5 Common Barriers to Building a Fee-For-Service Practice

Building a fee-for-service practice can be scary, especially if it means resigning from insurance panels and finding other ways to attract clients. Others may have already made the switch, but don't know how to successfully navigate the change. I have found some strategies to help ease the transition. Here are 5 common barriers to building a fee-for-service practice and ways to overcome them: 1) "I'm uncomfortable marketing myself"

I often hear therapists say that marketing themselves feels like bragging or tooting their own horn by self-promoting. In order to move past this barrier, it's helpful to reframe the way you think about marketing. Consider it instead as REST: Relationships, Educating, Serving, and Trust Building. You are building relationships with potential clients who might see your website or other media, you're serving your community by educating them about important topics related to your niche, and you're establishing rapport and building trust with those who encounter you through your (online) content (REST is essentially why you're in the profession in the first place, right?). If you can focus on these 4 things, you can (and will!) attract clients who will pay your full fee. While your "marketing" strategy (I'm not a fan of that word, by the way) REST strategy is meant to benefit you by helping your community become familiar with you and your services, it's really about those who you can potentially help through receiving services through your practice. Don't be shy in getting the word out about yourself; it's a way for you to use your professional skills to serve and educate your community.

2) "I'm afraid of the ethical issues surrounding social media"

Those new to the world of social media may be wary to fully embrace it because of the potential ethical problems that may arise. Potential for unethical dual relationships, confidentiality concerns, and lack of knowledge are common fears. But these fears (and others) can be overcome: having an official social media policy included with your intake packet, avoiding directly soliciting your additional products or services to existing clients, being familiar with privacy settings online, and overall just using your ethics training and common sense will help you be prepared to face these potential issues.

Click here to read a more comprehensive article about overcoming fears associated with social media.

3) "I'm not good with technology"

The internet gives us incredible opportunities to communicate and reach an audience that is unprecedented in size. However, for those unfamiliar with all the ins and outs, it can also be intimidating, overwhelming, and frustrating to start. Mari A. Lee, an LMFT who specializes in sex addiction recovery, understands this feeling all too well. She describes being scared and resistant to learning new technologies. But she was able to overcome her "technophobia" by starting with manageable goals, finding a patient and persistent mentor, asking lots of questions, and setting aside time to devote to learning and practicing new tech skills. Her success in building an online presence paid off big time; she's currently a best-selling author! "If I can figure out how to blog, attend and facilitate webinars, host online trainings, navigate my Facebook business page, and so forth, anyone can... If this 52 year-old former tech scaredy cat can do it, so can you!" Mari explains (read more about her experience here). 

Understanding and applying the language of technology does not happen overnight. Be patient with yourself, as there's certainly some trial-and error learning here. Remember that everyone starts somewhere. And just like Mari, look for a mentor to guide you and bounce ideas and questions off of. You've proven yourself to be an apt and competent learner by becoming a licensed therapist; have the courage to learn another skill set as well.

4) "I can't do media appearances or speaking engagements because I hate seeing and hearing myself"

Therapists tend to get shy about media interviews. It's one thing to sit in front of a client and offer counsel in a one-on-one session, but speaking in front of large audiences can bring out anxiety in even the most confident clinicians. But remember how much you know; you are a trained and experienced expert. The aesthetic and "performance" aspect of media appearances will come with time. The more prepared you are, the more comfortable and relaxed you'll be. And if by chance you do feel like you bombed a television interview or radio podcast, learn from it and try to move on. It's not the end of the world if you make a mistake!

Read here for more tips on how to look good and sound professional in your media appearance.

5) "If I'm a great clinician, my work will speak for itself"

Some therapists plan to rely on their hard-earned reputation as an excellent mental health professional to be their main source of client referral. They then focus solely on refining their clinical skills, as they don't see the need to engage with their community beyond private sessions. While referrals can be an effective strategy to build your clientele, depending on others in the field to refer to you should not be the only way you attract people to your services. The harsh truth is that there are a lot of excellent therapists who fail in developing a successful private practice. Everyone has to start somewhere, and it takes time and experience to gain a loyal following and individuals who actively seek you out.

You may find that by being persistent in building trust in you and your services over time will be the major benefit to the growth of your practice. Because we have worked hard to establish ourselves as trusted professionals by embracing social media and building our online presence, my practice, Wasatch Family Therapy, receives most of our referrals from Google searches. This is something I feel very grateful for, and it's largely due to the fact that I stopped participating on managed care panels and consequently had to work within the community to build trust directly with potential clients.

Embracing a private pay practice model brings more than a few questions, unknowns, and worries. But by using these strategies, you can overcome barriers and build a thriving practice.

