188 Transcript

Dr. Jeremy Sharp Uncategorized Leave a Comment

[00:00:00] Dr. Sharp: Hello, everyone. Welcome to the Testing Psychologist 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.

Introducing ChecKIT, a one-stop-shop for Testing Psychologists that puts common mental health checklists in one place, saving you time and simplifying your assessment process. You can learn more at parinc.com/checkit.

All right, everybody. Welcome back. I’m so glad to have you. Hey, today is the last day in our Practice of the Practice February takeover. I’m talking with Alison Pidgeon today all about systems and processes in our practices.

Let me tell you a little bit about Alison. Alison is the [00:01:00] CEO of a large group practice called Move Forward Counseling in Lancaster, Pennsylvania. She also works as a business consultant for Practice of the Practice, and she is the owner of a virtual assistant company called Move Forward Virtual Assistance. Allison is also a mom to three boys and she proudly drives a minivan. It takes a lot to proudly drive a minivan, but Alison is the one to do it. She, as you can tell, has made a career out of developing and teaching others systems and processes. And I am really excited and lucky to have her on the podcast here.

So we talk about all things systems. And what this means, if you don’t even know what a system is,  that’s totally okay. We define systems versus processes. We talk about what kind of numbers and data you might want to track in your practice and how to do that. We do a brief dip into Facebook ads and how they can be helpful for your practice. [00:02:00] And we also talk about what it might look like to hire a Chief Operating Officer or a COO in your practice.

So we really kind of run the game from beginner practice tips and easy things that you want to think about as you’re just getting started. But then we take it all the way up to delegating on a large scale for bigger group practices. So I think there’s probably something for everyone in this episode.

Now if you are a beginner practice testing psychologist and you would like some support launching your testing practice here in 2021, I would love to have you consider the Beginner Practice Mastermind Group. So this is a group coaching experience where we will hold you accountable and give you support as you launch your practice or try to refine your practice if you’ve launched it recently. You can get more information at testingpsychologists.com/beginner. And as of recording, I think we have two spots [00:03:00] left. I’ve been lazy. I have not sent it out to my email list. I’m just putting it on the podcast. So Jump in while there are a couple of spots left if you’re interested. So you can schedule a pre-group call and see if it’s a good fit there at testingpsychologist.com/beginner.

Okay. Let’s jump to my conversation all about systems and processes with Alison Pidgeon.

Hey, Allison, welcome to the podcast.

Alison: Hi, Jeremy. Thanks so much for having me. 

Dr. Sharp: Yes, thanks for being here. You are, I think Practice of the Practice expert number three this month in the series.

Alison: Oh, nice.

Dr. Sharp: Yes. So I talked to Joe, I talked to Whitney. Oh no, you’re number four.  Latoya, I [00:04:00] think we released before you. So yeah, you’re closing out Practice of the Practice. You’re the last

Alison: Very cool.

Dr. Sharp: Bring it home strong. So as we said before we started to record, I don’t know that we have actually talked one-on-one, but I know we’ve been in the same zoom rooms at different events. And I have sent so many of my testing consulting clients to your VA company. So I’m excited to be talking with you all about systems today.

Alison: Yeah, me too. It’s one of my favorite things to talk about.

Dr. Sharp: Yeah. Well, let’s just jump right into it. I want to know when you say systems or anybody says systems, what does that even mean in the context of a mental health practice?

Alison: Yeah, that’s a great question. So I think sometimes people use this in different ways, but how I see it is that a system is something that is like the main vehicle that you use. So for example, an electronic health record, a phone system, an email system, [00:05:00] and then I often use the term processes to describe the little tasks that happened in those systems.

Dr. Sharp: I like that distinction. I think I’ve been using those mostly interchangeably, but that is a very nice distinction. So yeah, I mean, my hope is that we can talk about systems and processes. So talk to me about… let’s go back. Can you even think back to the beginning when you realized like one, I need better systems and, or two, I need better processes in my practice. What was that moment like or what was happening at that point that led you in that direction?

Alison: Yeah, I think it was really in the beginning when I started the group practice, of course. I was trying to do everything myself and then I realized, “Oh wow!, I shouldn’t be doing all these things. I really need an assistant.” And then teaching the assistant how to do what I was doing and then realizing, Oh wait, there’s probably a much more automated way of doing this. Like, why am I doing all of this manually when there’s probably a software tool or [00:06:00] something already built into the EHR that could do this for us. And so it was really just like looking at the whole…

A process can be quite long. If you think about the process of scheduling a new client, especially if you’re an insurance-based practice, that’s many, many steps. And then you can see how a weak link in that process can really mess up a lot of things down the line. And so in my brain, I’m looking at the whole process and trying to figure out, “Okay, where is the weak link or what is something that could be more efficient?” Because I know this thing takes up like an inordinate amount of time and there has to be a better way or a quicker way to do this thing. And I just kept working on how to improve it either by automating it, delegating it to somebody else. There are lots of different ways that you can approach it, but that was kind of how I started.

