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Are Cash Therapy Practices Good For Patients?

September 12, 2016 • Practice Leadership • Paul Potter


There are a lot of people who consider health insurance to be a necessary evil.

Insurance and government health programs and can be expensive and frustrating to use for both consumers and providers. However, when patients need medical care, they’re generally glad they’re insured. One of the first questions patients often ask is “Will my insurance cover this?”

At this point you might be saying something like my adolescent daughters used to say to me, ” Duh dad, everybody knows that.” Well, maybe because everybody knows it we are blinded to how much healthcare economics have changed.

One tactic of healthcare reform is to reduce total healthcare spending by shifting upfront costs to consumers. Yet many clinics still think because patients have insurance their practice isn’t functioning as a cash practice until deductibles are met.


Dependency on the insurance cash cow can lead to ignoring the tens of millions of Americans who are either uninsured, have high-deductible health insurance, or just want to escape from bureaucratic medicine all together. There are thousand of consumers who want healthcare without an insurance company’s or governmental involvement. They reserve the right to choose their preferred provider with no outstide influence.

There are therapists who are bypassing insurance all together too.

Therapists are setting up cash-only practices with the goals of spending more time with their patients and taking back financial control over their livelihoods. They cater to consumers who are looking for affordable medical care and expect to pay out of their own pocket for some or all of their healthcare.



Now the question is not ‘Will my insurance cover this?’ but ‘Whom can I trust to give me the best care for my money?’

This is where a cash practices makes the most sense. A cash practice is built from the ground up to serve self-pay consumers. As mentioned before until deductibles are met patients are essentially paying cash for the care they received.

The cash practice model comes in several names and forms. It’s sometimes known as self-pay, cash only or concierge medicine. Cash practices among therapy entrepreneurs are not a fad.

We are starting to see more self-pay clinics among primary care doctors too and there are some specialists are going this way, too. The growing trend of medical practices catering to self-pay patients is in direct response to economical and cultural shifts in the United States.

What are the big benefits for therapists?

Therapists leave the traditional insurance-based payments for the cash pay model for variety of reasons. Here are a couple of the main ones:

1. Tired of the churn

Many therapists are fed up with factory-like therapy with its over emphasis on production and profit.

2. Frustrated with bureaucracty

PTs and OTs have grown tired of dealing with the bureaucracy of insurance. The endless stream of paperwork to comply with over reaching regulations has caused many therapists to look for different practice options.

3. Feel undervalued

Therapists are tired of fighting to get paid for what they feel they are worth. They see insurance payments for patient treatments as being ridiculously low. At the same time they see their operating costs rising. The only solution some therapists feel is to work faster and see more patients,

4. Compromise quality

Therapists are seeking alternatives because they feel they are compromising the quality of the care and their professional self-respect.

5. Loss of freedom

Everywhere therapists turn outside forces are telling them what they can and can’t do. Increased regulations and employer productivity demands are stiffling therapist’s growth and freedom. Not just their professional work but their personal lives as well.


“I’m mad as hell and I’m not going to take it anymore”




Therapist’s angst reminds me of the 70’s movie Network where newscaster, Howard Beale yells into the camera and tells his viewers to get up out of their chairs, go to an open window and yell “I’m mad as hell and I’m not going to take it anymore”.

Therapists all over the country have reached their breaking point. They are not going to take abuse from the insurance system anymore. They are mad as hell and they are going off the insurance grid.

That’s all good and well for therapists but we haven’t answered our initial question.

Are cash practices good for patients?

Cash-based practices can be a good investment, even for patients with insurance. Contractual requirements from corporate health plans have intruded into the medical provider-patient relationship. Obamacare with its more than 132,000 pages of regulations has added even more layers of red tape creating a bigger wedge between therapists and patients.

Patients experience this wedge when they have to fill out more forms and provide more personal information. They feel it when sitting in waiting rooms much longer than they do in front of a physician. They experience less time with the primary care providers before they are passed on to supportive personnel. They know they are paying more but getting far less.


What are the big benefits for patients?

1. Cost effective care

Therapists have the extensive education and training to be neuromuscular primary care experts. For the majority of patients’ with movement problems therapists are the provider of choice. For people with high deductibles, it makes financial sense to pay a therapist for a comprehensive evaluation and treatment.

Fifty percent of Americans will experience some type of musculoskeletal episode each year. Skilled cash based therapists are a third-party-free alternative for self-pay patients.

2. Accessibility

In most states therapists have direct access. Patients typically have a shorter wait times in a cash practice. Most clinical prediction rules state that the sooner the patient is seen the better the outcome.

Let’s face it, patients are becoming impatient driving around town, filling out insurance forms wherever they go. The busier they are the less tolerate they become with poor customer service.

