In the last few years—and especially in the last several months—interest in cash-based and mobile practices has surged. To get the inside scoop on what makes these models so lucrative from a business and care perspective, we asked Dr. Eric Ullman, PT, DPT, the owner of ReThrive Wellness, to share his experience in opening a cash-based, concierge mobile physical therapy business.
In this Q&A, Eric details:
- what led him to launch ReThrive,
- why he chose to pursue this model,
- what challenges he encountered along the way, and
- his advice for other therapists who are considering this path.
You’ve been a PT for more than 17 years now. Can you tell us a bit about your background leading up to founding ReThrive?
I graduated with a bachelor of science in physiological sciences from the University of Arizona in 2000. I then went to physical therapy school at the University of St. Augustine for Health Sciences in St. Augustine, Florida. After graduating with a doctorate in physical therapy in 2002, I primarily worked in private practice. I focused on orthopedic injuries treating people of all ages with various diagnoses. Job positions I had included staff physical therapist, clinic director, and partner. During that time, not only did I improve my skills as a physical therapist, but I also learned a lot about the business aspect of the industry. I also built strong relationships with my patients and referring healthcare professionals. I knew early on I wanted to own my own practice.
What inspired you to pursue concierge mobile PT?
Over the years, I watched health care change, and not for the better. I saw insurance reimbursement for physical therapy decrease as the cost of delivering care increased. For physical therapy practices to be profitable, they were forced to be more volume-driven, which meant the PT saw more patients each day and therefore, spent less time with each patient. Over time, this led to a decrease in the quality of patient care.
In 2018, I’d had enough. I knew I loved what I did for a living, but I was not happy with the direction my profession was heading. I thought about leaving the profession but knew that was not really what I wanted to do. What I really wanted was to have my own business and focus on what I called “old school health care.” I wanted to spend a lot of time with each patient and not be constrained by an insurance company dictating how I should treat my patients. I started researching different types of physical therapy business models, and I came across the cash-based system, where a full hour is spent one-on-one with each patient. I learned that with the cash-based system, because patients had so much time with the PT, they often only required one visit per week, and their care plans were typically complete within five to eight visits. Also, if desired, patients could be provided a superbill receipt for each visit to submit to their health insurance for out-of-network reimbursement.
I also decided to add mobile services as an option, meaning I would go to the client’s home or place of work. This would allow people to be treated in the comfort and safety of their own home, remove the burden of a commute to and from a PT office, and eliminate the wait in the lobby. I launched my mobile concierge physical therapy business in 2018, and business picked up rapidly.
What is the size of your practice (e.g., how many therapists)?
Currently, we have a staff of five including myself. Additional staff include a part-time physical therapist, an occupational therapist, a dietitian, and an office manager who handles the administrative part of the business.
How long does a typical mobile PT appointment take?
The initial evaluation is 75 minutes and each follow-up visit is one hour.
How does your experience as a mobile PT compare to that of an in-clinic PT?
The in-clinic PT has the obvious benefits of being in one location all day, having equipment in one place, and having a more structured schedule. As a mobile PT, my day is a lot more dynamic. There is travel involved, as I commute from client to client. I schedule my clients logistically so I have a minimal commute between clients. I bring all necessary equipment with me—including a treatment table and various exercise equipment—although often, clients have exercise equipment at their homes. Based on my experience as a mobile PT, people are often a lot more relaxed and at ease because I am in their environment.
How does a concierge mobile model uniquely benefit physical therapy patients?
Because each visit is one full hour, one-on-one, and in the privacy of their own home or office, patients often prefer this model. Also, the concierge mobile model allows for patients to progress more rapidly because it is so individualized and treatment is conducted without the constraints of insurance payers. Each appointment is utilized to its fullest extent without any distractions or other people around, as is often the case in a standard clinic setting. There is no commute for the patient, so the therapist can optimize the time spent with the patient, and it’s less of a burden on the patient’s schedule. Also, with the cash-based practice model, because people are paying out of pocket, compliance with attending sessions and completing home exercise programs tends to be high, which allows for better patient outcomes and satisfaction.
Similarly, how does this model benefit PTs?
My cancellation rate is virtually zero. I am coming to them, so there are rarely reasons for people to cancel. Also, spending the full hour with patients in their home allows for quicker progression and fewer total visits needed, which means that patient satisfaction is very high. Due to high patient satisfaction, ReThrive receives a large number of patient referrals from current and previous patients.
What was a significant challenge you had to overcome in building ReThrive? What did you learn from it?
This was the first time I started a business—and my business model was fairly new and uncharted—so I was unsure whether it was going to be successful. I’d spent my whole career in a traditional, private practice, insurance-based, brick-and-mortar setting, so it was difficult for me to feel confident with something that was so different. Before I officially launched the business, my thoughts constantly revolved around the challenges I was going to have in marketing the business model. I was somewhat pessimistic. Once the business was up and running, things started to pick up rapidly, and it evolved and grew over time. My mindset changed tremendously at that point. I learned that you have to put one foot in front of the other and have faith that it’s going to work.
