After the pandemic, what are some trends to be aware of that are circulating in the private practice world? Should you do telehealth or in-person counseling post-pandemic? How can you take part in passing a bill that allows over-state line counseling?
In this podcast episode, Alison Pidgeon speaks with Whitney Owens about the current trends in private practice.
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In This Podcast
- Having trouble with hiring
- Telehealth or in person?
- Over state counseling
Having trouble with hiring
Due to the pandemic and most services in the world going online, many therapists are starting their own practices because many of the pre-practice-launching costs such as paying rent, hiring an office, and so forth have been cut.
This means that for general practice owners, it is becoming more and more difficult to hire clinicians because many clinicians are creating their own practices.
Group practice owners now have to evaluate the benefits that they offer and their working environment in order to make it more attractive to potential clinicians.
What has been a big game changer for me is offering health insurance for my staff. We switched over at the beginning of 2020 to W2 employees and now we’re offering health insurance and that actually helped bringing people on who were already in the practice parttime, they just changed to fulltime because they knew they could get benefits. (Alison Pidgeon)
Work on proper wording and describing the advantages that clinicians can enjoy by working in your practice when you advertise for hiring.
Telehealth or in person?
How group practices have set up counseling services after the pandemic has varied from state to state. Some practices are doing mostly in person and others are doing mostly telehealth.
If you are thinking about going back to in-person, here are a few precautions you can take:
- COVID wavers: you can alter it for your practice so clients can sign that when coming in.
- Clients wear masks, social distance, and sanitize often.
- All surfaces are cleaned constantly between clients.
- Meet the client at the front door to minimize their touching all the door handles.
Over state counseling
By joining PSYPACT, clinicians and practice owners can obtain the license they need to practice over state lines.
Georgia was the first state that had this bill passed. Maryland, Nebraska, North Tennessee, North Carolina, and Delaware all that this bill pending.
If you are in any of those states look this up [because] they are really great resources [in] the American Counseling Association and look up the counseling compact and it allows professional counselors to practice across state lines. (Whitney Owens)
Rally up counselors in your area and write to your local representative to get the bill passed in your state.
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Meet Alison Pidgeon
Alison is a serial entrepreneur with four businesses, one of which is a 15 clinician group practice. She’s also a mom to three boys, wife, coffee drinker, and loves to travel. She started her practice in 2015 and, four years later, has two locations. With a specialization in women’s issues, the practices have made a positive impact on the community by offering different types of specialties not being offered anywhere else in the area.
Alison has been working with Practice of the Practice since 2016. She has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting.
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[ALISON]: Welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon your host and today I have with me, Whitney Owens, my counterpart at Practice of the Practice, my fellow business consultant, and my friend. And before we jump into our topic today I’ll let you introduce yourself, Whitney.
[WHITNEY OWENS]: Yes. Well, hey, you just gave me the best introduction I could get. I like, the counterpart, I liked that. yes, so I’m Whitney Owens. I have a practice here in Savannah, Georgia on the coast. There are eight of us and three admin staff because I really like to delegate and not work so much. I also do consulting with Practice of the Practice, really joined Alison and some membership communities that we run together, Group Practice Boss and Group Practice Launch. I also kind of niche with faith-based practices, helping them start and grow nd how do you make faith a part of the work that you’re doing. Yes, and I love talking about private practice.
[ALISON]: Nice. All right. So Whitney and I were talking before we started recording about how interesting it is working as business consultants and talking to private practice owners really all over the United States. I’ve had some clients in Canada and just hearing what the different trends are that are happening that you may not realize if you’re just sort of doing your own thing in your private practice. So that’s what we wanted to talk about today. Like what are the trends that we’re seeing? What are our consulting clients asking us about? What are private practice owners really thinking through right now, especially changes related to the pandemic and that type of thing. So the first trends that I wanted to bring up is that it seems group practice owners in particular are having trouble with hiring. So I think what’s happening is mental health services are really in high demand, getting overwhelmed, and because of the pandemic, it’s very easy now to start your own private practice.
You don’t even need an office. You don’t have as much startup money to get things going because you don’t have rent and furniture and all of that. So I think a lot of people are going into private practice for themselves, which is great. But then for the group practice owner, it’s difficult for them to find really good people to hire. So I have been talking to several group practice owners who’ve been having that difficulty and I don’t know if you’ve been seeing that kind of same trend Whitney.
