Adapting to Change Part 4: From Fear to Strategy — Implementing Fee Changes Without Losing Clients

A Five Part Series on the Business of Private Practice Physiotherapy in British Columbia

This article has been posted originally in the BC Physio Members App - join the discussion on the app.

Setting our fees in line with the 2025 PABC Fee Guide will aid in making clinic ownership more alluring and viable while ensuring quality care remains available for the public. 

A business that is financially healthy benefits everyone involved and owners will be able to give support staff wages more in line with BC living wage standards and invest in other staff retention offerings like benefits, bonuses and more education and training. 

Practitioners will be supported with better education incentives and retention strategies as well. 

Clients will benefit as they will receive even higher quality care and more unique service offerings, staff will be less burnt out and businesses will have space for creativity in offerings, innovation in care models and the ability to implement more pro-bono and sliding scale models. 

Ultimately, healthier clinics financially will reinvest in their businesses and provide clients with better services and equipment, more resourced staff, unique community access care models and innovative service offerings. 

Ok great - these arguments are all well and good but the fear of client push back and loss of clients is a huge argument against implementing this. 

I get it, as a client it would be quite shocking to be subject to a sudden near doubling in prices. 

Here are some strategies that can make the transition less jarring:

1. Look for other areas to cut costs. Are there any unnecessary expenses being paid or areas that are lower priority in terms of costs allocations? Running a thorough revenue and expense analysis is an ideal starting point and should happen prior to raising fees.

2. Re-evaluate your fee splits. This topic requires an article in its own sense, but a huge source of outgoing cash is practitioner pay. While this is an absolutely necessary fee (it’s your cost of goods sold!), many clinic owners in the past few years have been giving excessive and unnecessary fee splits. There is a shortage of physiotherapists in the province and as such, many practitioners recognize this as an opportunity to ask for higher commissions, and not surprisingly, many owners are giving these splits out of desperation. This has become a huge issue industry wide and leaves slim, if any, margins. It also puts all clinic owners in an incredibly hard position. While clawing money back in established contracts isn’t always possible, any new contracts or renegotiations should evaluate and reflect appropriate practitioner payment structures. 

3. Be super transparent with your clients. Transparency builds trust and if your clientele understands the real costs of running a business, how increased fees will support staff and clients and has references to the PABC fee-guide, trust and understanding will be at the base of your pricing transition.

4. Phase the fee increases over shorter periods of time. Clinics often increase their rates to reflect inflation changes once per year. Increasing the frequency for a period of time to twice a year or even quarterly (with communication to clients about what is happening) can make the fee increases less of a jump all at once.

5. Create pricing models for new clients at the new rates and returning clients at a discounted rate for a period of time. This may help retain clients and even give them a sense of receiving something discounted. Be sure to put a time limit on this at which point both price tiers will merge.

6. Offer a variety of service models. A variety of appointment lengths can be a way to offer shorter sessions at a lower price point. Using physiotherapy assistants or hybrid appointments can be more cost effective for clients and offering different price points for senior staff (or staff with unique training) and junior practitioners can be unique service offerings offered at different rates.

7. Create a community access fund. If prices are raised the business is more financially viable, this creates more opportunities for pro-bono work and sliding scale practices. Funneling money into a community access fund allows owners to continue to pay staff for service delivery while reducing or eliminating fees for clients who lack funding for care. 

8. Update your marketing language. Remaining confident in pricing and framing physiotherapy as a health investment with primary care practitioners will go a long way in optimizing the public view of physiotherapy. Focusing marketing language on health outcomes not time spent in session is a strong shift in language. Avoid apologetic language such as “sorry we had to increase prices” and shifting to “we have updated our fees to reflect true value and the quality of our care” can largely shift understanding.  

9. Create a sliding scale of offerings. While a sliding scale of session pricing isn’t always feasible, a sliding scale of offerings might be. Creating new service models that still give access to your team at lower price points may be appropriate. Creating offerings like digital on-demand exercise program memberships, YouTube channels, group classes, workshops and other unique models can create unique ways for your community to access quality services at lower price points, while still generating revenue for your clinic. 

10. Be an active PABC member. If you are not already a member of PABC, join now! PABC is doing really incredible work in this area and advocacy work needs support. If you are a member already - thank you! Keep being a squeaky wheel and support the profession with your voice. Take meetings with your government representatives and keep pushing for meetings with insurance companies and third party payers. Support PABC’s advocacy work for including physiotherapy in the public sector in areas like emergency and urgent care, public outpatient and community care - this is where we should be able to send those who lack funding for private physiotherapy. 

11. Add a coat of paint. When launching a large fee increase, or an increase at all, sometimes a little sprucing up of the entry way, the treatment rooms or a new piece of equipment can go a long way in showing that the increased fee is going towards something tangible and visible for clients.

12. Learn which resources are available locally in the public and municipal systems. Familiarize yourself with publicly or municipally funded or subsidized programs in your area. Depending on your area, there may be resources such as urgent care centres, outpatient physio, falls prevention classes, post-stroke classes, healthy heart classes, OA classes etc…. If they don’t exist, offer them! Group classes are a fantastic lower price point option for some patients. Just be certain to inform patients to check with their insurance provider re: group class coverage. 

I would love to hear your ideas and strategies for implementing pricing that aligns with the PABC Fee guide.

Reach out to today to learn more about how we can work together on implementing a fee raise in your clinic that is ethical and in line with PABC’s Fee Guide.