My Cash-Based Story
From New Grad, To Standard Healthcare To...A Thriving Cash Based PT Practice!
Hi, I'm Ron Miller, DPT, OCS, Cert DN,
I'm a physical therapist, just like you, who believes in the vision and benefits of physical therapy. We all experienced what standard healthcare is and how horrible it is...insurance limitations, high productivity standards, being overworked and underpaid, and experiencing the total let down from what we thought practicing physical therapy was suppose to be. Well, there's a better way!
Here is my story (..with a touch of Star Wars) of how I started my cash practice, overcame obstacles, and grew my clinic to reach over $1 million in revenue...all cash! You CAN get paid well for the value you bring, treat patients the way its suppose to be, and have a great work life balance! Enjoy!
Yes...I actually had hair in the past! This is me during an acute care clinical rotation in Charlotte, NC
The Beginning - The Academic Menace And Being A New PT Graduate In The Clone Wars
After receiving my Doctorate in Physical Therapy from University of South Carolina, I wanted to be the best. I contemplated doing a residency or starting working in a clinic. A prominent opportunity came up so I moved to Savannah, GA and started working in a outpatient orthopedic clinic. I quickly saw what standard was like and saw 4-5 patients an hour was not fun...and the documentation!... Being forced to slap some stim and ice, to get that 4th or 5th unit...forget that! I was thankful for my time their and I did get some great mentorship...but I wanted something more.
One of my old mentors reached out to me about doing a new orthopedic residency that they just started in Florida and I was in! Boom! I will be able to do a residency, have great mentorship, get another publication out of it, work a little, and move to Florida....this was it! So I moved to Florida and started a 1 year orthopedic residency. I enjoyed the extra work and grew as a PT . While I was working, I was taking more continuing education courses too. I tried to really surround myself with the best PTs and kept learning from my mentors, as a good padawon should do... But I noticed the treatment and the system was still the same! Still double and triple booking patients and crazy documentation. There was a disconnect from what is best for the patient and what my bosses were telling me to do. This was not the way I wanted to practice nor treat patients. After the residency was completed, I had a meeting with my clinic manager. I was told, I wasn't going to get a raise, I wasn't going to get this, I wasn't going to get that...etc. So I was like..."well I got big and better plans, So I guess I can't work here anymore." So I quit.
I picked up some side shifts at a local SNF and I was actually scheduled to present research at the CSM conference. When I was there, I ran into the director of rehab of the hospital where I did the residency and she came up to me and said..."Ron, why did you quit?" I told her... that I was told that I wasn't getting any raise, etc... but I also told her the numbers... " the average reimbursement per visit in Florida is $70...so I'm seeing 2-3 patients per hour generating over $200/hour for you and you only wanted to pay me $28/hour! Sorry but I cant do that." She looked at me in shock that I knew the numbers and just said...."Sorry" She then proposed me to come back to PRN and work for $45/hour. I agreed to this, just as PRN, but only for the short term...Because I had big plans coming!
Standard Healthcare - Revenge Of The Sith
So I continued working as a PRN and they actually gave me more part time hours at a facility that specializes in spine... I loved the caseload there. I started kicking ass and taking names! I was showing great outcomes. Getting patients better faster. I was developing relationships with local physicians, who were referring just to me, and taking research with them too...I was killing it. Then I had a moment...I was treating 2 patients...one beside me doing exercises on a table and I was treating another one with manual therapy...then I looked up and my 3rd patient was walking in! Damn. I knew I could have helped this patient that I was working on more.. but I had to move on to the 3rd patient. That's not right...and I could have still helped this patient. So, I had to pass them on to a tech to go do some exercises...and still had to make sure they got there 4-5 units in! Later that week, I attended our team meeting and the clinic manager was looking at the clinic and PT stats. She looked at me and said..." We need out PTs to average 4-5 units a visit Ron and you are only averaging 2.5. You need to start billing more." I was getting patients better, faster, in fewer visits, and doing what is best for the patient...but that did not work in this model. The model was designed to maximize revenue per visit and maximize revenue per case and doing what was best for the patient was a conflict of interest. It was like a light bulb tuned on in my head...it just clicked. I had to do something different. This was not the way I wanted to practice nor treat patients. I was tired of the insane documentation that took forever to do and my bosses trying to tell me to bill 4-5 units per visit when I was getting them better in 2.5. I had enough and it was time for a change...I had enough of standard healthcare already! I was tired of being overworked and under paid. I had enough and it was time for a change. I had enough when I was continuously being double and tripled booked with patients! It was time for a change...
