Jumping into a Cash Model

Welcome to Pelby biz podcast. I'm Dr. Kelly Alhui. I have grown and established brick and mortar practice in Northern Virginia called Ortho Pelvic Physical Therapy and also founded Pelvibiz, which is an online business consulting company that helps healthcare providers make more money and be healthy while doing it, especially in the pelvic health realm. And let's get into today's episode.

Today I'm going to talk about how to make the jump from an insurance based model to a cash based model. Now most of you right now that are listening to this podcast potentially are working for someone else maybe in an insurance based model, maybe you have your own cash based practice. Either way this is going to be amazing podcast to listen to of the pros and cons with insurance and hybrid and cash. And if you are considering going into the cash based model, I'm here to give you all the tips and tricks. So let's get into it. So when I first started my cash based business I was so sick it forced me to actually just make the jump. So there's only two ways to to make the transition from working for someone else, which is typically going to be an insurance based model, to then working for yourself. So for eight years I worked for someone else doing the whole insurance thing and eventually I got so sick I couldn't get out of my bed that I knew there had to be a different way. And so after coaching now over 100 pelvic health therapist, I realized there's only two ways to make this work. So here we go. Number one is where you just make the leap. You don't have any patient on schedule. Just make leap. This is exactly what I did. Number two, you're like half into another business working for someone else and then you're half into your business. There's pros and cons to both models. I'm going to go over that. So let's first start with how I did it. Basically was I just went all in. It wasn't that I was not scared, I was absolutely terrified because every single person in my family said there's no way you can make this work. Except for my mother. She was the only person that believed in me. And I just after crying in my bed for hours and hours, I was like, there has to be a different way and I'm going to do it. So I made the jump. I mean even to this day I remember the feeling. It just literally gives me chills because I remember how much I was hysterically crying in my bed and Then when I did it, I felt so relieved that I made that phone call to my boss to say, hey, I'm not coming back. And then it was like, oh, crap, what do I do now? And I didn't have a safety net. I had $800 in my bank account. I needed $4,000 to live. So I said it was Covid. I said, how am I going to do this? Where do the people hang out? That's the number one thing you guys need to know. Where do people hang out? Covid? I guess maybe it's a positive. I realized no one was at grocery stores. No one was, you know, anywhere at, like, a mall or anything. They were all in their home. Except for the runners that wanted to be active. They were still on the trailheads. So I drove 45 minutes to a trailhead that I knew was very popular. And the. It's called, like, the GW trailhead. I don't know. It's. It's somewhere, like, 45 minutes away from me. And I found out about it. I was. I was new to the state. I felt like I just wanted to make friends. How am I going to make friends? And so I went to that trailhead, stood there. I didn't have an llc. I didn't have a bank account. I didn't even have a business name. I had no business credit card. I had no documentation system. I had nothing, literally nothing. I had no table nothing. And I was like, okay, my goal is just to make friends. I gotta make friends. So I just started talking to people. Some people would ignore me. Yes. I felt like a homeless person because I was standing there just, like, honestly yelling at people. Hey, I see you're leaning to the right. Do you want to come over here? I'll help you run better and run faster so that you can pr. I knew that that's what they wanted. Was I ever a runner? No. But I knew how to communicate to these runners so that they would stop and actually listen to me. So then I'd pull them in the parking lot and do, like, jump testing on them. I would do running tests. I would say, run faster, run slower. How does that impact you? And just like, starting to talk to them. And I realized, wow, this is how I can actually get clients. So I just started treating people for free. And in the parking lot of trail heads, and that's literally how I got started. I would say, you know, just doing this, it's more risky when you jump face first and go all in. Also, I didn't have a backup plan. Like, there was no backup plan that I had. There was no plan B, no plan C. And I think if I had that in my mind, then I wouldn't have gone all in. Of course you can get another therapy job. But I was like, I'm not going to. This is literally my only plan. And if this doesn't work, I truly will be homeless and my health will be better. And I was actually okay with that. But I still want to be able to pay my bills because I needed to make $4,000. So I said, all right, I'm going to try to make $4,000. Whatever it takes. I will drive wherever I need to drive. I'm going to get clients. And I just thought about making friends. That's literally how I said. It wasn't like, oh, let me put together a business plan and let me, you