Besides the obstacles presented in this article, another major reason why clinicians may be wary of switching to private pay involves how they think their clients will be affected. I address (and debunk!) these fears here.

Click here to view my webinar and learn more strategies and tips about breaking up with managed care!

Join my Private Practice Toolbox Facebook group and connect with 2800 therapists around the globe in 2 simple steps: 1) Click request to join the group and 2) Fill out this brief questionnaire before you'll be added to the group.Get practice tips and blog updates in your inbox.

Sign up for the Private Practice Toolbox Newsletter here.

Choosing the Right Electronic Health Record (EHR) for Your Private Practice

The key to running any company smoothly is to keep meticulous and clear records, and psychotherapy private practices are no exception. Virtually all businesses today operate with an electronic data-keeping system; paper files don’t cut it anymore. More and more private practitioners are moving toward a paperless practice, which includes a professional Electronic Health Record. And advances in technology have created software programs designed for the unique needs of those in the mental health profession.

An efficient EHR can reduce no-shows, provide instant and secure information to authorized patients, and overall contribute to a well-kept and professional business environment. In other words, a good EHR is nothing to skimp on!

The purpose of this post is not to provide a comprehensive look at every EHR on the market (as there are hundreds), but instead aims to identify important features and criteria in choosing a system and also to analyze some of the pros and cons of a few prominent brands.

Here are a few of the most important factors and features to consider when looking into a new EMH software for your therapy practice:

1) Basic features: these include to-do lists/ task management sub-systems, billing, scheduling, and patient appointment reminders

2) Price (many offer a free 30-day trial with limited features)

3) Client Portal (this would allow your clients to login to view their payment history, appointment history,  schedule appointments, or print out a superbill)

4) Data Reports (a detailed analysis of revenue, percentages, tracking referral sources and history, etc.)

5) Single Provider vs. Multiple Provider: (can multiple people or groups use the same system?  Can records overlap?)

Now let's look at a handful of some popular Electronic Health Record systems:

TheraNest

A major push for TheraNest is that it is workable for multiple providers in multiple locations. It also provides highly detailed analyzed reports to track data over time.

TheraNest does offer a client portal, but it's an add-on, so you have to upgrade and pay more for it. They offer a free 30-day limited trial (though it doesn't include client reminders during that time).

Simple Practice

Simple Practice is one of the most popular EHRs today, with most supporters praising its highly efficient and clear billing capabilities. Whether your customers pay full-fee or with insurance, Simple Practice can make it easy for you to keep everything in order.

While Simple Practice is top rated for a reason, a disadvantage of it is that it doesn't have a feature for multiple providers. And it's customer service reviews are relatively high, though some may wish they offered 24/7 technical support instead of just during business hours.

TherapyNotes

This system is known for its excellent and responsive customer support, user-friendly interface,  high security measures, and low cost. A possible downside of TherapyNotes is its limited billing features, including its inability to monitor secondary billing insurance. It also lacks a client portal.

Click here for a more detailed review of dozens of mental health software systems:  http://www.capterra.com/mental-health-software/

What are YOUR experiences with EHRs? What have you found that you like (and don’t like!) about different systems? I'd love to hear from you!

Get practice tips and blog updates in your inbox. Sign up for the Private Practice Toolbox Newsletter here.

Join my Private Practice Toolbox Facebook group and connect with 2700 therapists around the globe in 2 simple steps: 1) Click request to join the group and 2) Fill out this brief questionnaire before you'll be added to the group.

How to Make Sure Your Online Photos are Copyright-Friendly

Graphics and pictures are a great way to enhance your social media engagement for your private mental health practice. They add something that words cannot, they show personality, they can break up large blocks of text, and they add visual interest. However, in our Internet age, there is a very real danger of getting into trouble if you use an unauthorized photo. The owner of the image(s) can slap you with a fine or a law suit. It's easy to disregard copyright rules, particularly if you are a small business owner. Some assume that if their blog is not a commercial site or monetized by running advertisements, then they can use any image without fear of legal penalty. And there are millions of blogs out there, so why would anyone care about an image or two you use on yours? The truth is that photo companies have software that crawls the web looking for their private images, and they’re not afraid to get you if you violate their rules. It happens a lot. It even happened to me. Moral of the story? Respect copyright laws.

