The Secret to transitioning out of network and going cash

[00:00:00] Hey, what's up? Welcome back to The Aaron LeBauer Show. Today, we're going to talk about the number one, maybe actually two secrets to transitioning out of network and going cash or adding cash visits to your business.

[00:00:13] Hey, my name is Dr. Aaron LeBauer. I am a physical therapist. I am a massage therapist. Yoga teacher. I'm a former semi-professional cyclist. I'm a redhead, a dad, and I actually love swinging kettlebells these days.

[00:00:27] I'm also a 100% physical therapy cash practice owner, and I've been helping physical therapists generate six to seven figures without relying on insurance companies for the last 12 years.

[00:00:41] So I started, if you don't know me, I started in 1999 as a massage therapist. Went back to PT school to help my patients further their healing and progression and realized in school, after I saw 43 patients one day as a student on my first clinical rotation,

[00:00:56] that there's no way I can get a job working from the hospital or the man or the PT mill making what I was making as a massage therapist and being able to treat my patients in the way that I thought they needed to be seen.

[00:01:11] In a way that they had already been let down. So I started a cash practice, and then people asked me how I did it. Someone asked me yesterday,

[00:01:18] did you decide that being a coach was a great idea and you were going to make money doing it? I was like, no, people asked me for it. People asked me for help.

[00:01:26] And that's how I got into coaching. And that's how I got into PT. People asked me, well, how am I going to know when I'm going to finally get better?

[00:01:32] I didn't have those skills. So back in 2011, 2012, I had sold my first online product. Then I think I sold my first online product in 2012, but I'd done some one-on-one consulting somewhere like 2011, early 2012.

[00:01:48] And the first like 10 people that asked me for help that paid me were existing physical therapy clinic owners doing it in network. And there are a lot of you out there. You may or may not be listening to this show, but this is for you.

[00:02:04] If you are an aspiring cash practice owner or you already own a cash practice, you're going to learn some really awesome marketing tips from this too.

[00:02:12] But let me just share one quick thing. If in-network clinic owners worked half as hard as we do in cash practice, just imagine the growth that you would have in your business.

[00:02:23] Your bottleneck wouldn't be new patients come in the door. It would be probably leadership systems and maybe finding, actually finding PTs to work for you.

[00:02:34] For such a low fee because insurance, the insurance is declining. So the bottleneck wouldn't be new patients.

[00:02:42] But really the number one question is, well, if I go out of network, if I'm no longer, you know, am I no longer marketing to physicians?

[00:02:50] Where do I get patients or how do I get them to pay cash? How do I get them to pay a hundred bucks for a visit when they were paying 50?

[00:02:56] You know, how do I get them to pay double? And I'm going to answer that today.

[00:03:01] Let me just share this thing with you is that in-network practice owners have low friction for patients coming in the door.

[00:03:10] Cash practice owners, we've got high friction because PT is already low friction.

[00:03:14] It's a medium friction because PT is a grudge purchase.

[00:03:17] But if it's already paid for in quotes by insurance companies and all I have to do is pay a copay, well then whatever.

[00:03:24] That seems kind of free.

[00:03:25] And you know what?

[00:03:27] You may have compliance issues because people don't want to come in three times a week for 50 bucks or twice a week for 50 bucks or 30 bucks.

[00:03:35] And you think it's about the cost.

[00:03:39] It's definitely not about the price of the copay.

[00:03:43] The price of the copay, it's the value they perceive.

[00:03:46] Okay, you've got, and this isn't everyone, but you've got three or four people in an hour or two people in an hour.

[00:03:51] You don't have that much time to sit and chat with them.

[00:03:53] You definitely don't have the time like I do to sit and build a relationship with them and create a vision for how they want their body to work and to move over the course of the next three to 12 months.

[00:04:06] We just have the time and authorization to work on the knee problem.

[00:04:10] You know what?

[00:04:11] A lot of people come to me and they've had their knee treated by everyone in the PT, the surgeon, the physician, the kinesiologist, the stretch therapist, massage therapist, etc.

[00:04:21] And now I have time to realize it's an ankle problem or maybe it's a hip instability or pelvic floor problem that's creating this condition where their knee hurts now at CrossFit.

[00:04:31] Let's get in some nuts and bolts.

