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[00:00:00] Dr. Sharp: Hello, everyone. Welcome to the Testing Podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. The BRIEF-2 ADHD form uses BRIEF-2 scores to predict the likelihood of ADHD. It’s available on PARiConnect- PAR’s an online assessment platform. Learn more at parinc.com.

[00:00:35] Hey everybody. Welcome back.

Today’s episode is a continuation of our Practice of the Practice takeover for the month of February for the business episodes.

Today, I’m talking with Whitney Owens about private pay practices. Whitney is a licensed professional counselor and private practice consultant. She lives in Savannah, Georgia where she owns a group practice called Water’s Edge Counseling. [00:01:00] In addition to running her practice, she offers individual and group consulting through Practice of the Practice with a special emphasis on helping clinicians start and grow faith-based practices.

Whitney hosts a podcast to help faith-based practice owners called The Faith in Practice Podcast. She has spoken at the Licensed Professional Counselors Association of Georgia’s annual convention as well as Maryland. She has spoken the past two years at
Practice of the Practice’s Killin’ It Camp Conference hosted right here in the Rocky Mountains.

She’s also been interviewed about mental health issues on several media outlets including WSAV in Savannah and the Atlanta Journal-Constitution. She’s a wife and a mother of two beautiful girls. I had a great time talking with Whitney about private-pay practices.

Now, you’ll notice right off the bat, Whitney is not a testing psychologist but she brings a lot of things, experience launching and growing private pay [00:02:00] practices. And I think that the information that we talk about in this episode is helpful for any of us. The principles that she describes and the strategies that we go into are going to be useful for anybody trying to build a private pay practice.

Whitney also has the interesting experience of having pursued an evaluation for one of her kids. She talks about that experience and what it’s like from the other side, in terms of seeing the marketing and customer service of different psychologists that she contacted.

So we talk about a number of things. We talk about really what not to do as a testing psychologist if you’re trying to get referrals and land customers or clients, we talk about the flip side of that which is great customer service, and how that shows up in her practice, we talk about phone scripts and how to sell private pay services to clients on the phone. [00:03:00] And a number of other things that I think will help you really just get into a customer service mindset more than anything else.

A cool thing about Whitney is that she launched her practice in Savannah in what she would call a saturated insurance-heavy area. So if any of you resonate with that situation, you’ll definitely want to check this out.

Before we get to the interview. I want to invite any beginner practice testing psychologists to check out the beginner practice mastermind group. So this group is launching on March 11th. It’s a group coaching experience just for beginner practice testing psychologists who are trying to launch their practices here in 2021. You’ll get accountability and support and guidance as you tackle all of those important components of starting a testing practice. If that sounds interesting, you can get more information at thetestingpsychologists.com/beginner.

[00:04:00] All right. Let’s jump to my conversation with Whitney Owens.

[00:04:22] Dr. Sharp: Whitney, hey, welcome to the podcast!

Whitney: Hey, I’m glad to be here with you.

Dr. Sharp: Yeah. Thank you so much. I’m so excited to be talking to someone who also has a Southern accent. So thank you for bringing that to our show today.

Whitney: Yes, I usually bring it on pretty fixed.

Dr. Sharp: I love it. Well, we were talking before the episode about how you’re in Savannah, right?

Whitney: That’s right.

Dr. Sharp: Yeah. So that’s just a few hours from where I grew up in South Carolina. So it’s a lot of that familiarity. There are here’s not too many of us southerners here, outside the South.

Whitney: No, [00:05:00] there’s not. I actually was born in Charleston, so I like having that kind of claim to fame there.

Dr. Sharp: Yeah, for sure. Of all the places in South Carolina, I feel like there maybe two or three you would want to go to, and Charleston’s one of them.

Whitney: Definitely. There’s kind of a competition between Savannah and Charleston actually.

Dr. Sharp: Yeah, I could see that. They do have similar vibes. Yeah. So what do you think? I mean, you’ve been to both. Which one wins?

Whitney:  Well, I have to say Savannah. I live here. But one of the other fantastic parks is the St Patrick’s Day Parade which we just found out was canceled. But there’s a lot of other great things to Savannah, but that is one of my favorite parks that you can’t get in Charleston or very many places. We have in the top… I think it’s in the top three in the nation for St. Patrick’s Day Parade.

Dr. Sharp: All of that’s incredible.

Whitney:  With Chicago and Boston. I know it’s crazy.

Dr. Sharp: Wow. Wow. Who knew? Well, so maybe that’s a good place to start actually. I mean, you have your practice in Savannah. [00:06:00] It’s a private pay practice. That’s what we’re going to be talking about today.  What is the private practice community like there? Can you describe it?

Whitney: Wow, that’s a good question. The way to go at. This is the first time someone’s asked me that on a podcast. Yeah, so I actually came here from Colorado. I am in a different experience. So I do compare just to be real about it.

Dr. Sharp: Sure.

Whitney:  I found it a little close to here in a lot of ways. I would say I’m definitely unique in the experience of a cash pay practice. In fact, I don’t know any other group practices in Savannah maybe someone will hear this and correct me, but I don’t know any that are cash pay. There’s a lot of people here doing practices. So I do feel like there is somewhat of a competition feel, which is really kind of sad to say, but it is saturated. So people are looking for clients. We definitely do have some membership communities. I shouldn’t say membership like Facebook communities where we talk to one another and help [00:07:00] one another and finding referrals.

But it’s very insurance-based in that. So I don’t get on those very often because they’re focusing on getting clients for certain insurances. So I don’t usually get those types of clients. It’s a different clientele.

Dr. Sharp: Sure. Yeah. So that makes me think of… so you moved from Colorado, how did you even decide to set up a private pay practice in this area? Did you scout it beforehand? Did you do market research? I mean, how did you even know that that was viable?

Whitney: I actually didn’t really do all that much to tell you the truth. The state decided for me because, in the state of Georgia, you cannot take insurance without being licensed.

Now, when I was in Colorado, I’d been licensed for several years, but Georgia has some different laws. And I could go into details if you were super interested, but basically, they would not let my license transfer, and had to go back and do more supervision even though I had already overqualified for the number of hours in the state. I  actually had a psychologist do my supervision [00:08:00] here in Georgia.