Dr. Sharp: One thing that I hear from my coaching clients a lot is they love the idea of automating and systems and processes, but the next question is always, how do I have [00:07:00] time to do that? How do I even find the time when I’m already working 60, 70 whatever hours a week and not seeing my kids and family, how do I make the time? Do you run into that or have you thought through that at all?

Alison: Oh yeah, that is a very common problem. And I feel like practice owners tend to start out just doing everything themselves and then they realized way too late that they’re drowning in all this administrative work. And then we’re like, ” You need an assistant.” And they’re like, “I don’t even have time to eat lunch. How do I have time to train an assistant?” You know what I mean? And so we always tell people like hire an assistant way before you think you need it. Because if you wait until you actually realize you need it, it’s too late. You’re like drowning in work at that point. And you don’t even have the bandwidth to train somebody or the time.

Dr. Sharp: Yeah, absolutely. 

Alison: So I would say if you have to hire out to get that done, I think a lot of times when people hire an assistant, they think like they have to have this like beautiful binder full of like, this is how I do all [00:08:00] the things and the practice. And that’s not necessarily the case. You could bring on an assistant and say, I need you as I’m training you to document how to do these things. So that way when you’re on vacation, or if you ever leave there’s something here that I can use to train the next person. And so you don’t necessarily have to be the one doing all that work. That’s what I did with my first assistant. I was like, I’m going to tell you everything that’s in my head and you’re going to take notes and then you’re going to put it in a Google doc. And that’s what we did.

Dr. Sharp: That’s amazing. I think I’ve in the past made that mistake of thinking that you do need a solid operations manual before you can bring someone on, you know, in the interest of not bringing them on and then confusing them or looking disorganized or whatever it might be. But I don’t know, I think there’s definitely some value in just having them write it at the moment while you’re doing the training. Right?

Alison:  Right.

Dr. Sharp: Yeah. How do you, I’m just asking hard questions right off the bat, but how do you find the time to train them? [00:09:00] Because that to me it was like, okay,  so I take a week off of work, I take two weeks off and just sit with this person. How does that even work when you’re a busy practice owner?

Alison: In the VA company, we call it progressive delegation. So if you brought on an assistant and you basically told them every single task that they’re ever going to do in their job the first week they were there, they would be so overwhelmed. You know what I mean?

Dr. Sharp: Sure:

Alison: So we go by what we call progressive delegation, which means you give them the most important tasks first that you want to get off your plate. So for me, when I first brought on my assistant and I was like, I don’t want to answer the phone anymore and do the scheduling. I’m going to teach you how to do this. So for the first two weeks, that’s all we did. We did this initial training for two hours. This is how you do the scheduling. And then we met at regular intervals just as difficult questions came up. And then I was like, okay, now you have the hang of this. Let’s now add this next task. So it was like, pieces of training broken down into smaller chunks. So it was easier for me [00:10:00] to train her, but then it was also easier for her to grasp everything that she was doing because she was just doing it one phase at a time.

Dr. Sharp: That makes a lot more sense to keep your assistant sane, I think. Keep them from running out the door screaming.

Alison: Yeah. 

Dr. Sharp: Sure. How do you identify those tasks that are most important to delegate first?

Alison: I think what we find typically is that scheduling and answering the phones and answering emails for new clients is usually at the top of the list for most people because they know they need to stay on top of that to bring new clients into the practice because obviously, that’s where your revenue is coming from. And if they’ve been in sessions all day and can’t get back to people for 24, 48 hours, they’re losing clients and they know it. So I would say that is usually the biggest thing that we get asked to take care of first because there’s an obvious financial implication to that.

[00:11:00] Dr. Sharp: Absolutely. I know people with me will often say I cannot delegate answering the phone. Nobody can answer the phone like I can. And this seems maybe a little more prominent in private-pay practices. I don’t know if you found that, but there’s this whole I am the magic and that’s part of the high touch, private pay boutique kind of thing that I do. What have you found in that regard?

Alison: That is so hard. And I hear that so often from people. And it’s so hard to change their mindset around like, you do not need to be the one answering the phone. You are the most overpaid scheduler that ever was because you’re the owner of the practice. I think it’s really about hiring the person who is the right fit for your practice and who can be open to learning how you do it.  You’re just going to become this huge bottleneck if you’re the one answering the phone. It’s actually not uncommon. I’ve had clients who have [00:12:00] million dollar practices and the owner is still answering the phone. They just cannot let it go.

Dr. Sharp: That’s crazy to me. 

Alison: Yeah, I know. But it happens. And I think actually they don’t think that maybe somebody could do it better than you could. What I often recommend is all pay practices as they have the assistant schedule like a pre consulting call with the therapist that they think is the best match for that client.

