Welcome to the 76th Annual Profit Games!

I have seen this post pop up on my news feed several times and each time I see it, I get chills. No, not chills... more like an allergic reaction to the terrible way cash-based physical therapy practices are presented.

First, I would like to point out that the clinics owned by this individual are in the UK, not the US, meaning that it's likely for rules and regulations to be slightly different than those we are familiar with. I am not certain about transparency laws in the UK, so I am not insinuating that that is being done here is illegal or unethical (ethics are relative to the country and healthcare system in play). No doubt, this individual runs several successful clinics and is a high profile character, meaning that is unlikely anything he is doing is wrong. What I am stating is that I disagree with how he is doing it and how he is encouraging others to do it.

For those of you that have not clicked on the link, it is essentially a list of tips on how to get your patients to pay cash when they ask if you accept their insurance. The article is definitely worth a read to comprehend the full context for this analysis.

Now...let us dissent.

I have several  qualms with this article as a whole, so I will try to keep it as categorical as possible for the sake of brevity. I have resisted the urge to write a line by line review (let's just call it a moment of personal growth), so below are a list of the top three moral sins committed by the blog post:

1. Painting our patients as unintelligent.  I have a real problem with people who treat consumers as idiots. In the advent of the internet, people from any level of education, socioeconomic status, or creed have the opportunity to research physical therapy as well as the healthcare field in general. It may not make them an expert, but it makes them more knowledgeable than they were 20 years ago. I have met some patients who are more familiar with the system than most seasoned clinicians. I don't agree with the idea that the patient doesn't know how to ask any other questions, as the author blatantly states. Furthermore, the author goes on to describe the interaction as no different than a guy throwing out cheesy pick up lines at a bar. How degrading. Maybe I bring a different perspective to this argument as I am of the female persuasion while the author is male...but these ethanol-enhanced conversations can be awkward and down-right threatening on the receiving end...which is not how I would like to paint my interactions with my patients. Demoting an important question regarding financial services to nothing more than a misogynistic conversational exchange between two parties at a bar is completely unprofessional and unacceptable. It also isn't funny as I suspect it was intended to be.
2. Anticipating  an uncomfortable response. Now, I can't say that I am innocent from this critique, as one of the major purposes of this blog is to stir people up and get them thinking critically about issues they otherwise wouldn't be pondering about. However, the author describes that his method may be awkward for people to execute. Now, feeling uncomfortable while thinking about something (my blog) versus feeling uncomfortable while doing something (this idea) are two completely different beasts. This leads one to ask the resounding question: why? Why should something claimed to be so simple and so right be so difficult? Because reading from a script and not answering a question that a patient is asking you is deceptive and borderline unethical according to the APTA's core values; mainly altruism (placing the patient's needs above the physical therapist's) and integrity (being trustworthy). If is sounds deceitful and it feels deceitful, then it probably is deceitful. And there is a huge difference between thinking like a deviant and acting like one.
3. Deceptively deceitful. For the remainder of the article, the author insists that you don't answer their question directly with a yes/no. That's right. Do not answer the clients question. Seems a little deceptive to me. This is similar to you asking a used car salesperson if the vehicle has been in an accident and the salesperson replied that is has recently had work done to upgrade its quality. This is a sneaky tactic to manipulate the consumer for your own benefit. Instead of losing out on clientele or from profits due to insurance stipulations, you aren't being forthcoming with information. This means that you are not providing all of the information necessary for the consumer to make an informed decision....which is kind of important, particularly in the eyes of the Nuremberg code which is an international credo. 

Cash-based clinics are popping up all over the nation and are a huge trend in physical therapy today. As insurance companies set tighter stipulations and regulations for what we can and cannot do (when they THEY get their PT degree, huh?), clinicians are needing to seek other ways to build revenue. I have no qualms with cash-based clinics, but I believe that this method of marketing is shady at best. Furthermore, it doesn't paint us in the most ethical light for the general public as a whole or other factions of the healthcare community which might not be our biggest fans (*cough cough* AMA).