Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I just keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.
This episode is brought to you in part by PAR.
The Personality Assessment Inventory Bariatric compiles the results of the PAI into a useful report for bariatric surgery candidates, available on PARiConnect, PAR’s online assessment platform. You can visit parinc.com\paibr.
Hey everybody. Welcome back. Guess what we are [00:01:00] talking about today; we are talking about making mistakes. In a cruel twist of irony, I have recorded this introduction several times now, so I am making mistake after mistake, even in this episode about making mistakes. Hopefully, this one will go well.
Everybody makes mistakes in their practice. That is an absolute given. There’s no way to avoid making mistakes. I think we’re all doing our best and, of course, very few of us got any business training in our graduate program so you can’t fault yourself if you run into some hurdles and make some poor choices over the course of practice development.
I have made a lot of mistakes. I’ve been pretty transparent about that over the years that a lot of my learning has occurred from making mistakes. Today, I’m trying to talk about what I would think are the 5 biggest mistakes that I’ve made in private practice; the [00:02:00] things that tip the scales more than anything else, and made the biggest impact on me, my employees, and my practice over the years.
If you’re a practice owner and you would maybe like to make slightly fewer mistakes, I would love to support you in that. I am doing both individual and group consulting for testing practice owners only. So if you are launching, developing, or trying to grow your testing practice, I would love to help you out. You can go to thetestingpsychologist.com/consulting and schedule a pre-consulting call. We will meet, we will greet, and we will figure out if it makes sense to work together. Again, thetestingpsychologist.com/consulting.
Okay, without further ado, let’s dive into this and talk all about my mistakes.
[00:03:00] Okay, people, I’m going to jump right into it as usual.Mistake 1. Who wants to take a guess? Anybody have a guess? I’ll give you three seconds to think about it. Say it out loud. Say it in your mind.
All right. Mistake 1. Yes, you’re probably right. Taking too much insurance. In the beginning, I didn’t even know that not taking insurance was a possibility, which sounds very naive at this point, but back then I had no exposure to practices or professionals or healthcare individuals who didn’t take insurance in any health-related field. I just assumed that healthcare providers took insurance as a matter of course.
You can make the argument, of course, that taking insurance allowed me to see more folks initially, which helped build word-of-mouth referrals that have continued to be our most valuable stream [00:04:00] of lead generation. I can’t dispute this but I think I just kept adding panels long after I should have. I added pretty much all the major panels quickly.
And even then after 2, 3, 4 years, I decided to add the last remaining major panel for some reason. Actually, I know the reason, because I want to help people. Back then I had a really hard time distinguishing between helping others and maintaining a healthy practice structure so I defaulted to helping others and I thought that taking insurance was a good way to do that.
On the flip side of the insurance game, I would argue that our practice has now waited too long to start dropping panels. Long after we developed a great reputation in the community, we are still taking quite a bit of insurance. If you’ve been listening to the podcast for the past year or so, you’ll know that [00:05:00] we’ve been on a journey to drop some insurance and that has gone quite well and we will continue that journey but I wish that we had started dropping panels a long time ago.
Okay, so what is the antidote to this mistake? Run the numbers and know what you’re signing up for before you get paneled. Most insurance panels, if not all insurance panels, are going to reimburse less than you would get from private pay. Many times, you will only need a fraction of private pay referrals to equal the same income from many more insurance referrals.
I will say this, it’s not just about straight dollar amount in reimbursement. It’s not a one-to-one relationship. The opportunity cost or lost opportunity cost from taking insurance bleeds far beyond the actual dollar amount that they’re reimbursing because it’s going to cost you time or money or both in administrative support as you mess with pre-authorizations or try to track down denied claims [00:06:00] or rejected claims and a lack of medical necessity and that kind of thing. So it’s not just a one-to-one.
Okay, that was mistake 1, taking too much insurance for too long.
Mistake 2. Keeping information in my head rather than creating standard operating procedures. I did a recent episode on standard operating procedures or SOPs that came out maybe 6 weeks ago. You’ve heard me talk about the importance of SOPs, but I didn’t realize the importance of:
1. Developing a consistent, standardized, operationalized process for everything in my practice.
2. Documenting and sharing those processes.
I did not realize the importance of that for a long time.