Here are three suggestions for safely using images on your website:

1) Use a Stock Photography Website

These sites have thousands of images to browse so that you'll be able to find some that portray what you're looking for. There are lots of sites to choose from: Shutterstock, BigStock, and CanStock are some well-known names (I personally use Canstock). This is an investment, but it's a reasonable and worthwhile one. Here's how Canstock works: you sign up for a package of "credits," which are points to use an image. If I were to buy the 100 credit package, I'd pay $50 and would be able to "buy" the rights to use an image with my credits (most photos are 2-3 credits). There are different credit packages available to give you the best deal depending on how often you utilize images. I encourage you to research Canstock and the other companies and decide which one will work best for your business and your budget.

2) Take Your Own Pictures!

Why not create your own images? Maybe you’re a photography buff, maybe you’re not, but nowadays, it’s easier than ever to capture clean and beautiful photos with an iPhone or other simple device. Take a picture of your therapy office, something in nature that inspires you, or anything else that relates to your online presence. Use your imagination (and your common sense!) and tap into your creative side. Best part? No worrying about legal consequences!

3) Use Public Domain Images

There are some photos online that are actually totally free. Yep, the owners have decided that anyone can use them, making them fair use images. Hallelujah! Here are 3 popular sites with great free images:

Death to the Stock Photo I love the tongue-in-cheek name, here. This site actually emails you free images every month. There really are some beautiful ones here, and there's a different theme every month.

Unsplash Unsplash is another one with free, high quality photos. Not quite as many to choose from, but there are always new ones being added, so you might be able to find what you're looking for.

morgueFile Strange name, I know. Here are even more great stock photos where you don't need to worry about licensing or copyrighting issues.

4) Get Permission to Use an Image Through Creative Commons

Sometimes, you find an image on Google that fits perfectly for what you're looking for, but since it's not public domain, you cannot legally use it. In these cases, you may be able to get permission from the owner through what is called a creative commons license. This is a tool to connect someone who wants to use a photo with the person or company that supplies it and help them come to a reasonable agreement that is in compliance with the law. For example, you might be granted permission to use an image on your site, but not on a newsletter or book. It's up to the copyright holder what sort of license they give. Creative commons licenses can get pretty complex; click here for more specific details about it.

So yes, images are becoming increasingly important when you build your online presence, but you must take precaution and protect yourself. Once again, I urge you to take copyright rules seriously in order to avoid landing yourself in hot water. By using these techniques, you'll be able to create visual content for your online presence and keep yourself safe from any expensive and messy copyright violations.

Click here for more about going graphic/ using images to enhance your online presence.

Get practice tips and blog updates in your inbox. Sign up for the Private Practice Toolbox Newsletter here

Join my Private Practice Toolbox Facebook group and connect with 2600 therapists around the globe in 2 simple steps: 1) Click request to join the group and 2) Fill out this brief questionnaire before you'll be added to the group.

Webinar: How to 'Break Up' With Managed Care and Build a Fee-For-Service Practice

New webinar this Wednesday on building a fee-for-service private practice

I've written previously about my decisions to 'break up' with managed care and build a fee-for-service only practice. This topic comes up often in my Private Practice Toolbox Facebook Group. Group members often ask questions like:

• Is it really possible for private practitioners to build a cash-pay practice in our current economy?
• How do you find clients who are willing to pay your full fee at each session?
• How do I overcome the fear of losing all of my clientele if I resign from insurance panels?
• How do you address the needs of those in your community who can't afford your services if you don't work with insurance?

If you've ever wondered these questions, you may be interested in my upcoming webinar this Wednesday.

Date: Wed. Oct 10, 2014*

Time: 11:00 a.m. (PT)/Noon (MT)/1:00 p.m. (CT)/2:00 pm (ET)

Length: 90-minutes

*If you can't make the live webinar at that date & time, no problem! You'll receive a link to watch the replay video at your convenience, but you do need to register.

Reserve your seat here

Here's why I resigned from managed care:

• Excessive paperwork: I was spending almost as much time performing unpaid work (paperwork, phone calls, tracking authorizations, and billing) as I was spending seeing clients. I went into this field to do therapy, not paperwork.
• Reduced income: I resented writing off 40-60% of my fee upfront just to be placed on a list with dozens and dozens of other therapists. The managed care companies weren’t doing anything to market my practice, and yet I was being asked to take a huge pay cut to work with their clients.
• Mandatory diagnosing: I grew tired of having to diagnose every client who walked into my office in order to get paid. When I met with a client who didn’t have clearly diagnosable symptoms, I was faced with a dilemma. Do I stretch a diagnosis just so I can get paid, or do I do free therapy because insurance won’t reimburse without a diagnosis?
• Denied or delayed payments: Being denied reimbursement for a variety of reasons and receiving payment weeks or months after I had performed the service was extremely frustrating.

