The College’s Practice Advisors are often asked whether physical therapists are permitted to offer discounted fees, gift certificates, or prepaid treatment sessions. We also are asked whether it’s okay to solicit testimonials from clients or to ask them to post a review of the clinic on an online review site.
The decision you, as a physical therapist, make about whether to proceed with specific marketing and promotional strategies will depend on the details and context of the situation. In all cases you will need to adhere to the College’s Practice Standards and regulations, including:
- The Code of Ethical Conduct guides physical therapists in providing ethical service by stating that we “treat clients only when the diagnosis or continuation of the intervention warrants treatment and is not contraindicated” and “act transparently and with integrity in all professional and business practices, including fees and billing, advertising of professional services, and real and/or perceived conflicts of interest.”
- The College Bylaws (Part 8, 83(1)) require any advertising or marketing to be “truthful, accurate and verifiable.” Section 83(2) states that physical therapists cannot “promote unnecessary physical therapy services” or “offer clients incentives or other inducements for services.”
- Conflicts of interest are defined as situations that arise when the physical therapist has a relationship or interest that may be seen as improperly influencing their professional judgement or ability to act in the best interest of the client. Practice Standard 6: Conflict of Interest requires physical therapists to identify and manage real, potential or perceived conflicts of interest. Conflicts of interest include but are not limited to “providing and/or accepting incentives to/from others to generate referrals, provide services, or sell products” and “providing services or any product for financial gain, rather than the benefit of the client.”
- Practice Standard 10: Fees and Billing requires that “fees are only charged for services provided”. Physical therapists must have transparent and justifiable fee schedules and billing practices and these must be communicated clearly to clients.
Keep in mind that if your clinic owner or your manager isn’t a regulated health professional themself, they may be unaware of regulatory obligations set out by the College. This makes it especially important that you are clear about the requirements of the College and understand that you are accountable individually to meet College regulations regardless of the workplace. If your employer, manager, or clinic owner is requiring you to take steps that are against what you know are your obligations as a physical therapist, you will need to review your regulatory obligations with them, and document having done so.
A few things to keep in mind:
- The College’s regulations are silent about specifying fees charged for physical therapy services. The regulatory obligations of the physical therapist remain the same when physical therapy services are provided, regardless of whether fees are charged, discounted, or waived.
- Remember that any marketing or advertising of discounted fees must be in compliance with Bylaw 83.
- Contemplate what you would do if the recipient of a gift certificate (purchased or donated) doesn’t need physical therapy services. Ensure that the terms of the certificate are made clear at the time of purchase or donation.
Prepayment for physical therapy services
- Consider whether offering the option for prepayment is in the financial interest of the physical therapist or whether it serves the needs of the client. Some clients or families request prepayment options for convenience; some physical therapists offer discounted prepayment for a specified set of services as encouragement to the client to attend the full program/series of sessions. When fees are prepaid for a specified set of services in advance (e.g. for ten sessions) the perception could be that treatment will be extended unnecessarily to use the full prepaid amount based on financial interests rather than the client’s interests.
- Be sure that you have a clear refund policy (and communicate it to all clients in advance) stating that if the client is discharged prior to completion of the prepaid services or if your client cancels the prepaid treatment, the unused portion will be fully refunded.
- Where prepayment options exist, they should be optional and the client should be made aware that they can pay for single sessions if they prefer.
- There is a risk with prepayment that the receipt will be submitted for reimbursement by a third-party payor even if the treatment (or part of it) is cancelled and a refund issued. Prepayment receipts should clearly indicate ‘prepayment’ for physical therapy services to be transparent. After the prepaid physical therapy service(s) occur(s), a receipt for the ‘physical therapy services’ should be provided.
Soliciting testimonials or web reviews
- Consider the power differential between you and your client. If a client is asked by a health professional to provide a testimonial or post a review, they may feel some sense of obligation or pressure to do so. If they choose not to, they might think their care will be negatively impacted.
- Requesting a testimonial or review might influence the professional boundaries between you and your client. Would you feel a sense of obligation towards your client when they provide the solicited testimonial or review? Would there be a feeling of obligation toward them in a way that could impact your ability to provide objective physical therapy services?
Published: January 6, 2021