When we opened MEND we wanted a Physical Therapy practice focused on excellent patient outcomes, in fewer visits, delivered by experts in their field. Our practice will not employ anyone other than board certified Physical Therapy orthopedic specialists and the care would be one on one in nature. To maintain our clinical principles we decided to become an out of network provider of Physical Therapy services and have seen our practice thrive as patients seek out an alternative to the standard quo.
Consumers often mistakenly believe out of network is more expensive than in network care. When you compare the number of visits utilized by MEND, on average 3-4, it is significantly less expensive than an in network model seeing a patient 2-3 times per week for 6-8 weeks. In addition, services provided in Physical Therapy clinics owned by physicians (POPTS) often bill under “incident to” allowing them to charge a more expensive rate than in or out of network Physical Therapy practices. Incident to billing, increased visits, and a higher utilization of technicians and aides contributes to the increased Physical Therapy costs seen with POPTS. A recent study highlights these trends and documents the cost effectiveness of the out of network Physical Therapy model.
Pulford and colleagues examined the cost effectiveness of Physical Therapy services provided by an out of network (cash based) provider (Health Care Manag. 2019). They analyzed the charts of 48 randomly selected patients over a 3 year period. Authors reported patients were seen a median of 5 visits at an average cost of $98 per visit for a total cost of $780. Conversely, in network care averaged $936. This is the first study to examine the practice patterns and health care costs associated with out of network or cash based practices. In the presence of higher deductibles and co pays, patients are advised to consider both in and out of network models of care to see which model is most appropriate for their clinical and financial needs.