Dr. Lisa Lovelace Started an Online Group Therapy Practice | GP 20

Dr. Lisa Lovelace Started an Online Group Therapy Practice | GP 20

Are you a group practice owner? Have you considered transitioning to an online practice? What things do you need to consider before making the shift?

In this podcast episode, Alison Pidgeon speaks to Dr. Lisa Lovelace about starting an online group therapy practice.

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Meet Dr. Lisa Lovelace

Dr. Lisa Lovelace is the founder of Synergy eTherapy, an online therapy group practice! Synergy eTherapy began about 3 years ago, several years after Dr. Lisa was doing her online therapy as a solo practice.

Dr. Lisa is a Licensed Clinical Psychologist in Minnesota, Wisconsin and New York and has over 20 years of post-graduate level clinical experience working with children, adolescents and adults who suffer from a wide range of mental health concerns including anxiety, depression, relationship difficulties, substance abuse, and other emotional or behavioral disorders.

Connect with Dr. Lovelace on Facebook, Twitter, and Instagram. Join How to Build an Online Therapy Group Practice Facebook group.

Get in touch via email at drlisa@synergyetherapy.com

In This Podcast

  • Starting an online practice
  • The future for telehealth
  • Insurance and telehealth after COVID-19 is over
  • Figuring out licensure laws
  • Things to consider when going online
  • Systems

Starting an online practice

You have to learn to delegate and ask for help.

When you go to school to become a therapist, they don’t teach you about business elements like management, social media marketing, accounting, etc. Dr. Lovelace had to learn how to manage a business and think like a business owner, not just a therapist. She had to learn who her people of support were, from her web designer to her lawyer, to her social media friends…people that she had supporting her practice.

Dr. Lovelace always did everything online so she never actually had to make the change from brick and mortar. She started it that way and then grew the group online. Now, with COVID-19, a lot of people have had no choice but to make the change from brick and mortar to online really fast and when crisis mode is over, they’re going to have to think about how to manage it and potentially have a telehealth arm or fully move online.

The future for telehealth

And so we are growing, which is weird to say in a time of a pandemic, where a lot of people are actually losing jobs. So, you know, it’s this thing that I have to kind of get my business mind on and then of course, my like emotional heart for people. It’s a hard kind of dichotomy to sit with, that our business is growing where others might not be. But the reason we’re growing is because we’re helping people and so that obviously feels good.

It’s an unfortunate but fortunate time. This is what we want to happen for telehealth and online counseling but not the way we wanted it to happen. There has been a shift and focus on mental wellness and mental health, everyone is talking about it. Because of this sad tragedy, online therapy, going forward, is not going to be as unknown or uncommon as it was before.

Insurance and telehealth after COVID-19 is over

Some insurance companies are basically offering free therapy for as long as six months which is amazing but what’s going to happen with insurance and telehealth after COVID-19 is over?  There have been petitions started for telehealth providers to be able to operate across state lines. There have been executive orders where governors are signing things allowing temporary licenses.

Insurances are hard to work with and they’re doing what they have to to stay afloat, but hopefully, they see the benefit of what is happening now and don’t just completely take away the telehealth benefits come end of May/June.

Figuring out licensure laws

You have to reach out to the boards of each state that you want to work with or check their websites for the rules/laws. You can also just get licenses where you feel you can do the best work. Getting a temporary license, or even completely licensed (takes some money, doing a test, applications, etc), isn’t too hard to do.

  • Make sure to follow the rules of each state and do your best to keep up with changing laws with any kind of reciprocity or licensure.
  • Look up informed consent rules and check what needs to be given to a client to make sure that it matches the informed consent rules.
  • If a clinician needs something specific added to the informed consent then they can have an addendum that is sent to the clients.

Things to consider when going online

There’s a lot of questions and there’s no right or wrong answer. It has to be what’s right for your group practice desires, and how you want it to look, and how you want it to feel for a client experience, and then also for a therapist’s experience if they’re not going to be in person. So, you know, there’s a lot to think about and a lot to work through.

  • You don’t have to figure it all out on your own – there are a lot of people that can help, find somebody to consult with, look for free resources, join a Facebook group, make some connections.
  • Think about what this is going to look like for you – are you used to everybody coming into your office and you having control over everything that’s physically there?
  • How do you onboard people outside of interviewing them in person?
  • How do you get people to know your systems, know your group practice, and build a culture where they’re not physically together
  • You’ll need some legal help in getting the telehealth piece together – have an addendum to your contract or revise what your contract says. Policies and procedures are super important.
  • Procedures when it comes to risk assessments – knowing where your client is located and what hospitals are in their area. It’s different from having someone in your office and you can just call 911.
  • Get a game plan together but now that it is going to change. You’re going to grow, learn, and need to revise things.

Systems

There are a lot of practice management and telehealth video platform systems available, some free and some paid, so have a look and see what is going to work for you and your group.

