This is the 1st post in the series
Reduced Fees, Sliding Scales, and Lessons Learned
When I first went into private practice, I tripped over several issues when offering my services for a reduced fee. Before you begin advertising that you reduce your fees for clients, there’s a few things you may want to take into consideration to avoid the same mistakes that I made. Here’s the first one . . . .
Are You Meeting Your Own Financial Needs?
Generosity is certainly admirable . . . if you can afford it. Airlines tell you to put your oxygen mask on before you try to help someone else with theirs. And, you cannot afford to give your services away if you cannot afford the rent and electricity for your home and your office.
There are other ways to do good in this world and hopefully you are doing them. But make sure that you are financially sound before you go trying to meet your clients’ financial needs.
And, if you are out there already doing good in this world without or in addition to reducing your fees, why don’t you take a moment to let us know about your good works!
I have a colleague in the world of media by the name of Melanie Mulhall. Actually, I’ve never met her except by way of emails and through my on line networking / support group, Boulder Media Women. How I met her isn’t really relevant to this post . . . except to remind you again that networking on line can prove valuable to you as you build your private practice.
What is relevant to you is that Melanie is a businesswoman – an author, a blogger, a copywriter, and an editor – and she also offers a very special marketing perk to her clients . . . . In November 2008, Melanie extended an invitation to each of her clients as a one-time “thank-you” gift. She sent the invitations, prepared a meal, and facilitated a meet-and-greet type evening. The event turned out to be such a huge success that her clients asked her to continue hosting similar events! Melanie says that since 2008, every other month, she has continued to host this free marketing meeting to discuss “what is and is not working for them in marketing their books and speaking engagements.”
What do you have in common with a bunch of wanna-be-published authors?
You / they typically work alone.
You / they tend to work with lots of ideas.
You / they want to meet key players in your respective profession.
You / they want to market services and grow your business.
So how can you make this idea work for you and your private practice? No, you can’t extend an invitation to 10 of your favorite counseling clients to join you for dinner. But, think about it . . . . What can you offer them? Do you work with divorce? How about a free 6-week seminar on Co-Parenting with Your Ex? Do you work with educators? How about a free summer group focusing on Self-Care for Educators? Working with children? How about a free monthly Art Group for the kids?
Whatever your niche is, there’s an attractive offer that you can make to provide a perk – that little something extra -to your clients. Are you already offering an add-on to your clients? Got a great idea for something you or another professional could be offering in addition to their standard service? If so, drop us a note below and share you thoughts with us as we continue to build our online community!
One of the choices every practitioner in private practice has to make is how to set your fees.
Karlaye from Arizona writes . . .
. . . I set my base fee at $ 125 per hour . . . but the insurance companies that I work for set it at $85-95. If I have a private patient, its fine, but when I have a client that wants to use their insurance, I can only set it at that price. Is that correct?”
And, Jason from Colorado asks . . .
Is it OK to charge my cash-paying clients $85 / hour and charge my insurance- paying clients $100 / hour? It’s the only way I can see surviving in this economy.”
When setting your fees, you need to be careful. Health care providers are the most common perpetrators of insurance fraud. Sometimes such fraud occurs out of greed; however, it is much more likely that you may be engaging in fee-related practices that are illegal and not even know it.
If you have chosen to work with insurance companies, make sure that you are not charging you cash-paying clients a different rate than those who are filing on their insurance. Regardless of your intent, charging different clients different fees for the same service (based only on whether or not your client pays cash / uses insurance) is not OK.
Look for a future post when I discuss reduced fees and sliding scale fees.
If you are a regular member of our community here, you already know that my practice is a
"Money Fight" by HikingArtist.com
fee-for-service-only practice. However, if you are a provider who bills insurance companies for your services and you are having difficulty recouping your fees, check out this post about a doctor in Florida who got his money back by taking an insurance company to small claims court.
And, if you have had success in working with insurance / managed care companies and recouping your fees, I hope you’ll drop in here to share your insights / experiences.