And then they can then have that high touch more therapeutically oriented conversation about, are we a good fit for therapy and all of that stuff, but there’s no reason why you have to be like sitting at a desk all day answering the phone if you’re the owner of the practice. There are other ways of going about it. That’s just not a good use of your time.

Dr. Sharp: I like that. I forgot about that option that you can have your assistant just do a little screening almost, or not even a screening, but put that person into spots on your calendar so that you’re not just waiting by the phone or feel like you always have to return messages or whatever you can [00:13:00] have dedicated spots on your calendar if you want to do that.

That’s great. So we’ve just sort of dived right into it, but let me back up. That’s so exciting to talk through systems. What are some of the main systems that you think are crucial for practices these days?

Alison: Yeah, definitely an EHR, obviously a phone system especially if you have a group practice having a phone system with extensions.

Dr. Sharp: Yeah. Which one do you use?

Alison: I use All Call Technologies which doesn’t have an app, which is the big hangup that a lot of people have, but I like it. I think they have great customer service. and the system works well.

Dr. Sharp: That sounds good. Are there others that you might recommend?

Alison: People obviously have different experiences with different systems, but really common HIPAA compliant ones are like Phone.com, RingRx, there’s one called 8X8, Spruce Health is another one that has a really good reputation.

Dr. Sharp: Great, [00:14:00] people are always asking what phone system. We moved to Google voice maybe six months ago and it has worked well for us. We have about 20 people in our practice and it has been pretty good. The only thing I don’t love about it is that you can’t record a human voice for the greeting. It’s like a robot greeting. That’s my main complaint about it. But otherwise, we like it, it integrates with G-Suite really well and otherwise works pretty well. But I interrupted you. So EHR, phone system.

Alison: Yeah. I mean, especially if you work with insurances, you’ll need some kind of fax which nowadays they have online fax systems which are really nice. So you don’t have to have a physical fax machine anymore. HIPAA compliant email obviously, especially now it’s some HIPAA compliant Telehealth platform.

Dr. Sharp: Yes. Good question there too. Which Telehealth platform are y’all using?

Alison: We actually switched to zoom a few months [00:15:00] ago and it’s actually been great in terms of reliability of the connection. So I think it’s been good. We obviously pay for the HIPAA compliant version. So it’s like $20 per therapist, but to have it work and know that it’s HIPAA compliant is well worth it.

Dr. Sharp: Got you. Yeah. We also use zoom and seem to love it, but TherapyNotes added Telehealth recently and that’s hard to switch. Nice so yeah, those are the major systems. Any other systems that you’ve got working in your practice then?

Alison: Yeah, I can’t really think of anything else. Obviously, depending on whatever types of marketing you’re doing, you might have a system. And for that, if you’re sending out email newsletters or things of that nature, but I think that’s dependent on how you do your marketing. 

Dr. Sharp: Of course, that makes sense. And then how about processes? When you think about the major processes in a practice, what comes to mind or what are you working with people on?

Alison: Yeah. Like [00:16:00] I said before, I think one of the biggest ones is how do new people get into your system? How do they get scheduled? How does data get entered into the EHR? How do benefits get checked if you take insurance? How are clients filling out new client paperwork? That’s a whole thing. Other systems too that are really important is what do you have set up in terms of when do clients pay their bills? Are they paying it during the session? Are you charging the card after? Are you sending them an invoice and waiting for them to pay it? There are all those different choices that you could make. 

And there are all these typical things that happen in the course of therapy, right? Like you come in for your initial session, you pay, you reschedule the next appointment. There’s all these common out like, no matter what kind of practice you are, what kind of therapy you practice, we’re typically all doing those same types of processes.

Dr. Sharp: Right. And how do you… I mean, I imagine there’s some process [00:17:00] for defining these processes almost, right? I just think about a beginning practice owner who wants to get started on this journey and figure these things out and define these things. How do you recommend somebody even start with identifying what processes they need or even systems to put into place?

Alison: Yeah. I think one really good place to start would just be to think about what is the normal day-to-day stuff that the therapist has to do to do their job. And what is the kind of experience of the client interacting in your business? So if you’ve hopefully worked in mental health before, you know, right?. A client comes in and they need to sign some consent, they need to give you some information. You need to write the progress notes. So really just thinking through on a fine detail level, what are all those things that happen? And do I have something in place to be able to do that? 

Something that I found out when I first started bringing people on was that I [00:18:00] thought I had things set up really well. And then some of the first therapists that I brought on were like, what about this? Where does this go? And I was like, no, I didn’t think about that. If a client hands me a cheque, where do I put it? Oh, I don’t know.

Dr. Sharp: Great question. I know. I’ve had that experience.

Alison: Yeah, good question. I didn’t think about that. So it’s just like those things that can get very very detailed, but at the same level, like, especially with group practices, as I’m sure you know, once you start adding volume of therapists and clients, you really need to make sure those things are very buttoned up because otherwise, it can cause big problems.