  • Make sure therapists have a BAA (Business Associate Agreement)
  • Spruce Health for texting, video, faxing and phoning.
  • G-Suite for email, online storage, and calendar
  • Doxy.me to create your personal meeting room

Useful Links:

Meet Alison Pidgeon

Alison Pidgeon | Grow A Group Practice PodcastAlison 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 and has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting.

Thanks For Listening!

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Podcast Transcription

[ALISON]:
When it comes to keeping your practice organized, you want software that not only is simple but the best. I recommend TherapyNotes. Their platform lets you manage notes, claims, scheduling and more. Plus, they offer amazing, unlimited phone and email support. So, when you have questions, they are there to help. To get two free months of TherapyNotes today, just use promo code JOE, J-O-E, when you sign up for a free trial at therapynotes.com.

Welcome to the Grow a Group Practice podcast. I’m excited that you are joining me for my conversation today with Dr. Lisa Lovelace. This is a very timely interview because we are still living in quarantine times, and Lisa has started an all online group therapy practice, which she started about three years ago. So she’s been doing this for a while and she is super busy right now, not only with referrals ramping up in her practice but also she has started doing some consulting for other practice owners who want to either start, or maybe continue, their online group practice. So, we talk about that as well. There’s lots of great nuggets of information in here if you’ve been thinking about maybe continuing your online group practice, or maybe starting one. So definitely take some notes for my interview with Dr. Lisa Lovelace.

Welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon, your host. Today I am so happy that Dr. Lisa Lovelace has decided to join us. She is the founder of Synergy eTherapy, an online therapy group practice. Synergy eTherapy began about three years ago, several years after Dr. Lisa was doing her online therapy as a solo practice. She is a licensed clinical psychologist in Minnesota, Wisconsin, and New York and has over 20 years of postgraduate level clinical experience working with children, adolescents, and adults who suffer from a wide range of mental health concerns. Dr. Lovelace, thank you so much for joining us today.

[LISA]:
Thank you, Alison. I’m glad to be here talking with you.

[ALISON]:
Yeah, I think this is such a great topic for us to be talking about because so many people, now that COVID-19 has started and quarantine, have been forced into switching their therapy group practice to hundred percent telehealth, and you’ve obviously been doing it way before all of this happened. So, can you tell us a little bit about like how you got started, was it very intentional that you wanted to be all online? Or did you just sort of stumble into it, or how did that come about?

[LISA]:
Yeah, well, that’s a great question. I started my own solo online practice way back in the day of about the year of 2012. It seems so long ago. I moved back from New York where I got my internship, I did a fellowship, I was directing some programs and my SAMHSA program ended, came back to my home state here in Minnesota. But I kept my clinical license in New York, and I was thinking, well, should I renew it? You know, how can I use it? I’m never going to live there again. And this world of online therapy was just so small, I knew nothing about it. It’s not like it is today. That’s for sure. There weren’t groups and classes and people doing it. And so, I just created this little website called Dr. Lisa eTherapy. I found a web designer that helped me out and I started using Skype and my cell phone, just kind of marketing to New York and I see a couple clients and it was great, no big deal. And then of course, the years go on. And I was doing that over the course of time with my own side hustle, I guess you could say, doing online work. Because I was also working in a clinic full time here in Minnesota. And I was also working at the University of Minnesota doing some research with adolescent substance use. And my colleague, Andrea [unclear], and she’s still with me today, said, hey, let’s go have some lunch, and we met at Panera. And she’s like, you know, I’ve been doing research forever, but I want to do what you’re doing, and will you teach me? She’s like, I just don’t want an office. I want to do some online work. I want to do some clinical work. And it was completely not intentional. It was super random. I had no idea of like, the desire to build an online practice, but we worked well together. And I thought, well, that’s silly for me to just teach you; why don’t we just do it together? And she’s like, great. And I completely had this novel idea from there of, let me rebrand. Let me get a logo and name, let me ask my web guy who I’ve been working with already for many, many years, to just totally rehash it. And in six months, I guess from there with a lawyer and a contract, I had two of my colleagues that I’d worked with here in Minnesota, I said, hey, want to come and do this thing with me? And they’re like, sure. No idea. They were just game for it. And Synergy eTherapy was born. And it was not my idea, per se. I didn’t think of starting it. But when somebody came to me, I thought, well, this could be a really fun thing to do. And of course, there was nothing really that I knew, again, three years ago about how to take like a brick and mortar practice and move it all just online. So I had a lot of help and a lot of people and we kind of figured it out and put it together and 2020, here we are with, you know, a good 10 and growing therapists and 14 and growing states and just living the life, you know, helping people in an entire state. And it has, yeah, just been a fabulous private practice side job that we’re doing to increase access for mental health care. And we’re all passionate about it. So that is a quick and dirty to my journey into the online group practice world.

[ALISON]:
Yeah, that’s amazing. And I wonder, too, if we could just go back to what you said about… you kind of had to figure out how to take your brick and mortar practice all online. What were some of those things that you had to think about or change when you made that transition?

