Interview with Physical Therapy Cash-Based Practice Owner Sean Wells


naples personal training
This past weekend I was in Orlando, FL as a presenter at the FLPTPP Annual Conference and I had the opportunity to attend a very inspiring presentation “The One Stop Rehabilitation & Fitness Center” by Sean M. Wells DPT, OCS, ATC/L, CSCS.  Sean is a physical therapist, athletic trainer and personal trainer and the owner of a 100% cash based physical therapy practice in Naples, FL called Naples Personal Training.  I took away a couple of very important points from his talk that I will use and implement in my practice; the importance of follow up with physical therapy patients after their episode of care has ended and that he offers two unique services; physical therapy as well as personal training.  Unfortunately I did not get the opportunity to talk to him in person at the conference, but I felt compelled to contact him this week and ask him for an interview so I could share his unique practice model.  If you have any thoughts, comments or questions please write them in the comments sections below.

Aaron LeBauer:  Can you tell us little bit about yourself and your background.  Where do you live, where did you go to school, and a little bit about your background as a personal trainer, athletic trainer, physical therapist and educator. 

Sean Wells: I currently live in Naples, FL – a wonderful, quiet city on the Gulf Coast of South Florida.  I became certified as a personal trainer through the National Strength and Conditioning Association in 2004.  I began my own consulting personal training business just thereafter, working at a local club in my community.  I received my Bachelor’s in Athletic Training from University of North Florida and sat for my board exam for Athletic Training in 2006.  I published my first article on aging and caloric restriction just after graduation. After this I began consulting with sports medicine teams with the NCAA, soccer leagues, and continued personal training at a local physical therapy clinic.  After roughly a year I became certified as a Strength and Conditioning Specialist, in order to better enhance my training and understanding of exercise physiology.  I finished my Doctorate in Physical Therapy at University of North Florida, with a concentration in orthopedics, ankle sprains, and wound care.  I published one more article on aging and caloric restriction and another in the arena of wound care analysis.  In graduate school I served as a graduate teaching assistant – this is where my joy of teaching began.

My wife and I then moved to Naples, FL, where I became licensed as a PT and began practicing orthopedics at our Community Hospital.  After two years of practicing, I decided to move into formal academics – I became an instructor in the Department of Physical Therapy and Human Performance at Florida Gulf Coast University in 2010.  By 2011 I had an interest in maintaining my skills in practice; therefore, I began a private practice, with a focus on transitional programs (e.g. exercise beyond traditional PT or exercise prior to procedures).  In 2012 I sat for my Board Certification in Orthopedics.  I successfully passed this examination and began to expand my practice.  I had more challenging patients coming into my practice, and I was able to publish an abstract at CSM in 2013.  In 2013 I also finished a small case series trial in body weight supported treadmill training on the AlterG in chronic stroke patients.  I also concluded data collection on a fencing performance study, examining velocity of movements in the Spring of 2013.

 

Aaron: Please give us an overview of your Cash Based Practice.  What are your treatment sessions like? How long do you spend with each patient?  How much do your treatment sessions cost?  How often do you see your patients/clients?  Does anyone else work with or for you?

sean wellsSean: Strictly one-on-one physical therapy and transition programs.  Personal training is one-on-one as well, with an option to have a buddy “train” with you (e.g. wife, husband or friend).  All patients that enter the practice are screened by me (licensed PT) for health conditions or function issues.  If the client is screened as safe (low risk on ACSM stratification, no/basic meds, limited past medical history) and no functional deficits are found, the client is safe for personal training with my personal trainer.

If the client presents with moderate comorbidities, several medications, or is of moderate risk, I will have the client work under my ADAPT (A Doctor Assisted Personal Training) program.  The ADAPT program is where I will assess the client, consult with my trainer in program development, and will monitor the patient’s progress.  Lastly, if I screen a client and they have frank functional deficits, or have been referred for PT with a MDs referral note, I will commence PT.  Personal training costs between $60-80/ 50 minute session; Physical Therapy is $100/hour.  Examination is $100/exam.

 

Aaron: Who is your average patient?

Sean: 58 year old female, golfer, healthy and conscious of her health but has occasional back and joint issues.

 

Aaron: How do you market your services?  Where do most of your patients find out about you?

Sean: Word of mouth – my reputation has fostered a synergy in town.  People know that I am here to help the community improve their quality of life for long-term; I am not in business to earn the quick buck and run.

I market to MDs, PTs, and advertise in several local magazines.

 

Aaron: What percent of your patients do you see without a referral?  What percent are sent to you from a physician?

Sean: 90% direct, 10% referral

 

Aaron: What do you say to patients when their first question is “Do you take my insurance?”

Sean: I do not accept insurance but I think I can offer a service that is a cut above any facility in town.  Given my credentials, experience in teaching and research, and private session – I know I can help you and you will be pleased.

 

Aaron: What is it about your practice that is unique and compels patients to call for an appointment?

Sean: The transitional programs, the safe personal training programs, and my credentials.