Not having SOPs, in the beginning, led to a lot of confusion, inconsistency, lost [00:07:00] money and time, and just general frustration on everyone’s part, mine included. Why can’t people just read my mind and know exactly how I want to do things? That’s reasonable. I’m kidding. So not having SOPs led to a lot of issues in the practice.
What is the antidote here? Develop your SOPs early folks. Even if they’re very basic, I would say, start at the very beginning. At least get them written down somewhere, make videos, record your screen- find some way to document what you’re doing, how you’re doing it, and why it’s important.
If you are in the beginning phases and you have not even started your practice yet, that’s ideal. You can start developing your SOPs before you even see a client. You can start to write out your ideal process for [00:08:00] getting leads, scheduling a client, testing a client, and writing a report. You can start to write those out very early. So antidote, develop the SOPs as early as possible.
Mistake 3. Ignoring or avoiding finances in all the ways. So here are some examples of ignoring or avoiding finances that I’ve engaged in:
1. I did not look at the aging statement for my practice for probably three years after I started. When I did look, it was over $90,000 that patients owed me. Looking back, this was a clear reflection of money messages that I got from my family growing up, i.e. we never talked about money in any context ever. It turns out that remained consistent as I got older and opened a business.
2. Even after becoming aware of the aging, I just [00:09:00] continued to assume that we were “doing fine” and didn’t put a bunch of time or energy into developing solid processes for collecting money from insurance or clients. Again, just assumed it was fine. Because there was money coming in, we were doing fine. Our family had plenty of money. We bought a house. It was great, but I was not paying close attention and I’m sure I lost a lot of money over those first few years.
Since then, I’ve learned that you have to track both of those; patient aging and insurance aging like a hawk if you want to run a profitable practice, especially if you want to grow or scale your practice.
Let’s take a break to hear from a featured partner.
Y’all know that I love TherapyNotes but I am not the only one. They have a 4.9 out of 5-star rating on trustpilot.com and Google, which makes them the number one rated Electronic Health Record system available for mental health folks today. They make billing, scheduling, [00:10:00] note taking and telehealth all incredibly easy. They also offer custom forms that you can send through the portal. For all the prescribers out there, TherapyNotes is proudly offering ePrescribe as well.
Maybe the most important thing for me is that they have live telephone support seven days a week. So you can actually talk to a real person in a timely manner.
If you’re trying to switch from another EHR, the transition is incredibly easy. They’ll import your demographic data free of charge so you can get going right away. So if you’re curious or you want to switch or you need a new EHR, try TherapyNotes for two months, absolutely free. You can go to thetestingpsychologist.com/therapynotes and enter the code “testing”. Again, totally free, no strings attached, check it out and see why everyone is switching to TherapyNotes.
The Personality Assessment Inventory Bariatric or PAI Bariatric compiles the results of the [00:11:00] PAI into a useful report just for bariatric surgery candidates. Log into PARiConnect, PAR’s online assessment platform where you can administer the PAI and select the bariatric score report to view results based on bariatric presurgical candidate norms. Learn more at parinc.com\paibr.
Let’s get back to the podcast.
3. Winging it with employee compensation. Again, this lack of precision and planning showed up a few years later when I started hiring. It took me way too long to figure out a real compensation rubric with transparent, predictable, and financially sustainable numbers. Previous to this, I did what a lot of people do. I listened to friends, I read Facebook groups and I ballparked it. I paid people whatever I thought I should with no real regard for the practice budget or the market.
So what is the [00:12:00] antidote to this mistake? There are so many antidotes. The first one is to get a bookkeeper and meet with them monthly. Having someone else mind and keep your books is going to go such a long way toward not ignoring your finances.
Another one is to read something like Profit First for Therapists and outline even a basic budget for your practice to have some sense of where your money should be going.
Another antidote; this is a three-part antidote, is to work with a therapist or coach to identify any money mindset issues that might get in your way. This might be the most important one if I’m being honest. That’s been the most powerful one that I have done and there are a lot of great folks out there who can help you on money mindset.