She did a fabulous job. I really loved that connection. And so I had to start out cash pay. And so I actually worked under a church because that was the only connection I could make when I got here and you have to have a director to be able to see clients. I tried to get jobs at other places in town, but no one knew me, and Savannah’s one of those you got to know somebody to get something. And so I met one guy fortunately through someone from grad school and then him and I came under this church. So they were the director, but we kind of did our own thing to tell you the truth.

And so I thought to myself, “Okay, I’ve got to do one year of supervision. Let’s try to build a cash pay practice. And if I can do it in one year, well, I go back” and so it worked. And I was full within a year and I was honestly about full at six months. So when the one year came, I just kept going.

Dr. Sharp:  That’s amazing. Were you pleasantly surprised? Did you think of what’s going to work or are you one of those…?

Whitney: Yeah, I was surprised. Well, when I was in Colorado, I [00:09:00] had joined a great group of ladies and they really mentored and helped me along the way. And we did cash pay. We had been at an insurance-based place. It’s another great story. We’ve been in a where the lady fired us all in one day. She called it bloody Monday. And it was bad.

And so we pulled all of our charts out as fast as we could before she locked us out. We contacted all of our clients and said, sorry, she just fired all of us. We’re going to set up shop elsewhere. We were in a new space within a week, but we couldn’t get on panels that fast. And I couldn’t get on panels at all because I wasn’t licensed yet in Colorado at that time. So we took cash and it worked. And so I had seen it work and so I thought I can do this again and I did.

Dr. Sharp: That gave you some confidence. Yeah. I love that. So let’s see. How long ago was this?

Whitney: How long have I been in Savannah?

Dr. Sharp: Yeah.

Whitney:  I started my practice in 2015.

Dr. Sharp: Okay. That’s fantastic. So you’ve passed the [00:10:00] five-year Mark, right? Isn’t that the thing that dreaded businesses fail in five years thing?

Whitney:  That’s what they say.

Dr. Sharp: Yeah. Well, congratulations! That’s awesome. These conversations about private-pay or cash-pay are always interesting to me because we have a pretty insurance heavy practice and I’m always curious how people are doing this out there, especially in areas where it’s super insurance heavy. So I’m excited to dig in.

Whitney:  Yeah. Again, I think so much of it has to do with the way you want to do therapy and how do you want to Market it? How much time do you want to put into your marketing?

If you’re an insurance-based practice, you can meet the needs of a lot of people, a lot faster. You don’t have to put so much into all that. You can still market and obviously be great practice and meet a lot of needs. But the way that you talk about your practice and the way you talk about counseling, I think is a little different for an insurance-based practice than a cash pay practice. So it really does dictate a lot of the way that you run your [00:11:00] business.

Dr. Sharp: Yeah, absolutely. And I know that you’re primarily doing therapy of course, but I think a lot of these things will probably translate to testing just some way that you present your services and talk about your practice and so forth.

So we’ll just sort of make that translation here at the beginning and let that apply here as we talk. Maybe that’s a good place just to dig into it. From the, I guess you’d say marketing perspective, how do you talk about your practice differently and present it to others in the community?

Whitney: Yeah. And so a big part of that is educating people on how insurance works. A lot of people think, especially in mental health, like mental health is a different ball game when we talk about healthcare and when we talk about insurance. So some of it is helping them understand some of the taboos around mental health and getting rid of some of those.

And then they don’t know what kind of [00:12:00] information is sent to the insurance company. All they think is, Hey, I give you my copay and that’s it. They don’t think about how you’re interacting with them. And you’re giving them information, especially if their insurance is through their work in such a way that’s very intertwined. Like you’ve worked for the city and so the city holds your insurance information, and that you have to be given a diagnostic code to be able to send that off. And then based on your diagnostic code will determine if they think you need services.

And I explained to clients in the same way that if you need heart surgery, your primary care doctor would have to send you to a cardiologist.

And that cardiologist would have to have a legitimate code for giving you heart surgery. Insurance is just going to pay for it. Like you have to have a legitimate reason for needing therapy for major depressive disorder and that code has to be sent to your insurance company and they will approve it just like with any treatment.

And people don’t think about that part. And unfortunately, we’d like to think the world is very confidential, but not always. The more people who have your information, the more concerning it can be. I think it was [00:13:00] in, you can maybe correct me, I think it was in 2014, there was a breach with Blue Cross and Blue Shield and tons of records got out. And yeah, we hope stuff like that doesn’t happen, but it does.

And so insurance does create a record for people. For example, if you were to become… if a child wanted to become a pilot or military, sometimes that information is found and so we want to protect you as much as possible. I do tell people, use their insurance if they need to. Don’t let that determine you not getting help because the most important thing is that you get help.

But if you can avoid it, then avoid it. I mean, I have a child, she got tested, we can talk about that a little bit about her experience. But yeah, we used insurance because I’m going to have to use insurance the rest of her life to get her care. And so that code is going to be there and I’m okay with that.

Dr. Sharp: Sure. Do you find that that’s a compelling reason for people to go cash pay? Like when you have that conversation with them, are they like, “Oh, I didn’t know that. I’m going to [00:14:00] avoid that then and go cash pay.”

Whitney:  Some. I mean, for some of them, if they’re coming in for something that’s not severe, I guess I should say, maybe they just have a situation they want to talk about or they just want to have a better life quality, and they don’t really have a legitimate diagnostic code. It could be a V code or something like that. Insurance is going to be a lot less likely to cover that. And it all depends on what their benefits are, right? So those situations I’ll say, or maybe it’s a couple that wants to come in, like, you know, your insurance, isn’t going to cover this kind of couples therapy that you’re asking for?

And so yeah, you could try to go somewhere else. It’s probably going to get denied eventually. So you might as well do this. So it’s helping them understand how that billing process works.

Dr. Sharp: Sure. Are you having these conversations? When people call to schedule appointments or is it on your website? I’m just trying to think through the workflow here as far as client acquisition because I would think if they [00:15:00] knew you didn’t take insurance, they might be less willing to call in the first place.

