How to Launch and Grow a Successful Cash-Based PT Practice: Aaron LeBauer, DPT, on Pricing, Marketing, and Making the Leap

Neil [0:01]: [Music] Hello and welcome to the Practice Marketing Podcast, highlighting successful strategies from North America’s fastest growing clinics and experts so you can learn from their wins and power your practice growth. Hi, I’m your host Neil Trickett, CEO of Practice Promotions. And today’s focus, we’re going to talk about how to launch and grow a successful cash clinic or service into your clinic with Aaron LeBauer here. Aaron is a business coach and mentor, and he’s helped thousands of passionate physical therapists build successful businesses without relying on insurance. He owns LeBauer Physical Therapy in Greensboro, North Carolina, a multi-therapist, 100% cash-based PT practice. Aaron’s personal mission is to save 100 million people worldwide from unnecessary surgery by inspiring other healthcare providers to start their own businesses and learn how to market directly to their patients, not physicians. So Aaron, welcome to the podcast.

Aaron [1:14]: Hey Neil, thanks so much for having me. It’s a pleasure to be here.

Neil [1:22]: Awesome. Well, let’s learn about you, because you’ve done something here which is happening more in the industry, but you cracked the code a while back. You’re one of the leading voices promoting cash pay services for physical therapists. So how did that happen?

Aaron [1:29]: Yeah, I think it’s a great question. It started when I was a little kid. My dad, my uncles, are all physicians, my grandfather too, and I would go with my dad to the office or hospital and do rounds. That was a time when you would actually go and talk to patients and visit with them. My dad always said, do what’s right for your patients, and the money will follow, or you’ll be successful. Just a primary focus on what’s right for the patient. Later on I got one night into organic chemistry and realized I’m not going to be a physician, so I went a different path, became a massage therapist first. As a massage therapist, out in California, people would say to me, Aaron, I know when I tweak my back I need to come see a massage therapist because they couldn’t get access to a PT. Or they’d say, I’ve been to PT, massage, acupuncture, an orthopedic surgeon, and I still hurt. You’re the first person to touch me where I hurt. No one else has done this for me. We’re talking about simple places like the trapezius, glutes, piriformis, QL, easy things someone should have touched. And then they’d say, well, when am I going to get better? And I’m like, well, I’m a massage therapist, I specialize in some myofascial release techniques, but I didn’t know how to give people a diagnosis, a prognosis. So I went back to PT school. On my first clinical rotation I saw 43 patients in one day, which is a lot. I’m sitting there thinking, I’ve got my hands on someone, I’m giving orders to someone else across the room on how to do their exercise, and people are already paying me $85 an hour as a massage therapist. This isn’t working, I can’t continue into PT as a career and do that. So I decided pretty much that day I was just going to have to open my own business as a PT, and really take my massage practice and transition it to being a PT. My clinical instructor said, no one’s going to pay more than a copay for PT, and this is when copays were $25, $30. And I was like, but they’re already paying me 85. No one believed it, and I was like, well, I’m going to have to do that. I started my practice pretty much right after I graduated, as soon as I was licensed. There’s a lot of other things I can talk about, but the general reason was: I don’t want Melissa in Iowa making decisions on how I can treat my patients, when Melissa isn’t even a physical therapist or physician or healthcare provider. But that’s the way it is, and that’s not the way it should be.

Neil [4:09]: Exactly. And it’s interesting, because you might have met a lot of patients this way, but I would imagine there’s a lot of patients who are also sick and tired of the medical system, just like the PTs are, right?

Aaron [4:24]: Yep, they are. And some people, they’re not sick and tired of it enough, you know? A lot of people go out and advertise, oh, we do one-on-one physical therapy. I’m like, no one cares unless they have context. Did they think four people an hour wasn’t giving them the result? There are plenty of people who get great results when the therapist is seeing multiple people in an hour, but do they have context? If someone’s been to see somebody else and had a less than stellar experience, or been discharged early because the provider didn’t know what else to do with them since they only had so much time, they think, I talked to someone like that today on the phone, but that person doesn’t have context, and no matter what, even though the emergency ortho can’t help her, they told her, you should go get a massage, find someone to work on the knots in your back who does massage. Well, Aaron LeBauer is the expert in Greensboro on massage, bodywork, and PT because I’ve been doing it for 25 years. But still, insurance is the deal breaker, because it’s just not covered, and she doesn’t understand how much time she’s going to waste not getting anything done, or having to go three times a week with a $50 copay, versus what we might charge for a different amount of time. So that’s just to say that people who have experience with PT recognize some differences, but most people don’t.