Okay, people. Moving on mistake 4. Growing without a leadership team in place. As I’ve said before, and many others have said, [00:13:00] growing is easy, but scaling is hard. Like many practices, we grew easily and quickly, especially during COVID and particularly on the counseling side.
After two years, my employees were almost literally begging me to get more help with running the practice. I was trying to do all the things, all the time. Things were falling through the cracks. We had no policies or procedures to speak of, and it was showing up in poor client care and unhappy staff.
I subscribed to the belief that I could do everything, which is dangerous because, I technically could, it would have just required working a million hours a week. I should have asked for help sooner. This is not my strong point. It never has been. It’s something I continue to work on; savior complex et cetera. So if you are one of those folks who has trouble asking for help, this is for you.
[00:14:00] What is the antidote to this mistake? Start looking for “leaders”. I put that in quotes because a leader can be any number of people or roles in your practice but start looking for those folks as soon as possible. This doesn’t mean that you have to hire a clinical director, an assistant director, a COO, or anything like that. It’s just looking for folks who can help you take care of important tasks, brainstorm ideas, and handle emergent issues. It’s never too early to take small steps in delegating or asking for help.Now that said, keep in mind that you are the leader of your practice and ultimately the only one who will care as much about your business as you want them to. I’ll say that again; you are the only one who will care as much about your business as you want them to. So don’t pass off the responsibility of visioning and guiding your practice but you can ask for help in doing some of the other tasks in your practice.
Maybe this is providing [00:15:00] supervision to someone. Maybe this is answering phones. Maybe it is developing SOPs for the billing side of things. It could be any number of things, but always be on the lookout for leaders in your practice as soon as possible so that you can start to offload and trust other folks as early as you can.
Rolling into the last mistake. Mistake 5. Speaking of visioning. The last big mistake, not the only one, but the last one I’ll talk about today is taking way too long to institute some kind of business framework or philosophy for running the practice.
What does this even mean? If you’ve been listening to the podcast, I’ve talked about the Entrepreneurial Operating System or EOS. This was a lifesaver for us. It’s a business framework that gives you a lot of ideas and structure for how to run your business and do it effectively but we didn’t put anything like this into place for like [00:16:00] eight years, maybe more.
Thinking back, I have no idea how we did anything or were even remotely successful in the practice without some kind of framework. So I would vaguely ask people to take care of things if at all. Our meetings had no structure and we didn’t put any time or energy into setting clear goals for the practice, let alone writing them down, tracking them, or maintaining any accountability. A lot of our growth was reactive versus proactive without any real direction.
So it doesn’t have to be EOS. That’s just one system. There are tons of them out there but you need to have some kind of framework to structure your business just for simple questions like how do we identify appropriate goals? How do you run meetings in a productive way that’s not just talking around and around without solving anything? Who’s responsible for doing this important thing in our practice? And probably most importantly, how do you keep [00:17:00] people accountable for what they’re supposed to be doing?
If you’re anything like me, it is really hard to institute accountability in a business like ours because we make the assumption, sometimes rightfully so, that folks will just show up, do their work, we will all get along, be kind to one another, and things will go great. Sometimes that works. It might work for a long time but at some point, if you want to be deliberate about running your practice, you have to get clear on how you set goals, how you track those goals, and how you keep people accountable for reaching those goals and doing what they’re supposed to do. Even if that goal is, I’m going to see 20 clients a week, or I’m going to bill two evaluations a month. Those are goals and those are numbers that people need to be accountable for.
So what is the antidote here? Read and implement elements of Traction or EOS system or any other similar system. You could also get a business coach to [00:18:00] help you tackle this problem or otherwise find a framework that works. There are many out there like I mentioned.
Like I said, I’ve always been transparent. A big part of my learning has come from making mistakes over the years. It’s going to happen to all of us, but hopefully, hearing some of my mistakes will help you steer clear of the same issues.
All right, y’all. Thank you so much for tuning in to this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.
If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes, Spotify, or wherever you listen to your podcast.
If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice [00:19:00] development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
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, [00:20:00] 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. 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.