Dr. Sharp: [00:00:00] Hey, y’all. This is Dr. Jeremy Sharp, and this is The Testing Psychologist podcast, where we talk all about the business and practice of psychological and neuropsychological assessment.
Hey, today is a little bit of a unique episode. This is a replay of a live Q&A that I did with John Clarke of Private Practice Workshop. Listeners know that John is a good friend of mine, and he asked me to co-host this live webinar with him just two weeks ago.
We talk generally about private practice and the COVID-19 shutdown. I think that a lot of the material is still very relevant, even though we’re two weeks into it. The only thing that I would probably put in the corrections corner, so to speak is that we did speak a bit about Zoom. Since this webinar, we’ve figured out that Zoom is less secure than originally thought. Our practice has now transitioned entirely to the HIPAA-compliant version of Google Meet, which you get with a VAA if you use G Suite. Many folks are using doxy.me as well. We do talk about that. I think that’s the main thing that I needed to correct from this webinar. Otherwise, the material I think is still quite relevant and also timely.
John just launched both of his programs after several months of them being closed. He launched Fully Booked, which is a do-it-yourself SEO website online marketing program that is self-paced. It’s a great course. He’s put a ton of time and energy into it over the years to hone it and has a lot of great feedback. And he also launched Business Made Human, which is his extended mastermind experience complete with a, I believe he’s still doing a live event as part of that mastermind experience.
So if either of those sounds interesting to you, I know John professionally and personally, of course, and just know that he has [00:02:00] put so much energy into these programs and they’d be totally worth it. So you can find those in the show notes.
In the meantime, please enjoy this live Q&A with John Clarke. We talk a lot about general practice, not as much about testing specific practices, but I think that there is still plenty to take from this event. Okay. Enjoy my conversation with John Clarke.
John: All right. Welcome, everybody. I’ll introduce myself first and then I’ll introduce my co-host here for the day who I’m excited to introduce. My name is John Clarke. I’m a licensed professional Counselor. Maybe I’ve got some LPCs in the room. Who knows? I’ve been helping therapists since 2013 run their private practices. I had a solo practice in San Francisco starting in 2013. I had a group practice in Charlotte, North Carolina that I sold back in April 2019. Now I have a small part-time online therapy practice and the rest of my time is spent helping therapists like you guys. And I really love what I do.
These current times have thrown us some really interesting challenges and as a private practice consultant, it’s been a really interesting time, and I think will continue to be a really interesting time. So, we threw this Q&A call together. I just got home on Monday morning and saw how things were going, saw how quickly things were changing, and thought, let’s put something together to support you guys as best as possible.
I’m going to bring my good friend, Dr. Jeremy Sharp up if he wants to start his [00:04:00] video. We’ll bring him on as my co-panelist here. I just asked him last night to help me out and pitch in on this call because we had so many signups at the last minute. So I think a lot more people are going to be coming in.
What we will do is I’ll introduce Jeremy real quick, and then we will just get started. So, Jeremy, you can try your video now. I just made you a co-host. Jeremy is a good friend of mine. There he is.
Dr. Sharp: Nice.
John: He’s also a group practice owner out in Colorado. He owns a testing and therapy group practice out in Colorado. He’s been doing it quite a while, so he’s going through it, right in the middle of it just like a lot of you guys are, and has a lot to offer. We don’t know everything by any means. And again, the situation is changing every day. So we’re really just here to be helpful to you guys for about the next hour.
Jeremy, anything else you want to say about yourself or just introduce yourself before we dive into our little outline here?
Dr. Sharp: Yeah, sure. Well, first of all, thanks for having me as the co-host. I think this is an exciting opportunity to be here for therapists and other practitioners who just might need some support right now.
Like John said, I’m a psychologist. I’ve had a group practice out here in Colorado for probably the last 8-10 years or so. We have about 15 clinicians. We do a mix of therapy and psychological testing or neuropsychological testing. I also consult with other practitioners around starting practices and building practices with psychological testing as a component. So as part of that, I’m host The Testing Psychologist podcast. And again, like John said, I just love being able to support practitioners however I can in that process. I’m looking forward to doing so here today.
John: Cool. A little introduction to the platform for you guys who are here. We’re running a webinar-style [00:06:00] call right now because it got so large. The chat is for you all to interact with each other. The Q&A section of Zoom is for you to submit your questions for me and Jeremy. My team member, Laura is going to help me manage the chat. You might even see my other team member, Matt Headland poking around there and maybe helping out in the chat a little bit, or if there’s a question that maybe we can’t answer between Jeremy and I, maybe Matt will pitch in, who knows. I’ve been known to put him on the spot every now and then.
Let me know in the chat really quick where you guys are from, where’s your practice, and maybe what’s going on right now. So get the chat started here while we’re at it. And then I’m just going to dive right in. Jeremy and I are just going to talk for probably about 5 to 10 minutes here in the beginning about what we see as what’s going on, some things that we think you all should be thinking about, and then after 5 or 10 minutes, we’re just going to turn it right back to you guys for questions for pretty much the rest of the hour.
The first thing I want to say is with what’s going on right now, it’s important to first establish your priorities and create a plan. Create a plan before a plan has to happen to you or be forced upon you if that hasn’t happened already. I want you guys to think about, and rank out your different priorities right now.
First and foremost, I want you all to be thinking about your health and your family’s health. That is something that is, in my opinion, not negotiable and something that should be at the top of your list. This should come before money or the money of your practice, or even your clinicians making money during this time.
You should be thinking about your clinicians’ health. We might take for granted our clinicians being healthy right now or even those who are still seeing clients in person, again are being maybe exposed to 5, 6, 7, 8, 9, 10 people a day if they’re still seeing people in person in their office. We also know that people who are asymptomatic can still be carrying the virus. So I think [00:08:00] you have to think about that as well for those of you who’ve got in-person work still happening.
