A Physical Therapy Business Mousetrap

Suspension Training

Every so often I get some folks that ask me about the business model I developed with CentraState Medical Center in Central NJ.
We were able to create an environment where we ultimately blended aggressive strength & conditioning with sound and meticulous manual therapy-based physical therapy.  And we ethically billed it quite successfully.
I think most people would come through and not see physical therapy in their view.  Instead of ultrasound and stim machines, we had UCS racks.
Instead of archaic knee extension and leg press machines, we had open space and a med ball throwing wall.
Instead of pink 2# dumbells and Theraband, we had Dumbells up to 55 and Kettlebells up to 36kg.
We trained people.  And if someone needed 1 or 2 sessions for a minimalist package of mobility drills, we spent the rest of our time with manual therapy.
We gave people what they needed, not what a fraudulent commercial physical therapy landscape offers based on huge volume, doing the same foolish workouts every session, being treated by techs, and complaining about low reimbursement.
We provided the niche of manual therapy and a training intensity that did not require aggressive and active individuals to slow down with body regions that did not require remedial training.

The model was based simply on our own interpretations of ethics. We were first able to increase our target audience for insurance-based dollars by marketing services for anyone that can demonstrate under a 14 on the FMS. The model allowed physical therapists to treat and train people that are not in pain. I trust most would agree that this is clearly a viable domain of PTs. Yet few PTs are actually capable of aggressive and appropriate corrective and metabolic exercise.

If your ethics are workplace allow for this, my opinion is that you have every right to charge insurance for training the entire body.  If functional means returning to previous level of activity, if doing pull-ups was pre-ankle sprain, then pull-ups are very much a part of the program.  Now if a patient needs authorization, this may not work or work in getting you a lot of sessions, but for folks that do not need regular “approval” from their insurance company, we have found a great and ethical avenue to get people what they need proactively.

If you follow my work, you know I do not delineate between rehab and training. To me, it’s all the same. It’s just about how your skill set allows you to restore or improve as many qualities as possible, so we just look at however we can get people in the door to do what we do, we don’t care how they pay.

We also had folks pay out of pocket and used insurance in the same work week to conserve authorization. If they do have authorization, and we know the insurance companies are going to care about OPS, ROM, MMT, etc. which we must ethically provide, we typically are going to get denied for more sessions. So we can ration them and use that session for manual therapy, and then be far more liberal with their scheduling when they come in to train. We had more of an S&C studio setup than a typical PT office, so we can yell across the room or out into the gym where we do our movement stuff.

It was a nice mousetrap, and because we were both very good at helping folks with pain and providing a product that other PT facilities did not provide.

Obviously this model was based exclusively on the movement-based approach where the FMS justified evidence-based risk for injury and the SFMA allowed for both a full body evaluation and proposal for both remedial painful and aggressive non-painful training.

  • December 24, 2010

Leave a Reply 9 comments

drperry@optonline.net Reply

This is the same mousetrap I use my friend. Poignant way to drive the heart of the matter home. Nice post indeed. I am 100% cash based practice and I am always busy because of this exact practice model. People will invest for value.

bkellylimerick@gmail.com Reply

Sound theory; unfortunately not too many PT’s or trainers are “equipped” to carry out such a methodology. They are almost the exception rather than the rule.

Keats Snideman Reply

Too bad 99.9 % of the rehab industry doesn’t use such a model! That .1% is hopefully going to grow by leaps and bounds in the next decade spear-headed by all of us lucky to enough to have mentors such as you, Gray Cook, Perry N., etc..

Donald Berry Reply

This is a model I follow as a chiropractor, RKC FMS. However, I find the hardest part is getting the patient to take ownership to do exercise. They are pain free at this point but the underlying dysfunction has not been addressed. How do i get the message across?
Don Berry

Charlie Reply

Donald – Honestly we didn’t have the problem because if someone didn’t want to go along with such things as uncomfortable manual therapy and aggressive exercise, we threw them out. We didn’t take their business and referred them to another hospital satellite.
If they stayed in the hospital system, we didn’t lose any money.
If they went elsewhere, they’re someone else’s problem and lousy outcome.

Garbage in, garbage out.
We didn’t deal with garbage.

David Reply

How do you (or the patients) get physicians to write a prescription for someone who is “under 14 on FMS” but doesn’t have pain?
I’m trying to figure out how to move to this cash-based type of practice without having to go to massage therapy school so I can bypass the restrictions on physical therapists.

Charlie Reply

David – In NJ, you don’t need a prescription for PT. It has Direct Access. Obviously not all states have this program.

Some (most) folks needed a script for insurance, where the prescription can read things like Deconditioned, Neuromuscular Disorder, Movement Dysfunction.
It could also read chronic –x–. Insurance companies don’t care. It’s APTA and ivory tower blowhards that make us feel that somehow this is unethical. It’s all bullshit. We need to figure out to get people into the door to help them.

Amanda Reply

Great article!! I am all for PT moving in this direction. I currently work for a private practice outpatient facility – I manage a clinic in my hometown. Things here are always “20 years behind” but, I constantly push for more and more current research that supports this and move away from the “cookie cutter” programs and redundancy. I would love more information regarding FMS and how to become certified!
Thanks again for your insight…its a breath of fresh air!

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