EP168: "3 Non-Negotiables Every Cash-Based PT Must Have"

[00:00:00] If you're a physical therapist and you're interested in cash-based physical therapy or you're a cash-based physical therapist and you're wondering what are three things that I need to improve upon or that the most successful cash PTs have had, I'm here to share this in this episode.

[00:00:19] Are you a motivated healthcare or fitness professional? Are you looking to work with more athletes, become a sports specialist or even get a job in a sports setting so you can finally enjoy the career that you've always dreamed of? If so, you're in the right place.

[00:00:31] My name is Chris Garcia, physical therapist, business owner, entrepreneur and residency training sports specialist.

[00:00:37] I've been fortunate to work in professional sports and travel around the world working with elite athletes throughout my career and I've learned a lot of lessons along the way.

[00:00:45] I created this podcast to share my experiences and give you everything you need to know to help you become a sports expert. Welcome to the SportsPT Academy.

[00:00:56] Welcome back to the podcast. Welcome all new listeners and welcome back to those who have heard my content in the past.

[00:01:02] Before I go on to the episode, let me share what's new, what's bigger, what's better, what's brighter.

[00:01:08] The previous episode, I had just talked about this. I had gone to Disney Cruise, which was fantastic.

[00:01:13] And now we're back to the normal daily activities. So we got back on the grind.

[00:01:17] But for those of you who know, I don't like to just do the same thing over and over again.

[00:01:23] So I got right back on the plane and I went to National Harbor in Maryland, which was fantastic.

[00:01:29] I went to the APTA private practice section annual meeting and that was great.

[00:01:36] Someone recently asked, you know, what did I take away?

[00:01:38] Anyway, there's a couple things in there, but I think that the most important thing I saw and even though it's not great for the profession,

[00:01:47] I saw where I can help. I can see where I'll continue to help, you know, clinicians like yourself, practice owners, cash-based practice owners, you name it.

[00:01:58] But I saw that the profession is slowly bleeding and it's bleeding out.

[00:02:04] And what I mean by that is at the event, they talked about reimbursement, they talked about insurance-based models,

[00:02:09] and they talked about out-of-network models and super bills and all these other things.

[00:02:12] And the thing I took away was that the insurance companies are continuing to drop in reimbursement.

[00:02:19] And there was 1,800 business owners there.

[00:02:23] And the common theme I heard was, you know, we can't afford to do this anymore.

[00:02:27] We're going to have to, you know, shut down.

[00:02:29] We're going to have to rethink how our practice works.

[00:02:32] And whether you're employed or you're a business owner, ultimately there are solutions.

[00:02:38] And I'll share some of those inside today's episode.

[00:02:40] But knowing what the next 10, 5 to 10 years holds for our profession, it's going to be very tough for us to be successful.

[00:02:48] And the only reason is because if reimbursement continues to drop, there's only two ways that you can continue to survive.

[00:02:54] You're going to cut your expenses.

[00:02:56] You're going to try and create more revenue somehow.

[00:02:58] And the only way to create more revenue is you're probably going to have to see more patients.

[00:03:02] So if you're an insurance-based provider, you'll probably go from two to four people an hour.

[00:03:06] If you're in, you know, seeing four an hour, you might have to go to six an hour.

[00:03:09] So that's the forecast from what I can see.

[00:03:12] And it was great listening to everybody else.

[00:03:14] But I'm excited to be able to help because my passion is about helping clinicians, whether you're in cash or not,

[00:03:22] help you understand what a patient wants and needs.

[00:03:26] Now, you might want to see athletes and those type of things, but you won't be able to see those athletes if you can't communicate with them,

[00:03:33] you can't jive with them, you can't build a relationship with them.

[00:03:35] And after their insurance is covered or they reach all their visits or they don't have enough funding,

[00:03:43] you're going to have to be creative in how you service these people because in your community, you want to be that expert.

[00:03:47] You want to be the person who serves your community and the people that you love.

[00:03:50] And you want to be able to help.