You have to think about your client’s health, right? So you have to think about even again, a client who potentially is sick and maybe doesn’t know it bringing the virus into your waiting room, your office, et cetera, and how that could spread.
Obviously, you have to think about your personal finances and your business finances. You have to think about making money during this time. You have to think about your business generating revenue. If you’re a group practitioner, you have to think about paying your staff. You have to think about whether you’re a W2 or an Independent contractor practice. And you’re going to have some looking into things to do to figure out exactly what’s required of you as an employer during this time.
So I want you guys to think about these things, but again, maybe even just think today, like what are my priorities right now? What have I been focusing the most on? And maybe where should I focus a bit just today in terms of what’s going on and what I know.
The last thing I want people to do is make bad short-term decisions out of anxiety that are going to have long-term negative impacts. If the coronavirus is impacting us, let’s say for the next month, the next two months, I want you to zoom out for a second and think, 10 years from now when I’m looking back on this period in time, what do I want to remember about how I handled that with my clients, with my staff as a leader? I want you to think about all those things and really use that to help make the best decisions you can.
Keep in mind that regulations in your area could change at any moment. There’s plenty of places that are already on lockdown or on a mandatory quarantine. I would just encourage you guys to think about getting ahead of this. I’ve seen some practices, in particular group practices, even with 20 clinicians who last week transitioned everything to online therapy like that. They just got out ahead of it and made that transition entirely. Other [00:10:00] practices, I think are doing a hybrid. We’re doing some in-person work, but doing it carefully are with different stipulations.
So I think people are all over the board right now, depending on you, your practice, who you work with, and what the regulations are like right now in your area. Again, that is changing rapidly as well. So I just think therapists should be getting out ahead of it right now.
One of the first decisions that you guys need to make is about, are we still going to be seeing people in the office? Are we just going to do online sessions? Are we going to do a hybrid? That’s probably the first decision to make. Maybe, Jeremy, you can dive in here and maybe we can talk a little bit about how you’re making that decision, how you see other people making that decision. Let’s touch on that for a minute.
Dr. Sharp: Yeah, for sure. Well, I think that it depends a lot on your practice and your population. For us, we have this hybrid practice where, like I said, we do testing and counseling. We have moved to telehealth only for counseling except in extreme cases. When I say extreme cases, I mean vulnerable populations who may not have internet access at home, who may not have a private space but yet still need the support from counseling. I’m leaving that up to clinicians to decide which clients need to be coming into the office because there just aren’t other options. And then we have safeguards in place.
The other place that we’re doing that is with the face-to-face testing appointments, which is really the only part of our practice that absolutely cannot go to telehealth because there’s so much interaction and manipulation of materials that we’re doing right there in person. So that’s how we’re handling it now.
John: If it gets to the point where you can’t be in person at all, I guess you would put the testing part of your practice on hold?
Dr. Sharp: Right. We just had a meeting this morning with all our testing staff talking about a contingency plan and how we might reschedule folks and handle that.
John: Okay. And what have you heard [00:12:00] from other folks, or even in your Facebook group or anything like that, of other practice owners in terms of what they’re doing?
Dr. Sharp: It really seems to depend on the area of the country. Honestly, there’s just so much variability with practice finances and who’s got an emergency fund and who doesn’t. But overall, it seems like the folks, and this makes sense, who are in those high outbreak areas are much more willing to transition to telehealth and cancel appointments for the next 2-3 weeks just to try and ride it out.
John: Yeah. So everyone is making different decisions with different variables. This holds true no matter whether we’re going through a pandemic or not. You have to make decisions for your practice in your particular variables. So I encourage you guys to just be keeping yourselves informed as to what those variables are. And again, getting ready for potentially your next step, if you haven’t already.
Let’s talk for a minute about seeing clients online. For some practitioners, they’ve already been doing this, or it’s a part of your practice, for some, they’re scrambling to get set up with telehealth. Obviously, this is not going to be a comprehensive guide to telehealth, but I want to start talking about your different options, different platforms, and basic things to keep in mind if you’re making this switch.
We also have put together a resource list for therapists around the coronavirus and it includes telehealth resources, business resources, and things to think about with your marketing. We have a bunch of examples of practice notices that you could put on your website or send to clients. I just dropped that link here in the chat, and you’re welcome to share this link with friends. You can grab that resource list there.
So the [00:14:00] things that you want to do is you want to figure out, well, what’s the plan for my practice right now? And you want to commit to that plan. I think you want to have a plan before you roll it out to your clients or your clinicians and you just want to stick with that plan. You don’t want to waiver or roll out a half plan.
If you’ve decided to go with online sessions, communicate that plan clearly to your clinicians, communicate it with your clients, or they can communicate it with their clients. You may even want to inquire with insurance, if you’re an insurance-based practice, to make sure that basically the service codes or the code for the service location is going to be no problem in terms of your reimbursement. We can talk about that in a minute. Or did we want to talk about that now, Jeremy?
Dr. Sharp: Yeah, sure. I would imagine this is going to come up in the questions. People seem to have a lot of questions. But just briefly, I can say that that location code is going to change. We are a heavy insurance-based practice, so we’re really digging into this, but that location code is going to change to 02 for telehealth. And you’re going to want to look at the modifier. The vast majority of insurance panels are using that GT or 95 modifiers. So between those two, you should be set. You just want to double-check to see which one is correct for each panel.
John: I’ve had therapists this week who have worried that insurance companies have maybe not necessarily said yes, we’ll reimburse for online sessions for telehealth. Actually, Maureen made some petition for Blue Cross Blue Shield of Illinois to authorize it basically for therapists and that was successful.
So, there’s definitely been some worry among some practice owners about getting reimbursed. I think at the same time [00:16:00] because we are in a bit of a crisis that could escalate even more over the next two weeks, it could get a little bit more intense the next two weeks, do the best you can. Try to do the right thing. And ultimately, we need to keep serving our clients as best we can. So I think to some degree, you could stick to that as a guiding principle, and worry about the insurance piece a bit later.
