Latest / Pelvic PT Rising / Cash-Based Services Increase Patient Access

Transcript

Cash-Based Services Increase Patient Access · Pelvic PT Rising

• 0:02
  Speaker 1: In the last 10 years, our field has gone from an unknown specialty to a household name.
• 0:09
  Speaker 1: This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve.
• 0:17
  Speaker 1: In order to help others get better, we need to be better.
• 0:23
  Speaker 1: This podcast will help you to become more confident with your patients, more successful in your practice or business and a leader in pelvic health, and we're going to have some fun along the way.
• 0:36
  Speaker 1: Join us as we rise together.
• 0:39
  Speaker 1: We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle, and this is Pelvic PT Rising.
• 0:53
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hey, nicole, hello.
• 0:59
  Speaker 2: Today's topic is when we are really fired up about how cash-based services actually increase access to care.
• 1:08
  Speaker 1: And yes, you heard that correct.
• 1:09
  Speaker 2: Yes, you did.
• 1:10
  Speaker 2: So we're going to dive into that and why this is such an important topic.
• 1:14
  Speaker 2: But first one quick announcement.
• 1:16
  Speaker 2: If you guys have been on the fence procrastinating, today is the final day If you're listening to this, on the day it drops to get the early bird discount on the PelvicCon recording.
• 1:26
  Speaker 2: You're going to save $50,.
• 1:28
  Speaker 2: You're going to get access to 15 talks by world-class speakers, all trailblazers in the field.
• 1:33
  Speaker 2: You're going to get access to the PelvicCon manual, 500 plus slides, everything, all the things.
• 1:39
  Speaker 2: So if you haven't done that, make sure you head to pelvicconcom slash recording to make sure you get that If you are coming.
• 1:46
  Speaker 2: Don't worry about that, you guys are all set.
• 1:48
  Speaker 2: Just be worrying about packing and getting ready to come, because it's happening.
• 1:52
  Speaker 1: Yes, I'm so excited.
• 1:54
  Speaker 1: For those of you who are coming in person, I'm so excited to meet you, to say hi, to have you experience PelvicCon.
• 2:02
  Speaker 1: If you're coming for the first time, I'm even more excited for you to come, and if you are a second timer, I am super excited to see you again.
• 2:11
  Speaker 2: Yes, it will be a game changer in your career.
• 2:15
  Speaker 2: We already saw that from everyone who came last year.
• 2:18
  Speaker 2: So, nicole, let's go ahead and dive in.
• 2:20
  Speaker 2: Cash-based services actually increase access for patients, and this is something that comes out of, I think, a.
• 2:30
  Speaker 2: I think it's a stereotype or an accusation.
• 2:34
  Speaker 2: Frankly, that has been going on for a very long time that cash-based services decrease access because some people cannot afford cash services, which is absolutely true.
• 2:44
  Speaker 2: There are a subset of people who cannot afford to pay out of pocket for services.
• 2:51
  Speaker 2: That is 100% true.
• 2:52
  Speaker 2: But I think that the cash-based community has played into this and then tried to defend ourselves against it.
• 2:59
  Speaker 2: It's like, well, no, we don't really decrease access that much because our prices aren't that high, or maybe we offer packages, or maybe someday I can offer a pro bono thing.
• 3:12
  Speaker 1: Or we also get into the oh well, you know I understand what you're saying, but I needed to do this for me to decrease burnout and I really feel great about what I'm able to provide.
• 3:24
  Speaker 1: So it's always this yeah, I totally understand you, and a little bit of agreement, and then an excuse or a reason why we chose to go a different path.
• 3:37
  Speaker 1: And today, my friends, that freaking ends.
• 3:43
  Speaker 2: Yes, we're going to flip this on its head, so I'm going to get it into some of the really specific examples here, but I think a couple of things.
• 3:50
  Speaker 2: You know, guys, we always want to take the best form of the argument on this podcast, but a couple of things to be thinking about when it comes to access one, and I think that we don't often just say these things out loud.
• 4:02
  Speaker 2: So we're going to say them.
• 4:03
  Speaker 2: We're going to be honest and raw.
• 4:04
  Speaker 2: Most insurance based providers don't accept all insurances.
• 4:08
  Speaker 2: I can't tell you.
• 4:09
  Speaker 2: I've always had an individual plan.
• 4:11
  Speaker 2: I've been rejected from going to a lot of different places.