In the midst of your strategizing for your 2010 marketing plan, you need to gather what I call supporting data. This is a file that contains information that might help a potential referral source or client choose to work with me. One type of data that goes into my file are articles and research related to the niche, domaine, and services that I offer.
I have made the choice not to contract
with managed care companies
for my professional services.
Here’s the 8 reasons why . . . .
Conflicts of Interest
As a Licensed Professional Counselor, I am required to avoid potential conflicts of interest. My primary concern is for my client’s well-being. Therapists working under the constraints of managed care companies are sometimes put in the position of having to choose between what is in their own best interest and what is in their client’s best interest. I do not want to be put in that position.
Managed care companies were created to “manage” and contain escalating health care costs. Their bottom line is to reduce costs and raise profits; it is not to increase the quality of care or quality of life for my client. In many cases, therapists who contract with MCC are actually paid to NOT see clients.
Restricted Choice
Often managed care companies restrict the client’s choice of therapist by offering only short term / brief therapy that I refer to as “drive-by” therapy. Such therapy meets the financial criteria of managed care companies but may fail to afford my client the opportunity to get the information / therapy that s/he wants / needs. It is my belief that this often results in my client’s quality of care being compromised. And, this, of course, can result in the possibility of my client’s needs going unmet.
Managed care companies often choose to limit what therapies are offered, can restrict what is discussed in therapy, and decide which clients can be seen and for how long. Some managed care companies have even included “gag clauses” in their contracts to prevent therapists from suggesting more effective treatments.
Professional Expertise
I believe that my client should be able to access the full range of mental health professionals according to client needs. Often managed care companies restrict the professionals that clients are allowed to work with – preferring to refer clients to therapists who have a record of providing short term therapy rather than to other therapists who may provide better results or offer a different packaging of services.
Contractual Limitations
I believe that a client has the right to full disclosure of any arrangements, agreements, contracts, or restrictions between any third party and me that could interfere with or impact your treatment. Managed care companies may label counselors’ choices to advocate for clients in this manner as “Managed Care Unfriendly Behaviors” and take such actions as they deem fit. Typically “violations” such as these result in therapists being removed from provider panels or censured in other ways.
Privacy / Confidentiality
By contracting with managed care companies, it is likely that I would be required to share my client’s deeply personal information with gatekeepers and utilization review professionals; it would mean potentially allowing literally hundreds of other to have access to my client’s personal information.
Medication
Research has consistently shown that medication for problems with mood is most effective when combined with psychotherapy. Nevertheless, managed care companies frequently approve medication only for their members rather than permitting them to also work with a mental health counselor. Again, the appearance is that of being more concerned about money rather than my client’s needs.
Time
Managed care companies usually require therapists to justify and convince Utilization Review professionals before treatment is approved / continued. This is time consuming for the therapist and for the client who is required to continue his / her therapy in “fits and starts.”
Diagnosis and Stigma
Managed care companies typically cover only those services deemed medically necessary which is defined as being literally about life and death and the treatment of illness. This means that they require a diagnosis of mental illness for my clients.
My practice is solution- focused on quality of life and personal goals. My work with clients focuses on prevention, exploration, and personal growth rather than simply survival. We typically talk in terms of possibility and resourcefulness, gratitude and integrity, commitment and personal responsibility. Working with managed care companies is not a choice that I can ethically make.
I Know Better
I have mental health professionals declare on a regular basis that you “can’t survive in private practice without participating in managed care.” But, I know better. What I know is that you can’t thrive – both personally and professionally – while participating in managed care.
Once I realized the ethical implications of working with managed care companies, I terminated all of my contracts with managed care. It’s not a decision that is right or necessary for all therapists but it was the best decision that I’ve made to date.
I am now celebrating 10 years of being an insurance-and- managed-care-free private practice. I’m thriving and you can, too! All it requires is courage.
If you, too, run a practice without managed-care, I hope you’ll drop in here to chat about your experiences. And, if you have yet to make the choice to opt out of managed care, I would be happy to help you find your courage and to help you create a path to a fee-for-service only practice.