Dr. Sharp: I totally agree. I might just jump in there. I’m sure there are folks out there who might disagree here, but given the circumstances, I’ve really adopted a view of this spirit of the law versus letter of the law. It’s that kind of time. And ultimately, what we’re trying to do is help our clients and protect ourselves at the same time. So, if that means we’re giving it our best approximation of billing and location and platform, we’re going to talk about that, that’s okay right now. We’re doing our best and I think that’s okay.
John: Let’s go ahead and answer Lydia’s question if we can because I think this is an insurance question, just since it came up. She’s basically said, anything specific to remember for authorizations?
Dr. Sharp: Yeah. Majority of things that I’m seeing and hearing is that most insurance panels are just going to cover things as they would for in-person sessions. So any authorizations you might need to get for in-person sessions, you would want to do that just to be safe, but there’s not going to be anything that changes specifically for most plans just to do telehealth, as far as I can tell. The thing is, always check with each of your panels, but that seems to be the way things are going, that we can just do telehealth without special authorization.
John: Cool. Let’s see. We have another question around that [00:18:00] which is cool. We’ll just stay on this for a minute, guys. Kartika says, should we charge the same rate for telehealth sessions in the traditional in-person rate? I’m assuming she’s talking about cash pay, if it’s a private pay client. Thoughts, Jeremy
Dr. Sharp: Short answer is yes.
John: Yeah, I agree.
Dr. Sharp: You agree?
John: Yeah. Guys, I don’t think when someone is paying for therapy that they’re paying for your couch. They’re paying for your time, not for your office per se. They’re paying for your time and they’re getting that time. I suggest you charge the same rate.
In normal times, I have heard of therapists charging a higher rate because it saves the clients the time and money of commuting to your office. I don’t have a problem with that, but again, I think at least charge your current rate. At the same time, there are plenty of people right now who are offering some sliding scale or for people who want help around coronavirus-related issues or anxieties, or issues around OCD or things like that. There are people that are offering that sort of help right now, which I think is a great thing to do and aligns well with our ethical foundations of mental health. That’s obviously up to you to your discretion right now, but there you have it.
Let’s see. Do we see any more insurance-based questions? Let’s stay on this for a minute and then we’ll get into the telehealth stuff. So we answered Lydia’s question. The next one, we’re going to look at Meera’s question. I’ve been working toward getting off insurance the past six months to move toward private pay only. In light of the developing recession, would you recommend staying on insurance? Well, that’s a fun one.
Dr. Sharp: I’ll just offer my thoughts. Generally, whether it’s getting off insurance or making a move [00:20:00] or hiring or anything, any big change, I would say table it for now and just hold the status quo because your cognitive and emotional energy is going to be tied up in dealing with whatever we’re dealing with here for the next few weeks. So put that on hold, stay with what’s working, and ride it out.
John: I totally agree. I think that’s a great guiding principle right now. I was speaking with other therapists earlier today and they’re asking, well, my Google ads aren’t working as well right now. Should I change it? Is it the coronavirus? Basically, should I make a bunch of changes to my website?
I think there’s a difference between adapting with what’s going on right now versus again, making decisions in a panic or decisions in a crisis, because these are not typical times right now. So, I agree. The answer is I think to keep the core elements of your practice intact, stabilize your practice right now, stabilize your caseload, focus on serving your clients and take it day by day or really week by week. I’m obviously not an economist, but to get too panicked around a recession happening, we just don’t know enough right now, so I would hold out there.
Other questions around insurance. I saw something in the chat. I think Gracie said, Texas did not expand telehealth coverage to all insurance clients. So if you’re in Texas, that’s at least what Gracie is saying that Texas did not expand telehealth coverage to all insurance clients. If that’s true, that’s really a bummer.
But again, something to look into, even with insurance panels or Blue Cross authorizing it for Illinois doesn’t mean they authorized it in Virginia. A lot of these insurance companies operate somewhat differently in different states. They have different rates for different states or for your particular practice. So again, guys right now [00:22:00] unfortunately, you have to just do your homework. If you’re the group practice owner, you have to do double homework to look into these things for your practice.
All right. We’re having fun so far, right?
Dr. Sharp: I’m having fun.
John: I’m so glad you’re here. I’d be overwhelmed without you. Next question. This is a good one for Dr. Jeremy. Gretel says I have a practice that primarily does testing. Any suggestions to continue to test during the shutdown?
Dr. Sharp: Yeah. And then it looks like Morgan has a similar question there. So these go together well. Good to see y’all are from my Testing Psychologist group on Facebook. I will say this at the top. I’m in the process. I’ve been trying to get in touch with someone from APA who could maybe do a similar Q&A just for testing because we are struggling with this too, how to do the typical face-to-face stuff over telehealth. Right now, we don’t have a great option for that.
What we are moving to in our practice is a two-pronged approach. We are still doing in-person testing appointments, but we’re making people wash their hands and making the kids wash their hands when they come in the door. They’re sanitizing. Everything is wiped down. We’re wiping down all those stimulus materials throughout the day. We are just trying to stay as far away as we can while we’re actually doing testing. And I gave my clinicians permission to send kids or adults home if they have any suspicion of illness.
The other thing that we have talked about is if you have the capability in your practice to do some of those more interview-based evaluations, I’m talking like bariatric evals or adoption evals that rely more on interview and personality measures that you don’t have to manipulate anything, of course, try to expand that side. And we’ve even talked about [00:24:00] going more to, do we have to read questionnaires to our clients over telehealth and help them answer those questionnaires just to keep them out of the office and still get some of that assessment done, but there’s not a perfect answer right now.
John: Yeah. Okay. Let’s move on. And we’re staying on insurance for a second. This is actually a super bill question from Mike. So for those of you, if you’re charging private pay or you have a client that’s private pay and you’re providing a statement further out of network reimbursement, what code should we be using since we aren’t concerned about certain insurance panels?
