The Practice of Therapy

Gordon Brewer
This episode is brought to you by blueprint health. Blueprint health is a measurement based care platform for mental health providers. You can find out more about them by going to practice of therapy.com/blueprint health. And also this episode is brought to you by therapy notes therapy notes.com, the leading electronic health record system for mental health providers in private practice there who I use in my practice, check them out at practice of therapy.com/therapy notes. Hello, I'm Gordon Brewer, and welcome to the practice of therapy podcast, where we explore the business and clinical sides of running a private practice.

Hello, everyone, and welcome again to the podcast. And I'm Gordon Brewer. And this is episode number 221 of the practice of therapy podcast. And if this is your first time joining us for the podcast, glad you're here and hope that you will come back for more and subscribe to the podcast or actually follow the podcast depending on which pod catcher you're listening to this on. And leave us a review. That way we know how well we're doing and also helps other people find us. So in this particular episode, I'm going to tackle a topic that's just kind of been on my mind here, here lately, particularly, you know, as we are kind of moving, hopefully, moving out of the COVID pandemic, I know, here in my area, at least as I'm recording this on March the 16th. Our numbers are really starting to go down and the mask mandates are being lifted and that sort of thing. So hopefully, we're getting back to kind of normal life in terms of not being locked down so much. But anyway, lots going on in the world. Obviously, as I'm recording this as well, we've got the ongoing war in Ukraine, which has been on a lot of our minds. But you know, this, I think all of this, all of this stuff that we've been going through over the last few years, really ties in very closely to how our professions are changing. And so I'm going to talk some more about that. And just, maybe I'll talk to you a little bit about some of the research I've really kind of done and in preparing for this episode, just around how things are changing in our professions. But before we get to that a few things I want to let let you know about. One thing is the upcoming faith and practice conference, if you listened to last week's episode, with an interview with my good friend, Whitney Owens, you heard about that, but love for you to still get some there are a few tickets still available. And you can find out more about that by going to practice of therapy.com/f I P, which just stands for Faith in practice. But this conference is going to be held in Jekyll Island on April 21, through the 24th. And as Whitney said, it's going to be a fun time for a lot of us, I'm going to be speaking at the conference just talking about how our vocation and just and how we live into a faith informed or faith based practice just based on my experience. And also, there's just going to be a lot of good time for relaxation, and just being able to kind of let your hair down and just be around some great people. There's some lots of great speakers going to be at this conference that are new Whitney's putting a lot into it. And even if you don't have necessarily a faith based or faith informed practice, I think you'll find the information at this conference would be fitting for anyone in private practice. There's going to be a lot of stuff on the business side of things. And I guess a big a big selling point is the location. I'm really excited to be on the beach and be at a conference and it's very reasonably priced to for for conferences. So be sure and check it out get more information by going to practice of therapy.com/f IP to find out more about that conference. The other thing I'd like for you to know about is I'm in 2022 I made kind of a commitment to really kind of changed the way I do things as far as offering training for people and resources for people. And one of the things that just seems to be really popular, and I'm happy to do it is providing a lot of different free webinars on different different topics, but love for you to go and check out what I've got up there. So far, I'm going to be adding to the list of free webinars and trainings for folks. And you can find out more about that by going to practice of therapy.com/webinars. And all of these webinars are automated webinars, so you get to pick the time you want to participate in the webinar. And so it makes it a little more convenient for people. But I've got one webinar up there, which is very popular so far, I have tons of people signing up for it every week, and that is using Google workspace in private practice. Another one is scaling without failing. It's a webinar that I partner with my good friend, David Hall, from sight Maven. And that is just on being able to go from solo to group practice and the things that you need to know about that. And the other one, and I'm going to talk a little bit more about why this particular webinar might be important for people now is accepting third party payers in your private practice. And so in other words, insurance, and how you might want to think about that, and if it might be a good fit for you in your practice, because, again, this ties in to how things are changing within our professions. So be sure to check those out practice of therapy.com/webinars. And then also before I get to just my thoughts on how our professions are changing, love for you to hear from our sponsors of the podcast, and that is blueprint health, and you can find out more about them by going to practice of therapy.com/blueprint health. And the other good sponsor of ours is therapy notes. And you can find out more about them by going to practice of therapy.com/therapy notes. But before we get to my thoughts on how things are changing love for you to hear something from our sponsors.