Neil [5:51]: And so really it comes down to the marketing message being the more important piece. So I’d imagine you have to do more orientation with a patient as they’re coming to a cash-based clinic or cash-based service within your clinic. The why, right, and maybe dig into some of the frustrations they’ve had in prior experiences.

Aaron [6:15]: Exactly. I’ve done a lot with, I’ve taken sales strategies I learned in my coaching business 10 years ago and started moving them into my practice, when we raised our rates. But if you’re not charging much, you don’t have to do much. My own in-network copay is 175 bucks, so if you charge 150 bucks, it’s still cheaper than my copay. You don’t have to do much to sell me, it’s cheaper than going down the street. Not everyone has that same plan, but there is a point at which that is really important. I know if all practices were able to do that, we’d get more people into PT. But we don’t always feel like it’s important, or have the time, or maybe we don’t need to do that at a certain level.

Neil [6:59]: Gotcha. And I think if you have cash-based, not necessarily a full cash-based practice, but even if you just have cash service lines in your business, what you really start to lean heavier on are the salesmanship skills.

Aaron [7:15]: We still do it every single day as a PT, whether you’re taking insurance or not. The more you have to sell that patient on your plan of care, why they should come and spend their time with you to get fully better, and what the outcome’s going to look like. There’s salesmanship happening all the time, from the front desk to the PT to the billing office, we just don’t realize it that much. Wouldn’t you agree? There’s plenty of people who say, hey, I can’t get my patients to come back and stay in this $25, $50 copay. Right, we didn’t do any sales, because the patient doesn’t know why they’re there. So you do have to do more sales. At the same time, a lot of people think, oh, I couldn’t possibly charge more cash because people don’t come in at the current rate, but they’re not even asking questions about future pacing, about what’s been the most frustrating part about this for you. I ask people, hey, if I could snap my fingers and change one thing about the way your body works or how it feels, what would that be? That’s bigger than just range of motion in my knee. I think that’s the important missing piece.

Neil [8:36]: Do you find this in your clinic? When I had my practice and sold it back in 2010, at that time we had some cash services for people with terrible insurance we didn’t take. We had cash-based programs and presold them on either a six or 12-visit package. I found that the people who invested in that were very willing to come, they wanted to come. So I’m just curious if that’s something you notice on your end as you coach other clinics.

Aaron [9:02]: Absolutely. The indicator, a lot of times, and you probably see this too, is, hey, we’ve got this great EMR or this great app for home exercise compliance, it really helps our clients with compliance. Well, I don’t have a compliance issue, because people pay enough that they’re going to show up and do the work. When PT is valued at the copay level, we’re only worth 50 bucks. But what we charge, or bill out, is hundreds of dollars. What people pay is maybe the same as a copay, but that’s not really our value, so the value gets skewed by that. It’s really about understanding what we actually do. It’s looking at it and saying, our value isn’t just what the copay is, but people will treat us that way because they’re also treated poorly elsewhere, like someone told me yesterday they went to the orthopedic surgeon just to make sure something wasn’t a real big problem and waited two hours. So they think they’re going to have to do that here too, because that’s the norm in the medical experience. And it’s not, it’s not that with my practice, it’s not that with most PT clinics either.

Neil [10:25]: And I find too, why is it that people pay for a Gucci bag, or Chanel, or a Rolex? I find it fascinating, there’s a guy I followed online who basically went into these different shops and stores, and they actually create exclusivity and urgency by limiting what they have to offer in those stores. But the thing is, it’s perceived value. When you hear that name, you think, oh, that must be an incredibly good brand, and people realize you’re going to pay more for that, you’re going to pay for that premium. Same thing when we go for different services, if you know you’re going to a high-end place, you expect a different level of service, and you expect to pay more. I like your analogy that when someone comes in with a $25 or $50 copay, the perceived value is low, because they don’t see the back-end insurance billing. All they know is they had to pay 20 bucks, so if they don’t show up, who cares? It’s just $20. While it’s a lot to some people, it’s not a lot in the scheme of things. But if it’s $100 or $150 bucks, and we enforce our cancellation policy, they won’t cancel on us last minute, because they’ve now invested. I think one of my business coaches used to say, the more people pay, the more they pay attention.