So if you’re just creating a generic, superbill for your clients, or let’s say you’re using SimplePractice or something like that, you might be using your EHR to generate superbills. This is something I’ve done for the past few years since I only have an online practice. All I do is change the code for location, basically. So where the service was delivered, you can change it from office to telehealth. I don’t know the code off the top of my head. I’m sure I could find it or someone could find it. Somebody in the chat probably knows it. As far as I know, that’s the only thing you’re going to change. The other codes are really going to stay the same.
Dr. Sharp: And that code, John is 02 for telehealth just to anybody.
John: Is it a different treatment code? It’s 45 minutes of therapy or it’s just the office code basically.
Dr. Sharp: No.
John: Cool. All right. Guys, we’ve just got one more question here coming up about telehealth. So start adding your questions as well. We’re going to move the topic here to telehealth, but we can come back to anything you’d like.
So really quick, I think you guys should think about some sort of practice notice, whether that’s just on your website. A number of therapists have been doing that. We [00:26:00] put that in the resource list that I’ll link to here. A lot of people are just making a page on their site with the notice or something in the footer. Another option is to email your list and let people know what’s going on, what your policy is, and how clients can keep getting sessions. I think you want to think about doing something like that. And just making sure again, your team and your clients are all up to speed on what’s currently going on and how your practice is addressing this.
Let’s talk about telehealth. So, if you guys are making that jump quickly, obviously the insurance piece is something you need to look into. It’s something that seems maybe a little shaky right now, depending on where you are or which insurance platforms, but again, that’s something to sort out individually.
The first things you really think about are choosing a platform and then I think ensuring that your clinician has a setting where they can do sessions confidentially and encourage your client to find settings where they can have some privacy as well.
Obviously, we can’t protect their confidentiality if they’re out on the street having a video call with you. But it is really important that I think if your clinicians are going home or wherever and doing these sessions, that they don’t have kids or a partner in the background, they don’t have audio coming out of their speaker and people are in the next room, whatever it is. So you just have to remember that you’re bringing your clients with you when you are doing this from your laptop. So obviously, use some common sense. Think through confidentiality, if this is not something you’ve done before.
Speaking of confidentiality, the next thing you’re going to be thinking about if you haven’t already is platforms. We’re going to talk through a bunch of platforms and we also threw some together in the resource list that I’ll link to. Two platforms are off the bat. If you have something that’s already working, then just use that. Okay? So if you’ve already been using something, just use it. That’s fine.
If you have a telehealth option that’s integrated into your EHR, [00:28:00] use that. That’s pretty common sense. SimplePractice is one of them. I’ve heard that generally, it’s working pretty well right now. I have heard that some people are having some connectivity issues, especially if they’re not on desktop. So if they’re on mobile, but not on desktop. Again, I’ve heard other people say SimplePractice has worked just fine, and it is integrated already into your EHR.
So if that’s something you have, I figure why not use it? However, as Dr. Jeremy Sharp pointed out, have a backup, if the first doesn’t work, because there’s nothing worse than a client in crisis or you’re in the middle of having a moment, and then the thing craps out. That has happened to me before. So have a backup.
There are two free options we can talk through. doxy.me is a free option. I think it gets decently reliable, but lately, I’ve also seen some complaints. They could be overburdened right now. VSee is another fairly reliable free option that I’ve used in the past. That is V-S-e-e. Fairly reliable. Again, I think with something paid, you’re going to get better quality, with something free, you’re rolling the dice just a little bit, potentially.
Finally, Zoom, which is what we’re using right now. I’m a big fan of Zoom. It’s more costly. If you want it to be HIPAA compliant, you need to get a special license with them that I saw was around $200 a month. However, you could split that with another practice or with other clinicians. You could actually split that account with different users.
The last two, and then I’ll let Jeremy talk about his, are Spruce Health. This is a company that has sponsored our podcast for the last while. I will say, I’m a big fan. They have a completely HIPAA-compliant communication platform. It’s very affordable. It’s very secure. Whether you want to have your phone number through Spruce or just use spruce for telehealth, that’s a good option for you.
So sprucehealth.com/ppw [00:30:00] will get you in there and then you can get 20% off for PPW20. This is not meant to be an ad, but it’s just a resource that I know is very airtight. And I know they’re taking things very seriously right now with making sure the platform is up to date and not going to cause you any problems. Jeremy, however, is using another option that I think is interesting to talk about.
Dr. Sharp: Yeah. I can throw this out there. Although things have even changed overnight since we talked last night, John. For years, we’ve used Regroup Connect, which is a telehealth platform that’s been around for a long time. It’s built on the Zoom platform but has the HIPAA-compliant overlay. But I’ve been hearing, as of late last night and this morning, that they are hitting their capacity for new practitioners. So that is a huge bummer.
So the default for us or the backup for us is Zoom. I think Zoom is great and it’s really geared toward hosting these huge calls with a lot of video participants. It’s very stable. So if you can swing the Zoom option, I think it’s a great one, especially with getting to Ashley’s question, the idea that they’re loosening the regulations around making sure they’re HIPAA compliant. That is a great option.
John: Let’s go ahead and talk about Ashley’s question real quick. Again, that’s not a comprehensive list of options guys, but it’s a list. If you are doing this, make sure that you have a decent set of headphones like iPhone headphones like this, so that it’s confidential, so that it’s not feeding back. You don’t need a fancy light or a fancy camera. I’m sitting just in front of a bright window right now. Simple stuff like that. Try to still provide a nice experience for your clients.
If things are really not working well, you could do something like have a video on like this right now, like Jeremy and I, and then call them on the phone, or have your AirPods in or something and [00:32:00] call them on the phone. So your audio is through the phone, which is reliable, and then your video could be through something that’s maybe not quite as perfect. But it’s still going to get the job done. Have backups, and explain to your clients that these systems could be a little wonky right now, but we’re going to get through it.