You know, as your practice grows, the systems and processes you have in place will keep your practice running smoothly. That's why it's important to have an electronic health record system that is specific to mental health providers, therapy notes as a complete practice management system. With everything you need to manage patient records, schedule appointments, meet with patients remotely, create rich documentation, and bill insurance all right at your fingertips. Their streamlined software is accessible, wherever and whenever you need it. There are who I use in my practice. And then I mentioned that they are one of the top rated EHRs for mental health providers. Their support is also second to none. So be sure to check them out at practice of therapy.com/therapy notes. And be sure to use the promo code Gordon just gr do in and you can try them out for two months for free. That's therapy notes.com. And this episode is also brought to you by blueprint health. You know one of the best ways to serve clients in your practice is through measurement based outcomes. In fact, more and more third party payers, aka insurance companies are demanding measurable outcomes. And with more and more emphasis on good mental health. Having a way to measure your outcomes just make sense. Introducing blueprint the measurement based care platform that administers scores and charts, hundreds of symptom rating scales to give clinicians deeper insights into treatment progress, ultimately, by helping helping behavioral health providers to grow top line practice revenue, increased clinician satisfaction and deliver more effective care. So be sure and check them out by going to practice of therapy.com/blueprint health and by going to that URL you can also get your first month free again that's practice of therapy.com/blueprint health.

So needless to say over The last few years, a lot has changed for us in our, in our professions, I know that one of the things that I hear kind of universally from people that are in practice, particularly those of us that have been in practice for a while, we are having no trouble at all getting new clients, there is just such an increased demand for our services as mental health providers. And I think a lot of that has come through our experiences through the COVID pandemic. It is affected every one of us in in many different ways. And I think one of the things that I've mentioned before on the podcast is maybe one of the Silver Linings for our, for our professions is is that it has made it less there's less of a stigma around mental health, it seems to me, I think, depending on areas of the country, but I think we've had lots of conversations about the anxiety around the COVID virus and how it's affected people. Certainly people have lost loved ones to the virus. So you're dealing with grief around that. And people are recognizing that they need to talk about those things. Plus, you know, I think the other thing that is happening in our profession, is there's been a lot more kind of press around mental health. I know. And President Biden's recent State of the Union address, he mentioned introducing legislation around making mental health care, universal, in other words, requiring insurance companies to treat mental health care, just like they would medical care. So that's a big, big change that's coming about, I think that we're going to see so is as much not that not to sound too. Too cheesy here. But now more than ever, is a great time to get into our professions. Because I think there's more and more demand. I know, even even as a private practice owner, finding people to hire has been a challenge over the last few years. So yeah, it's a great time to go into mental health care and our professions are, are really growing because the demand is going up. So