Here's what has happened since 'breaking up' with managed care:

• Exponential growth: My private practice grew from a solo practice to a clinic of 20 providers and 3 locations in a fee-for-service model during an economic downturn.
• Immediate payments: We get paid our full fee at each session (including late cancellations and no shows)
• Streamlined paperwork: We do assessment, case notes, and discharge summary.
• Motivated clientele: We work with clients who value our time and expertise because they are more financially invested in the therapy process.
• Diagnosis has become a tool, not a requirement for payment: We don't have to diagnose anyone.

In this webinar, I'll show you how to:

• Identify and attract your ideal clients.
• Demonstrate the value of your services to your community through building a strong online and media presence so clients will be willing to pay your full fee at each session.
• Wean off of managed care contracts and smooth this transition for your current clients by offering many options.
• Talk confidently about your services, your fees, and financial policies.
• Provide options for potential clients who can not afford your full fee or who want to use their insurance benefits.

The decision to resign from manage care panels and build a fee-for-service practice is not the right path for every practitioner. However, there are some private practitioners who want to go this direction but lack the knowledge, skills, or confidence to implement their desired changes. If you fall into this second group, this webinar is designed for you.

I hope to see you on Wednesday!

Here's the link to reserve your spot for the webinar and access to the replay video

Oh, and if you have any specific questions you'd like me to address in this upcoming webinar, contact me here with "Managed care webinar Q" in the subject line.

4 Ways To Use Pinterest To Build Your Practice

Pinterest is a social media platform that therapists might overlook when building their online presence. It may seem more tailored toward foodies, pop culture junkies, or book lovers than for people wanting or providng professional counseling. However, Pinterest can be a valuable way to serve your online community and also get the word out about yourself and the clinical services you offer. Joe Sanock, an LPC who also works as a private practice consultant, explains that “People who go on Pinterest are dreaming about having a new life. It could be a new hair style, a new dress, or a renovation. They are in a mindset of change. As counselors, we fit perfectly into that mindset.” He says that Pinterest is his leading referral for both his private practice and consulting business. Bottom line: Pinterest can work as a great marketing tool for you (read more about Joe's experience here).

Here is some more information and tips for using Pinterest to benefit your practice:

1) Regularly Pin and Re-pin Inspiring and Informative Material 

Make a point to pin and re-pin inspiring quotes and ideas that are relevant to your work as a therapist. Quotes about change and personal development often work best. Try to use quotes that are universal enough to not seem super technical or boring, but specific enough to establish that your niche deals with emotional and relational well-being. Use original material as well as curating existing content.

It’s a good idea to strategically include your name and website links on your graphics or memes (see left for an image I pinned as an example). This can be helpful when you get share and re-pins. It’s more than okay to tap into the promotional side of using Pinterest.

There is of course no cut-and-dry rule about how regularly you should post. But as is the case with any social media platform you utilize, you must commit to make content creation and curation an ongoing thing if you want it to make a difference in your marketing; pinning a new picture or idea once every month is not going to do much for establishing and maintaining your online presence.

2) Optimize Your Bio and Profile

The bio at the top of your Pinterest page is your "hello" to new followers. First impressions are important, and you want to introduce yourself professionally and accurately to your viewers. It should have your picture, a clear description of your speciality, and links to your main website. Optimizing your biography is also good for SEO (making your stuff for findable on the web). See screenshot below for my example:

3) Be Deliberate in Selecting Categories and Board Titles

Similar to your biography, be strategic about your titles, categories and boards; they're more important than you might think. Not only do they give a clear indication of the nature of your material, but they're also good for the search engines because your titles are your keywords. Not every one of your boards must be directly related to the field; it's good to diversify and show your followers that you're a multi-dimensional person. For example, you might have a board of humorous memes.

4) Follow Others in Your Niche

And finally, we come to the social part of the social media of Pinterest. Follow other relevant users. Look at the categories and boards of those who re-pin your stuff and see if they are similar to yours. Engage in Pinterest not just for yourself, but use it as a way to learn more and continue to be inspired. Check out other people's pins as well. And yes, follow to be followed (among other reasons).

So there's some tips to get you started or help you more with using Pinterest. It can be a useful tool to engage with the online community, invite more visitors to your website, as well as build your own professional online presence.

What's your experience using Pinterest for your practice?

Get practice tips and blog updates in your inbox.

Sign up for the Private Practice Toolbox Newsletter here.

Join my Private Practice Toolbox Facebook group and connect with 2600 therapists around the globe in 2 simple steps: 1) Click request to join the group and 2) Fill out this brief questionnaire before you'll be added to the group.