With that being said, I do think some clients, let’s say if the video’s not working or maybe they’re not comfortable in video, they could be comfortable with a phone session. I have had clients want that before. And that can be a good backup as well. It just depends on you and depends on the client.
Okay. Let’s talk about Ashley’s question real quick. We’ll stay on this idea of telehealth and platforms. So we answered Amy’s question that doxy.me has been glitchy due to some high demand. We did recommend other platforms like VSee and Spruce, precisely. Ashley’s question was, I read this morning that HIPAA laws have been loosened to allow for nonconfidential telehealth platforms such as Zoom and Skype. Any word or thoughts on the loosening of offering telehealth across state lines?
Those are two different questions. One is, can I use something like Skype or FaceTime or Google Hangouts that’s not HIPAA compliant? I did see that as well. I did see basically an announcement that is okay that they’re going to be loose about something like that right now. So I think that’s fine. I think there are HIPAA-compliant options. So why not use one, right? If this ends up being something you’re going to use for your practice anyway, why not have a decent option that’s HIPAA compliant so you can rest easy?
Now, any word or thoughts on loosening of offering telehealth across state lines? That’s another question. That’s a big question. Probably one that we can’t answer today. At least, I don’t really have the answers and I haven’t heard anything about that. Jeremy, anything?
Dr. Sharp: I’ve just, in skimming, I don’t know how many articles and emails [00:34:00] about this kind of stuff. I did see something about a temporary authorization for 20 visits or fewer across state lines if you’re not licensed in that particular state. Don’t quote me on that. It’s not set in stone. I know that I saw it somewhere and I’m not sure if that’s every state or what, but that’s something to dig into a little bit more and see what’s really going on.
John: So just to clarify, if any of you go to court over this, a good alibi is not Jeremy Sharp told me I could do it.
Dr. Sharp: Please don’t say that. Yeah.
John: Or John Clarke hosted a webinar and then his friend, Jeremy Sharp told me he could do it. I don’t know. That’s a good question, guys. If someone finds that or wants to Google that right now, let’s pull together our resources, and put them here in the chat. This is what we’re here for. So, let’s try to figure this stuff out together. Someone could do some Googling here and maybe find an answer to that. That’s a really good question.
Oh my goodness. We have so many questions now. Good grief. All right. We’ve talked about telehealth practices. I want to make sure I get in all my points before we just open it back up to all questions. I do want to tell you guys that in terms of financials, it’s definitely a big concern for a lot of folks. That’s where a lot of the anxiety comes from. I think that’s why a lot of people are maybe keeping their practices open in person longer than maybe they should in their area.
I know this is hard to do, but I teach every therapist to have an emergency fund of expenses plus payroll that would last 3 to 6 months of expenses plus payroll. I know this is really hard to do, but this is literally game time of why we do this sort of thing. I know it can take a while to build up that sort of fund or even build up one month of my payroll and my expenses, but this is literally why we have something like that.
Again, I’m not a financial advisor, but I recommend doing the same thing for your personal finances, especially because we’re all business [00:36:00] owners. You potentially have some more liability, some more financial risk, and you also have potential higher reward as a business owner, but I think because we have a bit more of that risk, think about building up that emergency fund both in your business and on the personal side.
The other thing I would say is, if you find yourself having some more downtime or some unexpected downtime, don’t see it as a curse. See it as a blessing. See it as an opportunity to just give in to what is happening, to embrace what’s happening, and maybe start to work on building some additional revenue streams that can help you in a time like this in the future, that can insulate you against stuff like this in the future.
There’s a lot of different things that we talk about in my own content around passive income, affiliate marketing, online courses, membership sites, things of that nature. So I think again, if you do find yourself quarantined, which is an intense word, but I’m quarantined right now, then think about using that time well. Think about using it to build some additional revenue streams.
We have basically a free mini-course on how to create your own online course. I’ll drop it here in the link as well if you find yourself with extra time or you want to get started on something like that. That’s all I wanted to say there.
Jeremy, anything else around that, or should we get back into questions?
Dr. Sharp: Just a comment about the emergency fund, the preparedness, that sort of stuff, and this is a little bit of a side note, but I know a lot of us right now are worried about the finances and what to do in our business.
I just want to give people permission to do things that you maybe said you would never do like get a small business loan or get that credit card with a 0% interest rate or something. You may never use those options, but if you don’t have an emergency fund, those things [00:38:00] can keep your business running for the next three months or so if it really all goes to catastrophe. Interest rates are really low right now. I just want to open that up to people because I know. I myself had “rules” for what I would do and not do with my business, and sometimes we got to bend those rules in the interest of staying afloat, right?
John: Yeah. Again not making just short-term decisions, making decisions in this situation for the bigger picture for the long term. Guys, you’re going to get through this. We’re all going to get through this. You will survive. Your practice will survive. And so, try to maintain that long-term perspective even though it’s hard for us to do and our minds are really wired to focus on short-term thinking. So that’s really the challenge right now.
I am going to answer this top question here, and Donna, I think you have a similar one, please post it in the Q&A section for me. We’ll talk about marketing just a little bit; marketing and also communicating with potential clients, and current clients.
This question says, “I’ve been getting a lot of clients who are laid off in the UK and are struggling to pay for therapy, even with reduced rates. Lots of people are suffering from anxiety right now. Is it better to write blogs or articles to address these issues or do I offer a few sessions for free for the sake of reaching out to those most in need?”
I would just say, if you can do both, do both. Again, like I said before, if you want to offer sliding scale or free sessions right now to people with specific coronavirus-related anxiety, which will probably be in the DSM next time, who knows? I don’t know. Then why not do it? If you have those resources. If another resource you have is time, then absolutely. Now is the time to create specific content for your business, your blog, your YouTube channel, your podcast, around dealing with this, or around dealing with a crisis in [00:40:00] general, or around dealing with anxiety in the midst of this pandemic. So, I would just say yes to both. I think you’re on the right track. This is time to get creative, guys. And that’s a good example of being creative.