Aaron [12:20]: I like that. Yeah, I think that’s probably something. Do you coach that in your programs, making sure you price yourself correctly to deliver that perceived value? There’s a couple mistakes PTs make when they price themselves. Mistake number one, they’re like, hey, $25 a muscle, I’ll needle you wherever, well, needling isn’t covered by insurance so I’ll just, but then they’re basically technicians without doing an evaluation, I don’t think that’s right. And two, we shouldn’t be letting our patients decide where they get treated and how many places, that’s really our job. A lot of them are coming from a job working in a traditional clinic, and thinking, what were the copays, what did people pay, okay, or I only made $55 an hour, so if I charge 75 I’m still getting $20 more per hour. But 75 isn’t enough to keep the lights on, unless you’re doing 20-minute visits and can do three an hour, now we’re getting to 200 something. I tell people 150 per hour per visit is really the bottom we should be charging as PTs. Most of my clients are charging much more than that, I’m charging at least twice that. I can’t tell you exactly what to charge, and if you feel like it’s too much you won’t sell any physical therapy, that’s a mindset piece, that’s where the marketing and salesmanship comes in. But I agree, one thing to look at is you’ve got to know your costs, what it costs you to deliver that service.

Neil [14:01]: There’s a lot of clinic owners looking to bring some sort of cash-based service line into their practice, maybe a sports performance program, a stretch program, a laser program, whatever it may be, adding cash value services. I think where it may not work well, or where they’ve had failures in the past, is they didn’t price it correctly. You’ve got to look at what it takes to deliver that particular service. Whether it’s a concierge PT, or a stretch program you wouldn’t pay a PT to do, you’d have a secondary, lower-cost trained person do that, but you need at least a three-to-five multiple on the cost of delivery, because you’ve got to pay for everything else: the marketing, the admin, the rent, you name it. So just like you said, if it costs you $55 to treat that patient but you’re charging 75, you’re not going to be profitable at all on that.

Aaron [15:09]: I’ve talked to PTs who don’t know what their cost to provide a treatment is, or their average revenue per visit. Once we look at it, they’re losing money on 40% of their patients, because it’s costing them $70 to provide a treatment but they’re only bringing in 65, or some other variation. They’re ultimately losing money but feel bad to say, well, I can’t drop that insurance because it’ll hurt all these people. Well, who’s it hurting? It’s hurting you, because you’re not going to stay in business if you don’t have a profit at the very minimum. I think that’s so true, you’ve got to know what it costs you to deliver that service per visit. When I had my practice and showed my therapists what it actually cost, with their salary and everything else, it was like $60-something dollars a visit, back in 2010, their eyes were wide open, like, holy cow, I didn’t realize it was that expensive. So know what it costs you to deliver, and then know where your price point needs to be. That helps with decisions around what insurances you’d take, and where you’d be out of network and work harder to bring those out-of-network patients in. You don’t have to stop seeing the patients, you just don’t take their insurance anymore, but you can say, this HMO pays terrible, I am not going to be part of that, this is the value I have, and for those patients they’re going to be on my cash pay program.

[16:59] There’s also something most people overlook, and I’d define cash-based and out-of-network slightly differently. I’m technically out of network, but there’s in-network where you file the claim on the patient’s behalf, and there’s cash like me, where I don’t file claims on their behalf, I’ll give them a superbill. In the middle is out of network, but you file the claim on their behalf, a lot of dentists do this. As a PT business with already established infrastructure of an EMR and a billing company or a clearinghouse relationship, you can do that much more easily than I could when I started, 12 years ago it wasn’t electronic submission the way it is now through the apps. You can still file a claim on people’s behalf, and say, yeah, we take your insurance, if they ask, do you take my insurance, and if you say no, they’re going to hang up. But yes, we absolutely take your insurance, let me ask your name, date of birth, what’s the problem, we have a conversation, and here’s how it works, we’re out of network, we’ll file the claim, every visit is 150 bucks, they say, okay, that might be lower than their copay, because we assume out of network is more expensive, but out of network can actually be less expensive for the patient, and practices can generate more revenue that way just as easily. It depends, every place is different, every city’s different.

Neil [18:32]: But that’s a great way of approaching it, yes we do take your insurance, we’re just out of network with them. Finding that information out first, because for a lot of patients they haven’t met their deductible either way, so they’re going to pay whatever they’re going to pay to meet their deductible whether in network or out, and their out-of-network deductible is probably a lot higher, but they may not even meet their in-network deductible anyway. I love that you said that, because it makes total sense, and you don’t have to drive people away by saying you don’t take their insurance. We make an assumption based on our own experience or our own plan that everyone else is going to feel the same way about money or where they spend it, but we can’t judge how other people make decisions or spend their money.

