Enhancing Your Physical Therapy Business with Nutrition

Physical Therapists (PTs) can easily add nutrition to their practice. Doing so can improve patient outcomes, provide a “stand-out” service versus other local providers, and offer an increase in revenue. Incorporating nutrition into physical therapy practice is recognized in the “scope” of PTs by the American Physical Therapy Association (APTA) and makes good business sense. Several of our other blog posts highlight the why and how PTs should offer nutrition and what the APTA and practice acts say about PTs offering nutrition, but this article is going to focus solely on the business side of PTs providing nutrition.

Adding nutrition services to PTs running cash-based practices is a must. The biggest standout item within cash-based PT practices is that the client pays, not insurance. As such, you as the provider only have to justify your time and services to the client, not a third party payer. Provided the State you are practicing in allows nutritional counseling and you’ve had the training, you can spend as little or as much time assessing, prescribing, and modifying a patient’s diet to fit a specific nutritional paradigm. The best thing to do is be sure to define the scope of work with the patient before you sink a good chunk of time in assessing a diet: come to an agreed price and know how much time you are going to spend before you begin pouring over dietary assessments and food logs. Some clients are willing to fork out serious bucks for nutrition, especially to a provider they trust, like the PT who helped them recover from an injury or surgery! Chiropractors, naturopaths, podiatrists, and other providers have been and still are offering cash-based nutrition counseling on-top of their existing practice patterns -- why should PTs be excluded? One tip I offer given my cash-based PT practice: avoid selling supplements. Supplements seem like a lucrative way to gain huge revenue potential...and that’s all they are there for. The evidence truly does not support most supplementation, perhaps with the exception of B12, Vitamin D, and/or probiotics in some cases. As a PT provider adding in supplements it opens you to a whole new risk area for liability, both financially and in practice. What happens when your supplements harms a patient? What happens when a client does not like your supplements? Do you offer a refund or pay for harm done? These are major questions, but wait there’s even more...You will need to buy and stock supplements, usually in whole-sale fashion. Inventory, track expiration dates, and develop a flow model and point of sale for your supplements. You will have to consider if you offer commission for staff to sell supplements, track commissions, and likely also have to worry about State and local taxes. In the end, supplements can make you big bucks but also big headaches: the evidence does not support them and neither should your practice.

For PTs working in an insurance model, whether in private practice or as a staff employee, nutrition can still offer a business perk. While the cash-based PT practice stands out already because he or she does not accept insurance, your practice can stand out further by advertising you offer nutritional services at your practice. You can place this on your Google search questions, your website, your business Facebook page, and by telling your active patients -- just be sure to check your State laws on how it ought to be phrased and if advertising nutritional counseling is even allowed in your specific State with your credentials. Offering nutritional services as an insurance-based physical therapy practice will certainly make you stand-out versus the other clinics in the area. Patients will see your practice as, perhaps, more holistic, complementary, or even wellness focused. Attaching such perceptions helps build brand identity, credibility, and can increase repeat utilization of your business for multiple lines of services (not just PT).

If you own a private practice standing out is important but so is the revenue stream that keeps operations afloat. Nutritional services can be yet another billable service that can be offered through insurance in various ways. First, some patients have insurance that pays for nutritional counseling specifically; as always, check your State laws as to what credentials you need to offer such counseling and check the insurance stipulations for payment too. Deriving revenue from solely billing nutritional counseling alone may be difficult for PTs given that many states and insurance plans require licensed dietitians or nutritionists to offer these services using those specific codes.

Second, PTs can provide billable time for nutritional counseling through the patient education current procedure terminology (CPT) code 98960 for individual patient education. The education must be rooted in an evidenced-based approach and sponsored by an appropriate medical professional associations. We recommend the APTA, American College of Lifestyle Medicine, Physicians Committee for Responsible Medicine, and/or American Nutrition and Dietetics as appropriate and evidence-based sources of nutritional information. Other codes can be used but it must be clearly rationalized in the notes to be justified for insurance. Here is a fabulous WebPT blog post that outlines how PTs can offer patient education in general. Appreciate that this may be the best avenue for insurance PTs to incorporate nutrition services. As a practice owner you can expect a PT to offer an additional unit or two per day depending on the staff PT’s engagement and patient caseload/type. Instead of pushing your staff to dig deep for extra therapeutic exercises or to kill their hands by adding in an extra unit of manual PT to increase units, consider asking your staff (if trained and it is State appropriate) to explore patients’ diets. Even a 15 minute conversation can open up other social determinants of health (SDOH) like smoking, stress management, and dietary patterns. Such things can not only impact physical therapy outcomes but also health and life! An extra unit or two per day could equate to an extra $27-54 per day or roughly $1,215 per month -- that could cover a salary for a technician for half the month! As a staff PT you may not care what the practice pulls in; but you ought to know that the practice assumes the risk, pays your paycheck, and fights the insurance fight everyday -- keeping a small private practice afloat by adding “extra services” will be the future need for small PT practices nationwide.

Third, PTs can transition patients to maintenance PT after traditional insurance therapy. Maintenance PT can include normal physical therapy services with the addition of nutrition counseling (again, depending on training and State laws). In such a case patients usually are cash pay and will be willing to pay for nutritional services, particularly if it will help their physical condition and health. Here is perhaps the best avenue for PT practices to capitalize on nutritional services, assuming your clinic or facility offers maintenance PT. Plus, with the recent changes in the eligibility of payment for preventive services from a health savings account (HSA), such preventative nutritional services may qualify to be paid from an HSA soon. The benefits of this method is the practice gets paid immediately after the service; there is no waiting for reimbursement or devaluation from a third party payer. Moreover, the practice will earn more per unit time if the practice bills for maintenance PT and the patient agrees to payment of services based on time. In other words, instead of earning $27 per unit like in an insurance situation, a practice could charge a flat $150 fee for a 1 hour nutritional assessment because it takes one hour of the PT’s time to complete (just like a 1 hour PT evaluation). That works out to more like $37.50 per 15 minute unit of time. Another avenue could be just to charge a flat rate fee for all nutritional services (assessment, prescriptions, follow-ups) and market and sell them in packages. Health coaches do a fabulous job of such marketing and business structuring. For example, one health coach in South Florida charges her clients a flat $4,000 fee with a minimum buy in for 3 months! In this fee the patient gets a nutritional evaluation, dietary recommendations, and follow ups of encouragement for meal and fitness compliance. When PTs complain about dwindling reimbursement and the lack of revenue opportunities, I look at such a health coach as an inspiration to change what and how we as PTs are providing care. Break out of the “model” and do something new by adding nutritional care to your practice today! To learn more about nutrition, dietary counseling, and how it all relates to physical therapy practice, check out our board-approved, online continuing education courses for nutrition and PTs.