As a business owner, is there anything you wish you had done differently?
The main thing that comes to mind is that I waited too long to start my business. I hit the burnout phase of my career and continued to work when I wasn’t personally and professionally satisfied. I should have started the business earlier than I did.
ReThrive is a cash-based practice. What are the advantages of this business model, and how does it impact the patient experience and outcomes?
The cash-based model allows me to provide the best care possible without the constraints of the insurance companies. Many payers have restrictions that guide—and unfortunately, limit—patient care. Plus, every policy is different, so there are different rules for each. The cash-based model allows me to focus on doing what needs to be done—like getting people better and meeting their goals much quicker. Also, as I mentioned earlier, because people are paying out of pocket, compliance is higher, and therefore outcomes are better as well.
What did ReThrive look like before the COVID-19 pandemic—including your patient populations, volume, and services?
Pre-pandemic, there was a steady demand for mobile concierge physical therapy with ReThrive. I was seeing patients from 8:00 AM to 4:00 or 5:00 PM, Monday through Friday. Patient volume was steady, and I saw patients for a variety of different diagnoses and ages. The services we provided ranged from treatment for musculoskeletal injuries and motor vehicle accidents, to sports injuries and general strength and conditioning training.
How has this changed since COVID-19? Are patients more hesitant to let you into their homes or workspaces?
At the beginning of the pandemic, we sent out an email to all of our current clients explaining that ReThrive is taking the pandemic seriously and would be implementing additional protective measures, including taking temperatures before each session and requiring our clinicians and patients to wear masks and gloves.
Since COVID-19, new patients referred to ReThrive typically want to know what we are doing to ensure safety. In my experience, most patients have expressed they would much prefer an individual coming to their home rather than going to a clinic, where cleanliness and safety become more challenging to monitor. While ReThrive experienced a quiet period for about two to three weeks early on in the pandemic (which we offset by ramping up our telehealth services), the demand for concierge mobile physical therapy has since increased at a steady pace, which has led to the addition of a part-time PT to our staff. We also added an occupational therapist and dietitian to our staff, each of whom is also mobile.
What has this pandemic taught you about continuity planning, and how are you planning to adjust your long-term strategy?
The pandemic has reinforced the principle that your business, including its policies and procedures, must frequently be reassessed. Since the beginning of the COVID-19 pandemic, ReThrive has evolved and modified daily policies and procedures on more than one occasion. The changes made were all in response to the changing circumstances and have allowed ReThrive to remain busy.
What does it take to establish a cash-based, mobile PT business? How does that compare to establishing a traditional clinic?
Similar to any service-based business, to establish a cash-based mobile business, you must learn how to sell what you’re providing. This strategy is even more imperative for cash-based practices, because many people are used to—or only familiar with—the traditional clinic-based insurance model.
When I first started the business, I encountered some pushback from people who didn’t understand the model or were only focused on the cost of each visit. So, when communicating with them, I always stressed the value of what I’m providing—and in this case, it can be defined in a couple different ways. From a monetary perspective, patients definitely get more “bang for their buck” with a cash-based mobile PT. Adding to this value is the full hour of undivided attention patients get from a mobile PT, which helps them progress through their care plans quicker and in turn helps them save money, as well.
Since I started the business, I have had numerous patients tell me they spent a lot of time and money going to a traditional insurance-based practice with minimal progress. Now, since switching to a cash-based physical therapy practice, they have made more progress in just a couple visits then they did in weeks or even months in the insurance-based model. This translates into a much more valuable patient experience, as they pay less out of pocket, make quicker progress, and achieve greater outcomes.
What would you say to other therapists who are considering pursuing this path?
Here are a few things I’d tell other therapists considering this path:
- Focus on the key patient demographic you want to treat. If you’re trying to speak with everyone, you’re speaking to no one. So, focus on your target audience when building your practice.
- While mobile concierge physical therapy has its benefits—including less overhead and not having to deal with insurance—this does not necessarily make it an easy path. As I’ve grown the business, my overhead has steadily increased.
- There is often an extra obstacle when marketing the business. Not only do people have to understand what you can offer as a physical therapist, but they also have to understand the value of paying for your services entirely out-of-pocket and not through their insurance. I encourage my new patients to only schedule the initial evaluation and after our initial session, they can make the decision as to whether this is a good fit and if it’s the route they want to go.
- When operating a cash-based practice, various items—such as the rules and regulations of their state practice act, HIPAA, and informed consents, to name a few—still apply.
- Lastly, make sure you consult with your attorney when setting up the business.
Patient needs and expectations, market demands, and even goals for personal career fulfillment are constantly changing. Being flexible and open to the idea of doing things differently will make you more resilient—and you just might stumble upon the next “big idea.” So, if you’re looking to shake things up—whether that means expanding into cash-based services or starting your own mobile PT business—we’re here to help! Be sure to check out the other cash- and concierge-based model content we’ve created here. And if you have any burning questions, leave them in the comment section below and we will do our best to answer them.
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