Dr. Sharp: Yes, that’s happened so many times. It gets problematic really fast. It’s like exponential problems.

Alison: Yes, snowball down the hill, right?

Dr. Sharp: Yeah, absolutely. It is hard.  That leads me to think about after you get past that beginning stage, who is keeping track of all these things and making [00:19:00] updates too? And is there a manual somewhere? Where’s all this held for anybody who might need this information?

Alison: Yeah, I think what’s really challenging is that you start a practice and everybody picks different systems and then your systems kind of… whatever set of unique systems that you picked all work together a little bit differently. And so it’s really hard, even as somebody who does this all the time, to tell you exactly like, Oh, you have SimplePractice and Spruce. And so they are going to work together like this or not work together like this. And so you need to make sure you do X, Y, and Z because of the ins and outs of those particular systems.

So it just makes it really challenging to advise people on that fine detail level of what exactly they should be doing or where they should be looking. But I have put together, like for my consulting clients, what I’ll do is I have what’s called a group practice audit. So this is a very long Google form [00:20:00] that asks all these questions about how do these things happen? And what do you think is working well here? What do you think is broken over here? And it Goes through every different topic and every different piece of their business. So we can identify where those weak points are or if there are things that fell through the cracks. So that can be really helpful.

And then we will go through and just say, okay, this looks like a problem. How do you think you could fix this? And a lot of times what I find is that people aren’t using their system to its fullest capacity. So they won’t realize that their EHR can run a report to see if there are missing progress notes, or if there’s outstanding money that clients haven’t paid.

They just don’t know that stuff is there and then when I’m like, ” Wait, does your EHR run this report to see if this thing is running smoothly?” They’re like, “I have no idea.” And they go and look. And it’s like, “I can click this one button and see all this information.”

Dr. Sharp: It’s incredible.

Alison: Yeah, it’s amazing.

[00:21:00] Dr. Sharp: It’s funny. I had that experience probably three months ago with TherapyNotes. I’ve used TherapyNotes for 10 years, probably and maybe more than that. And I just discovered the activity log. I don’t know if you… are you familiar with TherapyNotes? Do you know TherapyNotes?

Alison: No we use TheraNest.

Dr. Sharp: Okay. So TherapyNotes, maybe TheranNest has a similar thing, but it has this section in the settings called the activity log and it records everything, literally everything in the system. You can search when credit cards were run and which ones declined and why they declined and any number of things, like everything. And it was a gold mine, I’m like, Oh, the cloud’s part of the group practice owners dream. That’s a great example of people under-utilizing their EHR.

Alison: Yeah. I think though, once I start to say this is something that you should be tracking, they figure out pretty quickly how to make that happen. Whether it’s just going to run a report or whether it’s, [00:22:00] Oh, I just need to set up the simple Google spreadsheet and have my assistant track this data or whatever. It’s pretty easily solvable, even if I am not familiar with all of the ins and outs of their particular systems. 

Dr. Sharp: Sure. Since you bring that up, I’m curious what you think practice owners should be tracking?

Alison: Yeah, we could probably do a whole podcast episode about that because there’s a lot of stuff. I’ll sort of hit the highlights. So definitely anything with like clinician documentation. You want to make sure your progress notes are completed in a timely manner, they’re being signed. Treatment plans are getting done. Is the billing happening in a timely manner? What’s the timeframe? Claims are getting submitted and regardless of whoever’s job that is to do that, what is the amount of money that is unpaid that should be paid so we can run what’s called an aging report so I can see any money that’s older than 30 days that [00:23:00] hasn’t been paid either by insurance or by clients.

And usually, after 30 days, it’s like, okay, there’s a problem. And now we need to follow up on what happened. And it’s amazing to me, how many practice owners don’t pay any attention to that, and then one day they look and realize there’s $30,000, $50,000 missing on there that they’re owed. And with insurance companies, after a certain amount of time, you can’t submit that claim anymore. So definitely staying on top of those things is so important. We’re able to keep our uncollected amount of money per year under 1%, which I think is great.

Dr. Sharp: That’s amazing. And you’re an insurance-based practice, right?

Alison: Yes.

Dr. Sharp: That’s amazing.

Alison: So because we have a good system and a good process in place to keep tabs on that and my assistant is regularly following up to collect unpaid claims and balances and that kind of thing.  We keep credit cards on file so that we can charge them if the [00:24:00] client disappears.  So these are all these things that you have to think about and be tracking on a regular basis because again if you can nip the small problem in the bud, especially with a group practice, you’re going to prevent the whole avalanche of problems down the line. Because like you said, the problem can escalate so quickly.

