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PTA Blog Talk

Therapy Menu

Published October 28, 2009 1:48 PM by Jason Marketti
Like buying fine foods by number we should offer a therapy menu for those who are undecided what will take care of their aches and pains. It would look something like this:


#1  Massage...........................$XX.00 (For first 15 minutes. $X.00 for each additional minute.)

#2 T.E.N.S............................$XX.00

#3 Ultrasound........................$XX.00

#4 Heat Pad




#5 Ice.................................$XX.00

Combo Special Every Tuesday

             Combine any two for one low price of $XX.00

Exercise Special Everyday

             One half hour session with two of the above $XXX.00

Of course we could alter it to offer iontophoresis, wound care, taping, etc.  Imagine the free market and competitive nature we could have trying to market ourselves.  Perhaps I could open a place across town from the busiest therapy office and offer a couple of my specials with coupons that offer a "Free Biofreeze massage With Purchase of Two Exercises".

Is the idea so far out there?  Hardly.  Clinics have run on cash only successfully.  When my place opens I will offer a lighted menu above the receptionist.  The receptionist will type the patients order into the computer, a therapist will call the patients number over the intercom system and bring the patient back into the gym or a room depending on what was ordered.

With direct access this may be possible.


Christie's right.  PT is supposed to be moving towards an evidence-based approach.  The PT is the one educated and trained to figure out what is going to produce results not the patient.  Patients would end up paying for the feel good palliative treatments such as estim and ultrasound which doesn't have sound evidence supporting its effectiveness.  A menu type option like this would reduce PT's credibility within the medical community and erase the fine line between the PT and Chiropractic profession.  Really if this setup existed it would reduce the PT profession to a technician role.

Mike February 23, 2010 4:44 PM

I think Judy hit the nail on the head, but I'm not referring to Pilates.  The tool she uses is Pilates, and I am not debating its efficacy here.  But I think the more powerful tool is ownership of the problem and the outcome.  By paying out of pocket, the client is investing in themselves.  We take care of our investments.  

Clients who are receiving medical treatment, mostly at someone else's expense, are not invested in the outcome.  Sure, they want to feel better.  But they want a quick fix.  They are okay having toreturn to the medical well to drink repeatedly because the well is comparatively cheap.  

If a client had to pay 100% out-of-pocket for all of their surgeries, I can't help but believe they would be more attentive to taking care of themselves afterward.  If they knew they would have to pay out-of-pocket for a surgery, they'd probably be more attentive to keep themselves from getting in such a state to begin with.

Our current medical system does not promote wellness or reward it.  Our current system is built on, and thrives on, illness.  We've accepted this paradigm and adjusted our mindsets to it.  In the absence of another alternative we have received this model as an intelligent solution.  

Paradigms don't shift quickly or without great resistance.  Judy offers clients the opportunity to invest in wellness.  Hopefully as more people adopt a wellness perspective and "illness-minded" people around them see the rewards for being healthy lived out in front of them, we will gradually see a shift in what society views as intelligent.

Janey Goude October 31, 2009 11:07 PM

I'm telling you cash based Pilates studios are already doing it very well. I'm proof and the owner of a successful Pilates studio for the past 6 years with a loyal clientele that keeps growing.

With a in PTA degree and advance training in Pilates method using, machines people come to me and stay. A lot of my clients come to me post physical therapy. Perhaps more than 12 PT vists and still have pain but get better after just a couple of sessions of Pilates.  Clients learn a whole new way to live in their bodies. They feel the results instantly.

It's not Yoga, its not massage, hot packs or ice. It's core exercise at its best. I gently kick butts from head to toe with over 500 different exercises that stretch and strengthen with control on many different pieces of apparatus. Its an intense workout for any level including post surgical and everyone in between. I've had clients walk out of the hospital after total knees without a walker to the doctors amazement.

Taught correctly the client learns to reconnect to their body by changing faulty movement patterns that cause muscular-skeletal pain.