• 4:14
  Speaker 2: Oh, we take Blue Cross, but not your Blue Cross.
• 4:17
  Speaker 2: I was like what the fuck does that?
• 4:18
  Speaker 1: mean.
• 4:19
  Speaker 2: Totally.
• 4:19
  Speaker 2: It's literally a huge sign on your website that says you take Blue Cross.
• 4:23
  Speaker 2: You can't tell me you take Blue Cross and not my Blue Cross.
• 4:26
  Speaker 2: And are you taking every insurance?
• 4:29
  Speaker 2: Are you taking your?
• 4:30
  Speaker 2: You know your states in here it's Medi-Cal, whatever that is.
• 4:33
  Speaker 2: The answer is usually not.
• 4:35
  Speaker 2: The answer is usually that insurance based providers are picking and choosing which plans to take because of the reimbursement rates, because of how easier, difficult the insurance is to work with, which is fine.
• 4:48
  Speaker 2: That's the right as a business to do, but it's not like everyone gets to go to an insurance practice for free all the time whenever they want.
• 4:56
  Speaker 2: Totally.
• 4:57
  Speaker 1: In fact, this is a little known fact that I want to be a very well known fact and I'll tell you a little story that I have changed over the course of my career when I've been marketing to different doctors.
• 5:09
  Speaker 1: So I used to be really scared when somebody would ask me oh, do you take insurance?
• 5:14
  Speaker 1: When I was marketing for public sanity, which is a cash-based practice.
• 5:17
  Speaker 1: And now one of the first questions that I ask back when they ask me do you take insurance, I say do you take all insurances?
• 5:25
  Speaker 1: And that one sentence and one question flips it and they say actually, no, we don't take this, we don't take that, we don't take that.
• 5:34
  Speaker 1: And I said, cool, Well, all of our services are covered by our out of network physical therapy benefits.
• 5:39
  Speaker 1: So my point with that story is that they don't take all insurances either.
• 5:45
  Speaker 1: There's HMOs they don't take.
• 5:46
  Speaker 1: There are certain other plans, like Jesse was talking about with these PPO plans that they don't take.
• 5:51
  Speaker 1: They sometimes they don't take the state in California it's called Medicaid and your state is probably called something different but they make decisions as well where they exclude low paying plans, Period, Like do you guys understand that?
• 6:08
  Speaker 1: I need you to understand that and if you are working at a an insurance-based practice, you too are in some way in.
• 6:19
  Speaker 1: Your higher ups are making decisions on what insurance coverage you have at for physical therapy or occupational therapy.
• 6:26
  Speaker 1: That decision is being made for you Period.
• 6:31
  Speaker 2: So this is one where we would always ask if someone is making this statement or even thinking it.
• 6:38
  Speaker 2: Just ask yourself is this a glass houses and throwing stones situation is the place you're working, taking literally every insurance out there.
• 6:47
  Speaker 2: Now maybe they are fine.
• 6:48
  Speaker 2: We're going to take the best form of the argument with some of this stuff.
• 6:51
  Speaker 2: The other thing that we always see is that many plans and this is escalating now but many plans and insurance world have high deductibles.
• 6:59
  Speaker 2: So what does that mean at an insurance practice?
• 7:02
  Speaker 2: A lot of times, it means they're actually paying more to go until they've met a deductible, and I want to.
• 7:08
  Speaker 2: I mean one of the reasons we're so fired up about this, nicole.
• 7:10
  Speaker 2: Three different instances we could think of this week that illustrate why this is so important.
• 7:16
  Speaker 1: Yes, and we'll talk about the high deductible situation first here.
• 7:20
  Speaker 1: So what most people don't understand is that when hospital-based programs are negotiating insurance-based contracts, they have a contracted rate and then they have an actual rate.
• 7:30
  Speaker 1: So what the patient has to pay is the actual rate, which is the bullshit rate that they deliberately set higher.
• 7:41
  Speaker 2: They let the insurance company negotiate them downwards and the insurance company pays them, let's say, $200 an hour, and they're happy with it.
• 7:48
  Speaker 2: The insurance company is happy with it.
• 7:50
  Speaker 2: The person who's not happy with it is the person at our local hospital paying $450 or $500 plus dollars for a 45-minute evaluation.
