The Practice of Therapy

Gordon Brewer:
Well, hello everyone and welcome to the practice of therapy podcast again and hello Rob. Glad you're back.
Rob Reinhardt:
Oh, very glad to be back, Gordon. Always enjoy talking with you.
Gordon Brewer:
Yeah. This you know, catching up with a fellow North Carolinian, although I don't live in North Carolina anymore, but grew up right there and Rob's neighborhood areas. So yeah, so I'm happy to have Rob Reinhardt back from tame your practice. If you don't know about Rob, be sure and check out his stuff. We'll have links in the show notes of course. And you can learn more about Rob and he's, he's really got, one of the things that Rob is best known for is his electronic health records system reviews. And so that's my go to was if you want to, if you're deciding on that, go check out Rob and what he's doing with that anyway, today. Really wanted to have Rob on here because as we are hopefully winding down, although nobody knows for sure with this whole Cova 19 kind of thing, one of the things that is really been on my mind and I'm sure it's been on other people's minds, is just thinking about contingency plans.
Gordon Brewer:
And just thinking about, you know, God forbid something were to happen to one of us and we needed to somebody else needed to take over our practice or somebody needed to pick up the reins. How do you do that and how do you prepare for that? And so that was a big part I think, of what I wanted our conversation to be about. And so before we jump into that, Rob, why don't you tell folks a little bit more about you for those that might not be familiar with your, with you and what you do?
Rob Reinhardt:
Yeah, so I'm Rob Reinhardt. I'm a licensed clinical mental health counselor. I had to do that slowly cause in North Carolina we just changed from licensed professional counselor to licensed clinical mental health counselor to just standardize things across States so that we can and someday have portability of a relicensure between States. So I still do clinical work, but I'm also the CEO of tame your practice where I help people all over the country choose technology that's going to help their practices run more smoothly. So as you noted, a big thing I do is review the EHR and that's publicly available on my site, but also help people, you know, examine their needs and choose the one that's going to fit down and also help with other technology and business decisions as well.
Gordon Brewer:
Yeah. And I know one, one thing that's you know, we were just chatting a little bit about, and again, Rob's one of my go to people as far as technology goes. Just talking about use switching to tele-health, which we've all, most of us at least that I'm hearing have done that and just some of the technology issues I've run across. And the good news is for us is that I think and this fits in with contingency plans. One of the things I've learned is whatever platform you're using in terms of doing your tele mental health and your online sessions is to have a backup plan. Because as I was explaining to Rob, I've used one particular platform and had to midstream when in a session switch over to another one and got a client through that. And the one that I switched to I don't have a BAA with, but we were just talking about, you want to say just a little bit about that. Just a little knowledge about the account of the grace period here with HIPAA stuff.
Rob Reinhardt:
Yeah, I had a similar experience. I've got a platform that I've used for telehealth for a retain years. It's always been very reliable, but there were some hiccups there. When, you know, living in the space of a week, a massive number of new therapists and other professionals were using their platform. And it was important to have a backup plan. Okay, what did we do in this case? The good news was that at that point they had already relaxed some restrictions with regard to HIPAA and other things saying, you know, insurance companies even said, Hey, we'll pay for things we wouldn't normally pay for and allowing people to use you know, vendors and systems that don't necessarily comply with HIPAA. A pay for telephone session sessions if you weren't even able to get establish a video connection with people. So this is all things that are temporary due to the pandemic and who knows where we'll be at.
Rob Reinhardt:
Somebody made me listening to this podcast six months, a year from now. And you know, none of this counts anymore, but at least right now when we're talking here on, what is it, the 22nd, 23rd of April in 2020, you know, some of the restrictions are loosened. So yeah, you're right. Contingency planning, a lot of people, it's, you know, coming more into the forefront of their minds now about having a backup plans. I see telehealth as being you know, this is kind of one of the pluses of this situation is tele-health, becoming more normalized, people getting used to it, seeing it as a good thing. And even though I think people are going to go back to in office visits being the norm for counseling and therapy, I think people are going to be more open to tele-health sessions when I can't get to the office or you know, when it's more convenient going forward. So sometimes contingency plans become more part of the norm as you, as you move forward.
Gordon Brewer:
Right, right. Yeah. And you know, what's really started me thinking, you know, I've thought about it before any of this, but you know, one of the things that I realized is that w for me with my practice, like many other people in their practices, if something were to happen to me and I was no longer no longer around, for lack of a better term people, you know, people would need to know what to do in terms of, you know, what happens to the practice, you know, how does the practice continue to, to operate in terms of our responsibility to clients and, and patients that we have. And just knowing how other people can pickup, pick up the reins because there's so many things that I do as a private practice owner that most people don't recognize. I do. I mean, like I've gotten employees and so doing payroll, I do that myself. And so all of those kinds of things you know, access to things like you know, different, you know, like I also use, I'm a big proponent of using Google G suite and so I've got the whole admin stuff behind the scenes that somebody would need access to to make changes and all that kind of stuff. So, yeah. So Rob D, give us your give us your thing on all of this and just what you, how you think about it.