Dr. Sharp: I might add to that, John if I could. For those of you who want to think about doing something like that, try to be systematic about it so that you’re not just offering endless pro bono sessions for folks, but really sit down and think what percentage of my caseload could I do this? How long can I do this? So, just be deliberate about it. I think that’ll help everybody and ease your anxiety a little bit.
John: Great point. Let’s talk about Donna’s question really quick. She says, can you share your insights about the online therapy specialty page and Google ads recommendations during this time?
If you want to offer online therapy to, let’s say new clients, then, one thing you could do is to create a service page or a specialty page about online therapy, how it helps, some of the benefits, how it’s different, answering frequently asked questions about online therapy.
If you want to make a push for this part of your practice, you could certainly run Google ads to this particular page, keeping in mind you may be competing with some of these bigger monsters, not monsters, these big companies like Better Help, and what is it, Talkspace, something like that. These companies that have a lot of venture funding in running ads for things like online therapy. Otherwise, you might just continue to run your current ads. Again, make an announcement on your site. Have a big, nice colorful banner at the top that says like, due to coronavirus, we’re offering online sessions, click here to get started. Something like that. I think that’s a decent way to do it. That’s what I would say.
I don’t know if there are specific keywords being searched around things like coronavirus [00:42:00] anxiety, and coronavirus therapy. There very well may be. If you guys want to integrate that into your marketing right now, go for it. Again, I can’t vouch for that right now, but certainly something you could look into. Look at Google’s keyword planner, or ask your marketing person to look into it a little bit if you want to make a particular marketing push around it.
Otherwise again, you can think about your warm audience meaning your email list, people who like your Facebook business page, et cetera, and you could reach out to those people and let them know how you’re altering your services right now. Good? Cool.
Man, I don’t even know where to start now. Let’s just start at the top. Beverly says North Carolina has been late in allowing LPCs to do telehealth. We are a discipline that Medicaid has not allowed to see individuals do telehealth. They have only allowed LCSWs to do so. What can be done to advocate at this time?
I don’t know. I guess I’d be surprised if you want to try to get that approved with Medicaid, that they would be making that change right now in the middle of everything going on. I could be wrong. Ashley, in the comment, says, ” Write to your senators, Beverly.” It sounds like a decent idea. I don’t really know. And again, I don’t know if you’re going to get something changed right now, but certainly, you could reference this event in your case and make a case and say, listen, in a time like this, you need LPCs, LCSWs, clinical psychologists, to be able to serve clients on telehealth. That’s all I can think of here.
Dr. Sharp: We mentioned Maureen and her petition in Illinois earlier. Again, no guarantees, but if you can start something like that, you have the time and the energy to push that through, you can always give it a try. The other component is I know in a lot of states, Medicaid allows Incident-to billing through a supervisor. So if you need some, this is just off the top of my head, if you have an [00:44:00] arrangement where you’re being “supervised” by an LCSW or someone who can bill for telehealth, that may be a little workaround to be able to do it yourself.
John: Great point. We have a little positivity coming from Sharon. Sharon, I appreciate you and this positivity, because this is really interesting, guys. And this also reflects how different things are in different places around the country and around the world right now in different countries, but even different parts of the US.
She says, some peace of mind right now regarding the anxiety around income for us and clients. She says, “We’re under quarantine here in LA. They’ve put in place a moratorium on all evictions. Utilities will not be turned off. Everyone will have a six-month window to pay rent and mortgages.” She says, “I’ve shared this with clients who weren’t aware, and it really helps. I imagine other cities will follow suit.”
So that’s the government taking action and really understanding that this is causing distress and hardship for a lot of people. And again, it could be starting to get a bit worse in the US over the next two weeks. So right now it’s just really good to see that, right? It’s good to see the government stepping up in different places. I appreciate that, Sharon. That’s super helpful.
And on that note, Ben says, positive news 2, I can sleep in more often now. Hey, why not get the extra sleep because we’re going to have a lot of work to do when we’re all back at it.
All right. Let’s get to the next question. Anonymous says, how would you handle out starting outstanding therapy fees from sliding scale clients at this time? And would you continue seeing them at their already lowered frequency? That’s an interesting one.
Dr. Sharp: Sure, it is.
John: Thoughts, Jeremy.
Dr. Sharp: I like how you kicked the hard question to me. Let’s see. What are my thoughts on that? [00:46:00] Personally, I would be inclined to maybe relax the collections process for folks right now at this moment. But I always default to setting realistic expectations. So if you’re going to do that, message your clients who maybe are in this position and say, we’re going to relax our collections process right now, but here’s the plan moving forward, and here’s what you can expect for that to resume, and continuing to see them as long as it was ethical and you were meeting their needs within reason to lower that frequency to protect yourself financially is fine. Those are just my thoughts though.
John: Good question. Let’s go to Laurie. She says, for those of you that are private pay, have you noticed a decrease in clients/hours due to people losing work/income due to the virus?
Again, I have a small online practice that’s all private pay. I would say right now, no, I haven’t really noticed that decline. If that decline happens, I’m not going to be surprised. I’m not going to freak out about it. The two things I said yesterday to someone was, right now, even this week has been very busy for me because:
1) Therapy clients want help right now, and at least a number of my clients haven’t started to worry about the money of it.
2) Therapists in private practice want help right now.
I’ve been quite busy. Again, even if you see a dip due to that economic hardship, I think it will be temporary.
All right, cool. We’re getting a little bit better here with the questions. Let’s go to Meera’s questions. She’s got two [00:48:00] 1. Can you let insurance companies know you only accept telehealth clients? Or is this something you communicate directly to an inquiring client? Good question.
Dr. Sharp: My thought is right now, no, you can’t really limit your insurance clients to the panel anyway. But again, who knows, this could be changing. It’s always worth a phone call to a provider rep to check out.