Aaron [19:19]: If we do, we’re not going to be very good at enrolling people, asking them for cash or not. We’re making a judgment based on them, and our judgment might be harmful to them when we’re trying to do something good. I think it also goes back to a lack of belief, that what I do isn’t really that effective, because I don’t feel effective, so why would I encourage someone to come see me? That person probably needs to leave the profession. But I’ve seen it, people have come to me and been told there’s nothing more that can be done. I had a woman who was a firefighter, she’d had both knees replaced at the same time, she was a captain who had to carry a 185-pound dummy up and down a two-story ladder, and they told her she’d never get more than 90 degrees of knee flexion ever again, sorry, there’s nothing more we can do, after eight weeks of PT. I don’t know what they were doing, but she came in, I laid her on her back in hook-lying, put her knee over her ankle on my shoulder, put my thumbs in her hamstrings, and her knee went down to 120 degrees. She said, you mean like that? Oh my god, I haven’t bent my knee that much in months. The other knee didn’t go as far, I saw her two or three times, and she said, great, got to go fight wildfires in California, see you later.

*[Mid-episode ad break: Neil mentions his book, “Market2Grow,” available free at practicepromotions.net/book, for podcast listeners.]*

Aaron [21:29]: I don’t know what they were doing before, but they certainly weren’t touching her hamstrings, and that’s where she told me it hurt.

Neil [21:34]: And again, you can see how important and valuable that was to her, because it was her livelihood, and she needed to get back to that. She was looking for solutions, looking for help, and willing to pay for that help where she couldn’t get it before, so she could get back to her lifestyle, her work. There’s so many patients out there who need you that way, and like you said, we put assumptions up that they would not come to us and pay that, which is wrong. Why is she even there? This woman doesn’t care about her range of motion, she needs to be able to squat and run and climb a ladder.

Aaron [22:12]: So how do we get them that result, not the result someone else told us was important? I think that comes back to training your therapists. I’m thinking about clinics with multiple providers, maybe multiple locations. Do we do enough training, not just from the medical aspect and new techniques, but from the salesmanship side, how we don’t come in with assumptions about what the patient can pay or what’s important to them? There’s training that needs to happen on a continuous basis around those soft skills, the salesmanship, the understanding, the communication skills.

Neil [23:00]: I’ve done those trainings for people, given recordings and all that, but the number one thing is the business owner has to have the right mindset and be bought in. I did a training once where all the PTs were on board, but the owner was like, no, what are you talking about, almost telling me I was wrong. I said, but she’s the one who hired me. I said, this is how you sell $200 PT, I’m just helping you sell $75 copays. It’s like, you can do it or not. But everyone on the team, administrative, therapy staff, has to be on the same page with expectations, how we’re treating patients, what’s the goal, not the patient’s goal but the goal of the business, and who’s the avatar. The goal of the business isn’t just to give everyone great range of motion or five out of five strength. For me it’s, I want people to see they can contact me any time, send an email or a text, and get in touch within 24 or 48 hours, even if I’m out of town, where they can’t even get in touch with a patient’s physician within two weeks. Most PTs would love to get there. If you look at what’s happened with concierge medicine and how that’s exploded, the doctors were sick and tired of spending 10 minutes with a patient clicking boxes in the EMR, they wanted to spend time with patients, and the way to do it was charge a membership fee, and people are very willing to pay that for premium healthcare. We have to mimic that within the PT world, the concierge type model, and it doesn’t have to be expensive.

Aaron [25:05]: If you think about what we’re able to deliver for a price point of, say, 2,500 bucks for 10 visits, you can get amazing outcomes for the patient, that’s well worth it, it’s not a huge lump sum of money. Think about the outcomes, like that firefighter, she didn’t have to retire early, that was worth a lot of money to her. We have to train ourselves and our therapists to think in a different model, different way of approaching patients. There’s even one-to-many programs that aren’t the traditional three-to-six-patients-an-hour type of PT, like teaching a yoga class on back pain, charging everyone 25 or 30 bucks, getting a 50 or 60% split, so I make 300 bucks and get a couple of patients out of it. A workshop can be worth a couple thousand bucks to me, but I’ve just helped 25 or 30 people in that same hour and a half.

