The Practice of Therapy

Gordon Brewer
Well, hello, everyone, and welcome again to the podcast. And so happy for you all to meet Margarita coach. And Margarita. I'm glad your view we found each other. So welcome. Thank you so much. It is such a true pleasure to be here. I am so excited to talk to you about my my jam. Yes, yes, that's gonna be fun. I could tell already. So yeah, Margarita is

Margarita Khosh
I consistently felt like there are better ways for us to improve it. And because I grew up in an Eastern European home, you know, we knew about mental illness because I grew up with mental and listened my family, but there was so much shame associated it was 30, you don't talk about it, don't talk about it to your friends, don't talk about it to your family, God forbid to talk about it to anybody that is not in the immediate family. And I actually never conformed, I never understood why. Why are we not allowed to talk about it? And I had, the more they told me Stop talking about the mental illness in the family, the more I was like, Well, no, I want to talk about it. So I saw a lot of different opportunities for us to improve health care. And given what I had done, I built outpatient pediatric rehabilitation facility, and they've managed contracting efforts for the largest specialty service managed services organization in the country, I consistently saw two problems that were incredibly flawed in our healthcare system. And that was that we never actually acknowledge that a patient is a consumer.

And we never leverage technology, the way that it has been leveraged in other industries. And I've been talking about this for years, but then COVID happens and all of a sudden, it's like, because I've been asking my friends, like, why don't we have telehealth the way that we should, you know, the way that we should and tell and COVID happened and all of a sudden, you know, for all its faults, for everything that COVID then for everything that robbed us of it literally the one good thing that I could think of it's propelled adoption of technology, in the way that we never imagined that to be applied in healthcare. And my caveat on that is that pretty much most of my friends had worked for. I was I grew up in New York into though I was based out of Florida, but most of my friends, they stayed in New York and they were on Wall Street. And you know, when the world turned upside down, 99% of them were able to go home have a computer and they were able to work without a problem. Because technology was there to support them. We had laws preventing us from working and using technology until the executive orders and 1135 waiver was activated. And then you know, presidential

executive orders and state executive orders and then the licensing boards really cool. Maybe we'll allow our providers to do telehealth. And that's when I really found myself where I am now because I understood how policy worked. I understood how rules and regulations work from the payer side and from the state side. So I started helping therapists, launch private practices beyond state lines, utilizing executive orders and understanding how to actually treat patients. Wow, that's what I have been doing most of the year. I mean, yes, we do credential. And yes, we do audits, and HIPAA and all of that stuff. But I would say nine out of 10 99% of everything we've done over the past year has been to help therapists expand their practice beyond state lines. Right. Right. Yeah. And that's a that's a huge thing. Because I think, you know, to kind of speak to what you had said about how COVID changed. things. I think one of the things particularly for, for our profession, as mental health providers, is it's helped lift the stigma that people were having around mental health issues, as well, because we all experienced a great deal of stress and anxiety around this whole COVID thing. And so, finally, people were saying, Wow, me, yeah, you know, it's,

Gordon Brewer
it's okay to talk about these things. So that's already. Right. Right. Right. Well, and the other thing, too, that I think you're that this is really exciting, because I think what has happened is, is that it's forced us. Maybe more pot at the policy level, I guess, to think outside the box about how people get help. Yeah. And so, yeah, go ahead. Yeah, sorry. I'm just like, I'm wired about this stuff. This is like,

Margarita Khosh
I really am infatuated by it. I think the very first thing that I saw that was blowing us away is that yes, we understand policy. And this is what we've done them for a very long time. But then we really started to come point to working with our clients and helping them understand how licensing works in other states, is that a lot of these states that allowed you to do telehealth and get emergency licensures, when you would go into the policy, when you would go into the, you know, to the actual rules and regulations. Some of these states, you would have a definition of what telehealth is. And then would list case point, all of the licensure types that were allowed to use the definition of telehealth. And then if you would look into the licensure type, and then see what they were allowed to do to break it further, because you read through to the you know, the cross reference. And you see, okay, well is lmhc allowed to perform telehealth, and you look at their regulatory compliance. And it doesn't say anything about telehealth.

And so the laws have been so behind us that this is why I keep saying that, you know, had it not been for COVID, our laws and regulations could not keep up. And we were seven to 10 years minimum, from adopting telehealth the way that we had. And then we started finding a lot of exceptions. And then we started finding a lot of kind of black holes that were like, this is actually you're in and this is how you do it.

Gordon Brewer
Got it just on the surface of thinking, Okay, this is a lot to take in. So, yeah, so I'm gonna be learning more about clubhouse. Oh my god, we're gonna host the room together. This is great.