John: She’s asking, can you let an insurance panel know that you’re only taking telehealth clients?
Dr. Sharp: Yeah. Sorry. Was that not the question I was answering?
John: Well, not that she wouldn’t accept clients from a particular panel right now, but that everything she’s doing is telehealth, I guess.
Dr. Sharp: Sorry. I was unclear in my answer. I still think the answer is no, as far as I know, but it doesn’t hurt to call and ask and let them know. As I think through this, though, those of us on insurance panels, we can call and say, we are not accepting new clients.
John: That was my thought.
Dr. Sharp: So that actually might open up as a possibility to let them know that you’re only doing telehealth. And I think the next part of the question, you can definitely communicate that with an inquiring client. In fact, we’re in that process right now with anyone who has an intake over the next few weeks.
John: Yeah. Good question. The second question is, is it okay for clients to email intake paperwork back? How do you feel about emails between therapists and clients in general?
I can answer this one. This isn’t really a Coronavirus question so to speak, but that’s fine. It depends on your email platform, right? If you’re using something like Gmail or Yahoo or Hotmail or something like that, certainly those are not HIPAA compliant by nature. So in my opinion, it depends on your level of risk or your [00:50:00] tolerance for risk.
If you want to be really careful, then use something HIPAA compliant. Use something like Hushmail or get a BAA signed with your email provider because otherwise certainly, they can have access to some of your Phi as it were. So I think you have to be careful with that. Otherwise, if you have a secure platform, then you can communicate with them.
Again, you guys should have systems like this in place for your practice, coronavirus or not. So, whether that’s SimplePractice sending paperwork that way, or something like Spruce communicating compliantly that way or confidentially that way, you should have something like that in place. And if not, now is a good time is ever to strengthen your policies, procedures, and systems.
Dr. Sharp: I might add to that too, that a lot of folks that I work with are using a system called IntakeQ to send intake paperwork back and forth. It is HIPAA compliant. It collects valid e-signatures and it’s relatively inexpensive. I’ll drop that link in the chat if anybody wants to check that out. That’s not an affiliate link or anything. It’s just a cool service that we use in our practice too.
John: All right, two more. Just as I think we’re cleaning them up. We got more. Diane is asking if we take on a new client for anxiety specifically related to the coronavirus, do we need to do a full intake? And what CPT would we use? Crisis code or regular? I’m stumped.
Dr. Sharp: I think the first time that you see a new client, it’s an intake code. Do you need to do a full intake? That’s up to you as to how many areas you’re going to cover. I don’t know if you dig into family medical history and all that, but that’s up to you as far as the content of the session, but you would still use that [00:52:00] code which is 90791.
The crisis code is really reserved for those sessions that would be ongoing sessions where the client is really freaking out and just cannot leave within that session boundary, that hour, then you would throw that crisis code in there to account for that.
John: I would be so screwed without you, Jeremy.
Dr. Sharp: That’s what I’m here for.
John: You probably hear that all the time in life.
Dr. Sharp: I’m not even going to go there.
John: I mean in life all the time, but especially right now in this Q&A call.
Dr. Sharp: Nice. I’ll take that.
John: All right. Let’s move on here before I get too silly because that’s always a risk. Our friend Ben getting extra sleep over there, says, I’ve signed up for several online therapy communities. What other ways can me and my one employee get referrals for online therapy?
Well, again, look at what you currently have in your marketing. I will also say, there are plenty of therapists who are referring out right now or who are full with online therapy clients. I think a lot of referrals are being passed around through referral or through recommendation.
Do I think that right now is the time to launch a totally new marketing campaign just for this or just for coronavirus? I don’t know. It depends on how long this goes for. Again, I don’t want anyone to just be scrambling. So I think in any sort of marketing, in any sort of product or offering or service, start with what you know, start with who you know in your current network, email list, followers, what have you, and go from there. Any other thoughts, Jeremy?
Dr. Sharp: The only thing, Ben, you maybe have already done this, we have an online therapy community Facebook group in our local area. And I know that a [00:54:00] lot of folks are making it very clear that they’re taking online referrals there. So if you have something like that, it’s always worth exploring because again, those are likely warm connections.
John: Yeah. Really good question. Let’s go to Grace’s question. And this is the last one you have right now. All right. Grace says, “I’m a play therapist, and schools are closed for the next two weeks, but it could be much longer. I provide play therapy in the office and parent coaching online. We are not seeing kids for the next two weeks, but unsure what it looks like moving forward. Should I just provide parent coaching services online?”
Well, you and Tara Egan should connect. If you haven’t already met Tara, she’s in Charlotte, and she works with parents. So what I would say is, you just have to work with what you’ve got and if all you can do right now is parent coaching services, then go with it. It’s certainly better than having no clients at all. If you can’t risk seeing those kids in person, then the answer is there for you.
The other thing that I’ve thought about or just thinking out loud right now is, those parents are needing a lot of help right now too, right? A lot of them with kids being out of school for their foreseeable future, or till May, for some, I’ve heard of some schools closing for the rest of the year and standardized tests being closed or being canceled, those parents are needing help.
Those parents are needing help providing structure to their kids, activities, and activity ideas. You could offer therapeutic activities for the parents to do with the kids. I think you have a lot of options here in terms of supporting families, in terms of maybe even getting new clients or working with parent clients right now during this time because of the added stress of what’s going on. Jeremy, any other thoughts? You guys work with kids as well.
Dr. Sharp: Yeah, absolutely. I would echo everything you just said. I was thinking this is actually a perfect time to do parent coaching because parents are home [00:56:00] and likely stressed out with their kids if they’re anything like me. So I think there is a big market for that.
I have read some guidelines, Grace, around if your kid is younger than 10, then it’s probably a good idea to just move to parent coaching for those sessions. But on the flip side, I just saw a resource this morning from our friend. Allison Puryear did a podcast on how to do play therapy online. So that is out there as well. And we can track down that link and probably drop it in the chat as well so you may check that out and see if there’s good content there.
