A cash-based system allows for more individualized care and one-on-one time with your physical therapist. Instead of getting 10-20 minutes of face time with the PT and then spending the rest of the time on a heat pack and going through exercises with a PT aide, you get 1-2 hours of manual therapy and individualized exercise prescription with a licensed physical therapist. The benefits of corrective exercise prescription and instruction are often undervalued - however the goals of therapeutic exercise should be to correct the movement strategy that likely caused the injury in the first place, and to improve the strength and movement coordination within the range of motion gained following manual therapy. Physical therapists are experts in human anatomy, movement dysfunction, and corrective exercise. All accredited physical therapy programs in the United States are now doctorate programs, and therefore physical therapists are essentially “Doctors of Movement.”
In contrast, there are no specific education requirements for PT aides, and therefore they are unable to provide the same level of expertise when instructing exercises because they do not have the knowledge base of anatomy, movement, and corrective exercise that a physical therapist does. https://www.ptbc.ca.gov/forms/ptaidsup.shtml Nevertheless, PT aides are prevalently used in many insurance-based practices because there simply isn’t enough time for the physical therapist to provide all the necessary manual and exercise interventions to the 15-30 patients on their daily caseloads. Working at this high volume also takes a toll on the physical therapist’s own body, which is somewhat hypocritical if you think about it because they spend all day trying to fix other people’s bodies at the cost of their own. https://covalentcareers.com/resources/physical-therapy-burnout/
So why such high volume if that is not in the best interest of the patients or the therapist? Well, often times insurance reimbursement rates are not high enough to sustain lower volume practices. Furthermore, contracts between insurance companies and PT providers are negotiated independently, and thus there are no standard reimbursement rates across different PT practices in the same sector - that means that different practices are paid different amounts for the same services. Insurance companies tend to give higher reimbursement rates to corporate, or hospital based systems because they have more bargaining power - however interestingly enough, these systems also tend to be the highest volume clinics and therapists may see as many as 4 patients per hour. This discrepancy in reimbursement rates and the lofty process involved to obtain contracts with insurance companies has led to a rising increase in cash-based practices. http://www.ncmedicaljournal.com/content/78/5/312.full
When all is said and done, your out-of-pocket expenses within an insurance-based system may still be quite high, and might even exceed cash-based pricing although you pay a hefty insurance premium every month. Some insurance plans do not cover PT services until your deductible is met, or place a hard cap on the number of PT sessions allowed. Your co-pay alone may even be comparable with cash-based pricing. https://www.restorationspt.com/blog/pocket-costs-physical-therapy/
Our health care system is far from perfect and there is definitely room for improvement, but a cash-based system ensures that 100% of the money that you spend goes directly towards your care. Its up to you to decide what you value in terms of services and how you want to spend your money, but keep in mind that your body is yours for a lifetime and there is some truth in the old saying “you get what you pay for.”