there's a shortage of providers. You know, I think that anybody that chooses to go into our profession is not going to have trouble finding work. And so in particularly, in particular, I think, when it comes to private practice, now is a great time to do it. I know in my last week's podcast, I know that Whitney Whitney Owens was talking about how she kind of got into private practice and just sharing about how she back a few years ago, when she first moved back to Savannah, where she's located, she was having trouble finding a job as a mental health provider, I don't think there's going to be that much trouble now. But what she, what she decided is, is I'm going to go into into private practice. And she said, in that interview, it worked. And so I think for a lot of us, going into private practice is a right now is a great time to do it. And I think you're gonna find that it's going to be very rewarding and give you the autonomy, that maybe working for an agency wouldn't provide you I think, for a lot of us not to go too far off on a tangent here. But I think the reasons why most of us go into private practice, those of us that are in private practice, is that is the autonomy of owning your own business, owning your own practice. The autonomy of that is something that is very appealing to us. Also, it's being in private practice, lets you kind of manage your caseload. You know, in talking to some of my friends and colleagues that are still working for agencies, they are just overloaded right now. And their caseload are going up. And it's quite overwhelming for many of them. I have been doing some clinical supervision, for licensure with some, some colleagues that work for an agency, and they are running into a problem of not being able to find clinicians and so the clinicians that are staying in agency work are overloaded. The timing for going into private practice I think is good and I think too, for a lot A lot of people out there going to someone in private practice is more appealing, rather than going to a mental health agency or going to a big mental health provider within their within their area. So again, great time to be going into mental health care. The other thing that I think is, is occurring. And I'm just kind of looking at my notes, here are some things that have come down the pike, particularly at the since the beginning of 2022, is this thing called the nose surprises act. And so, for those of us, particularly those of us that are insurance based, that is something that has come on our radar, and

when when you read the literature on it, or you read the kind of the, the kind of the nuts and bolts of what that means for folks, is it really only applies to folks that are receiving federal funds. So in other words, if you're a Medicare provider or Medicaid provider, you have to adhere to the no surprises act. But not to worry too much about that. It's kind of like HIPAA, I think a lot of times, people get hung up on the fact that, oh, somebody Big Brother is out there is going to kind of zap me if I don't do things in a certain way. And I think there's a there's a misconception, I think for a lot of particularly private practice owners, around HIPAA and some of these federal mandates here in the United States I was. So what I'm speaking of I know, we have listeners in other parts of the world. But here in the United States, there are certain things that we have to do to maintain the requirements of the federal government and also state governments of how we conduct our business. But the bottom line to the no surprises act is is that we need to let our clients know, on the front end, how much they're going to be paying us now, for those folks that are private pay, that's an easy one, they're doing it anyway, you're gonna let people know on the front end, how how they're gonna, how the client is going to pay you and what it's going to cost. For those of us that are insurance based, though, what we get paid by the insurance companies is can vary a great deal, because we have contracts with those insurance companies about what the reimbursement rate is. But if we are out of network with with a particular insurance company, and we're filing with that insurance company, what the client pays out of pocket can vary a great deal. So here are my thoughts on this is number one, I think all of us need to be published, publishing our full price. On your website, you need to have a Play page or a place where you say, Okay, this is what my fee is, this is what my full fee is, for if you use our services, and if you were to pay us out of pocket by cash. So that needs to be very transparent with people. And I think we need to communicate that to people. Now here. Here's the clincher though, with the no surprises act, one of the things that we're going to have to be doing for those of us that are insurance based, is for people that have maybe have high deductibles, or they have,