Cash Based Physical Therapy - The New Hope
It was time to open my own business but...should I open a standard insurance based practice or open a cash based practice. The standard insurance clinic would still give me the freedom of a small business owner, but I would still be limited by insurance companies. Have to hire staff just to verify insurance and fight for reimbursement, and it would be the same mess and the same system that I just was working in. There has to be a better way. I started researching about a cash based practices and concierge medicine practices. I really liked this concept and it would give me the freedom that I wanted. It would give me the opportunity for One-on-One patient care, to not be restricted by insurance companies, and I would not need such high overhead to get started. If I was ever going to do this, I would have to do this small business/cash based practice now when I was 31 years old, married with a mortgage, but no kids yet. This was the perfect time for me but could a cash based physical therapy practice really work? Would patients pay cash for my treatments when they could go somewhere else and use their insurance? How would patients find me? Could I make enough money (because I had bills to pay and I am apart of the new generation of PT students who come out with $100,000+ in student loan debt), and how do I start. I began reading books, changing my mindset, taking online courses, and thinking in a new innovative way.
My Insurance Rebellion
So I invested $3000 of my own money for start up capital and I started Pursuit Physical Therapy in 2013. I got everything started from registering as an LLC, to consulting with a lawyer and CPA, bank accounts, designing a logo, buying equipment, making my own website, business cards, etc. I decided to not take a business loan to avoid more debt and just reinvest profits back into the business. Where was I going to open my clinic at? Orlando was already over saturated with hospitals, outpatient hospital PT clinics, chiropractors, outpatient PT clinics, acupuncturist, and physician owned clinics. Even massage therapist were treating patients and personal trainers were calling themselves "corrective exercise specialists" and offering post op rehab. I know! This big clinics were dominating the local market so it was going to be hard. I was blessed that one of my former patients owns a lot of buildings around the area, so I asked him if he had any space that I could lease. He just leased a beautiful building to a fertility physician who may have extra space right now. I was introduced to the fertility physician and he was happily willing to lease a room to me, as he was starting his own private practice too. So I found my clinic space: one room, upstairs with 18 steps to get to ( Yes, this was not ideal for a PT clinic), in a Fertility Center building, but the building was beautiful and the lease was affordable for me to start. So I moved in all of my equipment, 2 chairs, finalized paperwork, and then Pursuit Physical Therapy was open for business in April 2013. So I quit my job and had no money coming in. I still had bills, a mortgage, student loans, and no income coming in with a business that had no patients, no referrals, no physician contacts, and no marketing. My wife was not going to like this, but it was time to get to work. I picked up some PRN part time work at some local skilled nursing facilities to help pay some bills. I started hosting guest lectures at certain niche markets, joining the local chamber of commerce, getting involved in local groups, and started ready books on marketing. I had no clue what I was doing. I did so much marketing that showed no results. I bought a window perf banner for the back of my car with Pursuit Physical Therapy on it with the phone number and website (Still to this day after 3 years, it has only brought in 1 new patient!). My website so horrible and it said the same thing as everyone else. Welcome to Pursuit Physical Therapy, we do this, I am this, we do manual therapy, I did a residency, call now! I sponsored local events and races for a low expense, with no one taking any interest. I wasted so much time trying to market (at the time I thought that was good marketing) with no results. Occasionally, a prospective patient would call asking about PT but they would get turned off as soon as I said cash based practice. I knew that I could help people, and show great outcomes, and I viewed myself as a great physical therapist, but still no patients. I charged my time and my per treatment session at $75/hour and I was giving away FREE EVALUATIONS just to get people calling and coming in. I really had no clue what I was doing nor how to run a business. In my first 3 months, I made $350, $175, and $350. This was not working. I quickly learned that you can be the best physical therapist in the word and you could help so many people, but if no one knows about you, your business will not make it. I was struggling with my business and wondering why patients were not coming in!
May The Force Be With You...Because I Need It When The Empire Strikes Back!
Here starts the hustle and the grind! This is where your foundation needs to be strong and be ready to persevere! I started running into other small business owners from networking who would help me out with marketing strategies, what works, what kind of mindset to be in, the sales process, and some better books to read. I started interviewing successful CEOs and attending seminars. I started learning how to market with effective marketing strategies and how to sell. I attended local lectures from sales experts and I started really learning how to sell my product and services. I started surrounding myself with people who are an expert in sales, having a successful business mindset, talking to millionaires, and successful entrepreneurs. Another big break I got, was attending a business lunch and socializing with a friend at a local radio station. This was around a time when I was questioning what I was doing. Is this the right thing that I should be doing, can I make it in a cash based setting, should I continue, etc. and BAM! Look who wins free radio time over a two week period! ME! Talk about your prayers being answered! Even though it wasn't during peak hours, it was free airtime that could really help get my marketing efforts going. My marketing strategies started to be effective, learning how to sell, and continuing to strive for business knowledge with reading books. In my fourth month, I broke my first $1000. By the seventh month I was generating over $3000/month in revenue. I started writing important content, learning SEO to drive traffic to my website, learned how to start PPC on Google, and how to take advantage of social media. I was growing and starting to generate revenue.