Neil [26:06]: I love what you do there, Aaron, it really helps me think, and I’m sure for a lot of our audience too, start thinking outside the box. We don’t have to be confined in this one box we’ve been in for so long under the insurance model. There’s a huge growing health and wellness space out there, $3 trillion in the next 5 to 6 years in the U.S. economy is going to be health and wellness. There’s so many ways we can tap into that as practice owners. But do we really think patients should go to Stretch Zone or Stretch Lab and pay 75 or 50 bucks for someone trained on a Saturday to stretch them? It’s good for some people, but if you’ve got back or hip pain, there’s a better place to go, but the branding of physical therapy is hot packs, leg lifts, ultrasound, postsurgical rehab, not, we problem solve for you and actually touch you and help you fix the problem. That’s unfortunately not the branding.

[27:11] I’m curious, as you’ve worked with different clinics, maybe larger ones, say five, six, seven, eight providers, have you seen a clinic that has more of an official salesperson, the person patients go talk to after their evaluation, about finances and options and things like that?

Aaron [27:52]: I’ve seen it, but not in physical therapy. Gyms will do it, car dealerships do it, dentists will do it, the dentist evaluates you and makes the plan, but isn’t doing all the cleaning or the veneers, someone else does. Gyms, I learned a lot about marketing and running my business from the gym profession, from personal trainers. Bedros Keuilian was one of my coaches for about five years, and larger gyms have one person who’s a salesperson who enrolls you in the program, and matches you with a trainer who’s a specialist in your sport. I’ve talked to some clients about doing it, but I don’t think they believe it’s something they should be doing. But I do believe a lot of times, even if it’s the business owner, the owner should do all the sales and say, hey, we’re going to put you with, I’m going to match you with Dr. Smith because they’re the specialist in knee pain, and together we’re going to follow you through your plan of care, and I’ll be right here. I know a couple of people who’ve done that as they’re transitioning out, or bringing in a new therapist, but not as the official role of salesperson, though I think it’d be a powerful formula.

Neil [29:17]: I think it has to be applicable, if you’re a small clinic it doesn’t make sense, it’s usually going to be the owner running that component, but if you’re big enough, say five, six, seven, eight-plus providers, I’ve seen it too. Gyms, higher-end dental, cosmetic dentistry, plastic surgery, you don’t talk to the doctor about the finances, you talk to them about what’s needed from a treatment standpoint, and then you go talk to the treatment coordinator, who’s really the salesperson, about the number of visits, the treatment options, the payment options, all that logistics. If you’re big enough, it makes total sense, to sell cash-based additional cash-line services, out-of-network clients, you sit down, and it actually puts the clinician in more of a position of authority, they’re not talking money with you, they’re talking about what’s needed from a treatment standpoint, and the payment side is handled by someone who’s very good with sales. It makes it so the clinician isn’t the bad guy.

Aaron [30:42]: Exactly. It’s really easy to say, here’s my plan, here’s what it’s going to cost, I’m going to have you work out the details with Sarah up front, and they say okay, and the person up front closes the deal and gives them the financing options.

Neil [30:54]: True, and that could be another way to think outside the box for a clinic, if they’re trying to pull more of those out-of-network patients or sell additional cash-line services, maybe you have a very good office manager, or even a biller, though usually not the biller, not as personable on the sales skill side, but usually an office manager, or even the front desk if they’re really good at it, you give a bit more time to someone in your office who’s good with sales, and they could be part of that, even if it’s not a full-time role, there’ll be times that person is needed. Sometimes it’s just looking at the process in a different way.

Aaron [31:42]: Have you been to Orange Theory, Neil?

Neil [31:46]: I know of it, and I have family members who go, but I’ve never been myself.

Aaron [31:46]: You should go, just for the experience. I don’t know if they do it the same, but the very first experience they give you this questionnaire and ask all these sales-based questions, like, what’s one thing you want to get out of coming here. I was like, holy cow, they’re really diving into the why. It’s a big organization, a big franchise, and not many places do that, in a way that’s empowering and not shaming you, but it’s like, if you could no longer work out, what’s one thing you’re concerned would happen? It’s building this case for why you should get a membership. It’s really interesting, but we don’t do that as PTs, where we ask about how many steps do you have, do you have a handrail in the backyard, and patients say, I’ve never been in the backyard in 10 years, why does that matter?

