I’m a Structural Integrator and massage therapist based out of Winston Salem not a PT. I took a look at your YouTube video and some of your blog. I just want to say …. WELL DONE!

    • Aaron LeBauer

      Reply Reply May 4, 2015

      Tom,
      Thank you very much for your comment and compliments. I really appreciate it. Thanks!

  • Diana Weber

    Reply Reply October 6, 2015

    Very useful info! Quick question: What do you use for scheduling software for your practice? Since you are keeping overhead low, I assume you have not bought into one of the integrated (expensive) software systems with scheduling, EMR, billing, etc. I am looking for a scheduling program that sends reminders to patients…that’s all I want but cannot find anything that simple. Any ideas would be very welcome. Thank you!

    • Aaron LeBauer

      Reply Reply October 6, 2015

      Diana,
      Thanks for visiting my website and your comment. I use Google Calendar. It does have options to send notifications to invitees to the event. However an easier option might be scheduling systems that integrate with Google and allow patients to schedule online such as Calendly, You Can Book Me, Appointy or GenBook. I don’t have 1st hand experience with these programs but I know folks that do. It’s on my list of things to look at to streamline my work flow.
      Good Luck!

  • Diana Weber

    Reply Reply October 6, 2015

    Aaron, thanks for your speedy and helpful response. It will come in very handy. All the best, Diana

  • Mike cocco

    Reply Reply February 23, 2016

    Hi Aaron

    How are you? I stumbled onto your web site and found it interesting. I wonder how your approach would work for chiropractic?
    Mike cocco DC

    • Aaron LeBauer

      Reply Reply February 23, 2016

      Hi Mike,
      Thanks for your comment and question. I’m glad you found my website. This approach can work for chiropractors. I have a few chiropractors in my programs and just recently did a tour of a Chiropractic cash practice with a friend of mine who subleased his satellite location from us for a few years and who’s model is very similar to ours. Everything should apply, just change “physical therapist” to “chiropractor” and some of the compliance issues may be different, some the will be the same. Let me know if you have any questions or if there is anything else I can do to support you.
      Aaron

  • Carol Neu-Frauman

    Reply Reply April 4, 2016

    Have you had any experience working with pediatric occupational therapists moving to cash-based practices?

    • Aaron LeBauer

      Reply Reply April 4, 2016

      Hey Carol, Thanks for your question. Yes, I have. It’s definitely a model that works. Let me know if you have any other questions.
      thanks
      Aaron

  • Samiat Tumasang

    Reply Reply June 2, 2016

    Hi Aaron,

    I do feel that it is important to have work-life balance. I have been thinking about starting a private practice. But I have many self doubts and fears. I’m trying to figure out where to start? From locations to billing to whether or not to focus on cash-based only or combinations.
    Should I take a course to learn about starting a business or should I just dive in? Thus far, the only think I have figure out is the name of the practice. How/where do I get the best information about in starting private physical therapy practice.

    • Aaron LeBauer

      Reply Reply June 5, 2016

      Hey Samiat,
      Thanks for your comment and question. The first thing you need to do is get clear on what you want and Why you want to start a practice. I think that the best way to get started is to work with a mentor and through a business course. I did this when I started and that’s what I offer in my online training program, The CashPT Blueprint. It is a 6 module online training course that teaches how to start a cash-based practice. Even if you want to start a hybrid or insurance based practice, the only thing I do not go over is initiating a contract with private insurance. Everything else is in there. There are also a few others who have business courses, like my friend Paul Gough’s Business Growth School. This is a course that is designed for current practice owners and it gives a great foundation for a new practice as well as a great place to pivot and grow for an existing practice. Be sure to check out some of my free trainings and let me know if you have any questions.

  • Barbara Shirts

    Reply Reply June 8, 2016

    Hello Aaron,
    I am sorry to have to ask, but you could please send my toolkit link to me again? When I first ordered it, I downloaded it on my ipad. I didn’t realize the files were zip. I was unable to unzip them on my ipad, and by the time if found the time to access from my desktop, it now shows me that the “download link has expired”. Bummer.I am really excitied about opening it and getting started on this project….
    If there is any way you could resend, I would greatly appreciate it. Or, know any tricks to transfer or unzip from ipad???
    Thank you Aaron, I am learning so much from you, your site, and your webinars…
    With appreciation,
    Barbara Shirts
    Order # 280680

    • Aaron LeBauer

      Reply Reply June 8, 2016

      Hey Barbara,
      Thanks for your purchase and your comment here. I’m sorry this was an issue for you. I’ve resent you the .zip download file. If you have dropbox , or other cloud storage account, on your ipad, you could also move the .zip file to the correct folder in there. thanks!
      Aaron

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