Success! It Works! - The Return Of The Jedi
My business was growing and and my WOM was starting to pick up. By now I have fine tuned my marketing approach, corrected my sales process, implemented my marketing strategy, and I was running my business full throttle and it was working. Early in my second year I broke the $5000/month and by the end of the second year I was reaching $10,000/month. I reached my break even point. Profit! I wish I would have known this stuff earlier when I started in the first year.
This is the time when I started to become obsessed with studying successful people, why some businesses succeed, while others fail, personal growth, and success books. I stopped reading marketing books and switched to personal growth and success books. I wanted to learn what qualities make certain people successful and if I could do this, I could continue to grow Pursuit and run a successful business. I started watching Shark Tank and honestly, learned a lot from this show. I always imagined myself on the show in front of the sharks and what they would say to me. (Even though they do not do health care businesses and I understand why! Why would anyone get involved or invested in a insurance based healthcare business with insurance limitations, declining reimbursement, and Medicare is going bankrupt. What business to do you deliver the product or service and not get pain, finish the service roughly a month later, still not get paid, wait 1-3 months for payment, and then get paid 50% of what you billed or even get denied reimbursement?) My business was doing great and I was so busy that I didn't even have time to market anymore. I was generating over $15,000/month of revenue and growing strong! I was developing a great name and reputation for myself in Orlando and I was helping a lot of people get pain free again. It was time to move and expand.
The Future Of Physical Therapy And The Force Awakens
April 2015 I expanded my location (it was time to get out of the Fertility Center and the 18 steps) to more space and I hired another physical therapist. I also had a well known massage therapist working with me too. I have mastered my system of sales, marketing, and how to run my cash based PT business and now Pursuit is generating easily over $15,000 of revenue a month and still growing. My first year was truly a proof of concept business. I made plenty of mistakes, failed multiple times, and wasted thousands of dollars on unproven marketing. I struggled for that first year with the business and was trying to make ends meet. I'm not going to lie, it was hard. Probably the hardest thing I have ever done in my life. But I pushed through and made it. My second year I learned how to sell and run a business efficiently. My third year we continued to grow reaching $250,000+ in yearly sales. In my 4th year we expanded again, brought on a 3rd PT, added new services, and almost reached a 1/2 million in sales in 2017. A cash based PT clinic DOES work and even in an over saturated market. This is my passion and my dream. I will continue to grow Pursuit Physical Therapy as I build my team of expert physical therapists, only treating with One-on-One care, showing better outcomes than standard healthcare. I believe this is how outpatient physical therapy will survive healthcare reform. I want to help others do the same thing. No more double and triple booking patients. No more being overworked and underpaid. No more insurance limitations. No more struggling to pay bills and the insane amount of student loan debt we have. You can practice and treat patients the way its suppose to be. I want the outpatient physical therapy profession to survive and to show that we can add value to the healthcare system, showing great long term outcomes, that are cost effective, and have proven results. The cash based model works!
Growing A Business, Scaling, And The Rise Of Skywalker
Yes, I did skip The Last Jedi, because that was the worst one and didn't fit...Our company values and company purpose is set. God. Family. Work. Now we are trying to scale Pursuit Physical Therapy and take it to the next level. We have a Dream Team of expert clinicians. The hiring process is set. We are starting additional cash based services to our model...like a medical fitness program and throwing velocity program. We are looking to expand into a new facility to hold all of this and next we will open a second Pursuit location.
The Vision And Being Grateful For The Blessings
I am truly grateful for everyone that has influenced my life. My family and those who have helped guide me along the way. I look forward to expanding on this story, as I continue to follow God’s path. Keeping my priorities God, Family, and then work...to be great husband and father... continuing to work hard to do what is best for the people of Orlando, and...strive for a higher standard in healthcare. I am excited for what the future holds for Pursuit Physical Therapy and for Cash Based Physical Therapy. To help more people in Central Florida with high quality healthcare, to do what is best for the patient at all costs, and to help other physical therapist do the same.
"So stop tolerating excuses within yourself, limiting beliefs of the past, or half-assed or fearful states. Use your body as a tool to snap yourself into a place of sheer will, determination, and commitment. Face your challenges head on with the core belief that problems are just speed bumps on the road to your dreams. And from that place, when you take massive action -with an effective and proven strategy-you will rewrite your history. It's time to no longer be one of the many but to become one of the few. One of the few who step up, own your true capability financially and in every area of your life. Most people start out with high aspirations but settle for a life and lifestyle far beneath their true capabilities. They let disappointment destroy them. Disappointment is inevitable when you are attempting to do anything of great scale. Instead, let your disappointments drive you to find new answers; discipline your disappointments. Learn form every failure, act on those learnings, and success becomes inevitable."