Neil [32:49]: That’s a great point. What you’re saying is we don’t have to come up with all of this ourselves, there’s a lot of successful companies and industries doing this every single day. Look at what’s happening in gym membership, Orange Theory, burn boot camps, and all this other stuff, what are they doing right that you could mimic if you’re going to add a cash-based service or service line into your practice? I love that. So talk a little more about cash-based systems or processes. What would you say is absolutely needed to be in place before a clinic can make that leap to bring more cash-based stuff into their practice?

Aaron [33:31]: I think you have to have a clear price, here’s what we charge, and everyone has to be comfortable with it and feel totally cool with this price, because if one person isn’t, as a business owner we have to coach our team, if they don’t feel comfortable doing PT at 150 bucks a visit, they’re not going to keep people on their schedule, and it’s going to cause problems. It’s really around the mindset of cash, but also doing it in a way where we’re not explaining or making excuses about why we take cash to patients. If people ask, we can have an answer that’s positive, reasons why it’s a benefit to the patient, but we don’t always need to explain why, and we don’t need to lead with it. So we’ve got to have the price, and it can be as simple as a hundred bucks for a half hour. One of my clients, Allen Ling, has an eight-person in-network clinic in El Cerrito, near the Bay Area, and they started doing $100 every 30 minutes, which isn’t much more than the copay, just for the cash patients, and they’re doing an extra 18 to 30k a month in cash, which is only about 10% of his business, but it makes a big difference because you don’t wait for that, it’s significant. So you’ve got to have a number you’re comfortable with, a number the team is comfortable with, and then we’ve got to get everyone clear on the offer. The offer isn’t physical therapy, the offer isn’t $100 a visit, the offer is, Mrs. Jones, based on what we went over today, my recommendation is we get you in for our 10-visit program, here’s what it’s going to do for you, and that’s going to be, let’s say, a thousand bucks, and it’s designed to help you feel better, faster, stronger, and not worry about the arthritis. Are you interested in saving $100 today? And she’d say, yeah, cool. If you pay in full, essentially you get a 10% discount, essentially get a free visit, or we can do $100 every time you come in, and we just have these options, there can be four options, but we’ve got to give them two choices, and incentivize adherence to the plan of care, not frequency of visits. That’s another mistake people make, giving Mrs. Jones, who needs 15 visits, a bigger discount than Mr. Smith, who only needs five. I don’t know why Mrs. Jones deserves a bigger discount just because she’s got a more complicated problem. If we’re doing personal training and you come in three times a week versus one, yeah, give a bigger discount because you’re coming in more often, that’s the incentive. But in healthcare, I don’t want to incentivize you to come in more just because that’s what your condition requires. Does that make sense? So how do you do it then? You do, if you pay in full, no matter how many visits I think you need, I’ll give you the same discount.

Neil [36:37]: Gotcha. So the incentive there is more cash up front.

Aaron [36:43]: The incentive for them is to save money, the incentive for me is cash up front. But just because someone’s got a sprained ankle, or someone else has an ACL tear, doesn’t mean the person with the ACL tear gets a bigger discount just because they have to come in more often, over 20 visits over six months versus five visits. That doesn’t feel ethically right to me. For other people it might feel fine, if we’re doing massage and, Neil, you say you’ll come in once a month, I’ll give you a 20% discount if you come in once a month versus whenever you want.

Neil [37:18]: Right, makes total sense, I like that too. And I think what really resonates there is you giving choice. It’s not a choice of whether I do this or not, it’s a choice of how much I want to do, and if I pay upfront I even get a choice of saving some money that way.

Aaron [37:34]: Yeah, it’s just like with our kids, partners, spouses, patients, you don’t give them a yes-or-no choice, you say, do you want Chinese or Mexican tonight, do you want to wear the red shoes or blue shoes, or, hey, do you want to pay in full and save, or get on the 10-week payment plan, whatever’s easier for cash flow. We give people a choice when we make a sale. So I think if we want to start doing cash services, we have to know here’s what we charge and be comfortable with it. There’s a lot of other things that are important, but that’s the number one.

Neil [38:10]: Love it. And have you worked with clinics incorporating different membership programs into what they offer? What have you seen there as far as the package approach or the membership approach?