[WHITNEY]: Definitely. Yes, conversations I’m having with lots of people I’m consulting with and then to be frankly honest in my own practice. I feel like I’ve never had issues with hiring and when I put something out and to tell you the truth, I don’t even really have to work very hard at the job description. It just seems like people apply no matter what. There’s a lot of just applications and this time I’ve had to really work hard on, maybe we can talk a little bit about this, but like really narrowing it down and really speaking to why it’s beneficial to the person to apply, because you want your job ad to compete. You’re competing with so many more job ads now than you ever worked before. So that’s such an important part of it, but yes, I’m seeing the same trend.
[ALISON]: Yes, and I think that the conversations that I’ve had with my consulting clients are really around how do they make their job as attractive as possible in terms of do you offer more benefits or do you offer better pay? Obviously there’s different answers depending on your practice and what you already have in terms of offering. but I think that is something really good to look at; is how do you make yourself as attractive as possible as an employer?
[WHITNEY]: Definitely, definitely. And I’m sure that changes based on your area, if you’re city or rural or kind of what your practice set up is will really change what you can offer in that job description.
[ALISON]: Yes. And I know one thing that’s been a big game changer for me is offering health insurance to my staff. We switched over the beginning of 2020 to W2 employees and started offering health insurance. That actually helped with bringing people on who were already in the practice part-time. They just made the change to full-time because they knew they could get benefits and then also it just was a big recruitment tool in terms of getting people to join the practice. So now that we have that in place, we’ve added like a 401k plan with a match and we’re at adding on to other things like we were going to offer a stipend to each therapist to buy supplies, to set up their office at home just as like a nice kind of gesture because we are saving so much money on office space so that they feel like they have everything they need to work from home.
[WHITNEY]: That’s great. I me thinks so much of it is finding what makes your practice great and really being able to verbalize that in your description, if it’s, “I offer health insurance or we’re W2 employees and so you don’t have to keep up with your taxes or we have a friendly environment or a flexible work schedule.” Whatever it is, being able to capitalize on those advantages and be able to word that appropriately to make it stick out to people.
[ALISON]: Yes, and I know for my staff, the flexible work schedule is huge, especially for the staff that have kids. So that is a really big selling point. So I try to highlight that in the job posting. Yes. So I think it’ll be interesting to see in the coming months if that changes, maybe some people will go into private practice on their own and realize they’re not made for it and they’ll want to start and go to a group practice.
[WHITNEY]: That’s true. And you know, we’re getting close to graduation for a lot of schools. So hopefully we’re about to get a lot of new therapists out there looking for jobs. So I hope that in the next few months we’ll be able to get some more people hired for group practice owners.
[ALISON]: Yes, for sure. So the second thing that we have been noticing is related to the pandemic and how, in some parts of the country, it seems like a lot of people expect clients expect to be seen in person versus other parts of the country where everyone is doing telehealth and the clients seem fine with it. So do you want to talk a little bit about that Whitney?
[WHITNEY]: Yes. This part really amazes me how different it can be. You know, down here in Georgia, it’s pretty rare now that someone would call our practice and want to do virtual therapy. And if they do, it’s usually not because of COVID it’s just because they don’t want to drive into Savannah. Maybe they live in one of the little suburbs around, or they have a busy demanding job, or they need to stay at home with their kids at night. Like it usually now people know that virtual is out there, so they’re using it to their advantage for other reasons but it seems like COVID is not a huge reason down here to be doing virtual, which is the exact opposite of 70 people I’m consulting with, especially people that are in cities. You know, when I tell them that we’re doing in-person and been doing it this long, they’re just blown away by that. And you know, even us, Alison it’s like your practice is all virtual. Mine’s almost all in-person. That’s so interesting to me.
[ALISON]: Yes. I’m in Pennsylvania and I would say about 98% of the people that call in are asking for in-person sessions, probably about 2% of the people are saying, “I absolutely want to be seen in person.” And we refer them out because we’re not seeing clients in the office yet, but we’re right on the cusp. Actually we’re starting to see people in the office and yes, I think it’s, again, something else practice owners in general are grappling with right now is like, when is it going to be safe to go back into the office? You know, like a lot of my staff were able to get vaccinated because we were under the first phase as healthcare providers and so, yes, it just feels like a little bit of a transition period and it’s not a light switch. It’s not like, “Oh, we all got vaccinated and now we can go back to work like normal.” So it’s just been interesting to have those conversations with my own staff, but also people all over the country like in Texas in Florida, it’s like, “The pandemic? What?” Like, they’re not taking any precautions at all.
[WHITNEY]: Yes, I understand.