Whitney: You would think, wouldn’t you? You’d be amazed how many people call and they have not looked at the website or have… even the psychology today, it’s clear that we don’t take insurance and they call and they’re disappointed. But I’d rather them call and then we can give them a list of providers that we know take their insurance and get them to the right place than not calling.

But yes, it’s on our website. We have a very clear description about insurance. We do accept other networks for the licensed professionals so they can come and we will give them the superbill and then they can send it to their insurance company for reimbursement and that does work some of the time.

Dr. Sharp: Sure.

Whitney: So, yeah, but we talk about it on the website. And then if they call, we have a discussion with them again about it. If they ask about it. It’s not all that often that we have to explain all that. Some people call, and when you give them the rate, they’re totally fine with it. Or that’s kind of becoming a little bit more of a norm than it was 20 years ago to cash pay for counseling. So it doesn’t surprise people as much as it used to.

Dr. Sharp: Got you. What about other [00:16:00] professionals? So these are the client conversations. Actually, before I move to the professionals, I’m curious how those conversations typically go with clients? Do they have objections? Do they have concerns? And if so, how do you talk through that with them?

Whitney: Yeah, a lot of people we’re really glad we explained that to them regardless, if they choose to use their insurance or not, they’re glad to understand the process and that their information gets sent somewhere else. That’s just good for them to know what’s happening.

I can even think about clients that I’ve had in my practice that did superbills. And I say to them, Hey, I want you to know your diagnostic code because someone else is going to see this or your work. Normally work doesn’t get involved, but what if they did, because they manage your insurance. And I want you to know what’s going on with this piece of paper because it’s your information. Sometimes that makes people not want to bill their insurance because they don’t want anyone to know like marijuana abuse or something like that.

Dr. Sharp: Sure.

Whitney: Yeah. No, I just went on a train there. I don’t [00:17:00] remember what else I was thinking about that situation with that client. He was so pissed at me. Yeah. I was like, well, you’ve been abusing marijuana. We’ve been talking about it every time he’d come in. I can’t put that on your diagnostic code. You’re doing it every single day for several hours and it’s impacting your job.

Dr. Sharp:  Yes. It seems like a no-brainer. Well, I did have another question that I was going to ask you, like, just very detailed. When is this conversation happening on the phone when the client calls? Is this right at the beginning or what? How do you work this in?

Whitney: Yes, this is such an important question. So I train people on this as well as part of having a cash pay practice. This part is really important when people call, the first thing I have them say, the assistant will ask is “Give me your name and your phone number..” She says it a lot nicer than that “…because if we get disconnected, I want to be able to call you back.” Right. And you’d be amazed. If you start getting into that call, people just hang up. They don’t give you a number. You can’t follow especially if you end up getting into a dangerous [00:18:00] situation, you want to be able to get back in touch with them for whatever reason.

And then the next question is, how did you hear about us? Because referrals are super important with the cash pay practice and following up with every single one, you always want to know where you’re putting your money in your marketing and what’s working and what’s not. So that’s the next question we ask.

Dr. Sharp: Sorry to interrupt. Is your assistant… I know we track intake phone calls through a Google form. We’re filling it out. Do you all do something like that?

Whitney: We do the same thing. It’s so helpful. And it gives that cool paragraph. I’m like, I could see my numbers really fast.

Dr. Sharp: I love it.

Whitney: I love it. Yeah.

Dr. Sharp: Nice.

Whitney: So after we find out where they got our name and number, then we ask them, “Well, what’s bringing you into counseling?”

We find then maybe the listeners are thinking this, when you call a place and the first thing they say is, “What’s your insurance?” You can tell me this, Jeremy, what does that feel like to you when you call a place in the first question they ask is what’s your insurance?

Dr. Sharp: Well, [00:19:00] there’s the assumption that I’m going to use it at first of all, which for me is not always true. We’ve opted not to. But it also kind of puts the financial piece right front and center. Like that’s the only thing they care about.

Whitney: Yes, exactly. And so when we speak to the clinical issue first, it shows that we care about the client and we care about the reason they’re coming in and it’s not necessarily about the money.

Now the money’s important. We’re going to talk about it, but we’re going to talk about their safety and their clinical concern first. So we build that rapport right there on the phone call and that’s going to help encourage them to come in because we know that so many practices don’t pick up the phone. They don’t call people back or they pick it up and they’re not friendly, or they don’t explain the process. Well, I can’t tell you how many times somebody would call and they’d say, wow, someone answered the phone. That’s the first thing they say and we’re like, yeah, we always, we almost always answered the phone. That’s so important.

And I especially think it’s important with the cash-pay practice because you’re going to lose [00:20:00] that client if you don’t answer. And when people finally call, we know that they’ve waited too long. Anyway. Right. And a lot of times they’ve thought about it. I mean, I can tell you that when I’m going to make a phone call, sometimes I wait for weeks before I call the doctor. You just don’t want to deal with it. And then you’re finally like, “Okay, I have to deal with this, let me call.”

Dr. Sharp:  Absolutely I’m going to interrupt you a lot because I have a lot of questions here. So tell me how, how many clinicians are in your practice, again?

Whitney: There are seven of us. We’re adding an intern next week, so there’ll be eight next week. So I’m excited about that. Yeah.

Dr. Sharp: Nice. Well, so the reason I ask is, I think a lot of us with group practices as they get larger especially kind of struggle with that live answer problem because of the phone calls, they’re just too many phone calls and we can’t seem to, and it sounds like y’all are spending a lot of time on the phone with people when they call. It’s at least I’m guessing 10 minutes maybe.

Whitney: If they schedule, it takes about [00:21:00] 20 minutes to get all the information. Yeah.

Dr. Sharp: Sure. So if you just do the math, that’s not a ton of phone calls in the day if you want to have time for something else, right? So I’m curious how you’ve handled that problem from a staffing standpoint and how you approach that because it is important to answer the phone, especially in a cash pay practice to acquire those clients.

Whitney: Yeah. So I’ll kind of share with you a little of my story of this because I think this will help listeners depending on their face of the practice. So when I first started, I was getting about three to five calls a week. So now we’re maybe three to five calls a week, one to two new clients a week. So not very much, but it was enough where I was tired. I couldn’t get back to people. And then I started growing a group practice and that became a couple more calls, not that many. And I hired my first assistant. Very part-time.