[00:03:52] And you can't do that if you can't explain the value of your services and how you do that.

[00:03:57] Insurance hasn't done it.

[00:03:58] The APTA hasn't done it.

[00:04:00] And even the message on your website or the company you work for in your website might not communicate that.

[00:04:05] And so when you meet people and you have patients in, you're going to have to be able to communicate and show them your value.

[00:04:11] And that's where most PTs are going to struggle because they assume that the APTA's message is clear.

[00:04:17] It's choose PT and PT first.

[00:04:20] The problem is that the title of our profession, physical therapy, has already been burned.

[00:04:24] So you're going to have to create your own message and really help people understand how you separate yourself from all the others.

[00:04:31] So fantastic, great course.

[00:04:33] But I came back on Saturday night, got to kiss my kids goodnight.

[00:04:38] And then Sunday, right back into everything else that we've been going on.

[00:04:43] But my kids, my son Zach, he is a character.

[00:04:46] He's trying to tell people what to do at the moment.

[00:04:49] I was just informed today that he was trying to tell my wife that she wasn't the boss of the family.

[00:04:54] So he's going to have to get some schooling pretty quickly.

[00:04:58] My daughter is doing fantastic in gymnastics.

[00:05:00] My son Jacob, he is fully potty trained.

[00:05:03] This is something that we've been working on.

[00:05:04] He's the fastest of all of three of our kids.

[00:05:07] It took him, for those who've been listening to the episodes, it's probably taken him six weeks to do this.

[00:05:11] And he absolutely crushed it.

[00:05:13] Yeah, it was fantastic.

[00:05:14] So we're out of the diapers there.

[00:05:18] It's official, which is fantastic.

[00:05:20] Yeah, and back right into everything else that's going on.

[00:05:23] So for those of you who don't know, I guess the other piece is I started my cash PT clinical elevation course,

[00:05:29] which is great to be able to help people thrive in cash pay and really just disclosing and sharing all of my secrets,

[00:05:37] all of my strategies, all of my scripts to be able to help cash PTs thrive in their business.

[00:05:43] So started that and everything's going great.

[00:05:45] All right.

[00:05:46] So what are three non-negotiables that every cash PT has to have?

[00:05:51] I originally was going to talk about PT business owners, but if you're working with cash pay patients,

[00:05:56] I think this is very important for you too.

[00:05:58] It's not just the owner, but it's also the cash PT.

[00:06:01] So if you work in an insurance-based company at a network, it's going to be super helpful for you.

[00:06:04] So here they are.

[00:06:05] All right.

[00:06:06] Number one, this is very uncomfortable for people to have.

[00:06:10] This is a tough quality to develop because it's not why you got into the business, into the practice, into the profession.

[00:06:20] So number one is you have to be able to have cringy conversations.

[00:06:24] And what do I mean by that?

[00:06:26] Cringy conversations are conversations that make you uncomfortable and make the patient uncomfortable.

[00:06:31] Now, they typically revolve around finance.

[00:06:35] They revolve around hard conversations about progress, about compliance, about forecasting, about scheduling, about creating a plan, and gaining commitment on the other side.

[00:06:47] These are cringy conversations.

[00:06:48] And they're tough for people to have because you got into this profession so you can avoid that.

[00:06:54] You wanted, you got into it because you wanted to help people, but you wanted nothing to do with the finance.

[00:07:00] You wanted everything to do with creating the program or the solution without having to create the actual financial package that leads into your conversation.

[00:07:11] And that's probably what you did really well in your career.

[00:07:15] You were able to get, you know, great outcomes.

[00:07:17] But if you eliminate the physician and insurance, which is what you wanted, and you probably wanted direct access, and you fought for it, and you're like, yeah, we can totally do this.

[00:07:25] Now, once the patient got into you without insurance or the physician, now they got to you, you're like, ooh, but I don't want to talk about the finance and how much it's going to cost them.

[00:07:33] So I'm just going to charge super low, and I'm not going to have that conversation.