know, be all businessy and salesy. Nope. I just wanted to make friends. That's it. And that's what I did. And that's literally how I started my business. So let me go back to this. When you go all in, there's things that I think are very important to know. Yes, it's more risky. And the fact of you do not have a backup plan. You do not have extra money coming in the door. You just go all in. However, I do think that you can bring all your energy to one thing. And when you do that, you're only going to accelerate so much more than when your energy is split, especially when it's split into something that you don't even believe in. That's when it's really bad. But when you truly believe in your product and who you are and how you can help people, the energy that you're going to get from helping people is phenomenal. And you're only going to be like, yes, this is what I was meant to do. And it's only going to just keep launching you, which will be amazing. I think the other thing is, the reason why I chose cash is because I knew it was very straightforward. I knew when I did insurance that we had to fill out paperwork and we had to do what the insurance one. And we could only treat one body part, and we had to see more patients because the insurance almost reimbursed us, you know, this amount. And I said, screw that. Why do I want to continue to be in that same cycle? I would create the same job for myself. Why do I want to do that? So let me just go cash. They pay you for the service. So, you know, I think I started out 175. They paid me 175. I did some math, and I said, okay, 175 times 8. That brought me to where I could survive and replace my income. Within one month, I was able to replace my income, and it was just simple math. I wasn't waiting on the insurance company to give me a check, none of that. And again, I still didn't have a business bank account at that point, because I just would, you know, I just like, all right, I got a personal one. I guess I'll put it in there for the moment. So that's what I did. And I just said, okay, I'm just gonna make more and more and more friends. So that's how I got started. I think there's another thing is you have to have a massive belief. I truly believed in what I was doing. I knew I was really good at treating people. I just knew it. I knew I was good at making people feel better. I knew I was good at getting the results because I did it for eight years, even before I started this. So I had lots of confidence. I had lots of belief. But doesn't mean that I wasn't terrified out of my mind. But because I was so scared, it made me push even more to go out there and communicate with people so that I could actually get the results and get to my goal, which was just to replace my income. That was my only goal, was not to hire. Just to replace my income and get my health back. And I remember even at that point, my neighbor saying, when I made this jump, Kelly, like, are you retired now? You're always home. And I was like, no, I just don't have patience yet, but I will. And then I would go out and then spend all day out, and he'd be like, wait, now I'm never seeing you. I'm like, yeah, because I'm talking to lots and lots of people. So even my neighbors were noticing kind of the switch in what was happening. So that was pretty cool. And I think the last thing when you make the big jump and you go all in is you have to have a massive. Why is if you do not have a massive, why on the hard days where you got to go stand on a trailhead and feel like a freaking homeless person? You will not do that. If I had enough money to pay my rent, I could tell you this right now. There is no way I would have been standing on that trailhead, because that was so uncomfortable. It was, like, so uncomfortable that I can't even fathom doing that right now. Because it's just, it was something that I was just so desperate. I was so desperate. And if you're in that situation where you're desperate and you have to pay your bills, you have kids, you got to pay, you got to pay for their school, whatever it may be, then maybe it's something that you consider go all in and go cash because you get the money right up front, you do the service and that's it. And then you got to book them out. Clearly, right now, here's the flip side. You can do the half and half thing. So if you're like, kelly, I'm just so scared. I'm not that type to go all in. Okay, cool. Well, I can tell you, I've coached over 100 pelvic health therapists and I can tell you this. There are two ways you can go half and half. The people that go half and half, this is what happens. When I say half and half, I mean half into someone else's business and half into your business. So typically they'll do about 20 hours a week working for someone else, and then they'll have about 20 hours a week on their business. Well, they will find quickly, not only do they get annoyed when they're at that other business working with people because they're just thinking about, man, I could be marketing right now, I could be talking to this person. But they also get irritated because not only are they spending 20 hours, like in person treating the patient, they then have an hour to two to three to four hours a week doing notes at night and sending hcps. That's the last thing they want to do when they're trying to work on their business. So these people, the business will grow slower. Some people