And then when I got to four clinicians, we were getting more like 15 [00:22:00] calls a week and she couldn’t keep up anymore. She was a work-from-home mom and so then I brought on a counselor who was a part-time therapist, part-time phones. Not a lot of people do that. I was really nervous about it. It actually turned out really great. So if someone’s needing someone in a bond and the more people you have trained on phones, the better. Someone goes on vacation, you’ve got somebody or someone’s sick.

Dr. Sharp: Right.

Whitney: And then her caseload filled up and then we were like scrounging around for someone else to answer the phones.

And so then I hired someone else and then the girl that had originally answered phones became the office manager. So what’s really great about that is that basically got two people to answer the phones now. I have the assistant or the intake specialist is what we call the office manager. And we have a phone tree. So if the intake specialist is on the phone or doesn’t answer after two to three rings, it flips over to the office manager, and then she can get it. So that’s helped us answer more live calls to have two people available.

Dr. Sharp: Great. Yeah, it seems like that’s an [00:23:00] ongoing problem for me and for a lot of other people, just so many calls. So we were talking about the phone call which you’re answering lives, like you said, as much as you can. So you’re talking about the client’s concern. You’re building rapport, you’re spending 20 minutes on the phone with them to go through the whole process. That’s a lengthy phone call.

Whitney: Yeah, usually we can get through the clinical part within the first five minutes. By the time we hear about how they know about us and everything. And then we hear about that and then we recommend a therapist or we might ask them a few specifying questions like, do you have a substance abuse problem or any disorder or whatever, and make sure we get them with the right person.

And then after that, say to them, “Okay, well, what are your hours? When are you available?” Because we want to make counseling as accessible as possible. We don’t want times or distance or whatever to make it more difficult for somebody. So, Hey, do you need Telehealth, or do you want to come in, and when are you [00:24:00] available? Like, can you do Saturdays or whatever?

And then we recommend a therapist that has those hours, but also that we think really meets that need and even above that, explain why we recommend that person. So we might say like, “Amanda’s our child and adolescent person. Amanda has been working with kids for years.

She likes to do some play therapy. She’s really great at communicating with the school counselors. These are the reasons why Amanda is a good fit for your child, instead of just saying, Hey, I’m going to schedule you with Amanda.: That really buys them into that relationship with that therapist from the beginning.

Dr. Sharp: Sure. Yeah, I think that’s important, especially…. you can tell me if this is right or wrong, I think of cash pay practices as a higher level of service that there’s that expectation from us or from the client that it is more high touch, more personalized,  almost like a concierge thing where you’re doing a little bit more to match and take care of the [00:25:00] client than an insurance-based practice. Is that accurate?

Whitney: Definitely. And I tell everyone when to hire them and bring them on the counselors, I say we’re giving them an excellent client experience. So when they come to our building, actually it’s a really old home built in the thirties. And if you can imagine Savannah, the Oak trees, and the moss hanging down, like when we found this building, I thought this is the place I thought I’d be 20, 30 years down the road in my life owning a practice.

But like, it’s beautiful. It’s two stories. I have five offices and wood floors. I feel very fortunate to be there, but it has that cozy feel. You’re not going into a white sterile office like all other offices in the area. And when you come in and we have coffee brewing when it wasn’t COVID, but we’d have coffee brewing and water and soda and chocolate, and you’re really trying to give them extra when they come in. So that they’ll want to make that step coming back because yeah, they’re paying a lot of money to be able to come in for therapy. So that plus the experience [00:26:00] really helps.

Dr. Sharp: Sure. Are there any other experiences, items, things you can think of to kind of increase the value add for clients coming in?

Whitney: Yeah. I do know that some practices do a lot more as far as like a Christmas gift for clients. And I’m talking about something small like I knew a practice… Wow. You’re asking me. I recently knew a practice owner who gave journals to clients like $3, $5 journals with stickers of their practice on them. We don’t do that stuff, but I do know that cash pay practices do do that. That seems like a lot of work.

Dr. Sharp: Well, I just think as you grow, especially in a group practice, not from a financial standpoint, more just logistically like, hundreds of journals or whatever the item is that you’re trying to coordinate, but yeah, maybe there’s the infrastructure to do that at some point.

Whitney: Yeah. We [00:27:00] do go above and be with our referrals in our referral network. So you’re giving them a really good experience. We do give them gifts on a regular basis, not big gifts, not manipulative gifts, but like, some cookies from a local place in town, at Christmas with a sticker on it that says joy and wellness or something simple like that.

Every time we get a referral, we call that provider. And speak to them about the referral. I think a lot of places are just too busy to do those things. That’s especially big far schools that were calling the school counselors. Hey, what’s going on at the school with this child? Here’s what’s going on in therapy. Here’s how we can work together. And we try to really make an effort to do anything that’s asked of us. So if a school calls and says, “Hey, will you come do a training with our staff on X, Y, and Z?” We really try to go out of our way to do those kinds of things because that’s how you’re going to get those referrals.

It’s the relationship that they can call you and talk to you about things. They’re going to refer to you if there’s someone else that they can’t get on the phone, or they don’t know what’s going on in someone’s treatment, they’re going to be a lot less likely to follow up with that person.

[00:28:00] Dr. Sharp: Yeah, right. I think that’s such a good point. Now, from a business standpoint, do you pay your clinicians for the time involved to do that?

Whitney:  No. So I include that as part of the treatment. So they have an hour that they get paid for. The sessions are 45 to 50 minutes. So that gives them 10 to 15 minutes of more pay to make whatever call they need to make, or if they need to write a treatment note, something like that. That’s kind of included in that. Now, if we get asked to actually go into a presentation or a networking event, they get paid for those types of things. Yes.

Dr. Sharp: Sure, okay. Got you. So those incidental contacts or collapsed contacts are included in the session, right? Yep. That makes sense.

So let me rewind way back. I don’t know if we closed the loop on when during that phone conversation, you’re talking with people about insurance because this is sort of like the closing the “sale” moment, right? So how do you work that in?