you know, a higher out of pocket costs for their insurance, we've got to let them if they're going to be using their insurance, say for example, they have BlueCross BlueShield. And they give us the they want for they they want us to file their insurance claims with Blue Cross Blue Shield, we're going to have to let them know particularly if they haven't met their deductible, what their out of pocket cost. And so if they haven't met their deductible, that means we've got to let them know what our contract gradients. So here, here's what here's where I think this is going as far as the future and how things are changing. I think what this is going to do is it's gonna force insurance companies to really be more transparent about how their what they are paying different providers, private providers, across a region. In an insurance contract, for example, there is a clause in there that I can't share with any other practice what I'm getting from that insurance company, it's kind of a thing that they we have to have A confidentiality clause that are in most insurance contracts. So with my practice, I can't share with my colleagues across town, what I'm being reimbursed by Blue Cross Blue Shield, Cigna, optim, or any of those, any of those companies, because I've signed a confidentiality, and I would break my contract with them, if I shared that number. But here's the thing is that we're going to have to start publishing that. So what I think that's going to do is that's going to force insurance companies to stop low balling a lot of providers. And I think in general, one of the things that we're seeing is that insurance reimbursement rates are starting to go up. In other words, insurance companies are recognizing that, okay, we got to pay a fair amount. So having said all of that, particularly, as compared to Medicare, and I'm going to talk a little bit more about Medicare, here in a minute, but in particular, with Medicare, those rates are published. And so if I am a Medicare provider, I can say to Blue Cross Blue Shield, okay, I want you to pay me what Medicare has, is going to pay me or I'm going to drop you. And so your clients will no longer have availability. And I think, as far as an advocacy kind of thing, I think for most of us that are insurance based, I think we need to be kind of Joining Forces and really kind of getting kind of a unified voice with the insurance companies about how they should reimburse us because they really should be reimbursing us a fair, a fair reimbursement rate. So don't want to get don't want to get political or anything like that. But that is something that I see as a trend that's going to be happening. Now, here's the thing about Medicare and I did some research this morning, just to kind of see where things stand with that, as it stands now in the United States and March of 2022. If you hold an if you're a licensed marriage and family therapist, or a licensed professional counselor, LPC or in some states is just a licensed mental health counselor, depending on the nomenclature there. Right now, Medicare will not reimburse those licensure types, they will only reimburse social worker. So if your social work licensed clinical social workers, they will pay for those folks. But they will not pay for LPCs or LMFT. So there's a lot of legislation going through right now in Congress to try to get that change so that they reimburse LPCs LM F T's in the same way that they will reimburse LCS W's. And I think when that happens, the whole insurance game for most of us is going to change, I think we're going to get start to see reasonable reimbursement rates for insurance, and that sort of thing. So accepting insurance, I will say is,

is a little more complicated in your practice. And I'll put in a plug here for the webinar that I've got traversing the third party payer labyrinth. And if you'll go to, as I mentioned in the intro to practice of therapy.com/webinars, you can find that free webinar there. It's an automated webinar, where I just kind of go over some of the ins and outs of accepting insurance in your practice, one of the things that I will say is just in my my thoughts around all of this, of how things are changing. I think more and more people that are starting to seek out mental health services are gonna probably show a preference for picking someone that will accept their insurance. So it might be something that's worth your while looking into. For down the road as far as accepting insurance, you don't have to accept all of them. But I think if you figure out which ones are the best ones for you to accept, that might be something to to consider, as far as you know, getting paid for your services. Right now, I think whether you're cash paid or you're insurance based or you have like what I refer to mine is kind of a hybrid. I have both cash pay clients and insurance Clients, the more, the more options you give people I think is gonna make you more more attractive to potential clients in the future. So I just put those thoughts out there, again, being TransFair. Parent. And disclaimer. That's my opinion. So, I know there are some folks that might disagree with my opinion on that. But that is something to consider the other. The other thing about accepting insurance, and then I'll move on to something else is that I know for me, when I go to my doctor, I depend on using my health insurance in order to pay for their services. And I think the same would be true for people seeking out mental health care, they're paying for it anyway, I pay, I pay a pretty, pretty stiff premium every month. Just as a private practice owner, small business owner, myself, premiums are pretty high. And so I would like to be able to reap the benefit of those premiums that I'm paying in to my health insurance. And so, again, thinking about it, just from an ethical standpoint, all that sort of thing, it might be something to consider. And if you want to explore that cold topic more, be sure to check out the webinar, the free webinar practice of therapy.com/webinars. And you'll find it there. And you can sign up for a time to watch that automated webinar. So the other thing that has really changed within our professions, is saying we're seeing, we've seen just an explosion of this over the last several years where tech companies are starting to get into mental health care. And so what I mean by that is that we are seeing things like BetterHelp talkspace. There are several others out there online, telehealth kind of based platforms for mental health providers are really starting to advertise a lot. I know with a lot of the podcasts I listen to, you're hearing more and more ads around those types of companies, those tech companies that are advertising, to people, for them to seek mental health, online mental health care, my opinion around all of that stuff has changed and evolved. When I first started hearing about those companies, I thought, well, that might not be a bad way for people to get their foot in the door, in terms of private practice. But one of the things that I feel like is something that we have to really consider. And again, disclaimer here, this is my opinion, and not necessarily based on