• 7:59
  Speaker 2: Because they're trapped in that and even though the insurance company wouldn't have paid that anyway, the hospital is forced to charge them that until they've met their deductible.
• 8:09
  Speaker 2: So we've literally had people at Public Sanity saying I can't afford to go to the insurance practice and then my jaw hits the floor Like I don't even know how to respond to that on the phone, sometimes Like wait what you can't afford to go to it.
• 8:19
  Speaker 2: I don't want to be the.
• 8:19
  Speaker 2: You shouldn't be coming here because it's the cheap option.
• 8:22
  Speaker 2: You should be coming here because we're the best.
• 8:24
  Speaker 1: Well, and here's the thing though it's like, this is the stuff that we need to be talking about, because I don't think that that's a common story, even though it's a common happening.
• 8:34
  Speaker 1: That's not a common thing that you're hearing, but it's happening every freaking day.
• 8:39
  Speaker 1: That happened to us in some form or fashion, like five times last week.
• 8:44
  Speaker 1: We're going to give you three examples of ways that cash PT and cash pelvic rehab can actually increase access.
• 8:52
  Speaker 1: But the high deductible is is one of them, and so it can actually be I'm not joking you guys more expensive to use your insurance if you have a high deductible at an insurance based practice.
• 9:05
  Speaker 1: Then coming to a cash phase practice and we need to understand that as a group, to understand how much we're getting fucked by insurance companies all the time- Very true.
• 9:17
  Speaker 2: And then, nicole, you ran into this head on.
• 9:19
  Speaker 2: You were talking at a mom's group which, by the way, the insurance based practices don't have time to send people to.
• 9:24
  Speaker 2: We'll talk about that stuff later but you were talking at a mom's group and someone who literally couldn't even get in when they were pregnant.
• 9:32
  Speaker 1: This is crazy, you all.
• 9:33
  Speaker 1: So I was talking at a mom's group and there was probably, I don't know 12 to 14 moms in this group and they were about four to five months postpartum.
• 9:43
  Speaker 1: And so I usually always ask like, oh, hey, has anyone heard of pelvic rehab, has anyone gone to pelvic floor therapy?
• 9:49
  Speaker 1: And increasingly over the years, a lot of people raise their hands.
• 9:52
  Speaker 1: In this case someone said, yeah, actually, hey, can you go with your pregnant as well at your practice?
• 9:59
  Speaker 1: And I said, absolutely, we highly recommend it.
• 10:02
  Speaker 1: And she was like, oh, that's super frustrating.
• 10:04
  Speaker 1: My doctor totally said that I didn't need to come during pregnancy.
• 10:09
  Speaker 1: So, you know, and I wanted to advocate for myself and so I asked to go postpartum as early as possible.
• 10:16
  Speaker 1: And so at my six week check I really said like I really want this thing.
• 10:21
  Speaker 1: I didn't go during pregnancy and now I really want to go to pelvic floor therapy.
• 10:25
  Speaker 1: And they said, sure, here's a prescription.
• 10:27
  Speaker 1: And guess what?
• 10:28
  Speaker 1: The wait list at the hospital based program that this physician sent her to was four to five months out.
• 10:35
  Speaker 1: She was already six weeks postpartum.
• 10:40
  Speaker 1: She was going to have to wait four to five months.
• 10:42
  Speaker 1: Her baby, as I'm sitting there, is four and a half months old and she has not yet gone to pelvic floor therapy because of the wait list at this freaking hospital.
• 10:52
  Speaker 2: And she couldn't have ever gone in pregnancy.
• 10:54
  Speaker 2: Like that's the other thing.
• 10:55
  Speaker 2: I get calls all the time for people who are 34, 35, 36, 39 weeks pregnant and they call their local insurance based practice and they're saying, well, great, you can come in in four months.
• 11:08
  Speaker 2: She's like, well, I'm pretty sure I'm not going to be pregnant in four months.
• 11:11
  Speaker 1: That's like a physically impossible for me to be pregnant still, come on, you guys.
• 11:17
  Speaker 2: And then we had another one today in our finding public sanity online support group, where a person that Nicole had actually done a remote consult with was asking questions about.
• 11:26
  Speaker 2: You know, her PT had either retired move, something like that.
• 11:30
  Speaker 2: She found another person and the facility would only allow her to come in every three to four weeks for two reasons One, they were so impacted on their schedule and two, her symptoms weren't quote that bad because she wasn't in an acute pain.