[ALISON]: Yes, and they were all just expecting to be seen in person this whole time versus like in New York city, my consulting clients are like, “No, we’re doing all telehealth and nobody expects to be seen in the office.” So it’s just interesting how different places in the United States are taking it, treating it differently.
[WHITNEY]: Most definitely. And you know, as far as protocols, it’s weird to think about, because people are asking me now, “Okay, what are the protocols that I should take as an office to get back in?” And I’m thinking, “Oh my gosh, I did this back in may. “Like, that is crazy that we’ve been seeing people since may and I will say we have taken tons of precautions as a practice. So just to kind of give a few to people, if they’re thinking about going in in-person; we do have COVID waivers. Actually, if you’re a member of Group Practice Boss, we have that in our teachable where you can take a COVID waiver that I got from an attorney and you can alter it for your practice and so your clients sign that before they come in. And then we do all the things that you would think to do, like wearing masks, social distancing, washing hands, sanitizer. Everywhere we clean, even the sofas, like Lysol them between clients. We ask clients to not use the bathroom unless necessary or not to go into the kitchen like they used to just be able to go in. Now we do that for them. We meet them at the front doors, they’re touching less handles and we walk them in and have them sit down. So we do take all those precautions. Even still with numbers going down, at least they’ve been going on here. Thank goodness. But we did take all those precautions.
[ALISON]: Yes. Yes. Thanks for going through all that because that’s actually what we’re grappling with right now, just figuring all of that out. Something else sort of related that I’ve been getting a lot of questions about and I’m sure you have, too, is practice owners obviously are thinking about what happens with insurance coverage when the pandemic is over? Are insurance companies going to keep covering telehealth? Are they going to take it away? You know, obviously when the pandemic started, it was like within a matter of days, it was just like a sweeping change and then all of a sudden, almost all the insurance companies covered telehealth almost like no questions asked and not really any particular restrictions. Like in the past they would require you had to use their own platform and that kind of thing but now all of those restrictions are much more lax. So I actually haven’t heard anything from the insurance companies one way or the other. Are you kind of having the same experiences with your consulting clients, they haven’t heard anything from the insurance companies?
[WHITNEY]: Yes, nothing definitive. It seems like due dates will be put out there and then they keep getting pushed back, which is fortunate. You know, I mean, you’d like to think that insurance companies are going to change now that the whole mental health world has changed and that their customers or clients are going to request that they can do telehealth because we see what the benefit is for people and the savings of money it is for people, you know? So let’s hope that they pay attention to that. And then it’d be interesting to see if some of them approve and some don’t and if people end up wanting to be with different insurance companies because they can get telehealth with one and not with another.
[ALISON]: Yes. And actually my educated guess, and again, I haven’t heard anything from the insurance companies about what they plan to do in the long-term, but my educated guests in my mind, the worst case scenario is insurance companies will say, “You have telehealth coverage, but your provider has to use our telehealth platform.” And then they’ll force providers to use the telehealth platform that pays them less, or they’ll restrict them from getting credentialed with the telehealth platform. You know, they’ll find some way to sort of prevent people from being able to provide telehealth as easily as they do now. So that’s kind of my worst case scenario in my mind. I don’t think they’re going to totally take it away, but I think they’re going to, as insurance companies do, they’re going to find ways to make weird loopholes so that it restricts access for people and providers. So yes, that’s me being a pessimist, I guess, but and I have a plan.
[WHITNEY]: Sometimes we need to be that way.
[ALISON]: Yes. I have a plan.
[WHITNEY]: When it comes to insurance.
[ALISON]: Right, right. I have a plan if that happens. I’m not opposed to going to advocate at the state level to make sure that the insurance companies can’t do that kind of thing, but time will tell what happens with all of that.
[WHITNEY]: That’s for sure. And I’ve also seen, we were talking about this too, before we went on air that with cash pay practices, even myself included, we’ve had clients request for lower cost therapy sessions because they’re telehealth. And so that’s interesting to me that it’s almost like clients, it gives me the impression that clients think it’s not as effective and doing it virtually or, and I wonder if that’s more of a cash pay thought pattern for people. We’ve had to explain to them that that’s not something that we do. I mean, I’m curious, Alison, have you heard any insurance-based practices’ clients saying they want discounts on therapy because it’s virtual.
[ALISON]: I have not. So maybe that’s a difference between self pay and insurance-based because typically insurance-based, you have to go by whatever the plan says. So if you have a $20 copay, you can’t like negotiate to pay less than what the insurance company says you have to pay.
[ALISON]: There’s not a lot of wiggle room there with negotiating. No wiggle room at all.