somebody else's opinion. I think that that is a good thing, and that we're making mental health care available to more people. But I'm really concerned about the the whole confidentiality issues that are coming up with these tech companies. In particular, I know that there was one particular tech company that approached me for maybe advertising on this podcast, really trying to recruit more therapists to join this particular tech company. And when I found out about their practices, I was really hesitant to do that. And in the end, I'd said no, I'm not going to let you advertise on this podcast, because I don't agree with the practices that you're doing. And so the practice, one particular practice is really monitoring the engagement of the therapist with with the client and offering bonuses for more engagement. So if a client texts you or send you a message, they're counting the amount of words that you're sending back to the client, I have a big problem with that. And I think maybe a lot of you out here might do might might as well because I feel like that crosses a pretty big ethical boundary as far as client confidentiality. So those are some of the things that we need to be aware of, and you need to be informed about around those, those kinds of practices. The other thing too, is that the reimbursement rates for those tech companies to the therapist is really kind of on the low end and realize that it's attractive to folks, maybe just starting out and that they're getting income and they're getting maybe a lot of referrals and clients from those tech companies, you're going to end up I think, maybe in the red if he's continued with that long term. So that's something to be aware of Have, I feel like, we just need to proceed with caution in, in jump being too quick to jump on some of those platforms as providers. I just I feel like you could do it just as well on your own, it will take more work on the front end to get the systems and processes set up. But the whole advent of telehealth particularly over the last two years, I don't think that trend is going to go away but tapping into some of the tech companies, I would just say proceed with caution. I don't know that has come naturally go away. But again, I don't know that that's the best opportunity for people. So think think about that. And

yeah, so just say proceed with caution on that particular thing. The other thing that I'm seeing as far as a trend is that there's been there's more and more emphasis on licensure portability. And so I think one of the things, too, that we're seeing is that it's getting easier for people to be licensed in multiple states. And so, again, along the topic of telehealth, there's going to be more and more opportunities for people to practice across state lines, so to speak, particularly using telehealth. So again, big opportunity there for folks, and just thinking about being in private practice. So so that that was a lot of a lot of information there that I kind of threw out. That has been on my mind, I think. And just to kind of recap here, what I was thinking about is that, number one, there's more and more, one of the big changes I'm seeing in in mental health care. And in particularly for those of us in private practice, there's more and more demand for mental health care, we're seeing our practices get full very quickly, it's a great time to go into this profession as a private practice provider, more and more demand of our services. And I think being in private practice gives us the autonomy that makes this profession more more attractive to folks, without getting burned out. By doing a lot of agency work where your caseload are just out the roof. The other thing that I see is a big change that is coming down the pike is that insurance reimbursement for those of us that are insurance based practices, we're going to see those rates go up. And I think that's a big plus for us. Because I think insurance companies are seeing that we need to be reimbursed higher rates. And also with the with Medicare becoming more universal to other licensure types, besides LCS W's, that's kind of forced their hand and being able to, in making sure that we are reimbursed and also with some of the legislations that it's coming down the pike of making mental health care as universal as medical care. Again, that's gonna I think, force the hand of a lot of insurance companies to reimburse us at a fair and equitable rate. The other thing, too, is just the no surprises act that I mentioned, I think if you are just transparent with folks about what they are going to have to pay you before they come in for their sessions, you're going to be meeting, they're no surprises. And the other thing, too, that I didn't mention is that part of that act is is that if, if someone requests something in writing about your, your rates, you have to be you have to offer that to them. So again, that's part of the no surprises, that kind of thing. And you, you can find lots of information on that. We're not heavily mental health providers aren't being affected by this as much as like hospitals and emergency providers, emergency room providers are, that was the big part of it is that people would go into the emergency room, and then be slapped with a big out of network bill, because they didn't know that the guy reading their x ray was out of network for their insurance. So that was the whole reason behind the no surprises. The other thing that I mentioned in this episode is just with more and more online therapy, and with the advent of tech companies kind of getting into the mental health space. I would say just proceed with caution before you sign on the dotted line with a contract with some of the tech companies that are offering mental health services to the general public. So understand the ethics behind that, understand what they what they are saying they would like for you to do. And I would just say, Follow our codes of ethics and keep information confidential. The other thing too, just, I think we're going to see a big trend of more and more licensure portability, and the ability to accrue practice across state lines. So that was a lot of stuff that I threw out there for you. And hopefully that gives gives you a lot to think about. Well, folks,