[00:04:33] My client, Alan Ling from PT Innovations, has like seven or eight physical therapists.

[00:04:39] At some point he's had three locations.

[00:04:41] During the pandemic, he scaled back to one.

[00:04:43] He's had a pool.

[00:04:44] I think he's got the pool back open now.

[00:04:49] Alan, it took him a little while to warm up the whole idea about doing cash.

[00:04:53] I mean, I worked there as a student on my final clinical rotation and Alan wasn't the one that told me I couldn't do it.

[00:05:00] Alan's the one that encouraged me to do cash and helped me with the business aspect and was like, I should have done it then, but he didn't because he felt he had a duty.

[00:05:08] And he was also still making money.

[00:05:10] Well, over the last years, you know, the price of he's in the Bay Area, the price of real estate there has gone way up.

[00:05:19] At one point, he owned his building and he ended up selling it again to bring in cash to continue running his business, but not just run the business to pay the employees so they didn't have to leave during the pandemic.

[00:05:30] You know, and he put that cash into real estate and other ventures like he's a he was nominated for a Grammy for a song and he's an artist comic book artist.

[00:05:39] He's amazing.

[00:05:40] I actually used to race bikes, too.

[00:05:42] But Alan, we had a couple conversations.

[00:05:44] And last year, we did a one on one private coaching session.

[00:05:48] And then it won to, you know, like I did a private training session for his team.

[00:05:54] I think maybe we did two of those and I'd done it like eight years ago, but I flew out there to talk about a little bit about business and more just, you know, teach some hands on skills.

[00:06:05] And Alan implemented just a phone script with his phone script team.

[00:06:09] And we talked to the PTs and and gave them a very easy way to, you know, two more questions to ask interview patients and how to pitch a cash program.

[00:06:20] And Alan went from one to two cash visits a day out of like 700 a week to was it 30?

[00:06:30] 30 cash visits.

[00:06:33] A week, whatever he went up, went to doing 30, $30,000 a month in cash visits after three or four months of implementing this.

[00:06:42] He had even sent me Aaron.

[00:06:44] I got one of the new grads coming in is seeing 16 cash visits this week, seeing six a day, almost six a day.

[00:06:50] And he's really added like I mean, he said it's only like 14, 15 percent of his business.

[00:06:58] I mean, they had to drop a couple insurance companies because it wasn't paying the rent.

[00:07:03] And you have to be honest with yourself.

[00:07:04] If you own a in-network business, how much longer are you willing to accept the fact that 10, 20 percent of your business coming in is costing you money?

[00:07:16] It's probably one of the reasons you can't afford to keep PTs there.

[00:07:20] And maybe they're leaving to go start cash practices because they found me.

[00:07:24] So how can we beat them at their own game?

[00:07:27] It's not just creating a cash practice in your practice or, you know, doing something.

[00:07:32] We have to like we have to like stop losing money and start making money because it's ethical to have people come in to see you no matter what they're paying.

[00:07:41] If you're providing a service that's high quality, high value and gives them results.

[00:07:47] So here's the secret to transitioning out of network and going cash.

[00:07:50] I mean, beyond the logistics of how do we drop insurance companies?

[00:07:54] Okay, you have to provide a high touch experience.

[00:07:57] It doesn't have to be that high.

[00:08:00] But you need to provide a high value service to high touch, high value service.

[00:08:06] Okay, there's a couple ways to do this.

[00:08:08] One, you can treat them yourself.

[00:08:09] But if you're the business owner with multiple other therapists, you shouldn't be treating patients unless you just absolutely love it.

[00:08:15] But them coming to see you isn't isn't like you're the cash person and everyone else is insurance.

[00:08:21] You really you should be driving this like customer service.

[00:08:26] So number one thing that I do in my my clinic is all new patients get an email from me.

[00:08:32] And what they get like a series of welcome emails from me, which introduce them to who I am.

[00:08:37] And here's the team I've built.

[00:08:38] Here's why I've built it.

[00:08:40] And you can always message me like I'm not always the one answering the emails.

[00:08:44] However, these this is an automated email sequence that all of our brand new patients get.

[00:08:49] I actually have given this same sequence to pretty much all of our mastermind and cash PD blueprint members.

[00:08:57] Anyone who's used our over the years PT email engine and now PT marking machine accounts can get this sequence.