• 11:46
  Speaker 2: She just wanted to get back to running and doing things that she loved, and they decided to prioritize everybody else in front of her, so she could only come in every three or four weeks, which, on one hand, I kind of understand when you're that crammed, you have to tree are somehow but also you can't tell me that that person was getting access to high quality care.
• 12:06
  Speaker 2: So we're going to run through some of the things that we're talking about when we think about access, because I think we've allowed this debate, this conversation, to be centered solely around cost for far too long.
• 12:19
  Speaker 2: And cost is one reason that someone would not seek out medical care.
• 12:23
  Speaker 2: That's undeniably true, but what we forget are the dozens of other reasons that people don't come in and I would argue that most of them are actually more impactful than cost.
• 12:34
  Speaker 2: And the first one is that they don't even know that public rehab is a thing.
• 12:38
  Speaker 2: They don't know that that's something that they can get.
• 12:41
  Speaker 2: They don't know that they have other options and who's out there doing it.
• 12:45
  Speaker 2: I know there are some people who work in insurance practices who are doing their best to educate, but whenever I look around online it's people who run cash based practices who are marketing for their practice.
• 12:55
  Speaker 2: If I look in person, we see this here in Orange County.
• 12:57
  Speaker 2: We go and support a local fit for mom group who shows up.
• 13:02
  Speaker 2: It's three different cash based public PTs Hospitals not sending somebody the orthopedic place who does public rehab as an add on pretends to do public rehab.
• 13:13
  Speaker 1: They're not there.
• 13:14
  Speaker 2: Isn't sending anybody.
• 13:14
  Speaker 2: It's cash based public PTs who are out in the community, who are educating, who are talking to these folks, who are getting more people to come in the door, and that's good, whether you're an insurance based provider or cash based provider, whatever that is.
• 13:28
  Speaker 2: But the single biggest reason that people aren't coming in is because they don't know about it, and the people I see who are doing the most work in that area are cash based practices who are out there letting people know about what we can do and we've already talked about.
• 13:41
  Speaker 2: Another barrier to access is wait time.
• 13:43
  Speaker 2: If someone is pregnant and you have a three to four month wait list, that an insurance practice you might as well not fucking exist.
• 13:49
  Speaker 2: Why are you like, literally, why are you there?
• 13:53
  Speaker 1: Yeah, that one really bothers me too, because you know, with all the work that we're doing to increase awareness, we have to be able to accommodate these people.
• 14:03
  Speaker 1: So, with all of the education that we're doing and I know over the last few weeks and months I've been really advocating for us to get out and on social media and that is a very valid thing that we're doing in the field, and it doesn't have to be perfect, but we have to be doing it and all of the things.
• 14:19
  Speaker 1: But if we're going to increase awareness in that way, we also have to make sure that we can accommodate the people that we are going To be serving.
• 14:28
  Speaker 1: It's not like come to pelvic rehab and then whoops, just kidding have your baby first and then get Substandard care because I didn't have room for you.
• 14:39
  Speaker 2: This doesn't do it and usually and you've experienced this, nicole, you've worked in these kind of settings it's not like the hospital administrator or your boss is treating it like a national Emergency, that they need to find another perfect person to help you.
• 14:51
  Speaker 2: When you have a three month wait list, it's like ah, whatever, that's fine, just make it work.
• 14:55
  Speaker 2: Triage people however you want.
• 14:57
  Speaker 2: That's how somebody ends up coming in once every three to four weeks and and you know what the tune that's.
• 15:02
  Speaker 1: The other thing is is that that creates in our field is freaking burnout, because we care sometimes more than our facilities do about Getting in.
• 15:12
  Speaker 1: We I have heard more burnout stories from people having massive like Legit anxiety because the facility that they're at can accommodate the amount of people and we're taking that on personally when the system is the huge problem and it's too much and the system does not care.
• 15:33
  Speaker 2: But you're right, we see people who don't feel like they can take a vacation or are worried about it, or working extra hours and essentially not getting paid for that.
• 15:42
  Speaker 2: I mean, you did this, nicole, for a long time, when you know you had such an administrative burden by being the only person, the person who started this program.
• 15:49
  Speaker 2: You were, you know, working two to three hours at night for free for this hospital for years.
• 15:54
  Speaker 1: And I was adding patients into my documentation time and then doing my documentation at home and all of the stuff.
