Concierge Physical Therapy: The Growing Phenomenon

Whether you’re starting a physical therapy practice or already have an established business, one thing you can’t overlook is compensation. Most people start with the traditional route, where they enter into contracts with insurance companies. By doing so, they can work with the health plan’s beneficiaries at a set and agreed-upon reimbursement rate. This method provides a level of predictability, as you can expect to receive consistent patient referrals, and a somewhat steady level of reimbursement and compensation. 

However, this compensation model also has some drawbacks. For instance, navigating the complexities of insurance billing, administrative duties, and decreasing reimbursement rates can become overwhelming. As a result, many practice owners are looking for other ways to provide care, like concierge physical therapy. 

Below, we’ll discuss concierge physical therapy, its pros and cons, and more. 

What Is Concierge Physical Therapy? 

Before we can fully explore concierge physical therapy, or concierge PT for short, it helps to explain its origins. Therefore, let’s explore where the idea came from. 

Before concierge PT, there was concierge medicine, a medical management structure that emerged in 1996. It was created in response to patients and physicians growing frustrated by the limitations established by managed care organizations. 

Under concierge medicine, physicians limit the number of patients they bring on so they can provide very personalized care on an on-call basis. It’s a cash-based model, meaning third-party payers are out of the mix. 

Concierge medicine practices usually implement membership—or subscription-based pricing. With this approach, patients pay a predictable monthly or annual fee and receive unlimited access to their clinicians’ services. 

However, some practices get really creative. For instance, providers not interested in a limitless subscription can construct packages that allow patients to select 5-, 10-, or 20 visits upfront at a set amount. 

How Did Concierge Physical Therapy Begin?

Concierge PT is very similar to conventional concierge medicine. The main difference is the provider type and the services offered. A concierge physical therapy practice, too, would operate using a cash-based model, offering its patients either memberships or packages.

So, let’s consider what the subscription and packages might look like under this structure. 

CT Physical Therapy: Subscription-Based

An example of a subscription-based plan might be allowing patients to choose between a monthly, quarterly, or yearly subscription, where they pay a retainer upfront. Practice owners could make it so that memberships with longer durations have the biggest discounts. While the monthly subscription is more expensive, it may attract patients trying your services for the first time or have some uncertainty. 

Subscriptions might be ideal for patients with chronic conditions that require long-term interventions, like arthritis. While there’s no cure, strengthening the muscles and expanding flexibility may alleviate symptoms. 

Concierge Physical Therapy: Package-Based

An example of a Concierge PT package might be creating visit bundles based on the condition/injury patients may present with. Maybe you develop a 10-visit fall recovery package designed for older patients or a 15-visit runner’s knee deal aimed at athletes. Here are some other injuries that packages might be helpful for: 

• ACL (anterior crucial ligament) knee injury 
• Ankle sprain
• Rotator cuff 
• Shin splits 
• Tennis elbow

Package deals may be best for short- to medium-term recovery. 

Concierge Physical Therapy vs. Traditional PT Practice 

As you might imagine, there are some differences between operating a concierge physical therapy business and running a traditional PT practice. Below, we’ll review some of the caveats that leaders should be aware of. 

Differing Administrative Duties

Did you know that billing and coding are one of the primary drivers of administrative expenses? The administrative burden can be so significant that physical therapists spend more time in front of their computers than doing patient care. Even on the patient’s end, they must determine which forms to fill out, decide how to get insurance pre-authorizations and more. These are some of the issues within a traditional PT practice. 

While there are still administrative duties in concierge physical therapy, it doesn’t involve the back-and-forth that is common when you work with insurance plans. As a result, concierge PT practices may not require as much staff. You won’t need employees to adhere to insurance regulations (as much), negotiate insurance contracts, or submit to the Merit-Based Incentive Payment System (MIPS). You also don’t have to worry about resubmitting bills when insurance companies refuse to pay due to coding issues. These issues are eliminated with a cash-based system. 

Practice owners can reduce administrative functions even more by incorporating EMR tools. There are productivity lists and workflow automation tools that’ll allow you to focus less on manual admin tasks and more on performing physical therapy. 

Legal and Regulatory Obligations

Although you have increased autonomy with a concierge PT business, you’re not exempt from legal responsibilities. It’s still up to you to know the laws and regulations for practicing in your state. 

Owners should especially look into direct access, a law where patients can start physical therapy without a physician referral. While every state permits evaluation and some levels of treatment without a physician referral, it’s necessary to know how it’ll work where you practice. After all, it’s possible that you may not receive referrals as often when you’re cash-based.  

Practices must also remain compliant with federal laws. It’s crucial to adhere to Health Insurance Portability and Accountability Act (HIPAA), licensing, scope of practice limitations, and other regulations. Proper documentation is also mandatory, even without insurance, as you need to showcase medical necessity. 

Medicare Restrictions

Although you don’t take insurance with concierge PT, there are some Medicare compliance rules you must follow. For instance, you can’t accept direct payment from any patients with a Medicare plan in exchange for providing physical therapy unless Medicare has designated the service in question as non-covered in all instances. 

So you might be able to accept cash payments from them is if it’s considered a wellness service. However, if the treatment appears medically necessary, in that a patient needs physical therapy to slow or prevent decline, Medicare covers that. As a result, you cannot charge cash for those services. 