Rob Reinhardt:
Yeah, so the, the, the background of my you know, expertise and knowledge in this, you know, goes back about seven years. When I was at at the American counseling association conference, and I don't remember even where it was that year, Orlando, maybe, I don't remember, but I was talking with Nancy Wheeler who for years was basically the legal expert spokesperson article writer. She even still writes articles for counseling today. As far as the legal aspects of, of counseling. And we got into a conversation and one of the big topics that we talked about was how many mental health professionals don't have a contingency plan. One of the things she ran into as an attorney for health professionals throughout the years not just counselors but psychiatrists and and other health workers was many of them didn't have contingency plans.
Rob Reinhardt:
She would get calls from the loved ones of healthcare professionals. So those who had passed away or who had become incapacitated in some way, desperate Denver, what do I do? You know, my spouse's in charge of helping all of these people that now need to be informed about the situation. There's all of this, these records to deal with. There's all of this business you know, stuff to take care of. What do I do? And she would have to help people through this because there was no plan in place. Right. And it's important that you, you mentioned, you know, people, you know, what if I'm not available, what if I'm not there? And that is important that a lot of people initially say, okay, if I, if I die, but there's a lot of other situations where that can occur. You could decide to retire, you could get an amazing job offer that you couldn't refuse.
Rob Reinhardt:
You could have something that your family decided to move across state lines. It would change things. You could have to take a long leave of absence to care for an ill family member. There's any number of reasons that draw you away from your practice and require you to have this plan in place. Even if you were able to carry out part of that contingency plan, having it in place would make it easier for you to then transition things. So you know, Nancy and I got into this discussion about how most counselors, you know, most perfect mental health professionals didn't have this plan. And then we started talking about, well there's not a lot of resources out there for them to create the plan. And that's when we decided to sit down and write private practice preparedness too. Basically talk about how to make the plan and you know, here are some templates that you can fill your information out and have that plan.
Rob Reinhardt:
And a lot of people talk about a professional will in this context. And, and the reason I don't say professional will a lot I talk about contingency plan is cause the professional wheel tends to be focused on, you know, if you yeah. And it also tends to be focused on the business aspects. Some people do incorporate some other things into the professional will, but when you talk, you talked about some very important things earlier. Things like, okay, what if somebody needs to get into my G suite? You know, what if somebody needs to get into my EHR, you know, these are the kinds of details that often aren't included in something like a professional will. And so we got really detailed into, Hey, let's make sure we're covering all these things that someone would need to address if someone else has taken care of business.
Gordon Brewer:
Right, right. Yeah. And I know there's, if, if I think a lot of people are like me, there's so many things I do that are connected to my practice, that are in my head that I've never really bothered to write down or explained to anybody else. I just know how to do it. I do it. And so this really caused me to really think about it. And one of the things I did a, you know, too with us with the whole covet 19 pandemic and, and all of that, I, you know, I struggle with, I have asthma and so I'm a, I'm a higher risk kind of person. And so, you know God forbid I were to contract the disease and be on a ventilator. Okay. Who would know what to do, you know? Right. In terms of taking, taking care of things here and making sure things were running, running through, you know, running. And so anyway, so
Rob Reinhardt:
Yeah, you would recover, you know, you, you would be strong and you would recover. But during that period of time where you're not able to make those phone calls, who knows what to do. Right, right. Yeah. And some people may be lucky to be in a group practice and have an administrative assistant, but they still need to know what to do. They may be taking over parts of the business that they haven't already committed DuPont.
Gordon Brewer:
Correct. Yeah. So, yeah. So, and in thinking about this, what, from your perspective, Rob, what is the place to start with all of this? I mean how does a person begin to put together a contingency contingency plan?
Rob Reinhardt:
Well, I mean, of course I'm biased, but my answer would be to get our book and go through you. You made the important point there is kind of, if you're kind of coming at this from your own perspective, if I were to just kind of do this on my own, would be to step back and say, Hey, I need to make a list of all these things that I do. You know, all these things that I don't even really think about. They're second nature to me. I just kind of, they just kind of happened cause I know they gotta get done, you know, stepping back and, and writing down, okay, what are all the things that I do and if I wasn't here, who would do them? [inaudible] Ah, and as you're doing these things, how are you doing them and what are you doing them with?
Rob Reinhardt:
In other words, what tools are you using you like you use G suite a lot. Some people have electronic health records, they have bank accounts for their business. They may be interacting with it. Telehealth platform. So also making a list of what are all the tools that you use and how do you access those tools? And then it can get even more detailed. So one example is electronic health records. So we're talking about protected health information here. And it may not just be enough that you make sure somebody has your login and password information. It may be you want to have them set up in that EHR as a, as a, as, as a confirmed user. And in fact, some of the electronic health record systems actually have that as part of their program that Hey, you can come in and identify an emergency contact person that can take over your account in these kinds of situations.
