How To Stop Patient Drop Offs Easily And Ethically In A Cash-based Physical Therapy Clinic


Patient journey in pain and cash-based physiotherapy

Every physical therapist has patients drop off. You make some progress. It all seems to be going smoothly. But by session three or four they don’t show up. Well, today I want to show you exactly how to put an end to this uncertainty.

I’ve had my fair share of no-shows. I’d sit for hours wondering what I could have done differently. But as a practice owner, I couldn’t afford to be losing patients and their payment. It took me years, but eventually, I found the truth behind why this was all happening.

In this article, I’ll give you the advice I wish I had when starting my own cash-based PT clinic.

Expect to find out;

Read on to find out the truth behind patient drop-offs in your cash-based practice..

Cash-Based vs Insurance Referrals

In previous posts, I have talked about a physical therapy insurance model in which patients don’t pay cash. They are referred by insurance companies, collecting payment from third-party payers, or if you’re in the US, medicare.

If you’re like me your cash-based business has never been a participating provider. You have never had the luxury of relying on an insurance company for referrals. This means that real long-lasting results aren’t just about getting your patient pain-free. These results are your source of reviews, referrals, and revenue. You are, like most local businesses relying on these people to facilitate the growth of your practice.

Getting it right is the difference between a successful cash-based PT practice and sleepless nights worrying where things are going wrong. You simply don’t have as much security in a cash-based model.

You need to stop patient drop-offs today…

Stopping patient drop-offs and building successful cash-based practices

The Truth Of Patient Adherence In A Cash-Based Practice

Before we move on, it is important to understand the truth behind patient adherence in a cash-based physical therapy practice.

Often the first session and the subjective assessment is a time of excitement for your patients. They may be nervous but they have reached out for your help. They are looking for a route out of pain. They believe your services are that route.

Then they leave your practice. The excitement settles down. Maybe they see a little improvement with your exercises but very quickly life gets in the way. They don’t want to spend their evenings repeating exercises over and over.

Patient adherence is rare… In a 2018 study on patient adherence to healthcare exercises study, Argent et al found that ‘only 35.0% (42/120) of patients were highly adherent with home exercises’ and noncompliance resulted in ‘detrimental effect on clinical outcomes’.

As time moves on most physical therapists will find their manual therapy and hands-on less effective, or their patient has become too reliant on it. You hit the session 3-4 slump and you never see them again.

This isn’t some kind of worst-case scenario, it’s the truth. It’s simply human nature. You have to be aware that this is probably going to happen.

So, how can you stop this? Well, the short answer is, you need to work smarter not harder.

Patient journey in pain and cash-based physiotherapy

What Is Causing Patient Drop Offs In Your Cash-Based Practice?

Getting patients to show up to every session isn’t some kind of magic trick. At the ProSport physical therapy practice, we have managed to take thousands of people in pain from their initial assessment all through treatment. But that only came after years of painful lessons.

To keep your patients on their journey, you have to get to the bottom of what is causing patients to leave.

In my experience, there are the main contributing factors I see when it comes to patient drop-offs in cash-based practices….

  • Mismatched expectations.
  • Lack of progress or perceived progress.
  • Flaws in your treatment plan.
  • Lack of a systematic approach.

I’m not saying these are always to blame but after 13 years in professional sport and private practice, I have seen these cause 99% of all drop-offs in cash-based businesses.

Think about it… Your patients aren’t just going to decide they don’t need physical therapy. They aren’t going to decide that they would much rather live with the pain. Just like their pain, there is always a true cause, a reason that has pushed them to leave.

Now we understand why patients may be leaving your cash-based practice, here are a few simple steps you can take to put an end to drop-offs today….

physio approach to your cash-based physical therapy practice

Setting Patient Expectations

In a 2011 study, Hush et al found that ‘meeting patient expectations will improve satisfaction ratings’. This may sound simple but it makes a point that so many physical therapists ignore. If patients are satisfied with their progress then it will dramatically reduce the chances of drop-offs in your cash-based practice.

In another study, Potter et al found that ‘communication ability, professional behaviour, and organisational ability’ are all qualities of the best physical therapy services from a patient’s perspective. You’ll see the word communication pop up a lot in the research. It isn’t just about setting expectations, you are using your communication to build a rapport.

Now, It’s all well and good knowing the research but how can you use this information in your cash practice?

The Most Important Question When Setting Patient’s Expectations

As we teach in the ‘Go-To’ Physio Mentorship you must always be asking your patients higher-level questions to elicit higher-level answers.

In the case of setting expectations, we use one simple question…

What is the most important thing you want from today’s session?

Take a persistent pain patient… You ask them this simple question and they reply saying they want to get back to playing rugby next Sunday. You now know, from the very beginning, that their expectations aren’t realistic.

Once you have this information you can use communication and effective explanation to shift those expectations. If an expectation is something you know you can’t meet then you must address this.