[00:09:03] And what does it do?

[00:09:05] It it includes a text message and some emails and it welcomes them into our facility when they become a patient.

[00:09:12] We also have a short version when they schedule their first appointment.

[00:09:15] Here's what to expect.

[00:09:17] Here's where to find us.

[00:09:17] There's a video for me in there.

[00:09:19] So you would create your own video and put your own signature in there and your own address.

[00:09:23] But pretty much a lot of it's done for you.

[00:09:26] And just imagine people do not get this when they go to a traditional clinic or they go to the orthopedic surgeon, etc.

[00:09:34] That's number one provide high value high touch experience.

[00:09:37] But that doesn't mean you need to change what you're doing.

[00:09:39] You just need to add a few little automated pieces and make sure that the staff is using everyone's first name and they're introducing themselves.

[00:09:48] Just some little customer service tips that you could learn from Disney probably.

[00:09:52] If you're already high volume, here's the deal.

[00:09:54] If you already got a high volume clinic, you don't need to make massive changes.

[00:09:58] Even I've got some clients who've been cash practice businesses and they're doing like in New York like $225 a visit.

[00:10:06] But because Yohei had five physical therapists, he didn't need to charge $300, $350 to maximize.

[00:10:13] He could stay there.

[00:10:15] I'm sure he's higher now and needed to be because it's New York City.

[00:10:20] And with a high volume, he wasn't losing money.

[00:10:24] So, for instance, Alan in the Bay Area, I think is charging like $100 or $150 a visit instead of receiving $65 a visit from insurance.

[00:10:34] And it's for like a 25-minute visit.

[00:10:37] So, I think he's doing two patients an hour, 30-minute visits.

[00:10:41] And, you know, it's like $100, $125 or $150.

[00:10:44] I can't remember.

[00:10:45] Something like that.

[00:10:45] And I'm like, dude, you need to charge more.

[00:10:47] He's like, I know.

[00:10:47] But he still added $30,000 a month, which is $360,000 in 12 months to his business by just dropping one insurance contract and training his front desk team on the script and training the therapists on how do we basically sell programs and packages and ask a couple extra questions in the eval.

[00:11:10] Boom.

[00:11:11] And also helping them feel like that they are worth the $100 visit rather than the $50 copay.

[00:11:17] And the caveat is my personal in-network copay to see a specialist, which includes physical therapists in North Carolina, is $175.

[00:11:27] So, just consider that not everyone has this $10 copay they used to have when you started your business.

[00:11:33] Okay.

[00:11:34] If you're high volume, you don't need to make massive changes.

[00:11:36] We just need to make two or three changes.

[00:11:38] Drop an insurance contract.

[00:11:40] Charge the right amount.

[00:11:44] And get the team on board.

[00:11:46] They need to all be speaking the same language.

[00:11:49] Okay, great.

[00:11:51] But then the next question is, okay, we drop, let's say we drop Aetna.

[00:11:54] It's 20% of our business.

[00:11:55] Okay, cool.

[00:11:56] Not all those people are going to stay.

[00:11:58] We need to actually start some marketing.

[00:12:00] And the key to the marketing is to market directly to the patients because the physicians are not your customer.

[00:12:06] You might have been treating them like your customer because they refer people to you, but the physicians aren't your customer.

[00:12:10] The insurance company is not your customer.

[00:12:13] And that's okay.

[00:12:13] Guess what?

[00:12:15] Patients are probably already coming to see you.

[00:12:16] You have great relationship with some of these physicians.

[00:12:18] You don't have to destroy your relationships.

[00:12:20] They're just going to be like, are you in network, the UnitedHealthcare, and Blue Cross?

[00:12:23] You're like, nope.

[00:12:23] They're like, well, we can't send you patients.

[00:12:26] And that's their loss.

[00:12:28] And it's your gain because you no longer have to lose money to Blue Cross Blue Shield.

[00:12:31] You don't have to lose time of your team to them.

[00:12:34] You might, depending on the size of your business, you might be able to let some low performers go in the billing department.

[00:12:40] Even if that's someone like WebPT, which I keep hearing a lot of people have problems with lately because they're one of the largest in the industry and it becomes big and problematic.

[00:12:51] Patients are your customers, not the physicians, not the insurance companies.