[00:07:36] And I'll make it easier and have less of a barrier by charging lower because I don't know if people are going to like me or if I'm that good.

[00:07:42] And, you know, you question yourself after mentoring thousands of cash-based PTs over the last years.

[00:07:48] I've heard it all.

[00:07:50] And having that cringy conversation is one of the toughest things to do.

[00:07:54] And what I mean by that, it's a very critical transition sentence that gets the customer to understand what it is that you're going to do for them.

[00:08:05] And for instance, one cringy conversation could be maybe you've had a former patient reach out to you, and they said, maybe I saw you in an insurance-based world, or I saw you years ago, and you have a rate of $150 an hour.

[00:08:21] And they want to see you for X amount of time.

[00:08:24] And they're like, you know what?

[00:08:25] Not right now.

[00:08:26] I don't have the money.

[00:08:27] Okay.

[00:08:27] Not a problem.

[00:08:28] And maybe even you were nice.

[00:08:30] You're like, I'll give you a discount.

[00:08:32] $120.

[00:08:33] And they're like, oof, I still can't do this.

[00:08:35] You go down to $100.

[00:08:36] They still won't do it.

[00:08:37] Okay, fine.

[00:08:38] And then months down the road, they reach out to you again.

[00:08:40] Hey, I was thinking about it.

[00:08:41] You know, what deals, what offers do you have?

[00:08:43] And you're like, hey, listen, I'm still at $150.

[00:08:45] I can't do it.

[00:08:46] I can't even do the offer anymore because I'm having financial trouble.

[00:08:49] I'm not even seeing the people that I want, so I have to charge what I have to charge.

[00:08:52] Okay, that sounds great.

[00:08:53] And they reach out again in a couple months.

[00:08:58] Why didn't they go see someone else?

[00:09:00] Why didn't they go see your friend down the road, your colleague, whatever it is.

[00:09:04] And they probably have.

[00:09:05] Maybe they went to three to four other clinics.

[00:09:08] And you are clearly different than everyone else.

[00:09:12] You are thinking this.

[00:09:13] You're thinking, gosh, you've already tried everybody.

[00:09:17] What is the delay?

[00:09:18] Why won't you just pay to play?

[00:09:21] Like, why won't you just do that?

[00:09:22] Now, that's the internal dialogue you're having in your head.

[00:09:25] You're like, I'm that much better.

[00:09:27] The peers that they're seeing are not that good.

[00:09:30] And they almost need to go through that pain, go through that process, and get those average results for them to see the value in what you're doing.

[00:09:38] The problem is that you don't feel comfortable having that conversation with them.

[00:09:42] That's the cringy conversation.

[00:09:43] So, for instance, maybe they come back another six weeks later and they're like, hey, I really want to come see you.

[00:09:52] And this is your chance to deliver that transition sentence.

[00:09:56] That one that gives them over the hump.

[00:09:58] And here's how it would sound.

[00:10:00] Hey, John, I understand we've been in communication for many months.

[00:10:05] You've tried three or four clinicians and they haven't worked.

[00:10:09] You've been in contact with me repeatedly throughout that whole process.

[00:10:12] You got average results.

[00:10:14] Here's the transition sentence.

[00:10:16] Right here is that piece.

[00:10:18] What is it that you're looking for?

[00:10:21] And why haven't you committed with me and just paid for the results that you need?

[00:10:29] You found out that cheap or free hasn't got you there.

[00:10:35] I can legitimately help you.

[00:10:38] But you're going to have to pay this rate in order to get there.

[00:10:42] That transition point is what you have this cringy feeling like, oh, that sounds so bad.

[00:10:49] It's so cringy.

[00:10:50] Really?

[00:10:51] Because that's what you're thinking.

[00:10:54] So you mean you have cringy thoughts?

[00:10:57] You don't feel comfortable conveying what's here to the customer in front of you, even though you know it's in their best interest.

[00:11:04] They're going to have better outcomes that could have saved all that time and all the money that they had in the past.

