The “Concierge” PT Model

Going beyond a traditional care provider model to that of care coordinator

By Karen Litzy, PT, DPT

When I used the phrase “concierge physical therapy practice” to describe my practice more than 10 years ago, I
envisioned being known as the go-to of a concierge at a luxury hotel.

The luxury concierge’s job is to create one-of-a-kind experiences where the client’s needs are carefully listened to and
cared for. As a health care professional, I like to guide my clients in their health care needs. I envisioned my role as
going beyond traditional physical therapy care and moving into the role of coordinator of care, being the person who
helps connect my clients to physicians, other health care providers, fitness professionals, and more. Just like a
high-end concierge’s job is to coordinate the best-possible hotel stays for a client, my job as a physical therapist was
to provide and coordinate the best possible care for my client.

CONCIERGE PAYMENT MODELS

Accomplishing this lofty goal in my community meant having a cash-based practice and providing care outside the
traditional brick-and-mortar clinic. There were factors that contributed to this decision.

The insurance reimbursement in my area is dismal and makes it almost impossible to see patients for the ideal amount of
time (one-hour treatments) I felt aligned with my vision of a “concierge” practice. A cash-based model was easier to
manage as an independent entrepreneur. This meant I did not have to hire full-time employees to take care of billing and
scheduling.

Treating clients where they are, in their home, office, gym, etc., versus having a brick-and-mortar practice was also a
practical decision. There is far less overhead with a mobile practice, and it lived up to the concierge name. I made my
clients’ lives easier by coming to them and sparing them one more appointment away from their office or home.

WHAT DOES A CONCIERGE PRACTICE MEAN TO OTHERS?

I posed this question to physical therapists, physical therapist assistants, and physical therapy students on social
media, and the answers were varied. A few themes did emerge:

• It is expensive, exclusive, and inaccessible for most.
• It can only work in specific communities.
• It is convenient, high-quality care with excellent customer service.
• It is a retainer service modeled after many physician practices.
• It is a way to increase freedom and opportunity in physical therapy practice.

Some of these themes centered around the impact on the clients, while others centered on the effects on the physical
therapy business. I would argue the impact on the client and business are intimately connected, as a practice cannot
survive without the clients.

Let’s unpack each of these themes as it relates to a concierge physical therapy model.

PATIENT-FACING ISSUES

Expensive, Exclusive, Inaccessible

Despite the word “concierge” being associated with luxury, it does not mean that this type of practice is out of reach
for most. Yes, a concierge practice is more likely to be a cash-based practice, but it can also be a hybrid practice.
For example, if you live in an area where an insurance company offers competitive rates and most potential clients in
your area use that insurance, it might be worth accepting that one insurance and being cash-based for all others.

Another example, if you live in an area with many Medicare beneficiaries, it might make sense to accept Medicare and be
cash-based for all commercial insurance companies. A hybrid practice can be more accessible to most people in your
community yet still bring in the income needed for longer treatment times and individualized care.

The expense of your treatments may be problematic for some in your community. There is no getting around that fact.
However, there are ways to navigate the cost of your treatments for those who may not be able to afford them.
Have pro bono slots available on your calendar for those who can show genuine financial hardship. These slots can be
free or low cost.

Create solid relationships with other physical therapists in your community. If a potential client contacts you and is
intent on using their insurance (which you do not take), then you can refer them to a great physical therapist in your
community. I have done this more times than I can count, and often the client I referred out will eventually refer
someone back to me.

Community Matters

I would agree that this model may not work in every community, but I think it can work in most. As a business owner, you
need to assess your community to see if the market will bear it.

Some questions to ask your community to see if a concierge model will work:

• Will people be willing to pay out of pocket for health care needs if they know they will be getting an individualized,
  holistic approach to their care?
• What do people expect to receive if they are paying out of pocket? For example, I have had my clients tell me they will
  gladly pay to have someone come to them and be available via email or phone to answer their questions within a few
  hours.
• What are physical therapy offices in your area charging as their cash fee?
• Are there fitness professionals in your community, and what are they charging for one-on-one sessions? Are they busy?
  How far do they have to travel for clients?

It is also important to remember that because you are running a mainly cash-based practice, you will not necessarily
need the large volume of patients that a traditional insurance-based business will require to keep the doors open. You
may only need a small number of people from your community or surrounding communities to have a profitable concierge
physical therapy business.

High-Quality Care Pairs with Excellent Customer Service

As Wayne Dyer said: “Go the extra mile; it’s never crowded.”¹

Of course, all physical therapy businesses should offer high-quality care and excellent customer service. A concierge
practice will need to go that extra mile. Some examples of going above and beyond may include:

• Weekend or after-hours appointments
• Attending physician appointments with your clients
• Coordinating all of your clients’ health and fitness needs
• Being available by phone or email during waking hours
• Researching medical or fitness equipment for home use
• Meeting the client where they are physically located. This may be the home, office, vacation home, gym, park, virtual, etc.

Two key traits you must have as a concierge practice owner to go that extra mile is flexibility and an open mind. You
must be prepared for situations to change rapidly and adapt to those changing conditions. This flexibility in practice
is needed now more than ever due to the pandemic. Having a concierge practice allowed me to quickly transition to
virtual care for most of my clients without much interruption in care. As we are coming up on a year of pandemic
protocols, people are still wary of going to appointments outside of the home. Having the concierge model’s flexibility
to work anywhere with clients has been an enormous advantage of this model during the pandemic. Clients feel more
comfortable exposing themselves to only one person outside of the home vs several people if they were to go to a
traditional practice.

BUSINESS-FACING ISSUES

Retainer Service Model

It is possible to have a retainer service or membership model as part of your physical therapy practice. Mixing
a-la-carte services with membership services can be a great way to diversify your clinic and bring in new clients. An
example of this mixed model is Body Dynamics, Inc (BDI), owned by Jennifer Gamboa, DPT, in Falls Church, Virginia. BDI
has a program where they “offer unique membership combinations at reduced prices that allow you to mix and match small
group and one-on-one programs and plans of care.” It is also important to note that BDI also offers individual
one-on-one physical therapy treatments in a cash-based setting. The retainer or membership model can be done well as
part of a more comprehensive array of offerings from your clinic.

Allows for Greater Freedom of Practice

As mentioned earlier, a concierge practice will be a mostly cash-based based practice. Because the business is not
beholden to insurance company constraints, you likely have greater freedom of practice as a business owner and physical
therapist. This may be evident in the amount of time you can spend with your clients. Typically, in a cash-based model,
you can spend more time with your clients because you are likely getting paid at a higher rate than an insurance
company’s payment. Because you are getting paid a higher amount per client visit, you do not have to see as many clients
per day to meet your business’s financial goals. As a business owner, you will have the freedom to explore other
offerings for your clinic, collaborate with other companies in your community, and spend more time working on your
business rather than in your business.

Outside of work, you will have the freedom to spend more time with your loved ones and avoid the pitfalls of burnout by
exploring activities outside of your business. Most important, you will have the freedom to love the profession you
chose and positively impact your community. 

References:

¹Dyer WW. It’s Never Crowded Along the Extra Mile [CD]. Carlsbad, CA: Hay House. 2002.

---