[00:13:02] Patients are your employees.

[00:13:26] Patients are your employees.

[00:13:27] You don't have to hire someone who is going to create these campaigns and give you more busy work.

[00:13:34] Number one thing we need to do is just tap into your existing database of clients, patients.

[00:13:40] You've been doing this for a year.

[00:13:42] You've got at least 20 people.

[00:13:44] But if you're like most in-network clinic owners who are feeling the pinch right now and you're feeling like this crush of insurance, like I have to work because I can't hire people.

[00:13:53] I can't pay them enough to keep them.

[00:13:55] You know, reimbursement is declining.

[00:13:58] You're taking a pay cut to keep the business open, etc.

[00:14:02] You've got 5, 10, 20, maybe even 20 years worth of clients in your database that we can tap into to send you referrals, new patients, and reactivate them as patients themselves.

[00:14:18] Okay, so here's the number one thing that you do.

[00:14:22] You install a HIPAA-compliant marketing CRM, something like PT Marketing Machine, which is the CRM that I've built, which has allowed me to give people my follow-up sequences and special promotions.

[00:14:37] You don't even have to set up the follow-up sequence for new patients, which is one of the first things I like to have people do when they're starting their business is to work from the sale backwards.

[00:14:47] But if we're going from in-network to cash and we drop someone and that date comes or even as the date is looming when we're no longer in-network with them, we need to build a leads list and new referrals, etc.

[00:15:01] So we get set up with a HIPAA-compliant CRM, like a marketing software.

[00:15:09] And then we run one of like five promotions or we can run all five promotions, you know, one a month or one every other week.

[00:15:19] The first one that I would run would be the referral factory promotion or even the checking in promotion.

[00:15:27] I mean, one of the, so Jordan Williams ran, you just, all he did was he loaded his contacts.

[00:15:34] He's a, he was an in-network practice owner in Flagstaff, Arizona.

[00:15:38] And in June, 2020, Jordan sent this one email and he got a dozen five-star Google reviews.

[00:15:47] He had about, um, and he made, he had, uh, what did, what did he get?

[00:15:53] He got like six or seven people to come patients and made seven, over $7,000 in his, in this first month from this one email.

[00:16:02] He got five, you know, a dozen five-star reviews, seven patients.

[00:16:05] And he had, you know, dozens of people just write back, say, Hey, I'm doing good.

[00:16:10] Um, I moved out of town.

[00:16:12] Appreciate you, et cetera.

[00:16:14] Just by sending one email, but we can't send, we can't blast an email out from our Gmail account or work email account to everyone.

[00:16:21] Cause one, if you're sharing everyone's email with everyone else, that's a violation of HIPAA.

[00:16:27] Number two, if you BCC everyone, people are going to mark you as spam.

[00:16:30] And now your, your personal email or your business email gets marked as spam.

[00:16:35] Um, um, believe it or not, I've have APTA subsections and, and, and interest groups like do this stuff to me all the time.

[00:16:42] Not as much anymore as they used to.

[00:16:45] Um, but it happens.

[00:16:47] Um, so we just need to, we run this promotion.

[00:16:50] It's an email that we give you and you send it out.

[00:16:52] And it says from your name, not mine, not Aaron Labauer.

[00:16:55] It says, hi, from Mike Johnson, you know, and, you know, uh, come back stronger, physical therapy in, you know, Topeka, Kansas.

[00:17:05] You know, whatever it is.

[00:17:06] And it's the same thing.

[00:17:08] And it's a very simple, um, email that gets them to respond to you and gets people to say, Hey, I was thinking about getting back in to see you.

[00:17:16] Or it gives you an opportunity to ask for referrals.

[00:17:18] Hey, we're running this new promotion.

[00:17:20] Do you know anyone who might be interested?

[00:17:22] Et cetera.

[00:17:22] That's a checking in email.

[00:17:24] And then we could, we could do that right away the first day.

[00:17:28] And then there's a referral factory promotion, which what we're looking for are happy clients and customers.

[00:17:34] And all we're doing is looking for them to bring in, uh, friends and family and new members.

[00:17:41] There's also a five-star review accelerator.

[00:17:43] There's a Black Friday appointment revolution promotion we have ready to go and a stocking stuffer promotion for the holidays.