 

Aaron: This is such a unique practice model, how does it improve upon the more traditional physical therapy clinic model? 

Sean: It allows a patient a continuum of care.  They can transition from an acute rehab situation to a fitness program seamlessly.   Moreover, the patient has strict one-on-one care with a DPT; if a client is working with a trainer, a DPT is present to assess any injuries and provide exercise guidance, if needed.  My practice truly embraces the concept of continuum of care while offering excellence in service as well – patients can have direct access to me via cell phone or personal email.  This allows my clients a “concierge-like” service not offered by any other facility.

 

Aaron: What would your response be to a physical therapist that says “a cash based physical therapy practice is not viable in Florida because 50% or more of my patients have Medicare.”

Sean: Personal training – if DPTs do not take on these patients a trainer will.  And with the complexities and health issues Medicare patients often have, a trainer will likely not have the education or training to adapt and manage these clients – hence why we as DPTs need to help these patients.  Although Medicare is a no-opt out as of now, if we all are APTA members and push our chapters for opt-out reform, we too can help Medicare patients in the same fashion as we do insurance patients.*

 

Aaron: What advice do you have for a physical therapist that is looking to start a cash based practice?

Sean: Be open to direct access.  Be willing to negotiate prices with patients – consider offering a sliding pay scale, alternative treatment frequencies, and provide the client open communication with you.

 

*Visit my previous blog post about the Medicare Patient Empowerment Act of 2013 to learn more & for a link to the APTA action center where you can easily contact your congressperson today.

 

About The Author

Aaron LeBauer

Aaron LeBauer PT, DPT, LMBT started a 100% cash based physical therapy practice right after graduation. He's on a mission to save 100 million people from unnecessary surgery & enjoys helping passionate therapists build successful businesses without relying on insurance.

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14 Comments

  • Shane Carpenter

    Reply Reply September 2, 2013

    Great insights! Thank you 🙂

  • Aaron LeBauer

    Reply Reply September 2, 2013

    Thanks Shane!

  • Theresa Bowers PT

    Reply Reply September 6, 2013

    For medicare patients — does Sean still do the ADAPT program and have the medicare patient be seen for some visits with him in addition to offering personal training in between for a private pay rate? We are looking at this model in our clinic. . . .

  • Sean

    Reply Reply September 6, 2013

    Hi Theresa,
    Yes, there are certain clientele that I have work with my trainer for personal training and I “check-in” with every 6 or 8 weeks (depending on comorbidities, progress, or issues). I will only spend 15-20 minutes during the follow-up. I usually will re-measure some ROM, circumference measures, balance, etc — the follow up tests are dependent on the patient’s goals and the initial exam/follow up exam. The time I spend is worthwhile because it markedly increases patient retention and truly embraces the primary PT model that we all hope for.
    All the best,
    Sean

  • Joe Caruso

    Reply Reply September 11, 2013

    Great information! Is there anyway you can share some info on the ADAPT program?

  • Sean Wells

    Reply Reply September 11, 2013

    The ADAPT program is specifically for those coming off of traditional PT programs or those with marked medical issues. I developed thus program for our community after I noticed these populations would either stop exercising, not go further with the exercise (fear/lack of ed), or concern for competence of their “trainer.” Hence, the ADAPT rx allows a smooth transition or safe program. Learn more at http://www.naplespersonaltraining.com/services

  • Aaron LeBauer

    Reply Reply September 11, 2013

    Sean,
    Thanks for taking the time to post your follow up comments!
    Aaron

  • Mike R

    Reply Reply June 22, 2014

    Hi Sean,
    You mention, if you notice the patient has frank functional deficits and a rx for PT, you will commence PT. Seeing as how we cannot opt out, How do you commence skilled PT devices for a Medicare patient if you you are 100% cash based?
    Thanks for your time.

  • Sean Wells

    Reply Reply June 23, 2014

    Mike,
    Thanks for your question. I get this one asked quite a bit…
    The direct answer is that we technically cannot provide physical therapy services for Medicare patients through the “opt out” process. Hopefully if we private practice PTs, whom do the most direct access, band together and push congress, this will change.
    I generally work with other PT facilities in town that can provide licensed physical therapy for Medicare patients. These facilities will often refer the patient back to me for continued exercise work following PT…a nice transitional program.
    On a different note, I also have a special class of older adults that do not use Medicare (never enroll). Naples is full of wealthy individuals who prefer to pay out of pocket for all services; in this case, opt-out does not apply. Depending on your location and the number of these individuals, this can really help your practice…
    Hope this helps.
    Sean Wells, DPT, PT, OCS, ATC, CSCS
    Author of Double-Crossed: CrossFit’s Dirty Secrets

  • Aaron LeBauer

    Reply Reply June 23, 2014

    Sean,
    Thanks for your reply! I too have trusted local physical therapy clinics where I refer out when I receive inquiries from a medicare beneficiary who requires skilled interventions for “covered services.”
    This brings up a good reminder for me and has me revisiting my Medicare and Cash Based PT post, which I have not completed. It’s such a huge issue, I’ve largely remained silent on it, but it’s such an important topic and one which people ofter do not fully grasp. I’ve been working on the post again this morning, thank you Mike, and which I’ll publish to my blog soon.

