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[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

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 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 podcast is brought to you in part by PAR.

The Clinical Assessment of Attention Deficit-Adult assesses symptoms of ADD and ADHD in adults. Now, you can administer and score the CAT-A on PARiConnect, PAR’s online assessment platform. Visit parinc.com\cata

What’s going on folks? We are back [00:01:00] here talking about insurance again. This is another episode in the private pay transition series. If you haven’t been listening to the series, you can go back all the way to January 2023. That’s when I started to chronicle my practice’s journey as I’ve tried to move away from insurance panels. We took all the major insurance panels for about 15 years and over the last 18 months have been dropping some insurance. This is meant to walk through that journey and shed light on what that looks like from day to day.

Before we jump to the episode, if you are a practice owner and you would like some support in a group setting, the next cohorts of The Testing Psychologist Mastermind Groups start in two weeks, I believe the 2nd week of July. There are spots in the advanced group; that’s aimed at folks who have larger practices 7, [00:02:00] 8, 9, 10. 20 clinicians and there should be spots in the intermediate group as well. This is what I call the get your life back group. You’re in solo practice. You might have an admin assistant, got plenty of referrals, but you’re feeling pretty overwhelmed. If either of those sounds like you, you can go to thetestingpsychologist.com/consulting and set up a pre-group call to see if it’s a good fit.

All right. Let’s move on and talk about dropping some insurance.

All right, everybody, let’s dive right into it. If you’ve been listening to the series, you know that I have been using the Stages of Change Model as a framework to talk about dropping insurance [00:03:00] over the last 18 months. It’s been 18 months since this whole process started.

A little bit of background. We chose to drop Blue Cross Blue Shield which is our lowest paying, highest pain in the ass panel in July 2023. We started the process in January 2023 to give ourselves a long ramp to the dropping of the panel. Here we are nearly 12 months after we dropped Blue Cross Blue Shield. The intent is to provide a real-time look throughout the process of dropping insurance panels. This is something that comes up a lot in The Testing Psychologist Community on Facebook and of course, in my consulting groups and sessions.

I coach people a lot on not taking insurance, not starting to take insurance or perhaps dropping insurance. Full disclosure, going through the process is a lot scarier than coaching other people to do it, [00:04:00] as you might expect. So, I feel like this has been a nice chance to walk the walk, so to speak, and do what I coach other people to do.

Again, we are using the Stages of Change Model. Last time, we were firmly in maintenance mode. If you’re not familiar with the Stages of Change Model, you can get a link in the show notes. Maintenance mode is essentially you have gone through all of the Stages of Change and you are simply maintaining whatever healthy behavior you have put into place.

I’m happy to say that we have regressed, so to speak, into another preparation and action cycle. Just to refresh, the preparation stage, in this stage, people are ready to take action within the next 30 days. People start to take small steps toward behavior change and they believe changing their behavior can lead to a healthier life.

[00:05:00] Action. In this stage, people have recently changed their behavior defined as within the last six months, and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.

What do I mean when I say that we have regressed to preparation and action?

Well, what that means is we have decided to continue to drop more insurance panels. After the success of dropping our biggest payer Blue Cross Blue Shield, they made up about 30% of our eval referrals, and seeing that our conversion rates stayed consistently high, it’s given us the confidence to drop another two lower-paying panels.

So we reverted to the preparation stage and the action stage very briefly moving through each of these stages a lot quicker than the first time, especially the preparation stage, because we’ve done a lot of preparation prior [00:06:00] to this when we dropped Blue Cross Blue Shield. I did not have to do a ton of preparation. I already had the financial models built out and moved toward action very quickly. And so at this point, you’re just waiting to take action.

Let’s dive into some data just to back this up.

We started from a nearly 0% private pay rate or prevalence, that’s not the right word. We started from a place where we were doing about zero private pay evals. 0% of our referrals were for private pay or our bookings rather. That was in January 2023 before the transition. Now, in late 2023, December into January 2024, we were at a 10.9% private pay booking rate. That means 10.9% of all the evals we were doing or private pay. I just reran the numbers and we are currently at [00:07:00] 16% private pay bookings scheduled over the next six months. So it’s trending in the right direction. This is giving me the confidence to continue to move forward with dropping insurance.

Now, conversion-wise, this is, of all the calls that come in, how many of them do we convert into a booked eval intake? We felt steady at 75% to 85% throughout this process. That’s been our historical conversion rate and that has not changed over this time, which is surprising, to be honest, but in a positive way because you typically think, when you move into more of a private pay model, the conversion ratio tends to go from, let’s say it averages maybe 70% to 80% with insurance, it can dip down to easily 30%, maybe even 20%, or 25% for private pay practices. So I’m happy to see that our conversion rates have held pretty steady at 75% to 85% [00:08:00] week after week.

Just as an aside this is one of those metrics that we track pretty closely. I’ve talked in the series about the Entrepreneurial Operating System or EOS that we track a number of metrics every week. I meet with my admin team, leadership team, and finance team. That’s all the same team actually, but I meet with them and we go over about 12 to 15 key metrics that are important to the health of our practice, and the conversion ratio of our incoming calls is one of those.