[LISA]:
You know, you go to school to become a therapist or a clinical psychologist, and they don’t really teach you, or they didn’t back then, how to become a business manager, how to become a social media marketer, accounting, you know, the whole thing; they don’t teach you that. And I really had to learn how to manage a business and how to think like a business owner, not just a therapist, and it is different hats that you wear. And I had to learn who my people of support were, from my web developer, to my lawyer, to my privacy people, to my social media friends, and people that I have supporting our practice, you have to learn to delegate, ask for help. And really just kind of… you know, I think what happens is a lot of people want to have everything set; they want to have their ducks in a row, they want to know it all perfectly, and then start, and it’s kind of not that way. Of course, you don’t want to do anything illegal or unethical, if you can help it, but we don’t know what we don’t know until we know it, right? So, it’s like you have to kind of start and then revise and change as you go and as you grow, so you’re learning along the way. And nowadays, of course, there’s lots of us to learn from, but we were, especially myself, I was totally blinded. Doing this on my own. So, asking for help, I think is super important and getting a good support system. That was really beneficial for me, and it still is to this day.

[ALISON]:
Yeah, I’m really glad you said that. Because I think that when you started there probably were no models for how do you do this? And so, like you said, you just had to sort of figure it out as you went, and obviously it looks like you did figure it out and you have a successful online practice now. I’m curious as to the structure, do you have any physical office space anymore or is everything online and every therapist is working from home? How does that work?

[LISA]:
Yeah. For Synergy eTherapy or before that, my private practice that I did online for Dr. Lisa eTherapy, it was always online. So, I never had a private practice that was in person. I’ve worked in clinics and you know, universities or different things that I’ve done that are in person, but with my own private practice, it always started as online. So, I never had to make the change per se. I just started right in online and then grew the group from online. So, I know a lot of people that have gone, nowadays with COVID, from that brick and mortar and they had to make that change really fast. And you do it because you have no choice. And so that’s kind of that paralysis by analysis thing; you can’t have it when your back is pushed against the wall and you need to get your client seen and your therapist income. You just figure it out. You do the best you can. And now I think people are like well now I need to think through this because I have to refine what I’m doing. Now that the crisis mode is over, and we’re online, like, how do we manage this for, not just a few months but potentially maybe, you know, having a telehealth arm or fully moving online? It’s a lot to manage.

[ALISON]:
Yes, yes. And I definitely want to get into that a little bit more because I think that so many practice owners now obviously were forced to do telehealth and very quickly obviously, because of quarantine and yeah, just curious too what your thoughts are around what you think that’s going to look like in the future? And also, curious too how that has affected your business. I imagine you probably didn’t have to change a whole lot because everything is already online, right?

[LISA]:
Yeah, this is kind of an unfortunate but fortunate time where, of course this is not how we would like it to happen where telehealth and online counseling are becoming household names now. In the news and the media and just everywhere, that’s what we wanted to have happen. But not, of course, the reason why it’s happening. So, it’s been a great shift to see the focus on mental wellness and mental health during this time, where everybody’s talking about it, you know, from Governor’s to our states. They’re saying we need to focus on your mental health, here’s the resources, do online therapy. And so, I think that aspect of this whole sad tragedy here is that online therapy going forward is not going to be as unknown or as uncommon as it was before. And so, we, of course, were very lucky that for three years before this, we were building our brand and building our website and building our SEO and, you know, building our community. And so, a lot of people have found us, which is really nice. And a lot of really new interesting things are happening with random TV shows or different things that are finding us, and we have no idea how they’re getting to us. And so hopefully what we’ve already established, will continue.

Our business, of course, we didn’t have to change anything. We’re growing. We’re super busy with lots of different partnerships that we’ve had from the [unclear]. We have a couple of therapists that do insurance, but most of us are private pay. And we have a lot of good EAP partners and different things. And, you know, it’s just been really busy. And so, we are growing, which is weird to say in a time of a pandemic, where a lot of people are actually losing jobs. So it’s this thing that I have to kind of get my business mind on and then of course, my emotional heart for people; it’s a hard kind of dichotomy to sit with, that our business is growing where others might not be. But the reason we’re growing is because we’re helping people and so that obviously feels good.

[ALISON]:
Yeah, definitely. I always think of mental health. as being recession proof.

[LISA]:
Yes. That’s a good way to put it.

[ALISON]:
Yeah. I think, too, I’m curious about what you’ve seen in terms of clients reaching out pre COVID – were they specifically looking for online therapy? Or did you just have really good SEO? And so if they type anxiety therapy and their state, like you would show up, or like, how have you found like, the awareness of potential clients has shifted or how they’re finding you, or are they specifically looking now for online therapy? What are you seeing in terms of those trends?

[LISA]:
Yeah, definitely. We started working with an SEO company, you know, probably back in October, I want to say, so I’ve had good many months on different parts of my website, getting the optimization going for keywords, and we’re in different states. So, we have landing pages for each state we’re in and all the services we provide, and so we’re constantly beefing that up. And that certainly can take time, you know, for Google to crawl and find it, but what’s happening now is more and more people are finding us from states we’re not even in; we get Contact Us forms that come to us from people in different states. And of course, we’ll see if we can work with them and get temporary licensure or I refer them on, but the number of people that are just contacting us has grown exponentially, and it wasn’t long ago I was looking at my analytics and I’m like, what is this Verywell Mind that we’re getting consistent referrals from to our website? I couldn’t figure it out and my SEO company looked it up and we were mentioned as one of the seven best online therapy programs for kids in 2020.