Aaron [38:29]: I think they’re both really good. To start off, say you’ve got a personal trainer, a massage therapist, or a strength coach, and the person needs PT, so instead of 10 visits we’re going to give you 12. You get eight PT visits and four, say, massage or training, it doesn’t matter, but I’m not doing the treatment on those four. Those additional package visits maybe cost me $25 for the hour, so that’s $100, but I add four things valued at $125 an hour, so I’ve added almost $600 of value that cost me a hundred bucks. If I combine it with the PT, I’ve increased the value, and I can give a discount, hey, when you pay for this 10-visit PT program, you’re going to get two free massages, so I’ve added $200 of value. If it was 100 bucks a visit, it’s $1,200 of value for a thousand, and if you pay upfront it’s 900 bucks, so you get a $300 bonus. By combining things that, as the owner, I don’t provide the service for, and it only costs me less, I can stack value. You can do it with a lot of different things, a gym membership, I’ve had clients say when they pay in full for their plan of care they get a free gym membership, they’re still told how much it costs, and they sign a contract after 90 days at whatever, 97 bucks a month. I had a client in Alaska who had a shoe business, a gym, and a PT business, and every PT patient should get a 20% discount on a pair of shoes, you build it in, and every person who buys a pair of shoes gets a free total body diagnostic at the PT clinic, because they’re probably buying new shoes since something doesn’t feel right.

Neil [40:32]: I love that, and again, we can think outside the box in our practices and layer things on, make them interact with one another, all our different programs. If I have to bring in a cash service line to what I’m doing with my insurance model, I’ve got to think about that patient experience, patient process, and how I expose them to the opportunities of this cash service line, whether it’s a gym, a stretch program, a laser program, whatever it may be. I like those examples where they’re really allowing the person to have the experience of those things, and there’s an incentive because they’re doing multiple things together, they get more of a discount.

Aaron [41:16]: Yep, and I have another client, we set up, they’ve got all the modalities, the laser, the pool, the stem, all the things that basically are self-served, a lot of them don’t require a trained professional, or aren’t required to in their state, or they’ll have someone on site who can do it, and they’ll do these Saturday drop-in clinics for a couple hours, 9 to 11. Maybe a couple of them you’ve got to have someone put on, but a lot of it’s self-serving. I think it was like a $25 drop-in fee, but you can get a $50-a-month membership, so $50 you can come in anytime, but the drop-in fee is 25 bucks the first time, then you can apply that to your membership. So now we’re getting members on there, recurring revenue, and they’ve got like 30, 40, 50 people coming in, sports teams come in, hundreds of memberships at 25 bucks, this is how Costco makes their money, the memberships, but as physical therapists we don’t think like that. Everyone there, when they’re hurt or not getting better, can get a discounted consult to get into the PT side, but no one wants PT, everyone wants to feel good. PT is a grudge purchase, but getting in the ice plunge, sitting with the Normatec boots on, that’s cool, that’s fun, the pros do it so we’re going to go do it, and you make a lot of money on one side and feed them in somewhere else.

Neil [43:02]: We work with some clinics like that, they have their professional service lines, physical therapy, chiropractic, massage, and then those kind of ancillary services, ice plunges, compressions, all kinds of stuff that doesn’t have to be a professional delivering the service, could be someone who’s skilled, depending on state rules, but for a lot of it, someone wants to come in once in a while, maybe once a week, and have that healthy experience, and then, hey, I injured myself, I go back into PT again. Lots of avenues for reciprocal referrals back and forth. So Aaron, you obviously coach and work with a lot of clinics doing a lot in the cash-based industry, are there specific marketing strategies you see work well for those clients?

Aaron [44:03]: Specifically for cash clients, or for anyone?

Neil [44:07]: For cash clients.

Aaron [44:07]: The number one strategy is getting in front of people. You’ve got to get in front of people, spend time in front of people, whether it’s being in the gym and meeting people, being introduced by friends, but really, how do you get out and run a workshop, participate in some kind of health fair, do injury assessments, sometimes mini treatments. Workshops are great, and then there’s things like Instagram paid ads, but you don’t run paid ads to things that don’t produce the result organically either. People think paying is the answer, you can pay a lot to figure it out, but for instance, I did a free workshop a few weeks ago, and actually they charged for it, so I made 150 bucks and got two patients out of it, made like $2,500 from that one workshop. Then I spent 300 bucks on an Instagram ad, boosted a reel that was already getting me followers, and got three new patients from that, by sending a message to everyone who followed me and starting a conversation. Those are great, but I have to have a proven offer and results and know what’s next, we can do a workshop, but if I don’t have an offer I don’t know where to send people.