Dr. Sharp: Yeah, sure can. I’ve told the story I think on the podcast before and written about it a lot, but there was a moment where I discovered the aging report in TherapyNotes probably three or four years after starting my practice. And it was like $90,000. I can remember that moment very well. And, we’ll never let that happen again.

Alison: Yeah it’s not that common.

Dr. Sharp: Sure. I mean, I didn’t know it was there. I didn’t even know what it was or why it was important.

Alison: Something else that’s really important to track that’s really simple is having your assistant keep a call log and keeping track of who’s calling, how many calls did you get in a day? Did they get scheduled? If they didn’t get [00:25:00] scheduled, why not? And then at the end of the month adding up what’s your conversion rate? Meaning like out of the number of clients who called, how many people actually scheduled. And if you were self-pay that number should be between 30 to 50%. If you’re insurance-based, that should be more like 70 to 80%. So those are just good rules of thumb. If your numbers are off from there there’s definitely something again, in the process that’s broken and you can go back through and figure out what that is.

But it’s just those things that can be so helpful in terms of like, is my assistant doing her job as well as she could be. And that tells me so much about marketing. Like I can see every day in real-time, how many calls we have coming in and I can see like, Oh, Monday’s the busiest day Friday’s the slowest day. I can see when a Facebook ad stops running the number of calls go down those kinds of things.

Dr. Sharp: Yes. Oh my gosh. I have so many questions about what lasts like two minutes. [00:26:00] So let me go back a little bit and just ask, for those of us who are in insurance-based practices, are there any systems or processes, maybe more processes that you think are worth mentioning to really keep that collections number pretty high, that you don’t see people doing all the time?

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

Alison: Yeah. So a big game-changer for us has been to get credit cards on file and we didn’t do it until they showed up for the first session. And then we actually changed it and we have them give us their credit card number in order to schedule their first appointment. And what’s interesting is that people who are not really sold on coming to therapy will make up some excuse about how they can’t give us their credit card right then and say, “I’ll call back later” and they never do. And then the people who do put it on file do show up then. Our no-show rate has improved since we started doing that. And then obviously too, like we have them sign a form that says these are the reasons we would charge your card. Like for a no-show fee or insurance didn’t pay [00:28:00] or whatever the situation. And that helps a ton.

And I have my therapist actually charged the card at the end of the session so that if for some reason the card didn’t go through, they can say right then, Oh, it looks like your HSA card ran out of funds. Do you have another card you can give me and they take care of it right there in the session because if you have to chase people down for money, likely you’re not going to see it.

Dr. Sharp: Right. That’s so true. Yeah. The credit card on file was a game-changer for us as well. Yeah, it’s huge. So then we move into the call tracking conversation. I’m curious how you track your calls. Is that like a Google form or?

Alison:  Yeah, Google spreadsheet. Nothing Fancy.

Dr. Sharp: That’s good. Yeah, keep it simple. So are you a -Suite user?

Alison: Yes, we definitely use lots of Google docs.

Dr. Sharp: Yeah, we love it. So tracking calls, I love being able to see … you kind of answered my question of what do you actually do with those numbers because people are like, why do we track the calls? What good is that going to do? And let me see, I had [00:29:00] one other question in there. Oh, Facebook ads, you run Facebook ads for your practice?

Alison:  Yeah.

Dr. Sharp: Tell me about the success or lack thereof that you’ve found with Facebook ads.

Alison: So I actually started doing them myself and just experimented with what was working and what wasn’t. And so what I found is any kind of blog post that was more timely related to something like current events that was happening. So like one year, right? Like the week before Thanksgiving, I ran an ad for a blog post I’d written about how to deal with your dysfunctional family at Thanksgiving dinner. It was very popular as opposed to something more generic, like how to set boundaries with your significant other, you know what I mean? Like that wouldn’t be as appealing, obviously as clicking on an article about Thanksgiving week of Thanksgiving. And then anytime Therapist join the practice, we run an ad saying help us welcome [00:30:00] so-and-so they’re taking this insurance. They see these types of clients. Those types of posts always do well.

Dr. Sharp: I love that. Yeah, I’ve always been down on Facebook ads. I don’t know why. I mean, it just seems, there’s a whole… people aren’t really looking for a therapist on Facebook that whole thing. So it’s cool to hear somebody having success with it. I know a lot of people are having success with it. I just don’t do it.

Alison: What I like about it is it’s relatively cheap. So you could spend like $50-$70 on a Facebook ad and that’s like, okay, if it didn’t work, no big deal. But then the other thing of it is that I think sometimes people think they don’t work because they don’t necessarily traceback that they heard about the practice from Facebook, they see the Facebook ad and I always have them click through to the website and they get to their website. And by the time they call and we say, how did you hear about us? They say, I found the website, but they don’t say, Oh, I found the Facebook ad first. But I know that the Facebook ads work because every time we run them, the [00:31:00] calls always increased pretty significantly, but hardly anybody says we heard about, or we saw this on Facebook.