Marketing Strategies

Traditional physical therapy practices can rely on insurance referrals to attract patients. However, concierge PT businesses must try different methods to attract clients. This may mean joining your local Chamber of Commerce, volunteering in the community, posting on social media, and email marketing. Patient engagement tools can help practice owners attract and retain clients by sending personalized emails and text messages.  

Patient Load

Concierge physical therapy is all about providing high-level, personalized care. The goal is to spend more time with patients so they get a full hour instead of 15- to 20-minute sessions. This may ultimately lead to better patient satisfaction and health outcomes. 

To accommodate this, concierge PT businesses often work with fewer patients than traditional ones. They have to ensure they can still meet their patient’s needs in a timely fashion and have room in their schedule when providing on-demand access. Otherwise, patients end up experiencing delays just like they might at a traditional practice. Keep in mind that they pay more for greater accessibility, so failing to provide that might cost you clients. 

The Benefits of a Concierge Physical Therapy Practice

Now that we’ve addressed how running a concierge PT practice might differ from a traditional one, let’s explore the benefits, shall we? 

Benefits for Physical Therapists

• Potentially higher profits: Decreased insurance-based reimbursements and denied claims can be a financial nightmare for a traditional PT business. However, when you operate a cash-based business, set a rate that the market supports, and require payment up front, you can achieve greater financial stability.  
• Scheduling flexibility: A concierge PT model allows you to design a schedule that aligns with the needs of your target patient population. For instance, instead of operating a typical 9-5, you might have evening or weekend appointments. This often aligns better with business professionals and adolescents. 
• Better staff morale: If you employ other PTs, they’ll be relieved not to have to deal with reimbursement delays caused by insurers. In addition, scheduling should be more manageable. In hospital settings, PTs often have patients back-to-back, which could cause burnout over time. With concierge PT, though, your team can achieve work/life balance. Maybe some work as needed and others part time, based on their unique availability. 
• Local industry leader: There are still very few concierge physical therapy practices, so your business may stand out if you offer this service. Plus, patients might start to see you as the primary care provider of the PT industry since they don’t need a referral to see you. 

Benefits for Patients

• Accessibility: Throughout the healthcare industry, patients are plagued by long waiting rooms, far-out appointments, and rushed care. Concierge PT should eliminate that. You can meet your clients where they’re at by going to their homes or offering telehealth visits. This level of convenience is what draws them in. 
• Price transparency: Patients, like providers, occasionally receive surprise bills in the mail from insurance companies that have denied coverage. With concierge physical therapy, they know what they’re paying up front and can plan for it. 
• 1:1 personalized care: Research shows patient engagement increases patient adherence and self-care, impacting outcomes. Concierge physical therapy encourages patient engagement as they receive 1:1 treatment sessions, simple scheduling, and the ability to contact their providers with questions on demand. 

The Drawbacks of Concierge Physical Therapy

As great as the benefits are, we must also acknowledge that this cash-based business model has some cons. Below are some factors that PT practice owners should keep in mind. 

• Costly initial investment: Launching a concierge PT company may be more expensive than a traditional one due to marketing and technology costs. 
• Limited patient base: Many patients believe their health insurance plan should cover some or all of their physical therapy expenses. Therefore, those patients may prefer something other than a concierge PT model. In addition, membership fees may be more expensive than some patients can afford, further limiting your patient pool.  
• Income variability: Your income is based on the memberships you sell, and concierge physical therapy is still seen as more of a luxury. Therefore, if there’s an economic shift or a change in a patient’s income, your service may be one of the first they cut. 
• Local competition: Patients are most familiar with traditional PT, so attracting them to a concierge PT business may be more challenging. They’d have to be educated on how it works. Plus, as more concierge practices enter the market, you’ll have to figure out how to make your business stand out.    
• Legal/regulatory hurdles: As mentioned before, the legal and regulatory landscape can be confusing and cause concerns for a concierge practice owner. 

Expand Your Practice with Concierge PT

If you already have an established business, the idea of fully converting to a concierge physical therapy practice might seem daunting. This concern is even more paramount if most of your patients operate through insurance. Therefore, is there a way to have the best of both worlds? The answer is yes!

Hybrid Model: Merge Traditional & Cash-Based

You can deliver two service levels with a hybrid model: conventional and concierge. 

The conventional approach would involve taking on clients who utilize their insurance plan. While that may mean less autonomy in terms of session lengths and treatment approaches, it also means you’ll get referrals. 

The concierge service can then be marketed to individuals looking for a more premium experience. Ideally, you’d market this to individuals who need more personalized care that aligns better with their schedule. Maybe you have physical therapists on your team who could accommodate house calls or perform telehealth visits after hours. 

By offering both, you’re expanding your market. Yet, this may also mean more work for you and your team. The hybrid approach allows you to see how sustainable the concierge side works without losing your current clients. Then, later, if it makes sense, you may feel comfortable operating a full concierge physical therapy practice. 

Concierge Physical Therapy Services Are the Future

Today’s healthcare marketplace heavily focuses on patient-centered care, which means giving patients more of a say in the decision-making process when planning care and treatment. Concierge medicine aligns with this patient-centered approach by working through the patient exclusively (except for Medicare-exempt services). 

One of the greatest issues in our industry is adequate access to care, provider burnout, and rushed appointments that may compromise patient safety. Business models like concierge physical therapy, though, help to address these pressing matters. They allow providers like you to give personalized care without feeling overwhelmed by insurance intricacies and a heavy workload.