[ALISON]:
Among…?

[LISA]:
Yeah, Talkspace, Doctor On Demand, Amwell, MDLive, and BetterHelp, and then there’s little Synergy eTherapy for the best free consultation and had no idea and I couldn’t figure it out. And we are getting, from this mention, they linked it obviously to our teen counseling page that we have. So, we’ve actually been getting teenagers contacting us directly without their parent even maybe knowing – of course, we then say, you know, we need to talk to your parent or guardian as well. And they’re contacting us directly. So, we’re seeing more teenagers reach out, advocating for themselves. And I don’t know how this mention has, you know, helped that but it certainly was an honor. And so we’re seeing the fruits of our labor, obviously, of what we’re doing and what we’re offering, being mentioned that way so, of course, there’s like organic SEO and then there’s, you know, different blogs we do and, you know, try to get the content to match where our ideal clients are, so that people when they do search, like online anxiety in my area, or in Minnesota, or in New York, or whatever it is, that it does pop up and doing the best we can to offer as much content for people through our blogs and different videos that we’re doing and social media.

So, I think it’s just a combination of what we’ve been doing for years has really been paying off in a way that we, I mean, I certainly didn’t expect that. And, yeah, it’s just like, you never know what is going to happen, so you just don’t give up and you keep going. And you can just imagine where it’s going to take us, like to rival with some big billion-dollar companies when we’re like, you know, this little company out of Minnesota is just an honor. And I think that was a huge help too.

[ALISON]:
Yeah, that’s great. So, it sounds like a lot of what you do in terms of marketing is digital marketing, like SEO and social media and writing blog posts and those types of things.

[LISA]:
I’d say in the first year or two, I probably did like 50 webinars, different podcasts. Just online, you know, Facebook Lives and sharing with other people and Instagram Lives and networking. So, the first few years were less… I’d say they were digital too, but it really was me. Getting my brand out there, my company out there, making real life connections, so you really can’t miss that part of it, too.

[ALISON]:
So, when you did a webinar, for example, was that just to your own audience? Like, you just built up an email list or do you try to connect with other people who may have had their own audience that you could connect with?

[LISA]:
Right. I did like Stress and Anxiety for teachers in the schools. And I would physically go there in Minnesota to the school or I did a webinar for youth workers with a company here based out of Minnesota called YIPA, where they train youth workers on how to work with youth. So, I was doing more good, where I was talking about anxiety or stress or some other avenue and of course, my business name is mentioned. So, you know, the more people that get to know that we’re here in our community, wanting to serve you, and serve our clients, and we just happen to be from Synergy eTherapy. So, come find us if you need us, or if you have referrals, of course, so we just really wanted to showcase you know, that we wanted to offer information and to help. And I think that’s an important part of marketing.

[ALISON]:
Oh, yeah, definitely. That’s great. Yeah, I’m curious too, what have you found in terms of a change in what people are searching for on Google now? I understood that from my own Google AdWords person that’s been helping me is that before all of this happened with COVID, that people weren’t necessarily searching for online therapy. They were more searching for like anxiety therapy or depression or whatever their issue was.

[LISA]:
Yeah.

[ALISON]:
So how have you seen that change? Like, did you see that before, but people weren’t necessarily searching for online therapy, but because you had such good SEO like they were just finding you anyway? And then they were going with it, or they were specifically searching for online therapy for a reason or… what did you see with that?

[LISA]:
Yeah, I think before, from what my SEO company tells us is, you know, of course, each state is going to have like its own keywords. So, like in Minnesota it might be online therapy, but in Florida it might be telehealth therapy, or it might be eTherapy, or it might be online counseling, right? So, each kind of area has its own number. of searches and what people are using, they can kind of track that. So we’re not trying to compete with some of the big money players out there, there’s no way you can compete with them being like number one or two or Psychology Today, even, you know, where they have just so much money to throw into that, which is great. If people were searching for, like anxiety therapy near me, or anxiety therapy for my teenager, and of course, that would take people to wherever Google takes them, right. So, we were able to kind of rank pretty well for just random things using our service pages, whatever people are going to search for. But now that people are searching for online therapy a lot more, I think that it has just grown exponentially, because everywhere on our website is something about online therapy almost in every page. So the more you’re mentioning that, so you think of brick and mortar practices, they’re not mentioning online therapy in every page before COVID started, so likely now what they’re doing is they’re probably switching and getting their web developers if needed to help them to start to rank and, you know, understand that aspect. So, I’ve learned a lot from my company, I work with Jessica Tappana, SEO Simplified, I think, or Consulting, I forget what the name is…

[ALISON]:
Yeah. Simplified SEO Consulting.