• 16:00
  Speaker 1: And all that is to say is that having cash based therapy services, cash based pelvic rehab services, helps with these wait times.
• 16:11
  Speaker 1: We have way more control over that Than a hospital based program does.
• 16:16
  Speaker 1: Hospital based programs a lot of times are running huge wait lists.
• 16:21
  Speaker 2: So and if you're running a huge wait list at a cash practice, that doesn't fly.
• 16:25
  Speaker 2: So when we run a huge wait list at public sanity, guess what we do?
• 16:28
  Speaker 2: We freaking hire somebody, we train them and we get them ready to see patients Because people don't know they don't come in.
• 16:34
  Speaker 2: That's a barrier to access, because there's too long of a wait time as a barrier to access.
• 16:38
  Speaker 2: Distance is a barrier to access and especially in some more rural areas.
• 16:43
  Speaker 2: A lot of our mentees are in areas where someone would have to drive Two, three hours to get to care and especially if that's a 30 minute appointment, that's a hard sell.
• 16:53
  Speaker 2: You're going to drive two and a half hours, Get to work with someone for a half hour and drive two and a half hours back and you're saying that the cost is the single biggest difference, like shoot the gas money alone to get there, probably cost more than the appointment Did yeah, totally.
• 17:08
  Speaker 1: I mean.
• 17:08
  Speaker 1: So we're trying to point out here just things that are Not good.
• 17:12
  Speaker 1: What's the phrase?
• 17:13
  Speaker 1: Is that oxymoron?
• 17:14
  Speaker 1: No, it's not an oxymoron.
• 17:15
  Speaker 1: I always get that mixed up.
• 17:18
  Speaker 2: Oxymoron is like jumbo shrimp.
• 17:20
  Speaker 1: Right, but it's a phrase, yeah, and it's a phrase Like a chill pelvic PT.
• 17:27
  Speaker 2: That's exactly.
• 17:28
  Speaker 1: Good job, jesse, but things that's like just don't match.
• 17:31
  Speaker 2: In congruence, in congruence.
• 17:35
  Speaker 2: Now you're making me spell, now you're making me say words I've only ever seen on in Jesse actually has a really bad problem with this.
• 17:41
  Speaker 1: He reads all the time and sometimes, when I actually have him read out loud to me Something, it's like that's not that, that's not how you pronounce that word.
• 17:48
  Speaker 1: He was like that's just pronouncing it in my head.
• 17:51
  Speaker 1: I'm like kindle and I'm like, oh my gosh.
• 17:55
  Speaker 2: We're not hanging out with the right people, but I don't hear people walking around talking about incongruous things all the time.
• 18:00
  Speaker 1: Anyways, whatever it's like opposite.
• 18:02
  Speaker 2: So you know we talked about distance.
• 18:04
  Speaker 2: We've already talked about high deductibles in those places.
• 18:07
  Speaker 2: Maintenance and wellness is another really big area.
• 18:10
  Speaker 2: So that was a perfect example of that remote patient, nicole, that you had talked to a while ago, who was basically being kicked out of a program because she wasn't that bad and all she wanted to do was to get back to being able to run Long distances.
• 18:27
  Speaker 1: She wanted to do a marathon eventually and the thing is is that she used to be a marathon runner.
• 18:32
  Speaker 1: You guys, and we have worked with her over the years in conjunction with her local public rehab providers.
• 18:40
  Speaker 1: The fact that she even has this goal in and of itself like makes me Want to almost tear up the fact she was in such a dark place and so to have her now be like I actually believe that my symptoms are going to continue to get better.
• 19:02
  Speaker 1: I want to work on my running form and we figured out that that's a lot of the root cause of why she was having these penile nerve symptoms in the first place.
• 19:12
  Speaker 1: The fact that she is now getting told, oh, you're not that bad, you can't be seen to get to your end goal is Talk about trauma-informed care.
• 19:24
  Speaker 1: That's like no trauma-informed care.
• 19:27
  Speaker 1: That is Re-opening all of those wounds like my goals aren't important enough.
• 19:33
  Speaker 1: She wants to do that.
• 19:34
  Speaker 1: She's been working to be able to say one day, I want to run a marathon.