[WHITNEY]: Yes. We have to educate people on what therapy is and the qualifications of that person and why the price is what it is and it’s not going to be different just because you’re doing it over the phone or through video or in person.
[ALISON]: Yes and I think too, like I’ve seen therapists discussions like in Facebook groups and things talk about that they do charge less for telehealth. And I just think that’s a mistake because you know, you’re really the bulk of what you’re providing as a service and that really the majority of your expense comes from paying the person delivering the service. So if you’re in an office or you’re at home, it’s not much different in terms of your overhead.
[ALISON]: Yes. So I know another thing that you have been hearing is about couples therapy and people having difficulty getting insurance to pay for couples therapy or like that seems to be changing. Can you talk a little bit about that?
[WHITNEY]: Yes, yes. No, I don’t actually do couples counseling, but I definitely consult people who have a couples-based practice or do a lot of couples counseling and they’ve definitely been talking about the difficulty with billing insurance. Some of the things I’m hearing is, especially with EFT, that they want to do the 90-minute sessions and so there’s not a way to bill for that within the insurance companies. So they’re trying to find loopholes or ways to get around that or some of them are even considering, “Hey, I can do a 60-minute session with a couple, but I can’t do the EFT that I’m trained in that I think is really effective because you need the 90-minutes to do that.” And so then they offer a cash pay rate for the 90-minute session, if that’s something that they choose to do or they’re coming off of insurance because they feel like it’s limiting their ability to do a certain type of therapy that they’re trained in, which makes sense. So it just makes it difficult for them.
[ALISON]: Yes. I think couples therapy is always a gray area in terms of billing insurance, because really you’re billing a family therapy code which depending on who you ask and your perspective on that, some therapists don’t really think that that counts and other therapists do. So yes, couples therapy is always a tough one and then also I think it’s more common that it is all cash pay for that reason. So if you are considering a self-pay practice and you specialize in couples therapy, I would definitely say go for it because it is one that people will self pay for much more commonly than other specialties.
[WHITNEY]: Yes. You know, the other one that I see people paying for is for kids.
[WHITNEY]: Like it’s this idea that parents don’t pay for themselves but they pay for their children and when your child is in crisis at school and you can’t get them in anywhere, but then there’s a cash pay practice that can, you’ll pay for that to get them in with a good therapist for your child.
[ALISON]: Yes, absolutely. Yes, I can see being a parent, I can see how I would absolutely pay for my kid to get help, especially before I would spend that same money on myself.
[WHITNEY]: For sure. Yes.
[ALISON]: So the last thing that I had on my list of things to talk about are some exciting changes. Also, I think they were already kind of in play before the pandemic, but obviously the pandemic really sped up this whole process of the idea that therapists could practice over state lines. And there was a movement, I don’t know, a law, I’m not sure what to call it, but it was called PSYPACT and it was for psychologists specifically, and it’s a group of states that basically say, “We’re going to offer reciprocity to psychologists.” I’m maybe not totally correct on the details but my understanding is that if you’re licensed in one of those states and you joined PSYPACT , then you could see clients in the other states that are in that association. And so what I understand is the same type of thing is happening now for master’s level therapists and Georgia is the first state to start the ball rolling. Right, Whitney?
[WHITNEY]: Yes. Oh no, I can’t believe, but we started something here.
[ALISON]: I know. I don’t have, you don’t ever think of Georgia as being progressive, but look at you. So progressive.
[WHITNEY]: Georgia has been a lot of things lately, that’s for sure. Even in the media, it’s funny when I go on my runs and I listen to NPR and they’re talking about Georgia. I’m like, “Really? Georgia again?” Or Savannah and that’s been really interesting, but yes, this was super exciting. I actually wrote letters to my representatives to advocate for this house bill. So, you know get involved in what you can on the state level because it’s really exciting when you make your voice known and something happens and it’s important as counselors that we do that. And just to say, if you are not a part of like state-level counseling association or social worker association or whatever your professional organization is be involved in it, because at least mine, it’s the LAPC that, I’m sorry, I’m saying that wrong. The LP, all those initials, we have, the LPCA of Georgia who actually sent all the emails and they were so good about sending them regularly to say, “Hey, here’s the letter you need to write. Here’s who you need to send it to. Here’s what you need to do to support this pact.”