[LISA]:
Simplified SEO. And they’ve been wonderful, and they’ve been doing this for my practice for a while. They really understand it because they’re clinicians. And so, you know, I think it certainly helps that we were in this market before and now people are searching for it. So, we’re coming up a lot more in searches, which is great.

[ALISON]:
Yeah, so you’ve definitely seen that shift that now people are searching for online, or whatever the word that they’re using is?

[LISA]:
Whatever it is, yep. Exactly.

[ALISON]:
Yeah. That’s cool. Yeah. I’m curious too what your thoughts are about everything that’s happened with more insurances now are covering telehealth. In my area, even, there’s one insurance company who’s waiving co-pays for telehealth, and I mean for like six months; it’s like a long time, which is amazing. So, people can basically get therapy for free. And just curious what your thoughts are about what’s going to happen in the future with insurance or telehealth, even after COVID is over.

[LISA]:
Yeah, you know, this is one of those watch and wait and, in the meantime, advocate. I’ve seen a lot of petitions started for telehealth providers to be able to do telehealth across state lines and not have every state and every board have their own thing that needs to happen in order to help somebody who lives in one state, travels to another, or has a home in one state and a home in another, however it’s going to work. Obviously, there’s a lot of executive orders now, where the governors are signing those saying, you know, if you have until June 7, or whatever, if you are licensed in another state, you’re in good standing, you can provide here, either with a temporary license or email us or you don’t need to do anything. So, I mean, it would be nice to have this pandemic showcase that we can do this, ethically. We can be cognizant of our laws and our rules, and we’re not going to step over those to harm anybody, right? We want to do good. So, I would love to see, not just with PSYPACT, and PSYPACT started for psychologists, obviously; I think it starts here in July. And nowadays, you know, I don’t know what that’s going to be like, because everybody can kind of do across state lines with permission. But that PSYPACT is for kind of that telehealth compact where if you’re in this state, then you can see anybody in any of those states, virtually.

The insurance piece, that’s a tough one, you know, because insurance is hard to work with, and they’re doing what they got to do to stay afloat. And they’re helping people now, which is wonderful. And I’m just kind of scared for the people who are doing telehealth and then, end of May or end of June, they don’t have telehealth benefits at all anymore. So, forget the co-pay, they just don’t have the benefits anymore. So, I worry about that. I really hope that some insurance companies can see the benefit, and not just completely take away telehealth benefits. And it’s awesome that they’re waiving co-pays, or different things like that to help make this more affordable for people. I just really want them to see the benefit and not just make this something that’s like, oh, we just did this because now there’s a pandemic but once the pandemics away, oh, everybody can go back to an office and they don’t need to do this. But that’s not the case. Otherwise it wouldn’t be thriving to do online therapy before a pandemic. There’s people in rural areas, there’s people with chronic conditions, there’s people with severe anxiety, people that really need to see a certain type of therapist that has a certain training and maybe they’re 300 miles away in their state. So, I really hope that they can kind of figure out a way to make this work beyond a month or six months. It’s great that they are, but then what? That’s what I worry about.

[ALISON]:
Right. Yeah. And I think too, there’re some states that are now passing laws that say that, essentially, insurances are going to be mandated to cover telehealth services. I know there’s a law that’s in the legislature right now in Pennsylvania related to that, and I think it’s already law in several other states. So, I’m hoping those kinds of things continue to get pushed out.

[LISA]:
That’s wonderful.

[ALISON]:
Yeah, because I mean, I think now that we’ve all been forced to do it, and we see that it’s working, I don’t think we should go backwards. Obviously, the insurance companies are going to do what they want to do, but I hope that, yeah, like you said, it sort of opens up the doors for them to continue to allow it. Yeah, I was wondering too about I know you have you said 10 therapists now and some of them are licensed in multiple states or they’re living in different states. I saw on your website, you cover quite a few different states, which is awesome. And how do you manage all of that with, you know, just like you were talking about licensure laws, and, you know, this person’s in this state, but they’re licensed in another state; how did you figure all of that out?

[LISA]:
Yeah, well, luckily, that part seems to be pretty easy. You know, where the laws of each state are pretty clear. So you know, obviously we have to make sure that if I’m sitting in Minnesota, physically, when my college students that I see go to college over in Wisconsin, that’s kind of why I got a Wisconsin license, I made sure before I did that, that Minnesota was okay with it, and that Wisconsin is okay with it. And you just have to reach out to the board. So, if you’re marriage family therapist or licensed psychologist, we all have boards in our state. So, you kind of just reach out or look for the rules if they have them on their website, and make sure that that’s legal to do. And then you kind of just get licensed where you feel you can do the best work or, you know, clients, like with New York, New Jersey, go back and forth, and you don’t want to have to feel like I can’t see them if they’re in their home in New Jersey, but I have to see them when they’re working in their, you know, in the city of New York. So that part’s not too hard – getting temporary licensed or, you know, completely licensed in a state can take some money, doing a test, application, keeping up with your CEU. So, it is a little bit of work. But that piece of things is not too hard.