[00:11:12] So you mean you as a great clinician could have saved them $500 to $800, a year's worth of time,

[00:11:21] if they would have just come to you from the beginning, paid your rate at $150 for six sessions.

[00:11:26] It's almost $1,000.

[00:11:29] Why can't you say that?

[00:11:31] You know it's what you're thinking.

[00:11:33] Why can't you convey that to the patient in a professional manner and then show them what their outcome could be?

[00:11:41] Now, there's a couple layers why you don't do it.

[00:11:44] One, you don't feel good about it.

[00:11:45] Number two, you don't have good confidence in it.

[00:11:47] And you're not 100% sure that you can deliver on that result.

[00:11:51] Isn't that crazy?

[00:11:52] So it's your lack of confidence that's literally limiting you from being able to convey what you do for people.

[00:11:59] But you're over here saying, well, yeah, APTA and direct access and, you know, choose PT first and no more POPs or physician referral conditions.

[00:12:09] And, you know, insurance is bad.

[00:12:11] Well, great.

[00:12:12] In order for you to take those big ballplayers out of the equation, you have to come down and have those hard conversations.

[00:12:18] If you can't, you can't run a business.

[00:12:20] You can't help a business.

[00:12:21] Whether you're employed or you own, you have to understand this is a requirement in today's world to help people understand the value that you bring to them.

[00:12:32] They're thinking it.

[00:12:33] You're thinking it.

[00:12:34] But no one wants to have that conversation.

[00:12:36] And every cash-based PT needs to have that.

[00:12:39] And now that comes with developing confidence with program design, building the value for yourself.

[00:12:45] But ultimately, if you can't have that one transition sentence to that cringy conversation, you're going to flatline, plateau in your business or in your schedule, and you can't grow it.

[00:12:57] Now, you might work in a cash-based clinic where there's two to three other people there.

[00:13:02] And for some reason, they seem to have more patience.

[00:13:04] It's because their ability to have these great conversations, the ability to have a really professional conversation faster.

[00:13:11] And ask people who you've never seen on an initial valuation that tough conversation.

[00:13:16] Why did you choose us?

[00:13:20] And they'll tell you.

[00:13:21] And it probably won't be, well, because you guys do the great, I've seen your exercise online and that's what you did.

[00:13:26] Really?

[00:13:27] There's 20,000 other Instagram accounts with cash-BTs doing the same thing.

[00:13:31] The ones who thrive are the ones who can have these genuine conversations and help people over the edge so they can get the results that they want.

[00:13:38] So that's number one.

[00:13:39] The cringy conversations.

[00:13:42] Number two, which goes along with this, is you have to have amazing people skills.

[00:13:52] And if you don't like having conversations, if you're, I don't want to say if you're not an extrovert, if you don't enjoy helping people and conversing with people,

[00:14:02] CashPT is going to be like, you just won't survive.

[00:14:05] Yeah, you can maybe go virtual programs and those type of things or maybe even Zoom might be better for you.

[00:14:10] And I equate this to like, you know, maybe PhD or research.

[00:14:14] Some people love to be in labs versus the clinician chose to be out for like at the forefront of the profession and treating people.

[00:14:22] If you don't love that, and maybe you did okay in insurance and because of principle or finances, you chose PT, but you don't love people.

[00:14:30] You'll find that wherever you go, there you are.

[00:14:33] So it wasn't that insurance-based PT was hard.

[00:14:37] It was that you couldn't handle the people and communication.

[00:14:40] So when you come into CashPT, that's just exposed even furthermore.

[00:14:43] So you have to have amazing people skills.

[00:14:45] You have to be able to read people, whether that's your facial expression, their posture, when they're processing, allowing them to have that time, but also their personality.

[00:14:56] The personality is a big driver of how to manage and set people and their expectations.

[00:15:02] If you have somebody who is a business owner, doctor, attorney, who is, you know, strong personality,

[00:15:08] most people drop their personality to allow them to have a conversation.

[00:15:11] That's probably worked in insurance-based care.