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, note-taking, and telehealth [00:09:00] 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 Clinical Assessment of Attention Deficit-Adult, or CAT-A is a comprehensive instrument that assesses symptoms [00:10:00] of ADD and ADHD in adults. A self-report tool sensitive to the symptomology of attentional deficits, both with and without hyperactivity is now available on PARiConnect, PAR’s online assessment platform. Learn more at parinc.com\cata.

All right. So why are we going to keep going with dropping insurance?

Well, more than ever, I think dropping insurance has become imperative in order to keep attracting and retaining high-quality staff. As the cost of testing materials and honestly, everything else goes up, I could not continue to take all the insurance and pay my staff a fair market rate. This is compounded by the fact that we live in an area with a wicked combination, which is relatively low reimbursement and a relatively high cost of living. Very unfortunate.

[00:11:00] Many of you know I’m in Colorado about an hour north of Denver. Median home prices are exceptionally high compared to many parts of the country. It’s not California or Austin, but it’s pretty high, and the reimbursement rate from our insurance panels is pretty low comparatively.

In deciding to continue to drop insurance, I had to go through a little bit more of a process than I did the first time around. Dropping Blue Cross felt a little bit safer because it was only one panel. I think that was a little mental trick though. They were 30% of our evaluation referrals but the math was a lot easier. They were the lowest-paying panel by far. I think if I’m remembering right, it was almost 30%, maybe even 40% lower than the other panels so it seemed like a no-brainer. It was [00:12:00] only one panel, like I said, but now, we are dropping another two panels that make up another 15% of our evaluation referrals. This is a little bit tougher. I had to make peace with two things:

One is that we continue to in theory limit access to people. We weren’t going to be able to serve everyone or as many folks moving forward. We’re fortunate that we have an internship and postdoc program that allows us to continue taking Medicaid, though, which pays lower than the commercial panel, certainly, but this helps with access to continue to be able to take Medicaid, but dropping some commercial insurance means limiting access for some other folks.

The other thing that I had to make peace with was the possibility of this whole practice going to zero. So if we dropped panels and lost [00:13:00] enough business, I may not have enough referrals and conversions to support a relatively large staff. We have 12 to 15 psychologists doing testing. Frankly, I’m not sure if there’s enough private pay business out there to support a staff that large in this area. So I had to work through that and make peace with the possibility that this practice could go to zero with testing and it might end up in the place where it was just me or maybe two interns.

I had to think through the pros and cons of that possibility. Ultimately though, I decided that I would rather take the risk of it going down to nothing if the upside was that I could pay my staff fairly or more than fairly, retain some amazing people, and continue to grow this testing program. After years of toiling in the low reimbursement of [00:14:00] insurance, I’m at a point in my life when I was ready to take the leap. That was a process though. A little bit more of a process than it was the first time around.

So what’s next?

We will be sending termination letters to Optum and Tricare in the next 4 to 6 weeks. I’ve talked about Optum a lot on the podcast. They continue to be incredibly hard to deal with. They’re our biggest administrative burden at this point, primarily because they can’t seem to get their ducks in a row. They tell us to submit all of the testing dates on the same claim at the end of the evaluation, but then in the claim processing process, they separate those claims for “expedited processing”, which means that the claims get rejected, we go around and around, and nobody can give us a straight answer. So we’re [00:15:00] going to sidestep all of that and let go of Optum and Tricare as well. Tricare is a relatively small percentage of our referrals here and they are a relatively low payer in this area.

So we’re going to be doing that in the next 4 to 6 weeks. I’ll be sending the letters to both of them, but given that we’re booking so far out, we’re already telling folks that we don’t accept these insurances. Again, this is the benefit of having a long on-ramp or a long booking time in that it gives us plenty of lead time to figure out how dropping the panels might affect our booking and conversions. So we have a good six months essentially to see how this is going to affect people.

Now, as I said last time, I wish that we had done this sooner. Even if you’re in an insurance-dependent area, I think looking through this lens of where the friction with insurance panels is worthwhile. There might be more room than you think to drop [00:16:00] some panels. You don’t have to go all in. It’s not a black-and-white thing. You can drop the lowest paying panel, the least frequent panel, or the one that sends you the fewest clients. Just remember the Stages of Change Model.

This can be a super lengthy process. It doesn’t happen overnight. We’re 18 months in at this point, so if you’re in pre-contemplation or contemplation, that’s okay. Everybody goes at their own pace. And like I mentioned last time, I found for me that, I think this is true for most people, I stick in contemplation for a long time, but when I’m ready, I move through preparation to action very quickly. Either way, I hope that this has provided a little bit of insight and perhaps some reassurance to those of you considering the switch.

All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your [00:17:00] 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 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.

[00:18:00] The information contained in this podcast and on The Testing Psychologist website are 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. 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 [00:19:00] need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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