Okay, go ahead with your intro.

Margarita Khosh
Hi, how are you?

Gordon Brewer
Hi.

Margarita Khosh
Hey, Gordon, nice to be here. Thank you so much for having me. My name is Margarita horch, and I am a healthcare implementation strategist. And I help healthcare professionals design a modern patient experience that leverages technology to reduce costs, eliminate administrative burnout, and make the health system work better for everyone. Pleasure to be here.

Gordon Brewer
start with everyone. Why don't you tell folks a little bit about your story and how you've kind of landed where you've landed?

Margarita Khosh
Sure. So um, I've been in the healthcare space for about 24 years now. And I started you know, working in private practice. I'm a healthcare administrator by trade. I'm trained from F IU, Florida International University with a healthcare MBA. And I've pretty much committed my life to understanding and learning how healthcare systems work, how policy impacts our decisions. And I've studied healthcare implementation in other countries and actually saw what works there. So that we could really broaden our understanding of how health care could be improved here. And what really landed me to where we are now, which is, I'm the CEO and founder of m. k medical solutions. It's a healthcare operations consulting firm, our mission is just single, it's to provide clarity and changing healthcare. And the reason behind that mission is really simple. Because I've been in the healthcare space, because I've been burned by the healthcare system, because I've sustained trauma in the healthcare system. And I've seen my family and go through a lot of trauma.

And the thing, what's really been exciting for a lot of our clients is I don't really like push it with the perspective of Hey, get licensed in another state and grow your practice. My whole thing is, I understand the value of niche branding, I understand the value of lived experience, and then understand the value of the fact that majority of our mental health professionals in this countries are of a certain pigment. And so when I talk to folks, I say, you know, we have an incredibly huge amount of underserved population that is not actually access that is not provided being a given therapy. And so when you expand your practice beyond state lines, think about how that will impact a population that has traditionally had a different viewpoint on therapy. So this is how you heal. This is how we bring the conversation you get to the folks that need the therapy regardless of where they are. And like you know a lot further. Like I've been doing a lot of stuff on clubhouse, which has blown my mind that's a different conversation.

Gordon Brewer
Oh yeah.

Margarita Khosh
Have you become addicted?

Gordon Brewer
I have. I have got that app and I've I've looked at it and then got what I love

Margarita Khosh
Therapy rooms. And I think folks would love to hear from you. All right.

Unknown Speaker
All right.

Margarita Khosh
So but you know, what was really interesting is simply put I, you know, I was in the room with a lot of African or African American therapists, and I said, Well, how are you guys reaching populations? And you know, like, what, what nation branding and stuff like that? And are you going across state lines? And they said, No. And I said, Why? And they're like, Oh, it's work at this at that I'm like, Look, at the end of the day. Ah, if I recall correctly, the statistics are that 16% of all African American families indicate that they have some kind of a mental health condition. Now, that number is probably a hell of a lot lot higher simply because of the fact that there's so much stigma and shame associated with it, nobody's really going to talk about it. But approximately 2% of all therapists are African American. So you can have such a direct impact and change if you grow your practice beyond state lines. And if you serve populations that traditionally haven't really thought about approaching therapy, so you know, we were talking about everything that happened in 2020. pick your poison, were you affected by the pandemic, okay, then see a therapist about that? Well, you're not affected by the pandemic, and you are affected by the racial tension than that. And if God we had an election, I don't know if you're right. But you know, there's so much things that we need to do that we need to heal. And I think that there's great opportunity in that rolling providers.

Gordon Brewer
Yeah. And in in, you know, I had a previous episode with my friends, Kelly Higdon and Miranda Palmer, and we were talking about just the fact that, you know, for us as providers of mental health services, we are really the ones that can dictate a lot of the change that these are, you know, one of the things that, that I am passionate about, that I'm going to hopefully always push for, and that is just licensure portability, the way that we the way the system that we have here in the United States is just broken, because you've got like 50 different rules, 50 different license, you know, well, I mean, you've got different licenses, you know, I'm an lm ft, then you've got LPC, lcsw, w, W's, psychologists, all of that. And we all do similar work, pretty much the same thing. And then you add to that 50 different ways of being licensed across the country. So yeah, and so I think we're the only country in the world that does it that way, probably.

Margarita Khosh
It's like, you knew I was going to go into this.

Unknown Speaker
Yes. Yeah. So tell me

Margarita Khosh
how many licensed professional mental health counselors, specialty types are there in America? Do you know?

Gordon Brewer
I've, I would guess probably at least a dozen.