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All right. Let’s get back to the podcast.

Whitney:  Yeah. So then after we set them up with the right therapist, we’ll say, okay, well, here’s the time that’s available. Does that work for you? And they’ll say yes. And then we’ll [00:30:00] say, and want to make sure that and I’ll say, Amanda, because we’ve been talking about her, I’ll say Amanda’s rate is $110 an hour. Are you comfortable with that rate? And they’ll either say yes or no.

Now, sometimes people are still confused and they actually come in and think we take their insurance, which still amazes me, but we try to make it super clear on that phone call. Hey, this is what the rate is, we’re cash-pay practice.

And then we do follow up with an email. Again, this is Amanda’s rate, we’re a cash pay practice. We put it in the paperwork, we send it to them in advance. So they have three different ways of hearing that we don’t take insurance. And this is what the rate is just to make sure.

Now when you get to that point, a lot of times people will say, Well, I have this insurance and then we have to explain to them, Oh, we’re not networked. And then we do offer, and then we do this extra step talking about clinical care. I mean the extra experience for the client, we will say, we are happy to call your insurance and check your benefits for you. At least that way, you know what you’re getting yourself into with mental health.

So one of the great things about that [00:31:00] is it puts us back in control of the situation. So we know what’s happening for that client, as opposed to saying to them, well, you go check your benefits. And plus they don’t want to make that phone call. It’s confusing. They don’t know how to get through to somebody.

And then the person tells them and they don’t know what all those numbers mean. So for us to call and get those benefits, and then we call them back and say, Hey, you know what? You have really great in-network benefits. You only have a $30 co-pay. We would love to work with you. But if you want to use this, we understand. And here’s some places that we would refer you to. Or if they have out-of-network benefits, we could say, Amanda’s not able to take your insurance out of network, but here’s another therapist at the practice that can, here’s how that works. Or sometimes their deductibles are so high or their code pays are so high. Like if your code pays already $`80, don’t go through the trouble of billing your insurance that may say, you know, three months down the road, we don’t want to cover anymore. Like, go ahead and just pay cash and not have to deal with that. Do you really want this other person dictating your treatment that doesn’t even know you?

Dr. Sharp: Right. That’s such a good [00:32:00] point. So that’s again, just another piece where you were helping remove hurdles. It sounds like it for them. And I totally agree with that. Bringing that back under your control makes such a difference because clients, I mean, nobody wants to make that phone call. And like you said they don’t really understand a lot of the time either what insurance numbers mean.

I’m interested to know how this comes across in the conversation. I would love to hear one of these phone calls. I know that’s impossible, but just the salesy part of like, ” Well, hey, listen…” You present it very straightforward, right? Like you have an $80 code pay. You might as well just come and pay $110 and not even mess with insurance. So just laying it out clearly seems important.

Whitney: Yes, definitely. And a lot of people do ask me this, so I’ll throw this [00:33:00] out there. And when we’re running our numbers each month, I’m always looking a how many clients converted on those calls? How many of them did not? How many said that they wanted to use their insurance? Almost every single month, 20 to 25% we lose because of insurance.

Dr. Sharp: Okay.

Whitney:  But that’s not that many in my mind. We usually convert somewhere between 50 to 55% actually schedule an appointment. And then a lot of the other ones, it’s just random stuff. Well, you didn’t have a time that worked for me, or by the time we called them back, they’d already scheduled elsewhere. All those types of things.

Dr. Sharp:  Right. I love tracking numbers. I’m glad that you brought that up. So tracking that conversion rate is super important. I would be curious, I’m sure there’s research out there about conversion of private pay versus insurance.

Whitney: Actually, I know what that is.

Dr. Sharp: Do you really?

Whitney: Yeah, I love numbers too. I track my numbers every week on my practice, all that stuff like retention, and how are the therapists? Are they seeing their clients? How many [00:34:00] sessions they do, and then going into Google analytics. It’s like, that’s so much fun, right? So cash-pay practices tend to convert at least 30% when you get into 50%, you’re doing pretty good as a cash pay practice. Insurance-based practices, it’s more around 70 to 80% convert.

Dr. Sharp:  Yeah.  I think this is a nice segue then into referral sources and how you get those folks in the door. It sounds like you have a pretty high conversion rate for a cash pay practice which is fantastic. But it is a numbers game than that you have to maybe get more people in the door. So that 50% conversion is at par with 70 or 80 at a different rate on insurance-based practice. So where are your referrals coming from?

Whitney:  Yes. So over 50% of them are through Google. It’s probably 50% to 60% in a given month. And I do a lot of stuff with marketing and the website. In fact, I had someone who [00:35:00] was a contractor who was helping me, but then I hired her part-time in July. She’s the marketing director and so she does SEO and she does all the social media stuff. Oh, it was so great when I hired her. I was so happy to get that off my plate and not have to even think about, “Hey,  what theme are we working on this week? What videos are we putting out?” Someone else does all that now and I can just be hands-off with it.

So once I invested in SEO on my website, though, I would say the practice tripled in the number of calls within a few months. That was a few years ago that I really started working on that.

Dr. Sharp:  Got you. So most of those  Google searches, is that like just organic search traffic or are you paying for ads as well?

Whitney:  No, actually I’ve never paid for ads before.

Dr. Sharp:  Oh, that’s somewhat surprising.

Whitney:  I know. I feel very fortunate about that. I think Google ads are really great and other ads in general, are really great if you have something you want to target really specific in your practice, like if you bring on a new clinician who does eating disorders like a target that, [00:36:00] but SEO, I say it’s the gift that keeps on giving. Like once you put your money into working an SEO, you will have it forever. The ads are just a small amount of time and then they’re over.

Dr. Sharp: True. That’s a good point. So how did you know how to do that in the beginning? Did you just get lucky and write good copy right off the bat or did you hire someone when you were setting up your website or what?

Whitney:  No, the contractor does it for me. I did create my own website at the very beginning, super basic. When people called and said, I like your website, I’d laugh. I’d be seriously, it’s terrible. I didn’t say that far but said it’s terrible.