A Simple Equation For Setting Patient Expectations

Patient expectations and happiness shouldn’t be forgotten after the first session. They both need to be monitored if you’re going to stop those drop-offs.

To do this in your cash-based clinic you can use a formula that has helped me understand my patients more than ever. Take a look at the formula below. It may not be the most technical but it doesn’t have to be. It works every time…

If your patient’s expectations are less than their current reality then they will always be in a positive level of happiness. If their current reality is lower than their expectations, this is a recipe for a no-show.

Simple formula for setting patient expectations in a cash-based clinic

Understanding How Your Patient Is Being Limited

The next step in ending drop-offs in your cash-based physical therapy practice is finding the internal motivator.

The internal motivator is the soul reason patients come to you. What is their issue stopping them from doing? Are they having trouble sleeping at night or climbing the stairs? Or is their back pain stopping them from keeping up with their kids?

Why is this important? Well…

Firstly, you know where you’re going with your treatment plan. If you know where they want to get back to then you can treat patients with that end goal in mind. You’re preparing them for success.

Crucially, it allows you to pick out how and where you can get quick wins. This doesn’t mean some easy exercise that will wear off. All you want is your patient to see progress within the first few sessions. If they’re making progress and they can see it they’ll have confidence in you and in themselves.

In the mentorship, we use the principal of 6 hours vs. 6 reps. We aren’t thinking about what patients need to do 6 reps of a certain exercise. We are establishing what they need to do for 6 hours per day. Ask yourself, ‘what can I do to help this patient to be successful and progress?’

It all comes back to focusing on the person in front of you.

Initial assessment and first session in cash-based physical therapy

Recalibrating With Your Private Practice Patients

When we talk of the 3-4 Session slump you have to realise that it isn’t always at session 3 or 4. It is a real possibility that many patients will leave your cash-based physical therapy practice at any point in their treatment.

As we have touched, a real cause of this is lack of progress or lack of perceived progress in your patient’s eyes. They may actually be making progress but if they can’t see it then you can’t expect them to be happy with your services.

In the Mentorship, we teach one easy step that can stop this from taking hold…. At the end of every session you must, in one form or another, recalibrate.

Communicate with your patient. Show them how far they have come, the progress they have made, and how they will progress in the next session. It is all about them seeing their progress and the benefits and value of the work you’re doing together.

Keep that end goal in sight and show them how each step is a logical progression towards that goal.

Effective explanation to stop patient drop-offs in cash-based physical therapy

Designing Your Treatment Plan

This is the one area all successful cash-based practices excel in. You need to be able to design the best treatment plan for the person in front of you.

Throughout my 13 years in professional sport, I have worked with some of the toughest cases that have tested my ability to create rehab programmes. I have only been able to do that by sticking to a structured system.

I look at the person in front of me, understand their goals, use the 80/20 rule to focus my energy and find the true stressor, I clinically reason, and take them through a graded exposure treatment plan to set the patient or athlete up for success in the real world.

So many therapists use their manual therapy and exercises to take their patients to the point at which they are pain-free. This is a huge mistake. You must be setting every patient up for success in their goals and the real world.

The biggest mistake in cash-based physical therapy practice

Implementing A Step-By-Step System In Your Cash-Based PT Practice

Ultimately, preventing patient drop-offs all comes down to having a system and with that, the 8 pillars of the go-to therapist.

With confidence and clarity in each of the 8 pillars, you and every physical therapist in your team can achieve real long-lasting results, providing the best one on one care to every patient.

Without the system and these pillars, you can’t perform your subjective assessment, you can’t find the true cause through your objective assessment, you can’t communicate with your patient effectively and your treatment plan will only ever fail.

You can pour all of your resources into marketing efforts and attracting new patients but if you cannot achieve consistent results with every patient then it will only ever cost you reviews, referrals, and revenue.

The 8 pillars of the go-to therapist - Must have skills for physical therapists in cash-based practice

Final Thoughts On Patient Drop Offs In Your Cash-Based Practice

Stopping patient drop-offs once and for all can seem like a daunting task but it is vital to the success of your clinic.

If you aren’t an insurance-based practice and you can’t rely on these third-party payers then every patient is a source of reviews, referrals, and revenue.

Take these simple steps to stop patient drop-offs and ensure the growth of your clinic…

  • Understand why your patients are dropping off.
  • Set patient expectations in the very first session.
  • Understand your patient’s internal motivator.
  • Recalibrate at the end of every session.
  • Design your treatment plan for the person in front of you.
  • Implement a system for consistent results.

And I’ll leave you with one final thought…..

Most cash-based practices out there just treat patients. If you want to truly differentiate yourself from other practices you have to give more in value than you accept payment.

For more information on unlocking patient adherence, ending drop-offs, or implementing a step-by-step system in your own cash-based PT business, click the banner below and book your free strategy call today.


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