Margarita Khosh
There's exactly 10. We have an element. And I'm only talking about the actual licensure level, I'm not talking about the incoming, the ones that are associates, the ones that are fresh out of school waiting to get their supervision hours. I mean, we have an lmhc. So think about that. In New York, you're going to be in lmhc, you're going to be in Chicago, you're going to be in lcpc, you're going to be in another state, you are going to be in lpcc. Or you're going to be an LPC, LPs. I mean, there are 10 there are 10 licensure types, and then for LCS, W's, they're not out of the woods, because we have an lcsw wR versus an lcsw w as well. And the thing about that is, a couple of months ago, I had the distinct honor and privilege of interviewing Dr. Bessel Vander kolk. And the man just like I mean, when he talks, I don't even know what plan that I'm on because such a powerhouse of knowledge and everything he's done for therapy and mental health. And I asked him this question of like, you know, what do you see, as a way for us to bridge this gap in fixing this problem that we have, we have so many different licensure types? And he said, what do they do? And I was like, What do you mean, he's like, what do they all do? It doesn't tell us what they do. They have different licensure types. But at the end of the day, it's like you have to start at the schooling of where how that is taught. And then think that the There's something there, in that it's not just because of the licensure types. It's because of the schools themselves that creates so many different programs. I mean, if you think about it, an OB GYN is going to be an OB GYN, and then the specialist for the OB GYN is going to be in the chronology. You know, fertility specialists. If there's going to be an oncologist, then they are oncologists. But with mental health, we literally in the words, mental health, we have psychiatrists, we have psychologists, which I understand why Okay, fine, one can prescribe the other one doesn't, okay. But then, between the psychologists and the LCS W's LMH, C's lcpc. I think that COVID did something beautiful. Like I said, it allowed us to propel technology. And it is what's going to be pushing the legislative bodies from state lines to acknowledge the thing that I mentioned at the beginning, which is if you're looking at those licensure types, the definitions of what telehealth is versus what an lm agency is, they're going to have to come to an agreement and update the licensure types across the whole entire divine because you're now going to put that genie back in that bottle. What are you gonna do? Buddy? You can't continue trading telehealth when the emergency order was over. Let me see how that works for you.

Gordon Brewer
Right, right. Yeah. Did you remind me of another kind of struggles? While we're on our soapbox here about this is just the whole Medicare kind of debacle about, you know, who who will Medicare approve? Well, I love my LLC as W's. But you know, it's time and I think it's worth close to at least I read something the other day that there were there were close to Medicare, allowing lpcs and lm FTS and other licensure types to see Medicare patients. So yes, yeah, absolutely.

Margarita Khosh
Well, what you're talking about is the two different they've been circulating around in Congress. And for quite some time. These are prepositions to allow for lm, ft, s, and L. PCs, or lm, hc, licensed mental health counselors, the

Gordon Brewer
right

Margarita Khosh
family therapists to be able to build Medicare. What I found comical about it this whole entire time is outside of the absurdity of why are you going to let an lcsw w go into Medicare? Is it the clinical part of it or is it like because essentially, when you're looking at the treatments that they are providing, like there's value everywhere to be had, what I found comical is two points. The first point is that you are literally shooting yourself in the foot, because there is a whole entire population that could benefit from this treatment. And it will drive down the cost of medical care, because you are going to actually help people work through some of their challenges and traumas, without uptaking, the medication that they're going to be taking because now they're addressing the root cause instead of just calling a bill to make it better. So you know, for a fact that it's going to actually bring down the cost of Medicare. So that to me, never really like I couldn't wrap my brain around that one. But you know, the other point about that, and by the way, if you hear in the background, my dog is singing, she is in the other room because she's begging to come out. And I said, timeout, so I apologize, the dog. But the other point about this whole entire thing with Medicare is that their only reason behind it is so that we can treat the opioid crisis. That's literally why they want to allow, you know, licensed professional counselors and lm FTS into Medicare is because what's been driving it is like that little backdoor entry, which is all there going to help with the opioid crisis. And I'm like, really, because you think that that's the only that's the approach because that's right, and everything else that they can do.

Gordon Brewer
Right. Right. Yeah. So Well, hopefully. Yeah. Hopefully, change is coming on that front. Yeah. So yeah. So yeah, you know, one of the things that I know that you help people with is to help them with the process of being licensed. You know, in other states, you want to talk more about that. Your process with that?