Dr. Sharp: Got you. Yeah, that makes sense. We have some trouble with that too. It seems like everybody just finds the website. That’s always like 50 to 60% of our referrals is Google, but who knows what they were referred from somewhere else.

Nice. I think those are all my questions from that whole conversation that we’re having about call tracking and insurance and all of those things. I think way back we started with what should we be tracking in our practice? So are there any other things that we haven’t talked about?

Alison: Yeah. There are tons of things and actually what I recommend to people is that cause they often think they have to do it all themselves. And I would definitely recommend you delegate that, especially if you have a group practice, you delegate that out to other people in the practice, whether it’s like your clinical director, your office manager, and then you [00:32:00] could just have one place. You can have one Google spreadsheet where you can open it up and see all these data points.  And it can take you five minutes to look at, okay how’s the health of the practice, basically, as opposed to you thinking I have to be the one going into the EHR, running these reports, doing this, doing that.

And I think that you could go crazy tracking data. I don’t know if it’s necessary to track every single thing, but I think you have to decide what’s important to you. So for me, it’s  The aging report because I want to make sure we’re getting paid, what we’re owed and we did the work we should be getting paid.

I know some practice owners are really big on therapist retention of clients.  Usually what I find is that I can tell how a therapist is retaining clients if, after the normal period of time, their schedule should be full, it’s not full. And also usually client retention is one of the issues that they’re having like they’re having other issues besides client retention. So yeah, it’s pretty obvious [00:33:00] to me without really tracking it at a detailed level, but I guess you have to decide what are your priorities? You want to make sure, obviously, your progress notes are being done in case you’ve ever got audited and that type of thing.

But again, it doesn’t have to be you keeping track of all of that. And actually for a while, how I had it set up was I basically told my assistant, once a month, I want you to run these reports. And so for example, I’m missing progress in that report and if there are one or two missings, just send it to the therapist and say, Hey, you missed one or two human errors can you fix that? Get it done.  But I said if it is like four or five. Well, now that’s a problem. And that’s something different other than human error. And that is something you need to alert me to. So if everything is running fine and nobody’s reached that threshold, she doesn’t even tell me she just does it and I know nothing about it until there’s a problem.

Dr. Sharp: That’s great. I mean, that’s the way it should be. Yeah.

Alison: Yes.

[00:34:00] Dr. Sharp: Yes. Okay. There’s a lot to think about. This is good. There was one other thing I wanted to ask about, which is call answering. So it sounds like you have a group practice. Right? A lot of us do. And even those who don’t live answering is a problem. So I’m curious what your philosophy is on. I mean, do you try to live answer every incoming call or do you have some other system to handle the incoming calls?

Alison: Yeah, in my own practice, we try to alive answer the call. So we’re at a size now where it’s actually somebody whose’s full-time job to live answer the phone. And then how we have the phone system set up is if she’s already on the phone, it will ring the next administrative assistant so that they can live answer the phone if the first person can’t. It’s so important.

And I think that has been one of the big contributors to the success of the practice and our growth in the past few years because I hired an assistant pretty early on because I don’t like answering the phone, but also [00:35:00] because Joe told me too. He was like, you need an assistant. I was like, really? It’s just me working part-time. Do I really need it? He’s like, yeah, you need an assistant. And he was right. 

Dr. Sharp: Yep. I hear you. We struggle with that as we get bigger and bigger. Live answering just the demand on admin time is large. So I’m always looking for creative solutions to them.

Alison: Yeah. I mean, I know people who try to do answering services and things like that, or they’ll basically just answer the phone and pass the message along, which, maybe can be somewhat of a band-aid, but I don’t know if that’s really going to hook the person into because when they call, they want to schedule right then. And if you end up playing phone tag, then you’ve probably lost them.

Dr. Sharp: Agreed and always an ongoing thing to think about or maybe that’s just the place to invest administrative staff money especially in a private pay practice.

Alison: Yes. For sure.

Dr. Sharp: So I also wanted to talk with [00:36:00] you about the next level here. So this has been great, like tons of how to get started, what systems do you need processes, et cetera, but you’ve really taken it to the next level where you have actually hired COO’s in both of your businesses to handle operations. Right? So can you talk a little bit about those individuals for anybody who might not know what COO is and how they can even exist in mental health practice?

Alison: Yeah, that’s a great question. So yes, both in the virtual assistant company and in the mental health private practice, I have, what’s called a chief operations officer. And so they’re really overseeing the day to day operations of what happens in the practice. I was fulfilling that role up until they came along and I found that for me, I’m much more the CEO type I want to look at the big picture and focus on expansion and [00:37:00] thinking in those terms rather than like, Oh, now we have this insurance billing problem and this client’s complaining. That stuff gets very tedious for me. So it was interesting in both situations how you’re never really quite sure when you are ready to get to the next level. But sometimes just like a leap of faith.