  • Mike R

    Reply Reply June 28, 2014

    Thank you Sean for clarifying and for the Great post gentlemen. I appreciate the dialogue. Sean, we indeed need to band together and push for reform as it pertains to PT opting out. Thank you guys.
    Mike

  • Jessica

    Reply Reply July 22, 2015

    I had a question. I am in the process of getting my personal training license I am PTA. I love personal training friends and family, but pta is my number one focus. I don’t know if you incorporate your personal training into therapy?
    I am curious if you are able to continue working with your discharged physical therapy patients with personal training needs at home. I don’t know if that’s contraindicated.

  • Dr. Sean Wells

    Reply Reply July 22, 2015

    Hi Jessica,

    Thanks for the question. I too love personal training and it is a great way to work with your clients in varied ways. I will answer your second question first.
    Most PTs consider clients that pay cash for continued PT after formal discharge “maintenance” or “cash pay” clients. I see them as personal training clients that also get “maintenance” physical therapy — a perk that they certainly gain from and pay for. As a PTA, you can also offer this “higher” level of service compared to a strict “certified personal trainer.”
    I like that providing personal training, with a framework and mindset of a PT/PTA, will help my clients prevent issues and probably prevent them from re-entering your physical therapy services (see my example below). The traditional referral-based physical therapy programs and companies would probably frown upon the notion of reducing returning clients through preventative means (look at how our medical industry functions — it’s problem based not results based). But when you consider that you are able to keep that client on-board through personal training, maintenance physical therapy, or whatever marketing term you wish to use, you are drawing revenue while continuing to help your client. After all, how many times do you discharge a client and think, “This person is 100% — there is nothing left to work on or improve!” Never.
    As for your first question, I do blend some “personal training” movements with my physical therapy. First, I must laugh how PTs must clearly define that a movement is either “training” or “therapy” — if it designed and intended to help the patient does it matter what the intervention is called? I clearly see the distinction of fitness or therapy goals, but aren’t they related in so many ways (e.g. the obesity driving the knee OA that you are treating).
    The drawback with the PT model is it often focuses on simply function (or dysfunction) and the related diagnosis. The beauty of “training” is that you can really expand into other realms of health related fitness and wellness that you would not normally be “allowed” to do under Medicare and Insurance Guidelines. For instance, do you think you would be reimbursed for providing calf stretching in a client with shoulder impingement? Probably not, unless you are a documentation wizard citing research or some long constrained rationale. Are the tight calf muscles causing plantar fasciitis or low back pain? Maybe not now but possibly down the road, especially if they take your discharge advice of continued walking as part of their home exercise program (HEP). My concept, along with other trend setters such as Aaron LeBauer and Jarrod Carter, is that physical therapy must stop the medical myopic approach of treating one area or region. We work with whole people, not limbs and quarters. As such, the “diabetic peripheral neuropathy” will not simply get better with balance exercise and light cardio and strengthening — eventually this person needs care in many realms to include detailed dietary counseling, moderate to vigorous cardiovascular exercise, power and agility training to prevent falls. The list will go on until we can safely nudge our patients higher and higher. The same goes for the “knee replacement” in room 3 — he will not regain full strength after his full course of PT in the first year (by my measures, after working with close to 3,000 patients with total joints, they are at about 75% strength when compared to uninvolved limb — this is consistent with research findings). Why is this? Perhaps we have focused too much on one area (hip, knee, ankle) and not the rest of his body? Perhaps we have ignored exercise science and “training” research that shows you must push patients so that can make significant gains. As for the latter notion, perhaps this is fear or laziness in our professional — regardless it happens all too often and you can be the difference maker.
    I hope I have offered some insight but also raised new questions for you as you endeavor into the world of cash PT and personal training. Their are legal ramifications for providing PT vs personal training, and this is something you must ultimately examine for your state and for each case. Obviously as a PTA you cannot perform an initial PT evaluation; however, you may be able to perform an initial fitness evaluation and use some of the advanced knowledge you have on pathophysiology and medicine to better help your client. If not being able to perform an initial PT evaluation is a barrier to gain new clients, consider partnering with a PT like myself — you guys can really make some waves. I do clearly define a scope of physical therapy work prior to a client agreeing to pay for services. I usually define the end goals and the expected costs. This is also the best time for me to then mention the continuation programming with either myself or a great trainer (like you!). I form a unique partnership with each of my clients — at the end of the day, they don’t care if they are getting “training,” “PT,” or physical therapy; as long as they are progressing toward goals (fitness and/or therapeutic) and are not getting injured. I wish you all the best!
    Best,
    Dr. Sean Wells, PT, DPT, OCS, ATC/L, CSCS, NSCA-CPT
    http://www.drseanwells.com

    • Aaron LeBauer

      Reply Reply July 22, 2015

      Jessica, thank you for your question and comment.
      Sean, Thank very much for taking time to offer a detailed response!

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