Margarita Khosh
Absolutely. So we actually decided very, at the very beginning that we're going to have a support role, and we are going to have an educational role. And essentially we offer two services, but there are It's up to the client to decide what they want to do. The first one is the interstate licensing report. And the report is not like an essay paragraph kind of a thing. It's an ask tell kind of a question format. And it literally is created to empower the professional to understand how licensing works in that state. Because it's one thing for them to do all of the research, but they might not be aware of certain questions that they need to ask, especially given the executive orders, and certain other things that are a part of this whole entire licensure process. Like, for example, with the Registered Agent information, a lot of folks don't really think about that, you know, whether or how the executive order impacted the licensing what they're gonna have to do. So we educate them. And that's called the interstate licensing report. And we also offer a half an hour consultation with that. And that's meant to really support them now, we actually give them pretty much most of the resources for them to be able to do it themselves. Because my goal is to empower and educate professionals so that they can make educated decisions, and understand the process themselves. And if they're like, you know what, at the end of the day, I don't have time for this, it's great that I know how to do this, then we'll offer the support. And that's a three month engagement. So we will go on this journey with them. We'll do everything for them short of you know, taking a test if a test needs to be taken, right, we will actually do the follow up, we will contact the board we will we've established so many relationships, and we're we're getting from a lot of the boards of the states, they know who we are just we have like the authorization of release from the clients. And they're like, Where have you guys been? dealing with us? The client? And they'll tell you why I think it's because we understand how they work. So there's no frustration when we call there's no. And that's not to be off putting to the therapist. But it's also because we understand which questions to ask to get to the bottom line, how to actually move the process along. We know from the beginning, when we submit a lot of times there's a lot of technical errors, like case point, there was a request from somebody for a consecutive order of where they worked and their employment history kind of like a standard of a CV. And they they provider, they asked us to fix their licensing because there was just not going anywhere. And we will call we found out it was because when they submitted the application, they didn't know the month like the day that they started working somewhere they just had the month and the year. It's something so simple. Oh, wow.

And we move that application along because we we cleared that out, but they didn't know that that was the questions that they needed to ask. There's just like, my application is not going anywhere. Fix me like why isn't it? So we, you know, and then another therapist, like they were fixing, they couldn't move along to an online application. They were trying to get licensed in New Jersey. And they kept saying that there's an error, there's an error, there's an error we went in, and we saw that it was because they they're very, the language was not that clear. So I understand why they clicked on what they clicked on. It was a simple fix. And then poof, the licensure went through. And then the ones that are like, you know, thank you for calling, because you guys understand it was because of a background check and understanding how that entire piece works at it. But again, it's been a really great journey. And we have nothing but positivity. Because at the end of the day, the therapists are like you because not only did you explain to us what we need to do, but you also took this on for us because like and I'm like, look at the end of the day. Can you do the service yourself? Heck yeah. I said the same thing about credentialing and provider enrollment. Do you want to save time and frustration and energy that you could apply to? I don't know. See your client? Yeah. The boat going? Right. Right,

Gordon Brewer
right. Yeah. Yeah, I had an experience like that just this past week. Excuse me. Sorry, can take hold of my throat. Experience. We'll be going over cough drop here.

Margarita Khosh
Yes, sir.

Gordon Brewer
Sorry.

Margarita Khosh
Please go redhead. health is important.

Gordon Brewer
Pay. It's not It's not COVID because I've been vaccinated. So

Margarita Khosh
your second dose or your first no pay them both. So

Gordon Brewer
are you going to vaccinate now So, okay, so this note is to Rachel, Rachel. edit this out. Okay. Oh, sorry. I'm gonna grab some water real quick, please. Okay, I need you back. Yeah.

Just got one of those tickles that wouldn't go away. So sorry about that. No problem. So okay, start again. So I had I had a situation this past week where I was trying to get some credentialing through our state Medicaid system. And like you said, the language in the application was just bonkers. Yes, it It didn't make any sense at all. And so I think that is a huge, huge need. because like you said, it just varies from not only state to state, but insurance company, the insurance company, and, and all of that is just crazy. So yeah, I'm so glad that you all are doing what you're doing, because it's just gonna be a huge help. And like you said, to just being you're speaking my language, just the importance of outsourcing those things, that just can be awfully difficult.

