LA GRANDE — Dale Johnston missed his patients.

The registered physical therapist worked at his private practice until his retirement in 2022, but his time off was brief because he missed his work and the interaction he had with his patients. Consequently, he came out of retirement and opened Grace Physical Therapy in 2023 as a private practice.

“This is my 50th year as a practicing physical therapist,” he said. “I like my work, and I like to help people feel better.”

Johnston is accepting patients at his new practice in La Grande. His services include manual physical therapy and orthopedic therapy with a specialty in treating shoulders.

Getting his start

Johnston received his education in California.

“I graduated from Loma Linda University in 1975 with a bachelor of science in physical therapy, and I progressed to earn my master’s degree there in 1977,” he said.

Johnston came to La Grande in 1987 and established Northeast Oregon Physical Therapy, which became a big clinic back in those days, he said. He sold his practice in 1996 to a corporation, and his former employees continued working under the new ownership.

“Eventually, it opened as Mountain Valley Therapy, so that’s how they got started,” he said. “There are a lot of good therapists there, friends of mine.”

As for Johnston, he left the area for six years, returning to La Grande in 2004 to reactivate his practice under its former name, Northeast Oregon Physical Therapy. The business name had been abandoned and was available for him to use again.

A changing industry

Johnston has seen many changes in the physical therapy field through the years. For one, an increased volume of physical therapy patients being served in orthopedic surgeries — which, in turn, has created long wait times for appointments. It’s not unusual for a patient to wait weeks or sometimes a couple of months for an appointment with a physical therapist. This is particularly a concern for patients with joint replacements that require immediate post-operative therapy to build strength and restore functionality.

Under this heavy volume of patients, there is also an evident need for more physical therapy practitioners and clinic staff. A December 2023 Bureau of Labor Statistics report stated, “There is a huge demand for physical therapists, and it’s only expected to grow. The job outlook from 2021-2031 is expected to grow 17%.”

That is also true in Union County where Grande Ronde Hospital and Mountain Valley Therapy are booked for orthopedic surgeries and patients needing physical therapy. Considering that patients often require multiple appointments with a therapist, it’s easy to see the health care system is very busy, Johnston said.

This is where Johnston feels that Grace Physical Therapy can fill a need in the system. When patients are waiting for their physical therapy appointment date to arrive, they can choose to get a head start on their therapy at Grace Physical Therapy. Then, when their long-awaited appointment date arrives, they may transfer to the other physical therapist or stay with Johnston, whatever the patient chooses.

In any case, patients get an earlier start on the road to recovery so they can return to their normal activities or jobs.

“I’m very happy to expand my hours … to accommodate new patients,” Johnston said.

Trend toward cash-based practices

A growing number of private physical therapy practices, like Johnston’s, are choosing to become cash-based businesses for the benefits it offers.

With cash-based physical therapy clinics, there are no referrals needed for the patient to receive physical therapy. Insurance companies cannot limit or end treatments for the patient. Johnston is able to work one-on-one with the patient and offer high-quality care and technologies without insurance scrutiny or censuring. This often means visits are not strung out for long durations, but only as long as is necessary to achieve medical objectives.

“A typical physical therapy visit with me is one hour long,” he said. “For hip replacement patients, they only need two visits per week for about two weeks. Hip replacements heal very well and don’t require a lot of therapy with the current surgical approach. Knee replacement patients require a little more physical therapy.”

Cash-based visits have financial benefits for both the patient and the practitioner. The practitioner receives full payment in cash from the patient, and the patient does not get any surprise billings in the mail long after treatment has been finished.

Another benefit of a cash-based practice is that this approach avoids the cost of collecting payment from third-party payers and the difficulties in negotiating rates with insurance carriers that might undermine the financial viability of a physical therapy practice. The practice also avoids the treatment delay that comes while waiting for insurance pre-approvals to come through. The practitioner also avoids the frustration of claim denials under the reason that the treatment was unapproved or unnecessary. Cash-based practices have lower overhead expenses and a smaller payroll.

“I researched what it would take to open a cash-only business and learned that it wasn’t as much as I had thought,” Johnston said. “I also learned that patients don’t mind paying cash for their therapy sessions.”

Instead, patients often pay below market fees. Johnston charges $95 for the initial evaluation visit for new patients and $85 for subsequent visits. Interestingly, Johnston said that some patients don’t want to bother with the insurance claims paperwork. They are just satisfied to get an appointment quickly and start their therapy sooner.

“I’ve never been in this business for money, and there are some folks who can’t afford $85 an hour,” he said. “That’s why I call my practice Grace Physical Therapy, which means that I will extend that grace to people and negotiate affordable payments.”

To make an appointment at Grace Physical Therapy, 1606 Sixth St., La Grande, or ask questions about possible therapy options, call Dale Johnston at 541-786-3221.