[00:15:13] You're like, you know, kind of like a scared puppy.

[00:15:16] In the insurance-based world, you have to be able to meet those people because that's what they're looking for.

[00:15:21] They've been to other people.

[00:15:22] They've eaten them alive and they're still looking for a solution.

[00:15:24] They're coming in strong because that's just who they are.

[00:15:26] They're not trying to do anything to you personally, but learning how to match that and be able to say,

[00:15:31] I understand.

[00:15:32] And you go toe-to-toe, chest-to-chest with them.

[00:15:35] That allows them to see, oh, I see.

[00:15:37] You are different.

[00:15:38] I'll give you a chance.

[00:15:39] That is the entryway versus learning somebody who is very analytic and wants to know all the information.

[00:15:44] You can't come in aggressive or hard.

[00:15:46] You have to be able to provide that information without allowing them to take the full hour of your care.

[00:15:51] Now, there's several personality types to be able to go through this,

[00:15:54] but ultimately you have to be able to figure out who these people are, read them,

[00:15:58] what's the solution they're looking for, have that tough conversation.

[00:16:02] And now if you were just used to, I just want to fix knees.

[00:16:05] I just want to fix low backs.

[00:16:07] I just want to work on ankles.

[00:16:09] And I came over to CashPT because I was tired of all the people.

[00:16:12] I just wanted people who are motivated and I wanted people who I can help

[00:16:16] and who are active or wanted to be active.

[00:16:18] That's probably why you chose CashPT.

[00:16:20] But the reality is in order to be able to help those people,

[00:16:23] you're going to have to get to the real root of they couldn't solve it in insurance

[00:16:27] and your personality won't get you to the other side.

[00:16:31] Personality was great in insurance-based care because they were paying the lowest price.

[00:16:35] They were paying at Walmart.

[00:16:36] And now they're coming over to a premium product.

[00:16:39] Your skills are only one portion of it.

[00:16:41] But if you can't get past the first, second, or third visit, your skills are irrelevant

[00:16:44] because you never even got a chance to deliver on them.

[00:16:47] And that's because your ability to manage people's expectations

[00:16:50] and understanding how they communicate, what type of personality they are,

[00:16:54] and be able to find yourself within their lifestyle.

[00:16:57] So your people skills have to be top-notch.

[00:16:59] So once you've been able to have cringy conversations,

[00:17:03] you've been able to manage their expectations because you get people at a high level,

[00:17:08] the last piece is being able to overcome the word no.

[00:17:12] No.

[00:17:15] In PT, rarely do you have a patient that says no to you, right?

[00:17:19] I need you to do these two to three exercises, four to six weeks,

[00:17:23] and I'll follow up with you every single session.

[00:17:25] Okay, sounds great.

[00:17:27] Rarely do you have a patient who says,

[00:17:31] I'd love you to come in two times a week for the next six to eight weeks

[00:17:34] and we'll get you on the right path and get you feeling better.

[00:17:36] No.

[00:17:37] Don't want to do that.

[00:17:38] Okay?

[00:17:39] The reality is because the patient came to you.

[00:17:41] They came to you because they were ordered by their doctor,

[00:17:44] the insurance to solve a problem.

[00:17:45] That sounds fantastic.

[00:17:46] So now you're in a cash-based PT,

[00:17:49] you are in the world of where the consumer has a choice,

[00:17:53] a very strong choice,

[00:17:55] because they went around the insurance company or the primary care or the surgeon

[00:17:59] and said, I'm going to pay out of pocket.

[00:18:01] So now I get to dictate what I want.

[00:18:03] Sounds good.

[00:18:04] Now the cash PT is not used to that.

[00:18:06] So if you say, hey, this is a plan I created and they say no or not right now,

[00:18:12] you have to be able to overcome that.

[00:18:14] You have to be able to say, I'm still going to be able to help and I'm your best,

[00:18:17] I'm your best asset in your recovery process.