are okay with it. I feel like it's hard to do that because you're basically torturing yourself more in my eyes and the fact of you're growing slower, but you don't realize you're staying in the hustle phase longer and it's just going to be more painful for you compared to if you just made the jump, went all in with the cash based business, it's going to be less painful. And typically those businesses are going to get, get out of the hustle phase a lot quicker than if you're like, I'm gonna be half and half and in. And then you start to wonder like, these were my thoughts when I was like at my job before, I just made the jump is okay. Cause when I was, I was thinking about this, right? I was thinking about it, but I Didn't do anything with it. So my thoughts were, okay, like, what happens if someone finds out? What happens if a colleague finds out I have a business? Do I get fired? What happens? As I'm treating these patients, thinking, wow, I'm now sending them to this aide after treating them for 20 minutes. This aide's messing them up. They don't even have a college degree. And then they're coming to me complaining, well, if I was at my own business, I could treat them for the full hour and provide such care that I could get the most amazing results. Like, what the heck? And I would, I would find myself starting to get pissed. Like, I was just like, why is this a doing this? And then I would also find myself, well, if they did find out about my business, then am I going to get in trouble? Like, what are they going to say? Do I tell my patients about it? I had all these questions and all those questions is just energy that's expended for not a good reason. Instead of when I just made the jump, I could just do whatever I wanted. I could promote on social media and not have anyone care. I could put up my website. I could do all the different things without feeling like, oh, I'm hiding this secret. And when you feel like you're hiding the secret, the last thing you want to do is promote it because you're trying to hide it. So there's like this ying and this yang push and pull happening to where you're just like, man, this is actually slowing down the progress. And eventually you'll start to see, yeah, I just need to make the jump because guess what? This, there's always going to be a therapy job that you can resort back to. So I personally like to tell people, just make the jump. Now, when it comes to cash versus hybrid versus insurance insurance, every single year there is lower and lower reimbursement. And I have worked with all these practices and I can tell you the insurance model practices that I work with are going to have the least amount of profit margin and we've got to have cash services coming in to help make up with those margins so that we can actually have profit and stay in business. The hybrid practices, I find people tend to do the hybrid. So what that means is they're only taking Medicare or they're only taking Blue Cross Blue Shield because they reimburse the highest, which is anywhere between $110 a visit to maybe 100 a 50 around there, depending on what state. But those people that do that, I find, tend to be scared they're scared to be all cash because they believe they're from a small town. They believe that no one's going to pay cash. And so they just go ahead and create another job that they basically just got out of. Having to deal with the paperwork, having to wait on the check, having to figure out, well, maybe I'll be reimbursed, you know, three months down the road. They're trying to figure out all that. And so I find, say, screw that, go all cash and just go all in. Because you're just going to be fighting with the insurance company if you're a hybrid and trying to. When patients call, they're trying to figure it out too. They're like, but you take my insurance, but you don't. And so it's a friction thing, too. So I find people that are hybrid, they're going to have very little cash clients coming in the door because people are going to want to use their insurance. Especially if you say, hey, we take Blue Cross, Blue Shield, we're in network. Well, they're going to look at you like, well, why would the heck would I ever pay you cash? So I typically recommend going all cash and just going for it. Like, literally going for it. I know it's scary, but it's. It's just going to be way less painful for you. So hopefully this helps figuring out how to make the jump from someone else that you're working for to going all in and why. I believe the cash model is definitely going to be the future. And going forward, patients are going to get the care that they deserve. We really focus on getting them to their goal rather than playing the insurance game and pleasing them. Testing range of motion and manual muscle testing. All that stuff we know is BS anyways. So why are we not truly bridging the gap and getting them back to their goal? And that's what we can do in a cash model because we can treat the entire body. So just a little insight there. If you guys want to know more or want to know how to get more clients, I would love for you to join me. March 15 to 17 in Southern California. In San Diego, we have the Pelvibiz event. We have only 15 spots available left, so if you want that click down in the show notes so that you can grab your ticket. We'll talk soon, guys. Bye bye.

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