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Thriving in Private Practice
            2013
  Starting and Growing a Counseling Business
Introduction



Transition: Technician to Entrepreneur
Running a Practice is Not Mostly
About Doing Counseling
Is it wise for the
 average counselor to
start a private practice?
Should I Start/Build a
  Private Practice?
Reasons NOT to Start a Practice
          I need/want money now!
          I want to keep work separate
          from my life
          I hate business
          I want to focus on being a
          counselor
          I don’t want to start from
          scratch
High Paid Agency Employee
                Spread the word
                Speak publicly
                Make the news
                Publish online and off
                Build a reputation
                Offer specialized services
                Help out
                Independently Credentialed
The Bootstrapper’s Guide
 Make a Commitment
 Pay the Price
 Focus
 Constant Forward Motion
The Bootstrapper’s Guide
  Reject Excuses
  Build Risk Tolerance
  Avoid Non-essential Partners
  Track your Progress
Activity One
Risk and Counseling Business
 Being an Employee is Risky Too
 Failure: Necessary but not Sufficient
 Betting the Ranch / Taking a Flyer
 Risk Versus Reward
Activity Two
Show me the Money!



             QuickTime™ and a
           H.264 decompressor
     are needed to see this picture.
Show me the Money!
According to salary.com, an LPC in
Cambridge, MA makes on average $39,778 a
year.
Show me the Money!

 Insurance: $70 per 45 min. (90801, 90806,
 90847)
 35 x 48 x 70 = $117,600
 That’s 26.25 hours a week of therapy
Show me the Money!

- $490 a month (5%) for marketing = $5880
yearly
$117,600 - $5880 = $111,720.00
Show me the Money!

BIlling is 6% (is $7,056.00)
$111,720.00 - 7,056.00 = $104,664
Show me the Money!
 Office: $500 a mo = $6000 yr
 Office Supplies = $3000 yr
 Professional Dues, insurance, education = $500
 yr
 Other Misc. = $500 yr
 Total = $10,000 yr
Show me the Money!

Final With Medical Billing = $94,664.00
Final without Medical Billing = $101,720.00
Both are a FAR CRY from $39,778!
Show me the Money!

   Let’s discuss some variables!
Rumors about Accepting
Health Insurance
              “I’ve heard I should stay away
              from health insurance”
              “I’ve heard that insurance
              companies don’t pay well”
              “I’ve heard insurance companies
              are impossible to deal with”
Rumors about Accepting
Health Insurance
             “I don’t want to be a slave
             to/employee of the insurance
             companies”
             “I don’t want to do all the
             additional documentation”
             “I don’t want to be told what
             clients I have to see”
Insurance Panels
               Gives you Leverage
               HMOs More Popular
               Universality of HealthCare
               Mental Health Parity
               Panels Will Close
As my 8-year-old
daughter Scoutie says:
“You Have GOT to be
Kidding Me!?!”
Medical Billing:
The Dark Side of Counseling
Practice
The Dark Side of Counseling
Practice
17 Reasons Your Insurance
Claims are Being Denied
1) You waited too
long to file the claim.
2) The insurance
 company lost the
claim, and then the
   claim expired.
3) You lacked
authorization.
4) The client didn’t
acquire a physician
      referral.
5) You provided 2
services in 1 day.
6) You ran out of
authorized sessions.
7) The authorization
     timed out.
8) The client changed
  his/her insurance
        plan.
9) The client lost
his/her insurance
    coverage.
10) The client was
late to pay his/her
       Cobra.
11) You sent the
 claim to the wrong
managing company.
12) The provider isn’t
  paneled with the
insurance company!
13) Services were
rendered at the wrong
       location.
14) The client’s OON
 benefits differ from
  their in-network
      benefits.
15) The service was
 already rendered.
16) The client has an
out-of-state insurance
         plan.
17) The client has an
 unmet deductible!
Medical Billing Takes
       Effort
Activity Three
Should I Specialize?
OR...
Finding The Right
Identity for Your
Practice
Should I Specialize?
 Populations Served
 Problems Treated
 Treatment Methods Used
 Business Identity
Should I Specialize? - TIPS
 Don’t Specialize in Group Therapy
 Avoid Creating a Whole Health Program
 Consider Demand
 Stay Consistent
 Be the Best in the World
 Can work in a Small Town, Too.
Your Therapy Office


                                  The Bar is Both
        QuickTime™ and a
      H.264 decompressor
                                  High and Low!
are needed to see this picture.
QuickTime™ and a
      H.264 decompressor
are needed to see this picture.
QuickTime™ and a
      H.264 decompressor
are needed to see this picture.
Your Therapy Office
                      Paint the Pig
Your Therapy Office
                      Wall Art
Your Therapy Office
                 Good Lighting
Your Therapy Office

                 Music / Better
                 Sound Barriers
Your Therapy Office
                 A Nice Place to
                 Sit
Your Therapy Office
                      Something to
                      Read
Your Therapy Office

                      Cell Phone
                      Charger
                      WIFI
Your Therapy Office
                      Refreshments
Your Therapy Office
                      Surprise and
                      Delight
First Impression...
(it’s actually NOT your office)
First Impressions...
                       For many
                       companies, its the
                       person at the
                       counter.
                       For Counselors,
                       it’s their voicemail
                       :(
Making a Good Impression By
Voicemail         Trim the Fat
(yes, voicemail)    Smile
                    Provide Value
                    Hang up
                    Um, Write it out
                    Update Daily
                    Emergency
                    Instructions?
First Impressions...