• 19:39
  Speaker 1: She actually believes it, she wants to work on it, and the freaking Practice that she's trying to go to is saying you're not that bad, our waitlist times are here and it's insurance-based practice and I was like, uh, we have to start thinking about this differently, because she can go To cash-based practice and get seen right away and that person's gonna be fucking stoked to get her back running for the marathon and working with her for a year and who cares, screw the insurance company, with them saying like, oh, she's fine, now she can have sex, she's not leaking on the floor, but she can't still run without feeling that she's got a golf ball up her ass, like that is a problem that is still working on and we can do that as a cash-based practice.
• 20:28
  Speaker 2: Yes, and this also leads in, I think, nicole, to another barrier to access for people is even just the comfort of going to a place, what the physical facility is like, frankly, even what parking is like.
• 20:39
  Speaker 2: So think about this in your facility and just be thinking about is this a place where people with pelvic health issues can be comfortable?
• 20:47
  Speaker 2: And one of our local places is an insurance-based place.
• 20:51
  Speaker 2: They do great orthopedic stuff.
• 20:52
  Speaker 2: They do a bunch of stuff with the local high school football team.
• 20:56
  Speaker 2: That's awesome.
• 20:57
  Speaker 2: But you really want to be talking about, if you're a 50-year-old woman with painful intercourse, all the things that are going on in your relationship and when it hurts and what position and all that stuff when there's a much a 300-pound lineman on the other side of this half-inch thick door and you're not sure that they're listening, whether they're throwing weight around in the gym.
• 21:16
  Speaker 1: Yeah, or you know that they're not listening, but they're grunting and like jashing around with each other and it's just not conducive to the type of therapy that we're providing.
• 21:25
  Speaker 1: It's just not cool.
• 21:27
  Speaker 1: They're doing their freaking football drills on the other side of the wall.
• 21:31
  Speaker 1: You have to walk through this one place.
• 21:33
  Speaker 1: You have to as a pelvic floor person, as a person with pelvic floor symptoms.
• 21:37
  Speaker 1: You have to literally hop over some of these cones that these kids are weaving in around and they're not paying attention.
• 21:46
  Speaker 1: You're getting knocked over half the time and it's like I just am trying to get back to this private room it's all the way in the back because it's a freaking add-on service at this place and it's like you want to talk to me about access.
• 21:58
  Speaker 1: Are you kidding me?
• 21:59
  Speaker 1: Like stop.
• 22:01
  Speaker 2: That's a one-time visit and then not coming back kind of access.
• 22:05
  Speaker 2: And then another one that we talk about a lot is early discharge, of discharging people when the insurance says that they are supposed to be, when they run out of their insurance visits.
• 22:15
  Speaker 2: And I can't tell you how many people we've had come to public sanity who said that pelvic PT, pelvic rehab, didn't work for me and we start probing a little bit more and they've had a 20-year history of vaginismus and their insurance gave them eight visits and they weren't cured at visit eight, whatever that means.
• 22:33
  Speaker 2: And so they were discharged and they weren't told that this is because your insurance is limiting you.
• 22:39
  Speaker 2: They were just said well, you're done and you've got a dilator.
• 22:42
  Speaker 2: So I don't know what the problem is.
• 22:44
  Speaker 1: Yeah, this actually happened not too long ago as well, like somebody had come in for vaginismus, actually made really great progress in a relatively short period of time.
• 22:54
  Speaker 1: Except for that, they weren't sexually active yet.
• 22:58
  Speaker 1: So we think the sexual activity is going to be OK, but we don't know, and so we have the ability then to put them on a sort of maintenance plan to sort of see if a relationship pops up, if they actually are able to test, is this working?
• 23:15
  Speaker 1: We keep contact with people.
• 23:17
  Speaker 1: Like that's improving access to care to us for questions, concerns things that pop up.
• 23:25
  Speaker 1: That is improving access.
• 23:28
  Speaker 1: Improving access is not discharging that person, being like good luck, hope you have fun on Tinder.
• 23:33
  Speaker 1: Like no, that's not the thing.
• 23:37
  Speaker 2: Yes.
• 23:37
  Speaker 2: So I hope that you guys have, by this episode, seen there are a lot of potential barriers to access.
• 23:44
  Speaker 2: And yes, cash pay or private pay is a barrier for some people, but so is never hearing about public rehab, so are wait lines, so are distance, so are high deductibles, so is not wanting to go into a hospital setting, so is not being able to do maintenance or wellness, or having a facility that really makes people who have pelvic pain issues feel comfortable, or discharging people as soon as their insurance says that they are.