And then every relationship, this is just a motto of mine, every relationship could lead to something, right? So many people at my practice have been people I’ve just known through other ways. So the person that created my website was my nanny’s husband years ago. And he was getting his master’s in [00:37:00] graphic design at SCAD, which is the Savannah College of Art art and Design. And he’s such a great guy and he still does the updates on my website and helps with that.

And then Molly is my marketing director. Her daughter and my daughter were like first friends when we got to Savannah. Like 18 months old, they were in the baby room together And we met. And we’re out at the pool one day, and I’m like, “What do you do for work?” She’s like, “Oh, I help physicians on their websites and social media.” I was like, ” Really, I can go for that.” So she just started really part-time. She did real basic SEO on my website and made huge differences.

In fact, right now she’s going through Jessica Tappana’s course.

She has a 12 part course that you can go through. And so, my marketing director is going through it and updating the website as she goes. She’s been doing it all for me. And then as far as the copyright, I did do the writing for a while, but now I have my clinicians do it because they know their area better than I do for service pages and stuff like that. And I just pay them an administrative right to do that and then Molly goes in and updates [00:38:00] it and puts all the fancy stuff on it and we put it out.

Dr. Sharp: That’s amazing. Let me ask you. What led you to hire that person in-house versus outsource it like a lot of us do?

Whitney:  Probably because I like control.

Dr. Sharp: Well, that’s fair if I can get…

Whitney: Yes, I’m very controlling with my practice. And honestly, the other part that… that sounded so bad that I said that. The other part is I actually just really like her. And I was really concerned about our friendship because she’s the only person I’ve brought on that I was friends with before I hired them.

But we really talked about that a lot in advance and have really worked together to figure out that relationship. And she was looking for a job. She was doing contract work, but she just wanted something more stable and she was wanting something more relational. And we have a very family feel to our practice. Like we get together like right now we get together and sit by fires outside. But yeah that’s why I brought her on and it’s actually been a really great fit for the [00:39:00] practice.

Dr. Sharp: That’s amazing. I know you’ve listed a few things, but just to pull it all together, what does she do in her role as a marketing person?

Whitney: So anything on the website that needs an update or is fixed, she does that. And then if she can’t do it, she sends it to the website designer. And he’s a contractor that I contract out to make changes. She’s also in charge of whatever social media we’re doing that week. We try to make themes based on what’s going on. So she’ll decide what the blog is going to be about. Sometimes she writes it and she’s a fantastic writer. I’ve been really impressed. But then sometimes my office manager also likes writing blogs. They fight over who gets to write the blogs actually, which is just so funny, right?

But they’re both really good at it and I hate writing them. So I let them do it. And then Molly will be, the director on, Hey, here are some videos we want to put out or I want a therapist to talk about this idea. So she’ll reach out to that therapist and they’ll make a five-minute video and she’ll do the SEO and get it put [00:40:00] up.

She also does all the referral stuff. So every time we get a referral, we put it on that Google form.  We get that call it’s on the Google form regardless of the person scheduled or not because sometimes they’re not going to schedule because we don’t take their insurance, but we want to follow up with that referral source and say, Hey, you know what, thanks for that referral.

So she will write a card, a handwritten note that says, thanks for the referral. Three to five sentences we enjoy working with you. It’s always really thoughtful that you think of us, no client information, just a general note. And then when we give out gifts, she was in charge of all that, putting the cookies together, creating the stickers, and then delivering all of them. We keep her busy.

Dr. Sharp: It sounds like it. So how many hours a week is she?

Whitney: She does about 20 hours.

Dr. Sharp: Yeah. Got you. That’s really cool. You can choose to answer this or not, but just from a compensation standpoint, how does this position compare to like an office manager or a [00:41:00] receptionist? You don’t have to give exact numbers, but just like relatively what are we talking about if we wanted to do this?

Whitney: Yeah. I can say she’s the highest paid of all the admin staff. And she also has a college degree and a lot of experience. And she’s been in the workforce for longer. So she has lots of reasons to pay her more. She has been very kind to let me pay her a low rate and that’s because she really wanted a consistent salary.

She was tired of not knowing what was happening and she also really wanted just one job instead of having all these different places she worked for. It just made her life more simple. And a lot of people work at my practice because of the culture I create. So it is not about the money, but it’s really about the people, right? We know that about all of our jobs. You could pay us so much, but if we don’t like the people we work with or the work we do, no one wants to work at that job.

Dr. Sharp: Right.

Whitney: So there’s a lot of flexibility. We all have young children. In fact, every single one of us except for one [00:42:00] has children. And so we make it flexible. It’s not like she has to work from this hour to this hour. As long as she gets the job done. So she might be at the beach or sitting by a pool or whatever she wants to do. And that makes it easy for her.

She says to me, my kid is sick or like, I think her kid had to quarantine. And so someone else went and delivered the bags and so we’re very team-oriented. So I think that’s a part of why someone’s willing to work for us without making an optical amount of money.

Dr. Sharp: That’s fair. Yeah, culture can make up for a lot. I mean, it counts for a lot. So tell me, since we’re talking about the money component, those being private pay, running a group practice, does that affect the compensation of your clinicians?

Is it higher, lower than an insurance-based practice? Not monetarily. I’m assuming it’s higher just because it’s more money per session. But if you want to think of it like percentage-wise, are group practice owners who are cash [00:43:00] pay to pay their clinicians a higher percentage or not so much.

Whitney: Yeah. I’m not quite sure how everybody does it. I still run my numbers about the same as an insurance-based as far as compensation. So if you have a W2 practice, all employees giving them around 40% to 45% is a pretty good ballpark for the revenue that’s coming in because you’ve got to pay for so many other things.

So that even includes if you have benefits that would be included as part of that. Now we don’t have benefits, so I can pay them a little bit extra because that’s not included. There’s a lot of reasons for that, but that’s about what they make 40% to 45% of whatever the client is paying for that session. And then they get paid. I also do a tiered system. So the more clients they see, they actually get paid more per hour. So it gives them the incentive to see more clients in a two-week period that helps as well.

Dr. Sharp: Yeah, that makes sense. That’s interesting. 40% to 45%, I guess, is on the lower side of what I’ve heard the other [00:44:00] W2 practices. So I don’t know if I have a question in there, but maybe just a reflection.

