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This model can definitely work. It depends on how you package it and what YOU want. There are a few things to take into consideration, the increased value for the patients, increasing your income and considering how this works ethically and legally.
My 1 problem, or sticking point, with this model is that most patients in my practice don't need intensive physical therapy every year. Some special populations and chronic conditions may need ongoing care, but most people in the general population do not. What I don't want to do is encourage my patients to utilize my services more than they actually need. For instance if I were to sell a package of 10 visits at a discounted rate and the patient only needed 5-7 visits to achieve their goals, then they feel like they may need all 10 or should use all 10. I may be putting more into what and how the patients think, however my goal is to empower my patients to change and care for themselves.
I like the idea of including an annual musculoskeletal exam or annual physical therapy exam, including screens and other baseline measures, similar to what Joe Heiler has on his website http://elitepttc.com/blog/annual-musculoskeletal-exam/ I'm not sure, “unlimited visits” would be the benefit I would sell for a subscription model. I would look at preferred appointment times, access to the PT, annual check-up (quarterly screens), discounted or free group classes, performance enhancement programs, etc.
In a concierge or subscription model I could see a successful model where there is a yearly fee that includes an "annual musculoskeltal exam," unlimited email access to you for questions, preferred appointment times and maybe a special patient portal with articles, videos, and even subscription to your "corrective exercise" library. Additional benefits may include, a customized plan for the patients based on their yearly or bi-yearly exam, memberships, discounts on wellness services, etc.
When considering offering a reduced rate on services, if you were to reduce 1 visit by $10 and the patient needs 10 visits, that's $100. If the patient pays you $100 per year for your “preferred access” program, what if you see that patient more than 10 visit, you loose money. The math needs to work too, for both sides. People generally don't make their decisions based on $5-20, but they will on a difference of $50. Fifty dollars x 10 visits is $500 per year. What is that worth to the patient if they don't actually need to come in for a treatment? Do you have other services they can utilize that do not cost you time or money to provide?
1-on-1 Fee for Service vs. Selling the Outcome
This may be where selling an outcome is more beneficial than offering to save patients some money on services. Is it worth $1500 or more for a patient to be able to play with their kids again? Run again? Go back to CrossFit? Or even just go to the bathroom independently? The patient’s pay for the outcome; regardless of the amount or type of treatment provided. I don't offer this and there is a gamble on the amount of treatments but for the right population and certain diagnoses, this can be a great model.
“How would a subscription model for physical therapy impact legalities of care?”
Modifying your model to fit the parameters of your practice act is an important consideration. In the case that “physical therapy” treatment needs authorization or re-certification by a physician and “wellness” therapy does not, are the lines blurred? Is there a distinct difference between the two services? It’s easy to define wellness care when provided by a personal trainer or massage therapist. What about when these services are provided by the physical therapist too?
It’s best to know your practice act and create a guideline and services that fit within it. In the case of restricted direct access to physical therapy, it should not be too much of a problem to fax a plan of care for a physician to sign every few months if you need it. You can always find a physician team member who believes in your philosophy and who is actually hungry for new patients. This can be a win-win marketing strategy for both the therapy practice and physician’s practice.
Drawing the Line Between Wellness and Physical Therapy
As far as wellness vs. physical therapy is concerned, I think the line is not well defined, unless you look at Medicare, and it’s still not super clear and an argument on both sides can usually be made and I don’t draw it with hands-on care. Manual therapy may be a determining factor, when defined as providing a joint manipulation.
As both a massage therapist and physical therapist the difference is minimal concerning my hands. Also, in North Carolina as a physical therapist I can perform massage therapy and need a physician’s prescription for a spinal manipulation. As a massage therapist in North Carolina I can perform a joint mobilization, just not a manipulation. Dr. Sean M. Wells, DPT, OCS, ATC/L, CSCS, NSCA-CPT has an awesome A.D.A.P.T. (a doctor as personal trainer) program that clearly defines the roles between physical therapy and personal training. http://www.naplespersonaltraining.com/services.htm I
I find that the difference between wellness treatment vs. physical therapy is more along the lines of which service am I stating to offer/which practice act am I operating under, why the patient is being treated and if they have a “medical condition” or not. Skilled services, even my assessment, recommendation and guidance for exercise, training and therapeutic yoga are still skills and information people want and need even if they are not actively injured or in pain. When teaching a yoga class I cannot just “forget” my physical therapy training or background.
What do you think about a subscription model of therapy? If you offer this in your practice, please share how it works for you and your patients.
Aaron LeBauer PT, DPT, LMBT, RYT
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