• 24:07
  Speaker 2: All of those are barriers to entry and I would argue that most of those are far more than the out-of-pocket cost for this.
• 24:18
  Speaker 2: So why are we putting cost on a pedestal instead of distance or wait times, or not even ever hearing about public rehab?
• 24:27
  Speaker 1: I just want to reiterate and echo a little bit what Jesse was saying, because I know that there's some people listening that are going to try to yeah, but us right now, yeah, but, and then you're going to go right back into your old pattern of defending the fact that cost is, you think, is the single most important factor, and I'm asking you to please open your mind and think about all of the different factors we just listed.
• 24:50
  Speaker 1: What Tenish, yeah, tenish, tenish factors, of which cost is one that are potential barriers where cash actually wins.
• 25:02
  Speaker 1: Cash wins on a lot of these different areas and it does happen for some folks to lose on cost, but not even as many people as you might think If you really take a look and break down what the need of the patient is, how they're paying for that service and what the facility is actually doing and how they're taking payment.
• 25:26
  Speaker 2: Yes, so I hope that we have at least made a very convincing argument for you guys that cash-based services are actually increasing access because of all of those different things.
• 25:36
  Speaker 2: A couple of other things I just want to point out.
• 25:38
  Speaker 2: We've now worked with more than 400 cash-based practices.
• 25:42
  Speaker 2: No-transcript.
• 25:43
  Speaker 2: I don't remember once, our advice being to tell them to go and fire bomb the local insurance practice.
• 25:51
  Speaker 1: I know this is like such another.
• 25:52
  Speaker 1: What do you call this?
• 25:53
  Speaker 1: A straw man argument?
• 25:55
  Speaker 2: It is a straw man argument because the insurance based practice in their town still exists.
• 26:00
  Speaker 2: All they are doing is providing opportunity for competition and opportunity for choice for patients, and no one is holding a gun to anyone's head and forcing them to go to a cash based practice.
• 26:13
  Speaker 2: They are adding an additional option.
• 26:16
  Speaker 2: No one looks at Mercedes and is like, wow, mercedes is really expensive.
• 26:21
  Speaker 2: They're eliminating access to driving cars.
• 26:24
  Speaker 2: It's like what the fuck?
• 26:25
  Speaker 2: They didn't put Kia out of business?
• 26:27
  Speaker 2: Kia still exists, if you want to Kia.
• 26:30
  Speaker 1: You can totally go Go get a Kia.
• 26:33
  Speaker 1: Kia is a nice car, right.
• 26:34
  Speaker 2: Kia might be a just fine car.
• 26:36
  Speaker 1: That's the thing, you guys, is that it's not a zero sum game.
• 26:41
  Speaker 1: It's not like everybody that goes to a cash based practice can't go to an insurance based practice, or doesn't.
• 26:45
  Speaker 1: It's just expanding the pie.
• 26:49
  Speaker 1: It's expanding the choice for folks.
• 26:51
  Speaker 1: So, by definition, being a cash based service in an area where there's also an insurance based service is increasing access for all of the reasons that we just said, and I also will.
• 27:04
  Speaker 2: Just, I want to end on this.
• 27:06
  Speaker 2: I think unless, nicole, you have another thought but cash based services are going to be the single biggest change factor in our field.
• 27:14
  Speaker 2: If your salary goes up over the next five years, it's not going to be because insurance reimbursement went up.
• 27:20
  Speaker 2: It's not going to be because Medicare reimbursement went up.
• 27:24
  Speaker 2: It's not going to be because insurance companies started giving a shit about your PRPC or your WCS or your 25 years of experience or all the con edge you took, or the fact that you went to Pelvicon and you're going to be a freaking way better practitioner.
• 27:37
  Speaker 2: They're going to still pay your facility the same, whether it was you providing the service or a brand new grad or a high school aid.
• 27:43
  Speaker 2: The thing that is going to change things in this field and hopefully we very much believe for the better is the rise of cash based services, and that is going to have a rising effect on everything.
• 27:55
  Speaker 2: A rising tide lifts all ships.
• 27:58
  Speaker 2: So if you want something to change in this field, it's not going to change because of the insurance model.
• 28:03
  Speaker 2: We know what that is.
• 28:03
  Speaker 2: We know what that looks like.
• 28:05
  Speaker 2: It's decreased reimbursement every year.
