OT Private Pay Practice: How To Achieve Occupational Choice

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As an OT you are constantly advocating for occupational choice for your clients. But, let me ask you a simple question: do you, as the OT, have occupational choice for yourself? If not, it may be time to consider making some changes in how you practice as an OT.


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Many OTs find themselves dealing with increased productivity and documentation standards that take them away from doing the very things they wanted to when they decided to become Occupational Therapists. And this can lead to increased feelings of burnout and frustration. However, the solution isn't to just switch to another clinic, a different SNF or another hospital.

Those places will be faced with the same productivity standards as well so while the environment may be new, the problems you will face will be old.

In this video, Doug Vestal, Ph.D., shares why Private Pay Practice brings OT back to its roots, creates a better job environment for OTs to thrive in, and ultimately benefits clients the most.

This video is not intended as professional or legal advice. Be sure to seek the services of a professional and understand the risks you are undertaking.


Transcript of Video:

I personally love this term “Occupational choice” when it comes to how OTs practice.


You probably spend a lot of your time talking to your clients and patients about what’s meaningful to them.  What are they hoping to get back to.


And you advocate for your clients for them to have choices.


But  - what I’ve found is that a lot of OTs don’t feel like they, themselves, have a lot of choices.


Their hours are inflexible.  There are high productivity standards and documentation requirements. 


There is a constant struggle with what a client needs versus what insurance will cover.


And so its easy to see why so many OTs face burnout.


So today I want to talk about how OTs can achieve more occupational choice for themselves.

Hi – I’m Doug Vestal and I help OTs just like you start and grow thriving private pay practices.  My wife and I founded our own successful OT private pay practice in NYC in 2014.  And I make these videos to help you achieve success even quicker.


So – let’s talk about occupational choice.


And maybe we should call it occupational freedom.


Because to me, the OT is at their best when they have the freedom to:

  • See who they want
  • When they want
  • Where they want
  • How they want
  • And for as long as they want


If we just take a step back – isn’t the whole point of healthcare to focus on the individual?  To focus on using your expertise to provide for that person in the ways you know best?


A the same time, this has to be balanced with the needs of an OT.


Just because you have clinicial skills and want to help, doesn’t mean that you have to sacrifice the important years with your family, doesn’t mean you have to constantly be stressed about money because you have high student loans.  


It doesn’t mean that you shouldn’t have a life outside of seeing clients.


And so, what I find is that we get into this situation that isn’t really satisfactory to anyone:

  • You end up having to spend less time with clients, see more of them per day, and focus your energy on tasks not related to direct client care.
  • And what happens is the service provided to clients is set up to not really get them better because the therapist is spread so thin
  • And – the OT providing the service is suffering.


So – it’s a really bad combination.  You have clients that aren’t getting their needs met because they aren’t being given the time.  And you have OTs providing this service feeling unfulfilled and stressed.


I mean – when I look it, it is clear to me that no one is winning.


Well – there is one group that is winning and that is the insurance companies.


The structure of much of our healthcare is built around insurance.  So much so, that insurance has become synonymous with healthcare.

And so what happens is there is this 3rd party that sits in between the relationship between the OT and the client.


And so only things that can be billed to the insurance company and reimbursed are done for a client – even if that’s not the best option.


Think about it – when you treat and put CPT codes into your documentation – why are you accounting for 8 – 15 min increments of your work?


I can tell you, no healthcare provider, including an OT, would think to themselves, “you know what – I’m going to work in 8-15 min increments with clients.  Yes, that’s the structure that makes sense.”


That 8-15 min increments is because you have to account for your time for the insurance company.  It’s not therapist driven, it is insurance company driven to ensure you don’t spend too much time with your client.  Because once they start commoditizing the time you spend into time units, then the insurance company can start controlling how those units work.


That’s why you hear things like “oh – I can only bill that CPT code once because the insurance won’t reimburse for 2 15 minute sessions.”


To me, that’s just crazy – the insurance company has never even eval’d your client.


So – what happens is that everything gets controlled in these units of time.


That hospital you work for, the SNF, the acute care rehab, the private practice that accepts insurance – they all face the same dilemma.


Someone else controls how the work can be done and how much they get paid for it.  So that means that now your productivity standards go up because reimbursements are going down and so for the company to make the same amount of money, they have to provide more services in the same amount of time.


And, oh, by the way, some claims will be denied if the documentation isn’t perfect so in addition to seeing 15 clients that day, you also need to spend a ton of time doing documentation you aren’t paid for.


My mentor, Richie Norton, has a saying “change the way you are paid, and you can change your life.”


And no where is that more true than for OTs. 


If you are working for a practice that takes insurance, then you are getting paid by the insurance company.


Your paycheck may not be signed by the insurance company, but the only way your employer can pay you is by the money they receive from the insurance company.


So – you are paid by the insurance company – which means you are at the mercy of the insurance company.  The insurance company can, does, and will change things without your input, without your permission, and without your control and these changes will impact you – often negatively.


But – you can change things by changing the way you get paid.


And you can change the way you are paid by going private pay.


In private pay the relationship is between you and the client.  Not, you, the client, and the insurance company.


The client pays you directly.  You get to provide your professional and expert recommendation for the type of services they need without regard to reimbursement for insurance.


You get to see the client for as long as you want and as often as you want.

Because you are caring for the clients best needs – not what the insurance company dictates.


You bill the client directly which means the client has 100% clarity on the cost of services – there are no surprise bills.


And because you bill the client directly, you don’t have to worry about declining reimbursements.  You provide a great service, at a fixed price you can count on.  This means that when reimbursement changes then you, your staff, and your business are insulated from the demands of needing to increase productivity.


All of this means that you get to decide how much time you spend with a client, how many clients you see a day, and how much money you earn while providing an amazing service.


Most OTs in private pay practice aren’t seeing 8 clients a day.  They might be seeing 20 – 25 clients a week.  And that’s because they can.  They can prioritize seeing clients their own way, make good money, but also not leave the practice so stressed and frazzled that they aren’t able to show up for their family the way they want.


This is how OTs can achieve occupational choice.  Until you change the way you get paid as an OT you won’t have occupational choice.


The structure has to be there to support it – and you can create that structure with private pay.


If you are interested in learning how to start your own OT private pay practice, then I recommend you check out our course for OTs called Private Pay MBA which teaches you just that.


I will leave a link in the description below.