Looking at the Logistics of (Successfully) Running an In-home, Private-pay, NeuroPT Practice

Do you daydream about opening your own neuro-based physical therapy clinic?

Are you wondering how you could make it happen without quitting your job or putting a huge dent in your savings? 

Even if your goal is to launch a brick-and-mortar clinic, starting with an in-home model may be a great way to launch into the world of private practice. 

There can be a lot of reasons why starting small and low-key with the in-home model would work for you, including:

  • low start-up costs
  • low overhead
  • lower risk (since you don't necessarily have to leave your current 9-5 with all its benefits), and
  • time to learn and grow (at a pace that's comfortable for you)

Going Beyond the Bare Bones

I was able to start my Parkinson's-specialized private practice, Invigorate PT and Wellness, as an in-home model from the very beginning. My aspirations were to eventually open a large wellness clinic, but I decided the flexibility and unique service proposition I could offer as an in-home therapist was something I wanted to maintain. 

I get questions about this model fairly often, which is why I wrote a short but dense, 17-page eBook that covers all the start-up logistics like insurance, payment systems, making a website, choosing tools like EMR, phone, fax, email systems, etc. 

Today's post will be going beyond the simple bare-bones of how to get an in-home model up and running, and instead answer questions from you all that focus on the logistics of the day-to-day that are so crucial in keeping your doors open for the long-term. 

(If you'd like to grab a copy of Start Your Dream Practice on the Side: 12 Steps to Your Bare Minimum Launch the commissions will go right back to the NeuroCollaborative if you use the link above. And obviously, I appreciate your support!)

Question 1: "What does a consultation call include?"

I offer a free, 20-minute consultation call to anyone who is interested in working with me 1-on-1 to make sure we're a good fit. 

My goal is NOT to sell anyone on this call! I don't want to work with everyone.  I want to work with motivated, committed, hard-working clients who are a fit for my program and business model. 

How it works

  1.  Clients fill out the "Get Started" form on my website.
  2. They fill out their information and a brief questionnaire about what they're looking for and struggling with.
  3. An email is triggered that contains more information about Invigorate, and lets them know I'll reach out to them within 24-48 hours. 

When I call, my goal is to find out what's going on with them so that I can offer them the best resources to help them succeed. Most of the time they've heard about Invigorate through Facebook, their physician, or family member, and are looking for someone to help them with their balance, strength, or stamina. Occasionally they just have a question about a Parkinson's-related topic and want more information on the matter. 

When it's appropriate, I let them know how Invigorate can help them with what they're struggling with in order to get them back to the life and experiences they feel like they're missing out on, whether this is traveling again, playing on the floor with their grand-kids, or getting back on their bike for the first time in 4 years. I never pitch "physical therapy" because the truth is people don't want PT! They want their life back. This is easily the biggest mind shift I had to overcome as a business owner, hands down.

Eventually they'll ask about cost, insurance, and the process of getting set up for an evaluation. At that point, I'll share those details with them and we'll either set up the initial evaluation or, if they're not ready to schedule, I'll let them know I'll be following up with an email containing some of the information we discussed on our call.

Answering the Medicare Question:  I always make it very clear during the consultation call that I do not accept insurance of any kind at my practice, including Medicare. I explain that I wouldn't be able to provide the high-quality care I believe in if I were to accept Medicare, but that they can go elsewhere to have physical therapy covered by their insurance. Most people are understanding. If they ask about submitting claims, I explain that I require all beneficiaries to sign a waiver stating they will not submit a claim to Medicare for services rendered. If someone is insistent on using their benefits, I help them find a Parkinson's PT in their area who does accept Medicare and pass the referral along.

Question 2: "Do you provide a free evaluation*? If not, how do you get people to fully jump in when you haven't established that relationship yet? How do you prevent a drive to a patient's house without pay?"

I grouped these all together because they all come back to one thing: Building Trust. 

As I mentioned above, the purpose of the free consultation call is to make sure that anyone wanting to work with me is a good fit for the program and my business model. It's also meant to give them a chance to get to know me, build some rapport, and make sure there are no surprises at the initial evaluation for either party. 

This process is helpful for both parties involved, so by the time I show up at the initial evaluation we've had at least one phone conversation, and they've received 2-3 follow-up emails from me explaining Invigorate's model, what we'll do at the initial evaluation, my cancellation policy, and payment policies (payment due at time of service). I've yet to show up to an initial evaluation where they refuse to pay. It may be my charm, but I'm guessing it has more to do with the processes I have in place before I show up at their doorstep :)

(*Side note: A free screening is one thing, but a completely free evaluation is undermining your value as a healthcare provider and business owner. Your time is valuable! Charge for it!!)

Question 3: "Do you stay within a certain driving radius or charge a travel fee?"

Austin is set up in a way that most of my clients are about a 20-minute drive from each other. 

This means my default is to stay within a certain driving radius, however I do have a travel fee ($15/session if they're outside of the 20-mile radius) but often get people turned off by it. Most of the time I'll refer clients to a Parkinson's therapist who is closer if they're able to make it to an outpatient clinic, but there are a handful of clients who don't mind paying the extra charge for the convenience of coming to them. 

Rule of thumb: Decide on your own if a travel fee is right for your practice, but set it to be equivalent to your hourly rate. For example, if your goal is to make $100/hour then a 15-minute drive outside your radius should be $25 travel fee per session. 

Other options: Group your clients together by location so you're being efficient with your driving; Split your week into two different areas (north clients MWF, south clients TTh, for example); offer group training or create a class in that area to make the drive worth it if there's a need. 

Question 4: "What do you use for home exercise programs (HEPs)?"

This depends on the client. I don't have a specific program or software system. Sometimes I'll record videos and make them a special playlist to watch on their own. Other times I'll handout pictures. Often I'll put together a weekly exercise schedule with page numbers, links, or descriptions of what they're supposed to do on specific days. 

Watch Sarah's Facebook LIVE recap expanding on this topic: 


Until next time—keep your #iloveneuro spirit strong and keep changing lives!

Sarah King, PT, DPT

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