Whitney: You’re definitely making a point. And when I do consulting, I actually was just talking to someone before this call. People pay a lot. People pay their people a lot because they’re worried they’re going to leave

Dr. Sharp: True.

Whitney: And so many practice owners, which if next time someone says that you should ask them if they pay themselves enough because a lot of practice owners do not pay themselves enough. If you’re a medium-based practice, if you’re making over $400,000 a year, Which I consider kind of medium size there to the like $500,000- $600,000, then you should be paying yourself at least 20%. Most people are not. Is that true or not? 

Dr. Sharp:  Yeah, that’s a good point. There are so many questions within that. But I can get past that. We could go down. People do ask about that a fair bit. This is maybe getting away from cash pay specifically, but just profit margins and what we could expect from a [00:45:00] group practice. And yeah 20% when you’re on the lower end, smaller to medium-sized practice, I think it’s pretty reasonable.

Whitney: Well, the smaller you are, the more revenue you take in. So if you’re a smaller group practice, just a couple of people, you should be taking about 50% of what’s coming into the practice.

Dr. Sharp:  Right.

Whitney: And no one does that.

Dr. Sharp: Yeah. Well, and I think that a misconception of people doing group practice is like, the bigger it gets, the more money I’m going to make. And I mean, that is literally true. Like you will make more money, but it’s a lower percentage certainly of the revenue most of the time as practices get bigger.

Whitney: That’s right. It’s all a numbers game. And you got to run your numbers right or you’re going to mess yourself up in the end or resent your job. I remember when I was first starting, I paid my people too much. I’d started with contractors, and I would write that cheque and I would be like, why is she making more than me? I run this thing. And [00:46:00] so then I changed everything and I did the W2 model. I was losing contractors because they would go start their own practice. It was so much easier. And then I really worked on my culture and the way I was doing things and things turned around. So, no problem.

Dr. Sharp: So one of the questions in there with compensating at 40% to 45%, I’m sure that is something you figured out just based on your overhead and revenue and all that stuff and what is feasible. And I’m guessing there are practices in your area that pay more than that. So that leads me to the question of what are you doing to keep these clinicians on board when they might be getting paid a lower rate or percentage than they could make elsewhere?

Whitney: Sure. Well, a couple of things here. First, with the cash-pay practice, we tend to take in more money per session, right? So our lowest rate is $100 all the way up to $200, depending on the licensed person and the experience and all that kind of [00:47:00] stuff. So, if you’re billing insurance, if the insurance is paying out $120 and you’re charging for cash $150, you’re actually making more to your cash pay practice. So your percentages change so is the amount. So that’s one thing to think about. So they technically could still be making more with me even if they went somewhere else that took insurance.

Dr. Sharp: Yes.

Whitney:  And the other thing is you have to make it desirable that they want to stay. Like, I don’t put too much work on them. They get to come in and easily do the work that they want to do. Or I provide them a bonus every year, or I do provide a PTO, which a lot of places don’t do or they get continuing education every year which is covered by us. We try to do one fun event a quarter where it’s usually some kind of nice meal and enjoying our time together. So that helps.

We do like group text messages. Lately., we’ve been sending each other funny videos where we do parodies, [00:48:00] get them and we’re laughing and we have all these inside jokes. So I think that makes people want to stay. Why would I want to leave something so great unless I wasn’t happy about something going on.

Dr. Sharp: Yeah, sure. That’s like a culture component for sure. And just to spell that out for people to double back to the rate and percentage and all of that. So many making 40% of $200, that’s going to be $80, right? So if you compare that to somebody making 50% of a $100, that’s a lot more money. The 40% is a lot more money. So just the fact that you’re charging more per session, even though it’s a lower percentage, it’s going to be more money overall for the clinician.

Whitney: Yeah, and it tends to be less work too, right? They’re not having to bill insurance or if the insurance doesn’t want to pay them, they’re going to get on the phone with someone to discuss that they don’t have to do any of that stuff. They don’t have to fill out any forms. So it’s less hassle for them and the client, which is really nice. And then I don’t have such high overhead with [00:49:00] my admin staff in that sense. I’m not having to pay someone to follow up with insurance and do all that billing. The clinician just hits the card in the EHR and that’s it.

Dr. Sharp: Right. Yeah, I think we underestimate the amount of time that it takes with insurance or that insurance takes up especially with testing. It’s complicated. Checking benefits can be hard. Following up on denials is hard. Here are a lot of hurdles that come upon you to take insurance for testing.

Well, let me see. What else? We talked about referrals. You said a lot of it comes from Google. Are you doing anything else referral-wise to connect with people in the community or diversify your referral streams?

Whitney: Yeah. Some other things that we do are we create good relationships with [00:50:00] churches. My husband is a pastor. And so that’s a big part of how I got going was use those networks that you have and that was the first one I had. We used those. And so a lot of times the church might say, ” Hey, we’re going to cover the first session for this client.” And then after that, we call and we say we did the first session. We think this client’s going to need eight sessions. This is what the rate is. And the church will either pay this portion or we won’t pay it all. Or the client will say, I can cover this. So that helps, especially as a cash pay practice to have someone else help pay for the treatment for somebody when they refer them.

Another really great thing we have is a relationship with an organization called Cure and it’s to help with childhood cancer here in the state of Georgia. Yeah. And it was amazing. My assistant knew the girl that was in charge of the marketing and the client relations at Cure. And so we had lunch with her and she said, we need a place to send people for counseling because we know that counseling helps with cancer patients and [00:51:00] helping their mental health, but also less likely to get sick when they’re in treatments. That’s really great.

And so we have a partnership with them and they pay for the first 10 sessions for our client. We do a reduced rate for that. So that’s a really great relationship that we have with them. So I think having those relationships and whatever, you can create an offer to make it beneficial for the person referring, make it easier for them if that’s a discount or they have access to you more quickly or whatever that is. That helps.

Dr. Sharp: Yeah, absolutely. This has been so valuable. I feel like we packed a lot into.

Whitney: I’ve enjoyed our conversation. I looked at the time. I was like, ” Damn, this went fast.”