So in the VA business, the person I had filling that role ended up leaving and getting a new job and I was six weeks away from having my third baby. And I was like, “I need somebody to run this business for me.” So that’s how James came along and he’s done an amazing job with taking what I started and really formalizing our structure and our systems. And he’s very good with processes and he’s done amazing things with the business and then my COO and the counseling practice, Valerie actually just started about a month ago. And we’re going through, looking at the structure [00:38:00] of the counseling practice because everything with the pandemic now we have a whole team of their business, basically, that just want to do a 100% Telehealth from home, which is cool.

But we have another team of therapists who want to be able to go back to the office when it’s safe to do so. We gave up some of our office space. We had three different spaces in the County. Now we just have one. So we gave up the places we were renting and the only space we have now is the building that I own for the practice. So just a lot of changes and just figuring out what makes the most sense now that we have the COO in place. So we’ve been talking about having a clinical supervisor or a manager over a team of therapists. So maybe like 12 to 15 therapists based on location. And then the COO is over top of those managers, so to speak. And so we could just keep replicating that structure and we could potentially have many teams of therapists with those [00:39:00] managers and then all the managers would report to the COO.

Dr. Sharp: Yeah. I love that. So tell me, I would love to delineate a little bit more, the difference between, like you said, you are a CEO kind of person versus the COO. Can you explain the difference there a little bit more, and even like in practical terms what that person, what a COO is doing day to day versus what you’re doing day-to-day.

Alison: Yeah, I think we’re still trying to figure that out. Really a lot of the stuff that I don’t like doing, I passed off to her. So for example, we needed to update some policies and procedures in our employee handbook. That stuff is very tedious to me and she loves doing that. So she’s like, I’ll do that.

We’re looking at expanding, she’s helping me with those. I’m giving her the ideas and she’s actually the one who’s making the calls and setting up marketing meetings and in the new location and any sort of like HR type things, she’s [00:40:00] really taking over. I’ll still be involved in terms of maybe doing the final interview with the candidate, but everything up to that point, she’s going to handle, so like doing the job postings, doing the screenings, doing the initial interviews.

And so that was really a big piece of the job that can get time-consuming that was bogging me down, especially because things were getting so busy, obviously fueled by the pandemic that we added eight therapists may be in the past six months.

Dr. Sharp:  Yeah, it’s been a crazy year.

Alison: Yeah. So in 2020, we doubled in size. We had 12 therapists at the beginning of the year. In the end, we had 24. So it’s a lot of HR tasks.

Dr. Sharp: That’s a lot. Yeah. That reminds me of the book Rocket Fuel. Have you read Rocket Fuel?

Alison: I have not.

Dr. Sharp: The way you describe it sounds very similar. They talk about I forget the exact terms, but it’s basically like in each company you need a visionary and an executor. Vision person, and then the person who makes it happen. And that pairing is really [00:41:00] synergistic in most companies. It sounds very similar to what you might be saying.

Alison: It sounds like I need to read that book.

Dr. Sharp: It’s a cool book. Yeah. I’ll recommend it. We’ll put it in the show notes for anybody who wants to check it out.

Alison: So in terms of answering your question about what I do, I focus on starting new things, expansion projects. I also do a lot with the finances, which is not my favorite thing to do, but I feel like that is something as the owner that should remain on my plate. So I still sign all the cheques and all that kind of stuff.

Dr. Sharp: Yeah, certainly. So some really granular questions with this whole COO concept. Who are these people? Are they within your practice or are they outside your practice? And if they came from outside your practice, are they mental health practitioners or are they, business people? What education and training do these people have?

Alison: Yeah, so my COO is a licensed clinical social worker. So she actually is going to have a small caseload of clients in the beginning. That’s actually what helped me to be able to bring her [00:42:00] on was because it wasn’t going to be a totally non-revenue producing position. She was still going to be producing some revenue that would go towards her salary.

And then she had had experience working in an agency and managing multiple programs. So she was doing a lot of the stuff that she’s doing now: managing staff and hiring and firing and marketing activities and things like that. So she definitely had a lot of those experiences already.

Dr. Sharp: I got you. And you mentioned the term salary was that literal?  Is she literally salary?

Alison: Yeah. So actually my therapists are all hourly. But she is the first salaried employee. Yes.

Dr. Sharp: I hear that. How did you arrive at a salary for her? And you can share as much or as little as you would like to about that.

Alison: So this is where I need to give major props to GreenOak accounting. So I started working with them about a year ago and I realized what was missing in my practice [00:43:00] was I needed somebody who had a CFO, like a chief financial officer type view who could look at my numbers and tell me what to do and how to make these financial decisions. So I said, I think I need to hire a COO can I afford to do that? And they actually ran all the numbers and figure it out. Obviously, it was collaborative like, well, what do you think people in your area get paid to do that and okay, this is how we can make this work. And so they figured that out all for me, it was amazing.