So it’s a partnership with all of my therapists that I hire, that they have a stake in the game, they have to, as well as I have to, make sure that they’re following the rules of each state, that we’re doing the best we can to keep up with any changing laws, with any kind of reciprocity or licensure, many different things like that. So we both kind of make sure we’re looking up informed consent rules and what needs to be given to a client to make sure it matches everything that I have in my gazillion page informed consent, that my privacy team and lawyers helped me create. And then each clinician, if they need something specific that their informed consent needs like in their state, we can have an addendum that they can send to their clients and have them sign that electronically too. So, I’m not constantly updating and revising our big informed consent if it has something very specific that a therapist needs. So, we’re just always being mindful of those rules and laws in each state and just working together and communicating with each other if anything changes.

[ALISON]:
Okay, so are all your therapists located in one state? Or are they sort of spread out over all the states where you provide therapy?

[LISA]:
Yeah, we’re all over the place. You know, from California to Maine, Iowa, Minnesota, Wisconsin, South Carolina, Georgia, we’re all over the place. But we stay connected, my goodness, text and talk and email with my clinicians weekly, hundred percent. We become good friends; we trust each other. We communicate really well and I take a lot of time to vet that out if I hadn’t already known them or if they weren’t referred by somebody I knew; I take a lot of time to make sure that they’re in it for the right reasons, get a lot of good conversation going with their people they have as references. And so that’s why we are small, where I’m not just taking everybody because it is important for me to have a really close-knit group. And then we have monthly consultation Zoom calls. So, we get to see each other, right? We get to talk about things and learn about each other so that we also get to know each other and their expertise and refer back and forth as needed.

[ALISON]:
That’s great. Do you have a particular structure that you use to make sure that you communicate well with them? Because I would imagine, because you’re all working from home, you have to be even more kind of diligent about communication versus like, oh, I see you in the office and we have this short conversation in between clients or whatever. Like obviously that’s not happening.

[LISA]:
Yeah, that’s not happening. So it is. I refined on my vetting process, I’ve learned along the way because I have had people come in through Synergy, and then for one reason or another, luckily nothing bad or anything; we’re still, you know, Facebook friends or we still refer to each other or whatever, but just not realizing what having your own online practice was going to be or how much time or energy it was going to take. And so I’ve gotten better at who I’m bringing on board and spending more time making sure they’re going to be a good fit for how Synergy works, how I work, and the communication style I need, so that I feel comfortable. And that trust can be built over time and a friendship as well as colleagues, it can be both. So, I take a lot of pride and a lot of time in that onboarding process. So I do recommend people to, if they’re going to have an online group practice that they’re going to build, that is a huge piece of it because it takes a ton of work, and a ton of money, to onboard somebody. And then if they come on, and they’re just like, oh, I got two other jobs, so I’m going to take those instead. And they’re off in two months or three months – that’s not worth my time. It’s a lot of time and money to get them on. And so, you have to make sure people are in it. Our contracts go for a year, but I’ll say, this can be a one to three-year thing to get yourself really to a point where you want it to be. And so, the people that I work with now, I love, I love them dearly. I know about their lives and they know about mine and there’s a relationship that we’ve built and so that’s super important. It’s not just colleague. It’s definitely a little family where we’re kind of protective of each other.

[ALISON]:
That’s great. Yeah, yeah. How do you support them then? Because you’re, again, you’re all working virtually, so how… like, I would imagine as the boss, it might be hard to get a handle on or get a read on like, hey, how’s everybody doing? Do you need anything? You know, that kind of thing?

[LISA]:
Exactly. Yeah, it’s pretty good because I do text with them pretty much weekly individually. Hey, you know, how’s it going? Are you feeling full right now? Do you want another client? Tell me what you need. People that might be really busy, you know, hey, I think it’s time to get a VA to help you, a virtual assistant or, you know, hey, let’s get caught up on, you know, notes, what can I do to support you? Whatever it is, I’m kind of behind the scenes with all of them, making sure their business is going well, making sure what they want to do, whether it’s blog writing or a video or something, that they’re engaged. And when they have personal things happen, for me to say, you need to take time off, you know, do some self-care. So, I’m kind of their coach, really, going through it and helping them just by you know, we’ll do video calls, we’ll do texting, phone calls and a lot of emails. So, I’m supporting them electronically, but also, just kind of like I would a friend or family member with how we keep up with each other.

[ALISON]:
Yeah, that’s great. I think that’s so important for them to feel like they still have that support, even though you’re not physically in the same office with them.

[LISA]:
Right. Yeah.

[ALISON]:
Another thing I was thinking about, too, I think, due to the situation with COVID, maybe some people are gonna consider transferring their whole group practice to just being online. I am actually looking at maybe potentially setting up almost like a hybrid of like, you know, half the time you’re online at home, and then half the time you’re in the office, or something like that. So, if group practice owners are kind of considering that are there some things that they should be thinking about or any tips that you have for them?