Dr. Sharp:  I know. It’s going fast. Are there other considerations on anything that I didn’t ask or we could have talked more about in terms of just things you’ve learned for sustaining and growing a private pay practice?

Whitney: Yeah, we’ve [00:52:00] discussed it, but the referral relationship is a big one. I think a lot of people reach out to someone to form a referral relationship. If it’s a school or maybe a doctor’s office or whatever, and then if they don’t hear from them, they don’t reach back out. And just because you don’t hear from them doesn’t mean that they don’t think you’re a great therapist. They don’t like you. It just means no one’s come in that needs your services at that moment. And so consistency is really important. So in the first few years of my practice and also… I wasn’t getting tons of referrals. I was getting them very slowly. And then I was consistent about my relationships with people.

So every three to six months we track how often we hear from people. So if we don’t hear somebody six months down the road, we reach out to them and in reaching out, it doesn’t have to be a big deal. It could be a quick text message that says, Hey, how are you doing? Or especially when COVID started and the relationship I had with churches, it was, “Hey, this is tough on people. I bet you’ve got people in your [00:53:00] church calling you up needing help. We’re here for you” or whatever the case may be.

Same for schools. A lot of students were really struggling. They still are, but really struggling at the beginning of the pandemic reaching out to us. So being really intentional about your referral sources in doing it over and over again even if they don’t reach out to you, just being consistent about that relationship really over time to make a huge difference.

Dr. Sharp: Yeah. I get that. That’s like compound interest in a way. It just keeps on building.

Whitney: That’s a good one.

Dr. Sharp: Yeah. How are you tracking that? How do you track how often you get to them?

Whitney: So I used to do that myself and now my marketing director does it. But I wish I could tell you, we have this perfect system, but we don’t. We still are trying to figure that out. So if someone’s listening to this podcast, like reach out and tell me your perfect system. Right now, we use a Google sheet. We have them all really organized at the bottom with tabs psychiatrists, schools, whatever. And then we have all their contact information. And at the back, it says, around the end, it will be like how many contacts this year? And when’s the last [00:54:00] time we heard from this person.

Dr. Sharp: Got you. I love the technology piece and systems. And is there some software that can pull all this together? I know everybody’s always looking for a CRM software that will integrate with our EHR and work for mental health practice. So maybe that’s what we’re digging into here, but I don’t think there’s a perfect answer that I’ve found yet.

Whitney: Well, I need you to create that for us.

Dr. Sharp: I will work on that when we’re done here and we’ll be back with you in a week. I’m just kidding. Yeah. So let me see, what else you up to? I know that you’ve… we didn’t really talk about this at all, but you are a coach as well or a consultant? I don’t know which.

Whitney: That’s right. So I work with Joe Sanok at Practice of the Practice. A couple of different niches I have: one is helping cash-pay practices. Some people will call and they want help on getting off of insurance panels and [00:55:00] growing that revenue stream with cash pay. So I help those group practice owners.

I also help people go from a solo to a group practice. And then I help people that have faith-based practices. So like, how do you integrate faith appropriately without overwhelming clients with religion. But how do you make that apart, especially in the South, as you know, we get a lot of calls from people who want Christian-based counseling? And so how do you offer that ethically and appropriately sets another part of the consulting that I do. So I really enjoy that part.

So I probably am in the practice and then I see about 30% of my time with clients, about 20% to 30% of my time with admin responsibilities, and the rest of it I spend consulting.

Dr. Sharp: Yeah. That’s awesome.  And you said you are launching a membership program, is that right?

Whitney: Yeah. So Alison Pigeon another one, a consultant at Practice of The Practice. We together have two membership communities actually. One of them we launched back in October, and then we just launched our second cohort which is called Group Practice Boss.

And those are for people who have established group practices of at least three people or [00:56:00] more. And until we really focus on the systems and the hiring and things that further group practice owners are really working on. So we have lab events every week and when we deep dive into topics related to group practice.

 Right now we’re working on systems for the month of January. And then in February, we’re going to be talking about hiring and clinician retention and being able to keep those clinicians on and the cultural things we’ve been talking about today, actually. And then we’re going to launch another membership community starting in March called Group Practice Launch. And that is for people who want to start a group practice.

Sometimes when you’re in those starting phases, I think it’s great if you can get individual consulting, but not everyone can afford that or they’re not ready for that. So this will be a membership community to get you from a solo practice to one to two clinicians within six months. So we’re really excited about that. So that’s a group practice launch.

Dr. Sharp: Very cool. Well, you clearly have your hands on a lot of different things. And from talking to you today, it’s [00:57:00] clear you have a lot of experience and success in building this practice. So I’m glad that you’re sharing that with other folks.

Whitney: Thank you. Well, it takes a team, right? If I didn’t have my team, my practice would not be functioning anymore. And even with Practice The Practice, I get to work with some really great consultants and people that reach out to me for the consulting, they teach me to. I feel very fortunate with the people that have come around me.

Dr. Sharp: Sure. That’s well said. I think I mentioned it on the podcast before, but yeah, that was my initial jump into consulting was working with Joe way back when… so I have a soft spot for Practice of The Practice and everything y’all are doing over there. It’s cool to see the team is growing.

 Thanks so much for the time. This was awesome.

Whitney: Yeah. Loved it.

Dr. Sharp: Thanks for tuning in to my interview with Whitney. I really enjoy [00:58:00] this interview for a number of reasons.

One it’s just nice to talk to somebody else with a solid Southern accent. But Whitney was so kind and clearly deliberate about what she has been doing and building her practice and how she continues to build her practice. So I hope you took away some gems from this one.

Like I said, in the beginning, if you are trying to launch a testing practice here in 2021, I would love to help you with that. The Beginner Practice Mastermind is going to start on March 11th. Right now we have three spots available as of the time of recording, three spots out of six. So if you’re interested in a group coaching experience where you’ll get accountability, support, guidance, homework, and just the collegiality that comes from connecting with other folks, this could be for you. So you can get more info and apply for a pre-group call at [00:59:00] thetestingpsychologist.com/beginner.

Okay, everybody, have a great weekend. Catch you on Monday.

The information contained in this podcast and on The Testing Psychologist’s website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. [01:00:00] If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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