John: Laura just did me a huge favor. She’s working fast. She just started a group for us called COVID 19 coronavirus planning for therapists in private practice. I’m just realizing we’re just scratching the surface here in terms of navigating this together and working on it. Christina says, “Laura is awesome.” Yes, she is.
Let’s hop in that group. Let’s use it for the foreseeable future in these related conversations around coronavirus. Let’s also compile our resources into there. Again, the resource list that we created is just a start, but everything else let’s pile it in here to the Facebook group. Let’s help each other. Tons of people are on Facebook right now. A lot of therapists and people are at home right now anyway. So let’s go ahead and use that resource to help each other. So again, she dropped the link here.
And maybe another thing you can do Laura is, if you can start collecting the links from the chat throughout this time, I know it’s a lot. Let’s send an email to everyone listening right now later today with all the links that we can find. So, we’ll do that as well. See, we’re figuring this out together. It’s all about figuring it out together.
All right. That was Grace’s question. And in fact, that was the last question we have from the Q&A [00:58:00] section. If we’re doing an hour, we got five minutes left to wrap it up or hear are some of my best knock, knock jokes. It’s really up to you guys. What are we missing, Jeremy?
Dr. Sharp: Hmm, good question. Thankfully Diane saved us with ideas for doing EMDR for telehealth.
John: Done.
Dr. Sharp: But that’s a tough question. I am not an EMDR practitioner. John, I know you are. You may be able to comment.
John: I am. Again, I would just say, if it’s within your scope, you can do it. I’m not going to do a lot different clinically right now, just cuz it’s online or just cuz the coronavirus right now. But if it’s within your scope and if you know how to do EMDR through telehealth, go for it. I know there are ways to do it. I think a lot of EMDR practitioners do not do it because it’s a bit harder. You also have to think about a client getting quite dysregulated via telehealth or if the connection goes out or something like that.
So the short answer is, I don’t know. Honestly, I would connect with an EMDR-approved supervisor or whatever they’re called. There are also really good EMDR Facebook groups online EMDR in particular. I’d probably go there. The short answer is not the best question for Jeremy and I, but there’s definitely people out there that can answer. We do have one answer. A therapist says, “I’ve used virtual EMDR on my platform and it has worked well” So you got one person that’s using it.
All right. We got three minutes left guys. Again, what I want to say is, just to wrap things up and bring us back to the very beginning, we’re assuming right now that this [01:00:00] is a short-term crisis. A crisis never lasts forever. And this is a crisis of sorts. So it’s all going to start with you establishing your priorities and creating a plan around those priorities, right?
And some points, your hand may be forced in terms of quarantine or lockdown, things like that. And other times, I think create some contingency plans around you, your practice, your clients, et cetera, and just be willing to alter that plan potentially every day. Again, I talked about this in the beginning, but in terms of priorities, think about things like your health and your family’s health, your clinician’s health, and your client’s health. And I would say last, your personal finances, your business finances. Those things will recover. I know it’s going to be a stressful time if it isn’t already but come back to your priorities. Work through some contingency plans, rely on other therapists and we will all get through this together.
Amy is asking, will you be offering another webinar in a few weeks? If you ask me really, really, really, really nicely, I just might do it because I could probably find the time and I bet Jeremy could too, but I’m not going to obligate him. To be determined, guys, I wanted to do this week because it seems like a lot is changing fast. If we do another one, you’ll hear from me. If you’re on my email list, you’ll hear from me through my email list.
Laura also says, expect an email later today with the link to the recording and links to the resources we shared in this call. She’s also reminding you of the Facebook group that she just created during this call. If you’re listening to this somewhere else or in a replay, then again, look for those links elsewhere. Look for those links in the notes of wherever you’re listening.
Jeremy, what final advice do you have for folks? Any parting words for us?
Dr. Sharp: Yeah, this is very topical for me, but on the way to work this morning, I’m a podcast listener [01:02:00] like a lot of us, and I have this feed of podcasts that there are physicians, there’s news, there’s all sorts of options to listen to basically how scary this is. But the one that I chose was a podcast with Tim Ferris and Jack cornfield, who is a well-known meditation teacher and psychologists. And it’s just a nice reminder to stay grounded as much as you can. This too shall pass. There are opportunities here if you can see them. And it’s maybe not as bad as we want to make it. So that was just a nice energy for me coming to work this morning. And that’s where I’m at as we do this call. So I’ll just offer that.
John: Very good. That’s a great note to end on. Very positive. There you have it, folks. We’re pretty good. Right on the hour. So there you have it. I hope this was helpful guys.
Again, you’ll get an email soon with the replay to this. Feel free to share a link to the replay with other therapists who would benefit from this conversation. If we do it again in a week or so, we will obviously let you know. We’re here for you. We’re happy to help and we’ll get through this together. So there you have it, folks. Thank you again so much for coming. Good luck out there. Stay safe. Take care of yourselves. We will talk to you very soon. Cheers, guys. See you.
Dr. Sharp: Thanks.
All right, y’all. Thanks as always for tuning in to this special episode, this Q&A with my friend, John Clarke. Like I said at the beginning, if you are looking for some resources to really grow your practice, John just launched a couple of his programs. I can speak from firsthand experience that they are quality, both from a professional standpoint and personal standpoint, just knowing how much work he’s put in and the energy that he dedicates to developing these programs. So [01:04:00] those are in the show notes. Again, Fully Booked, if you’re looking for a DIY website, SEO, online marketing program, and then Business Made Human is his extended mastermind program. So check those out.
Let’s see. If you were looking for more testing-centric resources on COVID 19 and telehealth, there are a lot out there. I just released two episodes over the past two weeks, specifically on teleassessment. So go back and check those out. Episode 112 and episode 113, and there will be plenty more coming as this shutdown continues.
So hope everyone is staying safe, staying healthy. I will catch you next time. Take care.