[00:17:50] Stocking stuffer is awesome because we allow people is basically we allow people to buy, um, a total body diagnostic or eval for a friend.

[00:18:00] The friend doesn't know what it costs and the current patients get to buy it and give them a stocking stuffers.

[00:18:06] And it's only good for people that have not been patients.

[00:18:09] And it's an amazing promotion.

[00:18:10] And Derek, who works with me with PT marketing machine, he worked in my clinic.

[00:18:15] Um, he had a, he ran this for his own business and, you know, got like, you know, it's a small one person cash practice.

[00:18:22] I think he got a dozen new patients from this, uh, from this promotion.

[00:18:27] He's run it with other, uh, other practices as well and help people make five, 10, even $20,000 running that promotion.

[00:18:36] It's super simple to sit up and to run.

[00:18:39] And it's really easy.

[00:18:40] Um, and we can get you running with these things right away.

[00:18:44] I mean, so in time I'm recording, this is October, right?

[00:18:48] We can run this promotion and you're not, I would say you check with your lawyer cause I'm not the lawyer,

[00:18:54] but running this promotion to give people a, a visit, not a, not necessarily even a free eval,

[00:18:59] like a total body diagnostic, like we teach, which is a basically a consultation, um,

[00:19:05] that should not violate any insurance contracts.

[00:19:08] And you have time now to start drop them if you, if you haven't already.

[00:19:12] Um, and look, if you're like, how do I get new patients?

[00:19:15] And whether I'm in network or out in network, these promotions are going to work for you

[00:19:18] because look, these are some of the ones we use with our cash practice, uh, businesses

[00:19:23] in our platinum mastermind.

[00:19:25] And like I said, you got an in network practice and you run one of these to your database of

[00:19:29] a thousand or even 10,000 former patients.

[00:19:33] Holy shit.

[00:19:34] If, if, if, uh, if some of my clients can make five, 10, $20,000 a month with, you know,

[00:19:43] a couple dozen patients, just imagine what you can do in a month.

[00:19:46] Um, I had a client in Florida whose average, like revenue per visit was $72.

[00:19:55] And all we had to do is get it up to $85 average per visit to help her make an extra $400,000

[00:20:02] in the year because of how high a volume that is.

[00:20:06] And that's not chump change.

[00:20:07] And that's money that comes in that you don't have to chase.

[00:20:11] Look, if there's, if it's not holiday season, when you're listening to this, you know,

[00:20:15] there's also a preloaded gift card strategy that we can run for you.

[00:20:20] And what we do is we hand you these emails to send out to your email list and we, and

[00:20:25] we hand you the scripts for how to respond.

[00:20:26] And you don't actually have to be the one that responds.

[00:20:29] It can be someone on your team or your daughter or your nephew who's like, you know, 15 to 20

[00:20:36] and they need some extra work.

[00:20:37] They can run these things for you too.

[00:20:39] They probably understand the tech, um, a little bit easier than you cause they grew up with

[00:20:43] computers.

[00:20:47] So there's, there was a question that came in when someone joined our group, the cash PD

[00:20:50] nation that really kind of spurred this.

[00:20:52] But also remember I said, when I started, it was mostly in network business owners transitioning

[00:20:56] and, and then for 10 years in the middle, it was all cash practices.

[00:21:00] People want to start.

[00:21:01] And the last year and a half to two years, I've got dozens of in network business owners

[00:21:06] coming through our program.

[00:21:08] David Turner in California.

[00:21:09] I would Alan Ling.

[00:21:11] I've got, um, Mike and Christy Bleffert up near Jackson Hole, Wyoming.

[00:21:15] Um, Kutua Pancik in, she was in Modesto and then, you know, sold her clinic, opened a new

[00:21:21] hand therapy clinic in Sacramento within a few months, was doing 15 K, um, a month cash.

[00:21:29] And, you know, Kutua can do it and she's older than me.

[00:21:33] I think, well, not to say she's not awesome, but I'm 50 and Kutua is like 50.

[00:21:37] I think she's 53 or 54.

[00:21:39] Cause she'd been in this game a long time.

[00:21:41] Um, and she restarted her business in a new town without knowing hardly anyone.

[00:21:47] Um, you know, because of a non-compete clause, you know, where she was and she had to do it

[00:21:53] in a new town and, uh, she crushed it.