Neil [45:41]: So are you finding there, obviously using your different approaches, social media, email marketing, whatever it is, you’re driving them to some sort of way to have an organic experience, a workshop, or coming in for an introductory offer?

Aaron [45:56]: Really the answer is you’ve got to have a funnel. We’ve got to fill the funnel by being in front of people, and then get them into either our email list, here, let me send you these free resources, or if you’d like to set up a time to chat one-on-one, we’ve got a talk-to-a-PT call, a 15-minute call, or you can come into the clinic for a discounted consultation, which I call a total body diagnostic, I talk to you, figure out your goals, and take you through a 10-point movement screen. I use the SFMA top tier, and I touch where it hurts, but people can use whatever screen they want. That’s the funnel, the system of how I move people from small pieces to bigger pieces and then make the sale. If I don’t have that, we’ll randomly have people coming in because someone told them, but we’re not going to get people who are halfway on the fence or haven’t heard of us before, we’re only going to get people who’ve heard a lot of really good word of mouth, and that’s really hard to build from scratch.

Neil [47:06]: I would say too, the more premium your service becomes, the higher the perceived value you have to create with your marketing, you have to elevate your marketing to the level of the price point you want to charge, for whatever service you’re incorporating into your practice. We see practices out there we get super polished, incredible brand online, and clients we’ve worked with, very high-end sports performance programs that are cash-based, they work hard to get testimonials and case studies, use that within the imagery of their websites and social media, with professional athletes, top-level athletes, and they sell that through their imagery and look, creating that desire, like I’ve got to go to this place, this looks amazing.

Aaron [48:09]: And that’s part of creating that perceived value, so when they come in with that introductory offer, you can work your magic within the clinic. It’s called manufactured celebrity, you’ve got to know your audience, your target, your niche, but you can manufacture celebrity by making yourself the celebrity, though I can’t manufacture celebrity if I don’t put myself on the internet, and if people are afraid to do that, it’s much harder.

Neil [48:38]: Understood, but it is, that’s it, we look like the expert, we’re the expert, right? I’m the expert in back pain, so you must be able to help me with my neck too, right, can I get some help?

Aaron [48:46]: Yeah, and I think that’s, if people are afraid to go too narrow, but it makes them the expert in this one thing, ACL rehab.

Neil [48:53]: Okay, great, love it. So as we wrap up here, what would you say is the number one piece of advice you’d give a practice owner who actually wants to implement cash pay into the practice?

Aaron [49:06]: Stop thinking too hard about it and just give it a shot, just do it. Most people think themselves into destruction, or the grave, it’s like you’re thinking too hard, making too many judgments on what other people perceive as value. Just make the offers, without making the offers you won’t know if it’s something people want. Really, people who are thinking about transitioning are just thinking for way too long, and missing out on all the time and help you could provide to other people.

Neil [49:34]: Totally, and there are great resources out there, coaches, and Aaron’s a great resource to learn about this, he’s helped lots and lots of practices implement these things, so you don’t have to figure it out on your own, get some help. So, Aaron, what’s the best way for people to learn more about how you help clinics with services?

Aaron [49:50]: The best thing to do is go follow me on Instagram, Aaron LeBauer, it’s spelled Le-B-A-U-E-R with a B, but once you start doing it you’ll find it. And if you message me the word “book,” I’ll send you a free copy of my book, the CashPT Blueprint, you just cover shipping and handling and we’ll print and ship it out to you.

Neil [50:10]: Awesome, great way to learn about how to get your cash services set up there, Aaron’s got that really figured out. Aaron, thanks for being on the podcast with us today, sharing your experience and knowledge. I’m very excited for the direction of our profession, there’s so much being done, and you’re on the forefront of making it happen. The hybrid model, the cash service model, is definitely the future for our industry.

Aaron [50:35]: Absolutely, thanks for having me again, Neil, appreciate it a lot.

Neil [50:40]: My pleasure. Thanks to all listeners out there on the Practice Marketing Podcast, don’t forget to subscribe to the podcast and also to our YouTube channel, where we have tons of great marketing advice for you. And don’t forget to follow us at our practicepromotions.net website, tons of great downloads and free advice there. This is Neil Trickett from the Practice Marketing Podcast and Practice Promotions, wishing you much success in your practice. [Music] A free way for you to support our show is by leaving a five-star rating and review on Apple Podcasts, it’s a chance to tell us what you love about the show and it helps others discover it as well. Just scroll down to ratings and review on your phone and click write a review. Thanks. [Music]