                       Return Calls
                       Veto Voicemail
Building a Full Caseload: 40
         Quick Tips
Ethically Improving Client
Retention
Ethically Improving Client
Retention
                  Familiarize
                  clients for a
                  suitable course of
                  treatment
“I let new clients decide how often they come in,
and I try not to influence their decision.”
“I think clients know how often they need to see
me.”
“It’s unethical to tell clients how often I think they
should see me for therapy.”
Ethically Improving Client
Retention
                   Familiarize
                   clients for a
                   suitable course of
                   treatment--
                   Again!
“During the first appointment, I try to convince
the clients not to come back.”
“The problem is that clients are ambivalent
about whether or not they want to be in
counseling.”
“If clients don’t continue treatment, they must
not be ready to change.”
Ethically Improving Client
Retention
                 Familiarize clients for a
                 suitable course of
                 treatment--Again! And
                 Again!
“Many clients can be finished with counseling a
5 or 6 sessions.”
“The clients I saw today only needed 1 session.”
Ethically Improving Client
Retention
                 Don’t adopt a strict
                 “disorder-model”
                 approach to care.
“We had little to talk about in therapy this week,
which tells me that we must be finished with
counseling.”
“When it seems we’re not making progress after a
session or two, I suggest clients take a break
from counseling.”
Ethically Improving Client
Retention

                 Break the “See You
                 Next Week” Mold
“None of my clients want to see me more than
once a week.”
“I’m not a psychoanalyst. I can’t see clients more
than once a week.”
Ethically Improving Client
Retention

                 Don’t terminate too
                 early.
“Really?” I said. “Did he buy a ring?”
“Um. No.”
“He proposed?”
“Haha, no. I didn’t think of that. Maybe we’re not
done after all.”
Ethically Improving Client
Retention

                 Follow up with Clients
                 who have lost touch.
“I’m worried that a phone call would be a
nuisance to my clients.”
“My clients will be ‘creeped out’ if I call them.”
“My client is an adult and should call me if
he/she wants to continue seeing me.”
Wrap Up
Thriveworks.com/Private-Practice
     1-855-4-THRIVE

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Build a Private Practice 2013

Notas del editor

  1. Prelude to Private Practice Pointers from Anthony Centore As counselors, when we venture into private practice for the first time, we make the difficult transition from technician, to entrepreneur. The immensity of this transition cannot be overstated. As technicians, we are responsible for our craft—professional counseling. As entrepreneurs, we oversee a much broader spectrum of responsibilities. The change is the equivalent to a pizza dough thrower deciding to open a restaurant. During this transition, many counselors make a fatal error: they assume that running a practice is mostly about doing counseling. It’s not. To many in our industry, that statement is blasphemy. Our care-focused culture tells us that to turn our attention to “business” is to undermine client care. In that vein, many of us are taught that if we provide really good clinical care, the business will grow around us as our just reward. It won’t. I have seen good clinicians fail because of poor practice management. Scheduling errors, billing errors, cash-flow problems, unreturned voicemails, unkempt offices, unfulfilled records requests, poor customer service, unsuccessful advertising spends—all of these contribute to a practice’s demise. While good counseling alone won’t make a practice successful, a well-run practice is best positioned to offer great clinical care, customer service and support, and a consistent quality experience that exceeds client expectations. This is easier said than done. As practice owner, you may be a “one man” clinical staff, as well as CEO, CFO, CMO, CTO, COO, and receptionist! How do you manage all these roles with excellence? This is what my columns will be about. In this presentation, we will address a variety of roles one must fill to start or grow a practice.
  2. One great thing about being a counselor is there are so many places to perform the trade. One can work for schools, insurance companies, employee assistance programs, group practices/agencies, nonprofits, residential care, government-funded programs and clinics, and many others. Although the employment landscape is diverse, many counselors begin their careers with the dream of someday having their very own private practice. To be their own boss! To steer their own ship! This article is for those counselors.
  3. One great thing about being a counselor is there are so many places to perform the trade. One can work for schools, insurance companies, employee assistance programs, group practices/agencies, nonprofits, residential care, government-funded programs and clinics, and many others. Although the employment landscape is diverse, many counselors begin their careers with the dream of someday having their very own private practice. To be their own boss! To steer their own ship! This article is for those counselors.
  4. One great thing about being a counselor is there are so many places to perform the trade. One can work for schools, insurance companies, employee assistance programs, group practices/agencies, nonprofits, residential care, government-funded programs and clinics, and many others. Although the employment landscape is diverse, many counselors begin their careers with the dream of someday having their very own private practice. To be their own boss! To steer their own ship! This article is for those counselors.
  5. Dispelling Rumors about Insurance, Not Advocating for It.
  6. Dispelling Rumors about Insurance, Not Advocating for It.
  7. Wall tattoos. Original art.
  8. No dark corners!
  9. Sound proof the walls. better sound machines. spa music. NPR
  10. magazines, community book, IPAD!
  11. Something notable. community book. ipad. over-signage. toys. puzzles.