Margarita Khosh
For you, though, it's funny, because a lot of times, well, I'm actually I'll give you a little secret we've been working on we already have one, but I'm not that proud of it, I think it's gonna be better. I've been creating a masterclass, that is, actually, I'm gonna have to figure out a word wording for it. But it's essentially how to get what you need to know on day one of launching a private practice that they didn't teach you in, in grad school. And we also have one for med school as well. And it literally provides every single therapist every single doctor, because we have based on specialty as well, with the intricacies that they need to understand, I cannot explain to you if there's any advice that I could give to your listeners who are right now in agency, who are working in a university institution who would basically folks that don't yet have their own shop, and they are employed by somebody and they want to one day have their own shop. Don't knock the idea that one day, you're going to have your own shop. So first thing first, ask whoever you work for, for the username and password to your NPI. And your ca qH

Unknown Speaker
Yes,

Margarita Khosh
I cannot tell you something that I don't really think about it. Because for me, it's like, it's really not that challenging to obtain it. But for therapists, they don't think about these things for doctors that launch their own practices, they don't think about these things. And when it's time, it's like, trying to clench it out of the claws of an eagle. And it's just

Gordon Brewer
Yes, that's right. That's right. I mean, it's just Yeah, all those little things that don't occur to people just

Margarita Khosh
know. And you wouldn't think that it would be that, you know, like, that difficult. But, you know, that's just like a silly, small little thing. One of the other things is like when you're assigning your employer contracts, and you're signing on with contracts, and really make sure you understand, not just what the, you know, non compete clauses. But um, you know, a lot of folks, they come to me and they're like, oh, listen, I just need you guys to update my credentialing file with BlueCross BlueShield. And I'm like, well, when you say what that what does that mean? That Oh, well, I was working there. And now I'm working here. So I just needed update it. And I said, but you are going to need your own contract. And chances are you will probably delegated before. And you're going to have to go through initial credentialing from scratch. But we don't know that until we start working out. Well, it's okay. You could just take care of it, but they don't realize the process. So we have to explain to them what it looks like. And a lot of times folks are like, Well, why is it so complicated? And I'm like, Yes, I know. Exactly.

Gordon Brewer
Yes. Right. Right. Yeah, it's a it's a lot of stuff. So Wow. Well, Margarita, I want to be respectful of your time and I'm so glad we had you on the podcast because I think this is just going to be stuff that's just real important to our listeners and just really thinking about our professions. Just kind of a movement into the future just around credentialing and licensure and all of that.

Margarita Khosh
Hey, Gordon, one more piece of advice to Yes, sure. Okay. Um, so there's actually there are certain states that they can explore in terms of getting taking their practice to the they don't need to fully become credentialed with licensed with case point, if there's anybody out of Milwaukee or out of Tennessee, I don't care where you guys are, but you would like to start seeing patients in Florida, there is something known as a Florida registration. Like, it's not a licensing, it's a registration. And it's simply put use of metadata for documents. And that allows you to be registered in the state to treat patients and it had nothing to do with the executive order, because it's been in place for two years now. So it means that you can actually solicit patients in Florida that are not your patients, and you could actually practice there. And you don't and it takes a couple of days. And Gordon, the registration is free. Oh, wow. And I think that Florida did this because of all of the snowbirds. They understood the amount of folks that are coming down and it's open for everybody. Okay, therapists, you guys. I just got a few guys enrolled in Florida. And they're all now I mean, that one was in Alaska, one was in Illinois, and one was in New York, and now they are all practicing in Florida, and they could solicit patients and they could advertise. So there's any piece of free advice. I hope that that does something Oh, wow.

Gordon Brewer
That's that's that's a great that is a great nugget so well Margarita, tell folks how they can get in touch with you if they have more questions and, and I'm sure they'll be wanting to find out more about that registration.

Margarita Khosh
Sure, absolutely. So they could reach out to me to support at MK medical solutions.com they could go to our website at MK medical solutions.com that's Amazon Michael case and kite medical lesson one medicine together solutions with plural and ask calm on social media everywhere I'm Margarita horsh. Last name is spelled k h s h Margarita is like the pizza like the drain like the island spelled the same. And you know, on Instagram, I am at MK med consultant, or Margarita horsh. Either way, you will find me so feel free to reach out if you want to get licensed or certified in another state. We can support your success and we can definitely make sure that your practice drives.

Gordon Brewer
Alright. Right. I will have all of this in the show notes in the show summary for people. So be sure to check it out. So Margarita, it's been great to talk to you and hopefully we'll have other conversations in the future.

Margarita Khosh
My absolute pleasure. Thank you so much. Gordon, you are incredible. I can't wait to see you on clubhouse as well. All right.

Gordon Brewer
All right. We'll have to have a probably have to have a whole episode just on clubhouse and what it is.

Margarita Khosh
Oh my god, can I be there?

Gordon Brewer
Oh, sure. Absolutely. Yeah, cheerleader. All right, great. Margarita.

Unknown Speaker
Bye