thanks again for joining me for this episode. And hopefully, I gave you some things to think about and just thinking about how things are changing in our profession. I've just noticed a lot of big changes over the last several years. And a big part of it, I think, was the catalyst for a big part of it was the COVID print pandemic. I think some of those changes would have occurred, occurred anyway. But I think with COVID, the, the change curve went by got real steep all of a sudden. So I think a lot of those changes are occurred because of the COVID pandemic, so but anyway, love to hear from you. On this episode, be sure to let me hear from you. But feel free to email me at Gordon at practice of therapy calm. And also, you can find us on Instagram and Facebook and also LinkedIn love to hear from you. And also be sure and check out the faith and practice conference that's coming up April 21. And love to see you there. I think it's going to be a great conference. And I think it's going to kind of stand set the standard for some future conferences. And I'm big thanks to Whitney Owens is putting hosting this conference and putting this on through the practice of the practice network. And you can find out more about all of this by going to practice of therapy.com/nfip. Man, that'll get you to the landing page for the faith and practice conference, hope to see you there that they get all it's gonna be a fun, fun conference. And also be sure and check out the free webinars that I mentioned at the beginning. And you can go to practice of therapy.com/webinars and find out more about these free webinars that I've got out there. And I'm going to be adding to the list as we move down the road. I'm already working on another webinar on the financial side of private practice. And I'm going to be teaming up with my good friend Julie Harris on that with green oak accounting. So quick shout out to her. And by the way, she's going to be at the faith and practice conference. So looking forward to being with Julie there. So and also be sure and check out our sponsors of the podcast. And that's blueprint health. And you can find out more about them by going to practice of therapy.com/blueprint health and also therapy notes. You can find out more about them by going to practice of therapy.com/therapy notes. And they are the leading electronic health record system for mental health providers there who I use in my practice, so be sure to check them out. So folks, thanks again for joining me for this episode. And look forward to hearing from you. Please feel free to reach out to me. Be sure to follow us on all our social media places. Instagram, Facebook, and also LinkedIn are the places we can be found right now. So be sure to check that check that out. And be sure to follow us wherever you might be listening to your podcasts, whether it be on Apple podcasts, Spotify, Google podcasts, Amazon, Audible, any number any of the places that you get your podcasts, you can probably find us there. So be sure and follow us or subscribe to the podcast wherever you might be listening to it. So I've got lots of great guests lined up it just the timing. This is a solo episode but got lots of great guests coming up for some future episodes and looking forward to hearing from them. So take care folks, and have a great week rest of your week or weekend. Whenever you might be listening to this. You have been listening to the practice of therapy podcast with Gordon Brewer, part of the psych craft network of podcasts. Please visit us at practice of therapy.com For more information, resources and tools to help you in starting building and growing your private practice. And if you haven't done so already, please sign up to receive the free private practice startup guide and practice of therapy.com. The information in this podcast is intended to be accurate and authoritative concerning the subject matter covered is given with the understanding that neither the host guests or producers are rendering legal accounting or clinical advice. If you need a professional, you should find the right person for them.