Dr. Sharp: That does sound amazing. Yes. I put them in the show notes as well. Yeah. It’s funny. I’ve just been emailing Julie over the last couple of weeks as well. 

Alison: Yeah, they have been so incredible, especially like I said, I started working with them right before the pandemic started and they helped me get the SBA loan and they were just amazing. And they have paid for themselves many times over.

Dr. Sharp: Love that. I think people are always looking for a good accountant and I know that it’s like accounting plus.

Alison: Yeah. It’s that CFO piece, which when you [00:44:00] start running, I realized at one point that this practice is going to make multiple hundreds of thousands of dollars in a year and I don’t know how to manage hundreds and thousands. I barely passed math in college.

Dr. Sharp: That’s amazing.

Alison: Yeah. Like this practice is going to… this past year we got close to grossing, a million dollars. I was like, I should not be managing this much money without somebody’s expert opinion.

Dr. Sharp: It’s such a good point. But it’s one of those I’m like boiling the frog situations, right. Where it slowly grows and grows and grows and then all of a sudden you’re like, Oh goodness. I think I’m in trouble here. So yeah, definitely happy to shout them out and put them in the show notes. I think that’s super helpful. And it’s one of those expenses that people are hesitant to take on but super helpful.

Alison: And I think that’s mindset around making those strategic investments in your business in order to get to the next level because, without the people that I’ve [00:45:00] hired and even not only my staff but also these other vendors that have helped me build my business, it would not be anywhere near where it is today because I only have so much knowledge. I’m not a CPA. I’m not a social media expert. So we have to make these investments in order to get to the next level.

Dr. Sharp: Yes. Absolutely. Well, Alison, this has been an amazing discussion. I feel like we have covered so much and hopefully given people a lot to think about in terms of systems and processes and how to put some of those things in place, or even take them to the next level.

So as we start to close one, are there any topics here in this area that we didn’t touch on that you definitely want to mention before we wrap up, and two how do people get in touch with you if they want to?

Alison: Yeah. That’s a good question. I’m trying to think if there’s anything I didn’t cover. I feel like it’s such a big topic that it’s hard to know if you touched on all the [00:46:00] facets, but it’s interesting because we were just talking in the virtual assistant company about making a service for people where they can get some help with their processes and their systems. What we find is that people reach out for a VA, but a lot of times they’re so disorganized or they have no systems and no processes that they can’t even bring on a VA because they don’t have anything in place to teach them.

Dr. Sharp: Right. I see that a lot, actually.

Alison: Yeah. That’s actually something we were just in the process of putting together as like figuring out, how do we teach this to therapists or practice owners? Because there is no one size fits all. But there definitely are ways to help people figure out how to make it make sense for themselves and the way they have their practice set up. So I guess I should just mention that as well, that’s in the infancy stage at this point, but if that’s something you’re interested in that is going to be a service that we’re going to [00:47:00] offer through the virtual assistant company.

So the URL for that is moveforwardvirtualassistance.com. If people want to get ahold of me the best way is to contact me through Practice of the Practice where I do business consulting. So it’s alison@practicesofthepractice.com. If you want to check out my counseling practice website, the URL for that is moveforward.lancaster.com. If you want to see what we have going on there. I think those are probably the best ways of getting hold of me.

Dr. Sharp: That sounds great. Awesome. This is good. I love when I walk away from podcast interviews, thinking about things for myself that I could do, or put in place in our practice. And this is definitely one of those times. So I’m glad that we were able to connect. This was really inspiring. Thank you.

Alison: Thank you so much.

Dr. Sharp: Thanks for listening everybody. I hope that that was useful for you. I loved it. I love talking about this stuff after we hung up the recording, so to speak. Didn’t really hang it up [00:48:00] exactly but I think, you know what I mean. We talked for at least 10 or 15 more minutes just about systems and processes and our practices and how we’re working on refining those things. So I love the stuff. Alison clearly has a lot of knowledge around this topic. And there are tons of links in the show notes, both for her practices her Move Forward Virtual Assistant company, and a bunch of other things that we referenced. So check those out. If you’re interested.

And like I said, at the beginning, if you’re a beginner practice owner and you would like some group coaching and support and accountability to help you launch your practice, you can check out the Testing Psychologist Beginner Practice Mastermind Group. It starts on March 11th. So we’re getting really close. And as of the recording, we have two spots left. So if you’re on the fence, doesn’t hurt to jump on a pre-group call and see if it would be a good fit. And you can sign up for that call and get more information at the [00:49:00] testing.psychologists.com/beginner.

Thanks as always for listening, y’all. I will be back next week with more clinical and business episodes. Take care in the meantime.

The information contained in this podcast and on The Testing Psychologist 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 [00:50:00] listeners of this podcast. 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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