3. Transparent Affordable Pricing

For the self-pay patient finding therapists who offers fair, simple and transparent prices is crucial. Cash based pricing eliminates the added administrative costs when submitting claims to insurance companies. No more “We’ll send to insurance and see what they pay” when both parties know that the charges are coming out of the patient’s pocket.

4. Protected Patient-Therapist Relationship

Imagine a practice where that doesn’t demand your insurance card and ID before they say hello. Imagine a practice where money doesn’t get in the way of patients getting to know their therapist.

Taking insurance middlemen out of the equation allows therapists to present themselves as an empathic professional who understands the true cost of healthcare.

5. All Patients Are Welcome

All patients, insured or uninsured, in network or out-of-network are welcome. Payment is by cash, check or charge. Patients aren’t rejected because of their insurance carrier. Cash practices that are designed for self-pay patients are free from outside interference to address the circumstances and needs of individual patients.

The cash practice alternative seems to satisfy a growing appetite among consumers, especially those who are under 65 and not on Medicare. Today’s healthcare consumer has become embolden to know what care cost and are demanding more transparent pricing.

Just like they do in every other area of their purchasing lives they search online, compare, asks their friends before making a wise purchase.

There is a growing intolerance towards the hidden cost of healthcare. Practices that change their billing practices from the ground up to accommodate the self-pay client will be better prepared for the next generation of healthcare consumers.

My final question for you. I’d love to hear your viewpoint in the comments or on social media.

Are you so hung up in traditional third party reimbursement that you aren’t doing what’s best for your patients?


Paul Potter is a physical therapist and mentor who lives in Lincoln, Nebraska, with his wife, who is also a therapist. They have four daughters. For more than 35 years he successfully managed his own private practice.

He has authored On Fire: Ignite Your Passion with a Cash Therapy Practice and Cash Therapy Practice: Professional Freedom in the New Healthcare Economy. His website and his podcast Functional Freedom are dedicated to helping therapists build their dream practices. Connect with Paul on his website or on Twitter @lifetouchpt. You can also get more free resources at

Paul Potter

For over 30 years Paul Potter has owned and managed a private physical therapy practice specializing in manual orthopedic rehabilitation and medical fitness programs for special populations. He hosts the Functional Freedom Podcast where he interviews current thought leaders on practice issues and strategies to facilitate the professional effectiveness of therapists. A few factoids about...

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Leda McDaniel, PT, DPT

Commented • January 25, 2020

Hi Chris and Mark, I LOVED this podcast and diving into the importance of the subjective exam! I also have been inspired by the work of Atul Gawande's "Checklist Manifesto" and have applied that reasoning to creating PT evaluation "checklists" to facilitate some of the similar points that you mention: keeping a logical flow and structure for an exam, asking comprehensive red flag screening questions, guiding a systematic decision making process and allowing for "checking" and self-reflection after patient evaluations to assess whether my clinical thought process for diagnosis and treatment followed a rational progression (also as a teaching tool for students learning exam skills). Would love your feedback on how I apply this and if you find these checklists useful (Below are 2 links to blog posts that I wrote specifically about these ideas, and within are links to my checklists): Thanks very much for sharing your experience and expertise! Best, Leda

Jon Waxham

Commented • January 24, 2020

Heidi, I appreciate you sharing your thoughts. I share in your frustration and certainly agree we need to think creatively and be pro-active when evaluating the administrative side of things and our commitment to high level documentation. I also agree that patient advocacy is the primary driver of change for an organization like CMS. My greatest frustration is that this seems fairly obvious, however the APTA has done nothing to communicate these changes to the patients directly other than social media. Drug companies long ago realized that they needed to cut out the middle man and make the case for their products directly to the consumer. As a result, every other commercial these days is from a drug manufacturer, so now patients go into the doctor's office asking about these drugs instead of waiting for the doctor's suggestion that they might help. We wouldn't still be bombarded by drug ads if they weren't effective. I can't understand why the APTA has not used some of it's marketing budget to speak directly to consumers about our services so patients were educated about the benefits of physical therapy, so they were aware how CMS policies will affect their care and can get directly involved, so when they went in to see the doctor because of neck pain or balance issues that they are the ones asking to go to PT. You point out that we must think proactively and advocate, but when productivity requirements continue to go up and more personal time is spent on documentation we need to rely on our professional association. I feel it is time that they consider some forward thinking and radical changes to the way they do business. I refer to the old adage that doing what you have always done and expecting a different result is the definition of insanity. The APTA needs to change their methods and communicate directly with our current and future patients if we are to stop this steady decline in reimbursement and spread the word about the benefits of physical therapy care.

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