[LISA]:
Yeah, definitely. I mean, I think that nowadays, you definitely don’t have to figure it all out on your own. There’s a lot of us that are here to help. So, find somebody, whether it’s somebody for a formal consultation or free resources. There’s Facebook groups and different things like that where you can kind of powwow together and make some connections. But I think you got to just think about what this is going to look like for you. If you’re used to that brick and mortar where everybody comes into your office and you have control over everything that’s physically there, now you have to figure out how do you onboard, you know, outside of maybe interviewing in person? How do you get people to know your systems and know your group practice and build a culture where they’re not physically able to have lunch together, and to see everybody and to kind of live and breathe the in-person feeling.

And I think just understanding that there’s probably going to need to be some legal help of getting the telehealth piece together. Maybe you need to have an addendum to your contract or revise your contract of what it says. So, get some legal people involved. Policies and procedures are super important. I’ve been working with a company called Cork Tree and they [unclear] for three years on my privacy policy and procedures because we are a small group practice and they’ve helped lots of big practices and big companies. And so, they really wanted to kind of home in on how to make it… how to do their business with smaller companies like mine. And so, I would never have been able to come up with all this stuff of like, what if all the internet goes down? Like, we can’t access somebody’s charts or records? Like, do we have it printed out somewhere, you know, random things that I would never have thought about. You know, you do need to think about procedures when it comes to risk assessments and like knowing where they’re located or knowing the county they’re in. What are the hospitals in that area? So, it’s different than having somebody in your office where you can just call 911, or whatever your procedures are to get them somewhere. We’re not always going to know a county that’s 200 miles away, and what’s happening for the emergency resources there.

So, I think there’s just some workflow things, contract things, onboarding, just to pay attention to and, you know, to understand like, is this going to be a hybrid? Is this what’s required? Can they come into the office? I think it’s just really getting down a little bit of like a game plan and then just know, it’s going to change, you’re going to grow and learn and you’re going to need to revise things. I mean, I can’t tell you how many times I’ve revised our workflow on our website, just because we had to start somewhere that was good enough. And then as we learned, well, how are your therapists going to get clients to you whereas before, maybe they’d go to a central hub in your in-person clinic and somebody answers. Now how does that work? Is it the same or does it need to be different? And so, I think there’s a lot of questions. And there’s no right or wrong answer. It has to be what’s right for your group practice desires, and how you want it to look and how you want it to feel for a client experience, and then also for therapist’s experience if they’re not going to be in person. So, you know, there’s a lot to think about and a lot to work through. And that’s probably the best advice I could say to start with. It’s a lot but…

[ALISON]:
Yeah, it sounds like just you’ve thought through a lot of the pieces, and there’s a lot of moving parts and just things that are different from having a brick and mortar location. I was wondering too if you could share with us what are some of the systems that you use? Because obviously, there’s been a lot of talk lately about, what telehealth platform are you using? And which EHR are you using? And all that kind of thing. So, if you could just give us the quick version of what you use. Yeah.

[LISA]:
So, well, all the things that I use are public, right? So, we didn’t create our own platform or anything like that. So, what I did is I, over time, I researched this and used things and I kind of got a workflow that works pretty good. It’s not like the best because we have so many different things we use. It works really well but it also keeps costs down. So I might not say like, everything I use because in my contract, it says like, even though these are things that you can use, I kind of put it all together to be a workflow and so I don’t necessarily say, like, you know, these are all the things I use and how, but yeah, cuz I worked so hard trying to put it all together that it’s not like I own it, but I also just kind of… I’m a little bit, you know, protective over just how I put it all together. But I think what…

[ALISON]:
[Unclear] intellectual property.

[LISA]:
Yeah. And so what I recommend people do is right now, there’s so many practice management systems out there that have kind of all in one, so you can look at that and see, you know, from SimplePractice, to Theranest, to TherapyNotes, to G Suite, a lot of people are just using G Suite for all their things, because now Google meets, you know, is HIPAA, if you get the G Suite package. So, Google has a lot of things. And then there’s a lot of free ones out there. Well, not a lot, but there’s a few, you know, Doxy, and there’s another one that just came out that I forget what it was called. But you can kind of Google some of these free telehealth video platforms, and then some of the better ones are paid. And, you know, you kind of have to figure out what’s going to be, with your group, how much control do you want to have over what you’re seeing your therapists do and what they just kind of do on their own. But the thing is, is you still have to have control over if somebody’s having, let’s say their own Doxy.me, I need to make sure that they have a BAA and I have a copy of that BAA, right? So, I still have to have some measures that everybody’s doing what it is our contract says they need to do and stay in compliance with our ethical and legal rules.

So, there’s a lot of work that goes into that. But I do have a workflow that I have; we have our own texting and video and faxing and phone app that I love and use, and I’ll tell you which one that is. That one is Spruce Health. And I think it’s like 24 bucks a month, I don’t even know anymore. And…

[ALISON]:
Yeah, Spruce is great.