[00:18:20] Do you understand that that's genuine and you're coming at them from the angle of,

[00:18:24] I know what I'm doing.

[00:18:26] These ones don't.

[00:18:27] You can try five other places and it's not going to help you.

[00:18:30] I'm going to be your solution.

[00:18:32] The ability to overcome that is seamlessly blended with the ability to have those cringy conversations.

[00:18:40] But you have to be able to say, I understand you said no.

[00:18:44] No is it equals not right now.

[00:18:47] And what I mean by that, if the person called you,

[00:18:50] scheduled an appointment, showed up to your office,

[00:18:52] they're interested in you.

[00:18:55] And they said no because it doesn't match their expectations currently.

[00:19:00] Now, how to navigate the no is,

[00:19:03] what are you doing afterwards to educate them on how you're different,

[00:19:08] why you're different,

[00:19:08] and then preventing people from saying that

[00:19:11] and having to seamlessly blend into your programs and everything you offer

[00:19:14] by showing them ahead of time,

[00:19:16] not just on Instagram, email, videos, whatever it is,

[00:19:19] and your ability to say no.

[00:19:22] So if you don't like cringy conversations,

[00:19:24] you don't love being around people,

[00:19:26] you don't have a lot of good people skills,

[00:19:28] and you don't like overcoming objections or no,

[00:19:32] CashPT is not for you.

[00:19:33] And it's great that you find this out now instead of later.

[00:19:37] So if you are stuck and you're like,

[00:19:39] I know I'm good at people.

[00:19:42] I want to be able to learn how to just have conversations.

[00:19:44] I want to be able to help support people

[00:19:46] who don't understand what I can do now.

[00:19:48] Now you're talking.

[00:19:49] Now you have an open mind towards,

[00:19:51] okay, what do I need to do to set myself up for success?

[00:19:53] So that's ultimately how you position yourself

[00:19:57] to be a fantastic CashPT.

[00:20:01] Now, how do you solve this?

[00:20:03] There's a couple different ways,

[00:20:05] but ultimately one of the big things that I've focused on

[00:20:08] in my CashPT clinical elevation course

[00:20:10] was how to do these things inside that.

[00:20:12] If you're a SportsPT and you want to be able to create more

[00:20:16] of a total package for yourself

[00:20:18] on how to manage athletes across the spectrum,

[00:20:21] plus learn communication,

[00:20:22] largely people skills,

[00:20:23] learn these conversations

[00:20:24] to be able to manage them properly,

[00:20:26] one of the best things you can do

[00:20:27] is take my SportsPT Kickstarter course.

[00:20:30] It's a crash course on how to be a really good SportsPT,

[00:20:33] work with athletes or our CashPT patients

[00:20:36] and be able to thrive in SportsPT.

[00:20:39] It's everything you've always wanted to do in your career.

[00:20:41] I'm excited to host that whenever you're listening to this

[00:20:44] in January of 2025,

[00:20:46] you can go ahead and register at

[00:20:49] drchrisgarcia.com forward slash Kickstarter.

[00:20:51] Otherwise, I will see you guys on the next episode.

[00:20:54] Take care.

[00:20:54] Thanks for tuning in to the SportsPT Academy podcast.

[00:20:57] It means the absolute world to me.

[00:20:59] If you enjoy my content,

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[00:21:11] to provide healthcare professionals

[00:21:13] and fitness professionals just like you

[00:21:14] with great information

[00:21:15] to become sports experts.

[00:21:17] If you have any questions,

[00:21:19] reach out to my team at drchris

[00:21:20] at drchrisgarcia.com

[00:21:22] and tell us exactly what you're looking for.

[00:21:24] Do you want more?

[00:21:25] Head over to my website, drchrisgarcia.com

[00:21:28] and sign up for my VIP email list

[00:21:30] to stay in touch with my latest updates

[00:21:32] on courses and mentorship programs.

[00:21:33] If you know someone who would benefit from my content,

[00:21:36] please share this episode with them.

[00:21:38] Until next time, have an incredible day.