Early in my career,I naively believed that the way to build a strong and independent practice was to contract with both insurance and managed care companies. I spent hours filling out the lengthy applications for each company. I followed up with phone calls and sent in supportive documentation just trying to get on the companies’ panels as a provider.
"Paperwork" by Luxomedia
Once I was approved to get referrals from the managed care companies, I had more paperwork to do and more phone calls to make. And, did I mention that the fee that I contracted for was significantly reduced from my usual and customary fee?
When counseling was not deemed medically necessary by the Utilization Review professionals, my reimbursement was abruptly cut off. My clients were unprepared to suddenly be financially responsible for my full fee. And, neither were they prepared to discontinue treatment with me.
As a therapist in private practice, you have many potentially practice-altering choices to make. Deciding whether or not to contract with managed care companies is one of them.
Make sure you take the time to consider the implications of working with managed care before you ever contract to do so.
I will be looking for an internship and practicum site in July and I’m not feeling very confident about the process . . . .
Why would an agency want to bother with a student who knows so little and has no experience?”
I get questions like this every semester and thought it might be useful to address this here so that others can read it, too.
Andrea, here’s what I know about why agencies, hospitals, and group practices want you . . . .
Interns tend to be full of energy, optimism, and enthusiasm. Who wouldn’t want those qualities on site when the staff is likely to deal with addiction, abuse, illness, and death?
Interns see with “fresh” eyes. It is easy after being in the trenches of mental health for a while to become complacent and sloppy. Teaching / supervising you helps us stay sharp.
Interns are cost-effective. This is particularly important for non-profit agencies and organizations who survive on a “shoestring” budget. These agencies often take great pride in being a training ground for new professionals – knowing that you will be lured away to more lucrative positions in a few short years. Interns are often open to new information and new ways of doing things. Because of this, they are often more malleable to the culture and policies of a new placement – more so than those of us who have done things “our way” for a long period of time.
Interns that excel in their internships and practicums make great employees. Many sites for internships and practicums have a high rate of employee turnover. If you stand out in your placements, it is likely that you will then become an obvious candidate for those newly opened positions.
If you have been in the position of hiring / supervising interns and practicum student, I hope you’ll drop in here and leave a few words of encouragement and advice to those just beginning their jouney in the mental health professions!
My oops . . . . I forgot to tell you that I would be co-presenting a workshop, “The In’s and Out’s of Private Practice” with Colorado mental health attorney, Denis Lane, on Friday, February 26th at the request of the Colorado Counseling Association.
My session was called Business Planning for Your Private Practice. Below are some of the observations made by participants:
“I really needed this information and the networking was an added bonus. Thank you!”
“Totally worth my traveling 5 hours from Western Nebraska! Thanks!”
“Wonderful information shared. Informative.”
Thank you! This was well worth the effort to attend!”
“Loved Tamara’s presentation. Would’ve been happy to hear more / longer.”
” Both presenters were extremely knowledgeable and passionate about the topic. It was even better than anticipated!”
“Tamara was warm and inspiring. She enabled me to set future goals for my practice.”
“Tamara was extremely informative!”
“The most valuable thing Tamara presented, for me was the idea of facing my fears regarding claiming my niche. Her presentation was a big push towards making a commitment / articulating that.”
Thanks so much to all of you who were able to attend! You were a terrific group to work with!
And, for those of you who were unable to attend, over the next few weeks I will try to post on some of the most salient points here in my blog so that you, too, can begin to develop (or tweak) a business plan for your private practice.
Earlier this month, I was asked to speak to a group of new professionals interning at Aurora Mental Health Center. The topic was on why it’s important to join your state and national professional associations. Just in case you are hesitating, here are 23 reasons that I believe you should join your professional associations today.
Tamara G. Suttle, M.Ed., LPC has maintained a private clinical practice since 1991 and founded Private Practice from the Inside Out in 2003. She has spent almost 20 years consulting and teaching marketing strategies to health care professionals like you. You can learn more about her clinical practice at her website.
Email Tamara
theirs. And, you cannot afford to give your services away if you cannot afford the rent and electricity for your home and your office.
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