• 28:07
  Speaker 2: It's more patience, it's more productivity, it's seeing two patients at a time, it's using aids, like we know what is, down that road, the thing that's going to change things for you.
• 28:18
  Speaker 2: Even if you work at an insurance practice and you're super happy and God bless, you like freaking great, we need people there.
• 28:24
  Speaker 2: So this is not an attack on you.
• 28:26
  Speaker 2: If you work in an insurance practice at all, it's super important, like we say, to have more competition, more choice for patients, but the only thing that's going to change your circumstances for the better is the rise of the cash based movement.
• 28:39
  Speaker 2: That's the truth.
• 28:40
  Speaker 2: Like that's the only thing that's going to change this field.
• 28:43
  Speaker 1: Totally.
• 28:44
  Speaker 1: You guys should be rooting for that to to be a thing, because then guess what?
• 28:49
  Speaker 1: People are going to be forced to change because the consumer is going to start to demand better stuff.
• 28:55
  Speaker 1: We live in a capitalistic, insurance based society.
• 29:00
  Speaker 1: That's what happens.
• 29:02
  Speaker 1: So when the consumer starts to demand stuff and better access and better essentially better product, then people are going to have to decide how are you going to do that?
• 29:13
  Speaker 1: How are you going to satisfy the customer?
• 29:14
  Speaker 1: And the customers are getting smarter, and a lot of times they're getting smarter is because we, as pelvic rehab practitioners, are actually teaching them how to consume our services better.
• 29:27
  Speaker 2: Boom.
• 29:28
  Speaker 2: So I know we were fired up there.
• 29:30
  Speaker 2: Nicole, I just want to say much love to anybody out there, whatever Practice your in and I know we talked a lot about cash based services If you are still in an insurance practice or you are passionate about that, then, like we said, that is amazing, it's really great, and I do.
• 29:45
  Speaker 1: I'm going to actually interrupt you, jesse, for a second, because if you are working in an insurance based practice right now, you can't.
• 29:52
  Speaker 1: The lesson from this podcast is not I need to get out or this is terrible.
• 29:59
  Speaker 1: What we're trying to do with this podcast is expand everybody's minds that it's not insurance versus cash.
• 30:10
  Speaker 1: It's just that cash based services don't decrease access like we've been villainized to do.
• 30:18
  Speaker 1: That's not the reality of the situation, and everybody that is going to thrive in a cash based market is going to also lift the way that pelvic rehab is provided in some form or fashion.
• 30:33
  Speaker 1: The lesson is not we think that everyone needs to go into cash.
• 30:37
  Speaker 1: That's not the lesson here.
• 30:38
  Speaker 1: We think that it's wonderful if you've chosen to work at a place like that, but I do want you to be aware that you are also, in some form, in limiting access in certain ways, based on how your place of business is choosing to Provide pelvic rehab and that's it.
• 30:56
  Speaker 2: So there is a room at the table for everyone.
• 30:59
  Speaker 2: Our job is to expand the pie.
• 31:01
  Speaker 2: I love what you said, nicol, about this is not a zero-sum game.
• 31:04
  Speaker 2: It's not insurance versus cash, but when more people are in this field, when more people are passionate about this field, we all win and, most importantly, patients win.
• 31:13
  Speaker 2: So we want to leave you with that.
• 31:15
  Speaker 2: If you guys have questions about this, if this has been inspiring to you, if you have felt a little bit ashamed or a little bit hesitant to talk about the fact that you're a private play clinic or a cash based practice man, reach out and let us know because I hope that this is a little bit freeing for you that we don't have to be sitting there and playing defense.
• 31:35
  Speaker 2: Yes, cost is one of the barriers to entry, but also the 10 of the things that we talked about, and those are all things that you, as a cash based provider or someone who's working at a cash based practice, can make a huge difference in.
• 31:48
  Speaker 2: So feel free to reach out to Nicole.
• 31:51
  Speaker 2: You can shoot her an email, send her a dm.
• 31:53
  Speaker 2: Remember, if you're not joining us at Pelvicon, today is the day.
• 31:56
  Speaker 2: Make sure you have got your early bird access and $50 off to the recording.
• 32:01
  Speaker 2: You'll get all of that amazing stuff from these incredible teachers, providers and trailblazers in the field.
• 32:07
  Speaker 2: As always, we want to keep this conversation going and let's continue to rise.