[00:21:57] Right.

[00:21:57] And she can do it.

[00:21:58] You can do it.

[00:22:00] So I think the question was something like, Hey, I've got two high volume practices and

[00:22:04] we're marketing to physicians.

[00:22:06] We want to transition to a cash practice.

[00:22:08] You know, how do we do this?

[00:22:09] And really the first identity, uh, the first step is to identify the low hanging fruit.

[00:22:14] Step two is to set up your direct patient marketing strategy.

[00:22:17] Like I've just mentioned, um, there's a lot of different marketing strategies.

[00:22:21] You're probably are using some things at work.

[00:22:23] Maybe, maybe you're like, well, Aaron, we see one patient an hour anyways.

[00:22:27] Okay, cool.

[00:22:28] Just imagine if you saw one patient an hour and instead of filing claims and getting a

[00:22:33] copay, you could, you know, get 150 or $200 for that hour without stress.

[00:22:39] Right.

[00:22:40] Without worrying about losing.

[00:22:42] Maybe you create a hybrid program where it's some cash, some, um, insurance.

[00:22:47] I mean, Mike and Christy in Jackson Hole, Wyoming, haven't given up their, uh, workers comp,

[00:22:51] which is $180 a visit.

[00:22:55] Um, I interviewed a client a long time ago in, uh, near San Clemente.

[00:22:59] I should not say in Clemente, but she's doing, um, Janae Brown.

[00:23:04] And she was like, yeah, Aaron, the, one of the, the dock workers union is paying us $175 a visit.

[00:23:10] I was like, even though she was charging 200 in cash, I was like, don't drop it.

[00:23:13] It's too easy.

[00:23:14] And if I got paid 175 for a visit of something by insurance companies, I'd probably keep it

[00:23:18] too, but I, there's no way to get that in North Carolina or maybe there is, you can prove

[00:23:23] me wrong, but I'm not willing to, to go that route.

[00:23:26] So if you got those, don't give them up.

[00:23:28] If you feel strongly about treating Medicare patients, you don't have to give it up.

[00:23:31] And there's a way to see Medicare patients for cash too, without being a Medicare provider

[00:23:36] and giving them an ABN, but that's another episode.

[00:23:40] So if you'd like some help, um, building out your cash clinic marketing strategy or building

[00:23:45] out a marketing strategy to bring in out of network patients as you drop insurance companies,

[00:23:49] or even just how do we build a whole game plan to drop them at the right time and do this.

[00:23:54] But really, if you want a marketing strategy, you want to review your marketing strategy on

[00:23:58] how to get more cash clients to add five, 10, even 30 K months like Alan did in the next

[00:24:04] 90 days.

[00:24:05] You can send me a DM on Instagram with the word audit and I'll get you set up with a

[00:24:09] free marketing audit call, or you can go to callwithaaron.com and book in a time to chat

[00:24:15] with me.

[00:24:17] And, uh, we'll see where you are, where you want to go.

[00:24:19] And we'll start to build a game plan and we'll see what options we got for you, whether it's

[00:24:24] coaching or getting you into some software and giving you these promotions or maybe a

[00:24:28] combination of both.

[00:24:29] I'm not going to say anything on the call and I would never recommend something I thought

[00:24:33] didn't work.

[00:24:34] Um, for instance, I had someone messaged me, um, get on a call with me a few weeks ago

[00:24:39] and he's got, you know, seven locations.

[00:24:41] And number one question was, can I start a cash practice inside the insurance space thing?

[00:24:46] Now, I don't think that was the real problem, but I was like, the answer to that question is

[00:24:49] you need to talk to your lawyers about that.

[00:24:51] Like, yes, it's possible, but I'm not the one to advise you on that because I'm not a

[00:24:55] lawyer.

[00:24:55] So just remember that the, um, I can't help everyone, but if I can help you and I do see

[00:25:01] that there is like an opportunity to 10 X your investment in your time, your, uh, income

[00:25:07] and your like stress levels, you do not have to work harder.

[00:25:12] You just have to work smarter and I'd love to help you out.

[00:25:15] So DM me on Instagram with the word audit and I'll get you set up with this marketing

[00:25:17] audit or go to callwithaaron.com booking a time to chat.

[00:25:20] See on the next episode.

[00:25:21] Peace out.