And so that was really, really great. So make sure you’re a part of that, but to talk a little bit about what it is. So this got passed back just like a week ago March 23rd and I’ll read here a little bit, because that way I make sure I say it right. The Georgia state legislature passed the counseling pact and interstate compact or a contract among states, allowing professional counselors licensed and residing in a compact member state to practice in other compact member states without the need for multiple licenses. So basically, yes, it’s the same thing Alison was just talking about and there are other states right now that are looking to do it, even though Georgia was the first to fully pass it. Maryland and Nebraska have these bills pending vote and Tennessee as well, North Carolina and Delaware. So if you’re in any of those states, like, look this up really great resources. The American Counseling Association, they’ll tell you all about it, but you can look up the counseling compact and it allows these professional counselors to practice across state lines. So this is really great for us.
[ALISON]: That’s amazing. Is it counselingcompacts.com? Is that what it is? [crosstalk].
[WHITNEY]: Well, let’s see.
[ALISON]: Now I’m asking you things you don’t know the answer to.
[WHITNEY]: I’m going to click on it now. Yes, counselingcompact.org.
[ALISON]: Oh.org? Excellent.
[WHITNEY]: So you can go there.
[ALISON]: Yes. So I know there’s usually a lot of conversation, especially obviously since the pandemic started about. Wouldn’t it be great if we could be available to clients, especially when you have like a specialty that’s rare or hard to find that you could be available to people in other states and it looks like this might be the way to get there. So yes, I would say, I think as a profession, unfortunately we have not been good about having really good lobbyists or advocating for ourselves as counselors. Obviously, we get usually overwhelmed with taking care of clients and then a lot of these things fall by the wayside and so that’s why I wanted to talk about it today because I feel really passionate about advocacy and making sure that people have access to services and that kind of thing. So if this is something that you’re like, “Oh, this would be great,” you have the power to potentially make a change if you and all of your colleagues in your area make some noise. It’s definitely going to get some attention. So I would highly encourage you to take the time to write a letter to your representative or whatever they’re recommending on that website so that this type of thing get some traction.
[WHITNEY]: Yes. And I just went to the representatives based on my zip code, and it was so easy in the state of Georgia to pull up who that person was and then copy and paste this letter and just change a few of the words in it.
[ALISON]: Yes, and I’ll just kind of briefly tell a story about, at the beginning of the pandemic. There was a insurance company that we were paneled with that made it seem like they weren’t going to, for some reason, allow LPCs to provide telehealth. Like they listed every other discipline, like social workers and all that kind of stuff, but they left off LPCs. So long story short, it ended up just being like a clerical error that they forgot to add us to the list but we were allowed to provide telehealth the whole time. It just made it look like we weren’t but I sort of rallied together like a whole bunch of therapists in my area to call and to write letters. And I went on to this insurance companies, like Facebook page and called them out and they actually called us back and were like, “We’re really, sorry. This was a mistake. You can certainly do telehealth.” But like, it effected a change, which was really cool because I think a lot of times we think about, you know we’re just one person and there’s these huge bureaucracies of insurance companies and the state legislature and all that kind of stuff. But I think it is possible to make some positive change. So don’t kind of dismiss the fact that writing that letter could be really important.
[WHITNEY]: Yes. Good story. Thanks for sharing.
[ALISON]: Yes. So I think those were kind of the big topics on my mind of current trends that are happening right now and that practice owners are talking about. I wasn’t sure if there was anything else that you wanted to add Whitney or anything else that comes to mind.
[WHITNEY]: No, that’s, we really hit on the big ones right there. I just want to re-emphasize, Group Practice Boss, like we have this membership community of group practice owners. So we talk about this stuff all time, you know to be able to grow together and help one another and you get feedback about these different things, these different trends or a practice owner can throw out, “Hey, what are y’all seeing? I’m seeing this, that and the other.” And other people can say yes or no, or what they’re doing about it. So it’s a really great community because being group practice owner can get kind of isolating.
[ALISON]: Yes. So we made a change recently actually to allow people to join at any point. Like we used to kind of say like, oh, this is the time, you know the week you can join and then we wouldn’t accept anybody else for like a period of a few months. But we decided that anybody who isn’t an established group practice owner, if you have at least yourself and two other clinicians it’s definitely geared towards your unique set of challenges that you’re going to encounter or you may have already encountered as a group practice boss. So if you’re interested in joining, you can check out the webpage, we have set up for it. It’s practiceofthepractice.com/grouppracticeboss.
[ALISON]: So thank you so much, Whitney, for coming on the show today. It’s always fun talking with you.
[WHITNEY]: You as well. Thanks Alison. Bye.
[ALISON]: Once again, thank you so much to Therapy Notes for sponsoring this show. It makes notes, billing, scheduling, and telehealth a whole lot easier. And if you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your client’s demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE] to get three months free to try out Therapy Notes.
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