Time based billing Problem 3: Client drop outs
In my last post I looked at the second problem that clients encounter when they receive health care services on a session to session basis.
Problem 2 Recap
The second problem being a dilution of the trust between the therapist and the practitioner administering the care. Why a reduction in trust? Well under session to session care the client will have suspicions warranted or unwarranted, spoken or unspoken, that the therapist’s recommendations may be based on self serving interests over their best interests as the client.
If you are reading this and you are a therapist you will appreciate that over-servicing of clients rarely occurs. Given the carer nurturer profile of the typical clinician the servicing if anything tends to be that of the client being under-serviced for their respective needs and potential recovery rate.
The Conflict of Time Based Billing
However despite over servicing being rare in allied health the very nature of the selling of time-based health services, like it or otherwise, is set up so that the longer it takes the better for the therapist and the worse for the client financially.
One of the other chief problems clients receiving health services based on a session to session basis encounter is the increased likelihood of dropping out of care.
The problem with premature drop outs from the care required is multifold:
- failure to fully rehabilitate can require the client to return for treatment if the problem or injury/pain returns at a later stage (a flare up).
- a return to the treatment process will ultimately incur greater treatment costs as opposed to rehabilitating the condition fully with the first incidence.
- greater frustration levels and potentially heightened anxiety levels may result from a recurrence of a condition or injury.
- overall greater impact on health and physical fitness of the client with a reduction in physical function due to the returning injury.
A Common Mistake: Self Discharging from Care
One of the common mistakes made by clients who self discharge from treatment is that they mistakingly perceive or believe that the absence of pain equates to full rehabilitation. The reality however being that if any of the causative or contributory injury factors remain unaddressed through the rehabilitation process than the client is at risk of experiencing a further flare up. Hence the absence of pain is a poor indicator of an individual being fully rehabilitated.
How POGO Physio Addressed the Problem of Premature Client Drop Outs
The below graph depicts the change that we experienced as a practice in generating client outcomes when we introduced Australia’s first fixed fee unlimited access physiotherapy programs from July 1st 2016.
You can see that several things over the last 18months have improved clinical outcomes* (a clinical outcome is defined as the client getting done what they came to get done-simple). We understand a clinical outcome for our clients to be either: getting out of pain, or back to their physical best-what we term going Into Performance.
When we introduced our 1hr initial consultations (Discover Recover™ Sessions) over a 6 month window our clinical outcomes improved from 34% to 52%. The next significant increase in clinical outcomes was when we introduced our fixed fee unlimited access Finish Line™ Programs. The introduction and initial 6 months of offering these programs to clients increased our clinical outcomes to 60%. Our target as a practice being to be >80% with clinical outcomes for clients.
Finish Line™ Programs
One of the chief differences for clients who had elected to undergo their rehabilitation with a 2, 6, or 12 week Finish Line™ Program was that they benefited from fully completing the required rehabilitation. There was no temptation nor ability to drop out and short change themselves of a full rehabilitation. If a client was to drop out or not attend treatment (in rooms or active rehabilitation) at the frequency required given their upcoming Finish Line™ date (end of treatment) than they would not extract the value from their fixed fee program.
In it to Receive Maximum Value
Drop outs or non attendances rarely occur on Finish Line™ Programs due to the fact that the client has invested in their health up front. Our now almost 12 month experience in delivering Finish Line™ Programs has shown us that clients do what is required to ensure they get their desired result, and also get maximum value from their investment in their program.
Interestingly on average the Finish Line ™ Program client will receive on average 30-40% more in value of services received than their fixed fee. As a practice whilst their is a ‘cost’ to this extra service delivery that the client benefits from on their unlimited access program, the greater ‘cost’ is client’s not getting back to their best when they prematurely drop out of care on a session to session basis. The loss of word of mouth advocacy of a client who could have gotten back to their physical best, yet settled for 60% function mistaking being out of pain as being fully rehabilitated is a much greater cost.
In contrast every time a client crosses their Physio Finish Line™ there is a win: win. The client wins by completing rehabilitation and getting back to their physical best, while the practice wins through the generation of positive word of mouth advocacy for the great clinical outcomes received.
In the next post I will look at the fourth problem of time based billing in physiotherapy, the client being under-serviced.
In the meantime if you are physiotherapy practice owner looking to get more respected results through heightened trust levels with your clients be sure to subscribe for our POGO Partners™ updates HERE>> POGO Partners™ Program.
From July 2017 our industry first Finish Line™ Programs will be available at select Australian physiotherapy practices.
Physio With a Finish Line™,
Brad Beer (APAM)
Author ‘You CAN Run Pain Free!’
Founder POGO Physio
Host The Physical Performance Show
Featured in the Top 50 Physical Therapy Blog