[LISA]:
Yeah. I love Spruce Health. I’ve been with them for a long time. They actually interviewed me for a blog on their site the other day, which was really nice. And their customer service is the reason I chose them. So I cannot stand when you can’t like actually get a response from an actual human being sometimes, like, I needed that in the beginning, to be able to talk to somebody and feel like I was getting some personal attention, right? And they’ve been great throughout. And so Spruce Health is a really great option to use. For not a lot, you get a lot for them, and it’s super easy.

And so, you kind of have to figure out you know, what is it that you need to communicate with clients, how much as a group practice owner, an online group practice owner? Do you want to see what’s happening? I can pretty much see what’s happening from our website and Spruce, you know, where I have administration control, and then different EHRs and, you know, our calendar system and everything we’re using, I can kind of see it. And I like to know what’s happening, not to be a micromanager which sometimes I can be, I’m not gonna lie, but I try to let my independent clinicians do their thing once they’re on boarded and know how it all flows, so that they can feel supported, or if they miss something I can catch it because customer service is a huge part of Synergy eTherapy. And I don’t want anybody to feel like they didn’t get a call back or didn’t get heard or didn’t get a referral if we couldn’t help them. So, you know, that’s really important for me, but every practice owner is going to have to decide, when they’re doing telehealth with a group, how much they’re going to need to have in control and how much they’re going to let go.

[ALISON]:
For sure, yeah, that’s something you have to weigh out, with how you want to manage.

[LISA]:
Yeah.

[ALISON]:
Yeah. So just switching subjects a little bit. I understand that you have another kind of side business now, and that’s doing consulting for people who want to start online group practices. Is that right?

[LISA]:
Yes, it is. I’m very excited. Because of the demand, I guess you could say, of a lot of people wanting to reach out to those of us who have been doing this for a while and not reinvent the wheel, I started an online Facebook group called How to Build an Online Therapy Group Practice. And it’s free, anybody can join, it’s just a private group that people can find. And in here, I go live, and I share things, and I talk about things, and trying to get people to just engage, and there’s people who are very new to wanting to build an online group. And then there’s people that have an online group that I have become friends and colleagues with, and we talk with a lot and we’re kind of just helping each other. And then pretty soon I was thinking about doing a mastermind because there’s such a demand and I thought that would be really helpful. And I do one-hour consultations, paid consultations, with people, with one group practice at a time to just help them understand very specific things to their needs, so that they can get some questions answered. And some different ideas and ways to think about things and where to go to look for this, that or the other. And so, I’ve been doing more of that now than I have ever in the past three years. And I just think that’s the show of the times, you know that people are really needing help and structure with bringing their practice, their group practice, online.

[ALISON]:
That’s great. Yeah, it’s so needed right now. And so, if people are interested in having a consultation with you, what is the best way for them to reach you?

[LISA]:
Yeah, you could either go to the website, synergyetherapy.com and there’s going to be something on there that says, under Resources, ‘How to start an online group practice’, you could read that page, sign up for newsletter, and there’s a way to schedule with me. We could, you know, I offer everybody like a free you know, 20-minute talk just to make sure we’d be a good fit. And then we’d schedule very easily just like in our consult, and they can also just email me directly Dr. Lisa, it’s just drlisa@synergyetherapy.com. Any of the Facebook things, you can always just send me a private message that way too. Any which way makes sense for them to reach out, I’ve pretty much had people reach out every which way possible. And I just have to try to figure out how to find all these things as Facebook changes, in those messaging areas, but otherwise, yeah, it’s very easy. Just a quick call, make sure we’re a good fit. People who want more of the mastermind groups, I’m going to start that I think end of July and see how it goes. And go from there.

[ALISON]:
Yeah, that’s awesome. Well, I’m really glad that you’re joining the private practice consulting world. I think it’s something that, like you said, when you started nobody else was doing it. And so, it’s great that we have somebody now who’s successfully running an online group practice that we could reach out to and ask questions and get some help. So yeah, so that’s great.

[LISA]:
Yeah, thank you. I appreciate it. It’s fun to talk about. I love what I do. And it’s a lot of work, a lot of work. So, don’t ever think that, hey, I’m gonna start this nice passive income of doing an online group practice. I hear that a lot. And I’m going, oh, no, no, no, no, no, don’t think that, because if I were doing this just on my own, still, it’d be a lot less work than doing an online group. So, definitely know what you’re getting into. But it is super fun.

[ALISON]:
Good. Good. Well, Lisa, thank you so much for joining us today. I really appreciate all of your information and the knowledge that you shared with us. So, thank you.

[LISA]:
Well, thank you so much for having me.

[ALISON]:
I want to thank Lisa again for joining me on the podcast. I learned some new things myself. I hope that you did too. I definitely am thinking about how I want to start incorporating telehealth into my practice more and more. Even after quarantine is over. And I think this is just a great topic that we were able to feature right now because it is on a lot of people’s minds. So, thanks so much for joining me for the episode today.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. This is given with the understanding that neither the host, Practice of the Practice, or the guests are providing legal, mental health, or other professional information. If you need a professional, you should find one.

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