It’s no secret that the cost of healthcare is increasing every year: national health expenditure in the US increased more than 4% each year from 2017-2019, and the American Medical Association calculated a per capita cost of healthcare of $11,582 in 2019. (1) It’s therefore understandable that many patients may be struggling to pay for all types of healthcare, including rehabilitation.
Sometimes, however, patients may be using cost complaints as a stand-in for their real concerns about PT or OT. Let’s consider a three-step process to navigate discussions around cost and value to learn what your patient truly needs, and how to deliver it:
  1. Lead with curiosity and open-ended questions
  2. Be prepared to negotiate and adjust expectations
  3. Highlight your value by emphasizing the patient’s goals

Lead with Curiosity & Questioning

Let’s face it: discussions about money and finances can be stressful and uncomfortable, and that discomfort can place everyone involved on the defensive. Defensive arguing tactics are no way to start a productive conversation about the cost of care.

Rather than jumping in with all the reasons that you think your services aren’t too expensive, start by asking open-ended questions: this will allow your patient to give more background and reveal the real reasons that they are concerned about continuing care with you. (2) Many of the motivational interviewing skills that therapists use to discuss clinical issues with patients can also be applied to discussions about the value of therapy. (2)

By using “we” language rather than “you” statements, you can affirm the patient’s feelings and foster the sense that you are both on the same team. (3) It’s important to recall that shame about their financial situation can prevent many people from voicing cost concerns directly to their providers. (3) In fact, while approximately two-thirds of patients report wishing to speak to their physicians about cost, only about 15% actually ever do. (3).

If your thoughtful questioning reveals that money truly is a concern for your patient, it’s worth asking what they actually can afford to pay for the rehab they need. This can open the door for negotiation and adjustment in some cases.

Be Prepared to Negotiate & Adjust Your Expectations

If you’ve identified cost as the primary impediment to the patient continuing care with you, you may be able to offer some assistance, such as a payment plan. (4). Other cost adjustments, such as sliding scales or discounted services, may be feasible for patients with certain insurance plans or those paying cash out-of-pocket. In these cases, you’ll need to make sure that you are in compliance with your local laws and insurance regulations. (4)

If cost isn’t the primary problem for your patient, then you’re often facing an issue of demonstrating value—that is, convincing your patient that your services are valuable enough to justify continuing care. Oftentimes, a frank review of goals and timelines to meet them is a powerful tool for demonstrating your worth as a provider.

Review the Patient’s Goals and How Therapy Can Help

Rather than wasting time trying to convince your patient that rehab is worth it by listing all your skills and successes, turn the focus back to the patient and their personal goals. The rehabilitation professions are constantly emphasizing the importance of patient-centered care that places the patient’s needs and goals at the core of all treatment decisions. (5) Why should financial decisions about care be any different?

Take the time to review the goals you set together at the start of care. Acknowledge first the goals the patient has met, either fully or partially: this can bring to light the progress they have made so far, particularly if their current frustration is preventing them from noticing change.

Secondly, address those goals they have not yet achieved. Be willing to have an honest discussion about when the patient can expect to see progress towards those goals, and to what extent. Be specific:

  • Set time frames for goal achievement, as precisely as possible. (4)
  • Define objective tools for measuring success – and make sure they matter to the patient. (Let’s be honest: your patient doesn’t care that their score on the Functional Gait Assessment improved by ten points.)
  • Discuss exactly how the patient can actively contribute to their own success, whether this is via habit change, HEP performance, or another tangible task. Consider using additional tools to facilitate this process: for example, the AC Health app can encourage proper HEP performance to help your patients meet their goals faster.

By placing the emphasis on the patient’s goals and how therapy can help them reach those targets, you can subtly reinforce your own value as a skilled provider, without feeling like you’re giving your patient a sales pitch.

However you choose to approach the value conversation, be sure that it’s kind and not too heavy-handed: after all, no one likes being bullied or pressured into important decisions, particularly those related to something as personal as their health. If you develop a reputation for being pushy, it can harm your business and even dissuade future clientele from engaging with you.

If you approach conversations about cost with the same care and compassion you apply to patient care, you’ll be more likely to gain your clients’ trust and retain them for years to come!


(1) American Medical Association. (2019, August 13). Trends in health care spending. American Medical Association.
(2) Motivational Interviewing: Open Questions, Affirmation, Reflective Listening, and Summary Reflections (OARS) | IGH Hub. (2007). Ruff Institute of Global Homelessness.
(3) Hardee, J. T., Platt, F. W., & Kasper, I. K. (2005). Discussing health care costs with patients. Journal of General Internal Medicine, 20(7), 666–669.
(4) McKee, K. (2020, September 8). The PT’s Guide to Retaining Patients with Bad Insurance Plans. WebPT.
(5) Commitment to Person-Centered Services. (2018, August 30). APTA.