Pilates feels like a total body massage. Only the client is not passive. He/she is actively releasing tension and building strength at the same time. The springs on the machines help direct and reinforce the neuro-muscular patterns needed to create change deep in the muscular system commonly know at the core.

It's very difficult for people to find these deep muscles on their own. The springs on the machines create eccentric contractions that decompress all the joints in the body at once. After one session a client feels like they have grown a couple of inches.

I have had especially good results with scoliosis and these clients believe they have found a miracle in the method of Joe Pilates work.

Not all my clients are weathly and they find a way to pay me cash to continue healing their bodies.  Once people embrace what Pilates can do for them, they will make it a priority to pay for it.  

Never would I even consider taking insurance for Pilates because it's not only the clients/paitents duty to achieve a healthy body but to maintain it and pay for that maintenance. Ownership of a pain free healthy body is a vital key to getting better. You can't own your workout if an insurance company pays for it.

I love working with people who really want change and will pay almost anything for it.

Most therapists have a vague idea what Pilates exercise is but do not have a full comprehensive clinical knowledge of it's power.

I believe whole heartedly Pilates exercise is the future of physical rehabilitation. More physical therapists and doctors need to research and study the Pilates patient rehab outcome.

Or maybe not because patients will get better, get off drugs and won't need surgery. Now that will certainly make a lot of people unhappy campers.

All I know is my work in Pilates method is extremely rewarding both professionally and financially. Not only do I help people in pain but often I have assisted them in changing their lives. I can't say the same when I do an occasional diam job in the rehab clinic.

We must change our current health care system. It's bad out there. Thank god for Pilates. No, Thank Joe Pilates for Pilates. Joe Pilates was 50 years ahead of his time. He predicted that at some point in time everyone will be doing his work. Now we just have to convince the health care industry ie. doctors and therapists.

Judy Lynch-Hudson LPTA, Cert. Pilates Instructor


Judy Lynch- Hudson, Exercise/Rehab - LPTA /Pilates teacher, own business October 30, 2009 11:11 PM
Easton MA

I have seen successful cash only practices. People will pay out of pocket for good quality care if they really want to get better. Aren't those the clients we enjoy working with anyway? With direct access this makes even more sense, people can come directly to us for evaluation and treatment and avoid the horrible cycle of pre-authorizations and following an insurance company's (miiliman guide) protocols. As for a "menu", NO, they are coming to us for our expertise not to place an order.

Dean Metz, interim care - Sr. PT, NHS of UK October 29, 2009 11:10 AM

On a cash only basis, would you have a successful business? Sure, because people are always going to pick the treatments that are easy and feel good...and they don't have to do anything.  The best part is, they won't get any better with US, STM and E-stim...so you'll have a large cliental with very little turnover (until they run out of money).  

In reality, patients rarely are keen on assuming self management for their problems and will rarely choose the most beneficial treatment (despite the education we provide).  

So certainly, you can open your cash based clinic with your "menu."  However, I warn you, you are going to have some major competition.  They are called "spas"...and some chiropractors.  The problem is, when their money runs out, they stop coming...and they'll eventually will run out of money under the "menu" concept...because they won't get any better.  

My menu will say only three things:

1. Evaluation

2. Treatment

3. Education....and education will be free with 1 or 2

I fully believe in the cash only concept...but the idea that patients should pick and choose what types of modalities or treatments they get in PT...not at all.  This is partly what got our health care system into the trouble it's already in....

Be sure to ask your doctor about Ambien...(but never about Zolpidem, of course)

Christie ,, October 28, 2009 7:11 PM

As crazy as that sounds, it could very possibly work. Drs used to operate on cash only basis. That was before the days having to bill everybody's insurance and wait for payment. If the practice of setting lower rate for everyone and requiring that payment when they are treated and only billing insurances when the procedures are complex and require more than an office call, the cost of healthcare could again be affordable. Not saying people shouldn't be paid for their services, but just think, it used to be done (sucessfully) years agao, why can't it happen now.%0d%0a

Carla October 28, 2009 12:57 PM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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