Rob Reinhardt:
And if they aren't noted as that as such in their system, they might not be able to get here. So, you know, one of the things I advocate strongly for when you're, especially when you're dealing with sensitive information, is using two factor authentication. So that means you're not just entering a username and password, but you're often entering a code that you either receive via text or through an authentication app. It's an extra layer of security to be sure that if someone gets your username and password, they can't personate you and get into this sensitive data. Okay, well how is your emergency response team? That's the terminology we use in our, in our book. How is your emergency response team going to get that authentication data? The EHR vendor is already aware of that person. There's a way around that. There's phone calls that can be made, identity verification of identity. And you know, the job can get done. But the key is that you identify these workflows, how do I access my information, what information am I using and how do I make sure that my emergency response team knows all of this? Right. And we say emergency response team, you know, that could be a team of one, it could be a team of 10. It depends on your practice and what your needs are and so forth. So a solo practitioner may only have a team of one or two people to back them up.
Gordon Brewer:
Yeah, yeah. And you know, I know when it has, I've gone through this process of really thinking about this. I think a good place to start would be to just start documenting what you do. And in other words you know, again, like you said earlier, is that there's so many things that we do on autopilot and we don't really think about it. And so, you know for example, you know, when I go to log into my EHR
Gordon Brewer:
I use a, I use an application called lat last pass. That is, yeah. Which is I can, I can really recommend it and go ahead and pay for it. And it's it's a way to create just a vault for all of your passwords and stuff. And then there's a using a Chrome extension that automatically you know, captures all of that and that sort of thing. And so you know, the first thing I thought of is, you know, okay, something were to happen to me, the best place for people to have access to would be my last pass.
Rob Reinhardt:
Yes. And you're probably aware of this. The paid account allows you to, you know, have a secondary person know about it. You can connect the accounts and they can have access.
Gordon Brewer:
Correct? Correct. Yeah. And so, yeah, so finding out about tools like that and then just being able to begin to think about, okay, when I do payroll, how do I do it? So, yeah, I log into Gusto and I this is the, this is the spreadsheet I use with that and that sort of thing. And so writing all those things down but also being able to think about, okay, if something were to happen to me, who would I want to take over in overseeing this? Is it somebody within my practice? Is it somebody outside my practice? And you know, I have my friend David Hall, we've, a lot of people have heard here on the podcast who has a a group practice in Knoxville and we've shared a lot of information just confidentially with each other about the running of our businesses. So he's familiar. So he's kind of my designee. It's as far as something were to happen to me, he would be the one that would to me logically would be able to jump in and kind of take over. And so I had that conversation with him ahead of time. Didn't want to surprise him with that later on, but and just, just had that conversation.
Rob Reinhardt:
Yeah. Gordon, you're doing it right. Yeah. Yeah. You want to identify, you know, once you've established, okay, what, what are my job duties? What are the things that need to get done? You want to identify your emergency response team, whether that's an individual or a group of people and you want to make sure you talk to them and you set an agreement and say, Hey, you're my backup. You know, here's my documentation of everything that I do and how to access it. And so you could at a moment's notice, jump in and, and, and take over for me. A lot of people do kind of mutual things. Well, you'll, you'll be my backup. I'll be your backup. But getting that established so that they know that they're the backup, it's not a surprise and they know where to find the information. They need to jump in and take care of business.
Rob Reinhardt:
And it's really important a month, if I'm understanding you correctly, this colleague is a, is a colleague of yours. They're also a mental health professional. I had a lot of people, their first instinct is to have family members. Especially when you're talking about a professional will. And while I'm on my a family member to take over business matters, that may be fine and well, but it's really important to consider having a knowledgeable mental health professional take care of logo. A lot of the other things that are emergency response team you need to take care of because they have the clinical knowledge, they have the knowledge of things like HIPPA and ethics that a family member is not likely to have. They're going to be able to step in and know what's important in identifying transition of care and how to take care of the records and all of those things. Right. That's a really important facet of deciding who's going to be on your, your response team.
Gordon Brewer:
Right, right. Yeah. So, yeah, so in my mind, you know, make a list of the tasks that you do and things that, and really think about things or what are things that you do that you really don't, I have written down that you probably should write down, but also who are those people that would, like you said, I like that term response team. Internally
Rob Reinhardt:
In a bit helps to envision this, you know, someone who, you know, has no knowledge of, of your line of work. And imagine you telling them, Hey, do my payroll, what would their first question be? Yeah. Okay. Where do I go? I mean, you use Gusto and not even know what Gusto is. Think of it. Blank slate. Hey, I got to include all of this information.
Gordon Brewer:
Right, right. Yeah. So, yeah. So what are maybe some other things, Rob, that people need to consider in just doing all of this? I mean, I'll let you know, I like to think of it kind of just kind of a metaphor that comes to mind. Is, you know, it's kinda like you've got a lock box that holds all the information that a person needs to have. And so then you decide on who's going to have the keys to the lock box.
Rob Reinhardt:
Yeah. You're essentially creating the stuff that's in lock box when you're creating your contingency plan. Right. Here's, you know, here's all of the sensitive information of how I conduct my business and who my clients are and how to contact them. And I'm going to lock this away in this little box and give my emergency response team the key. And they're only supposed to use it in these situations. Right? So that's a good analogy. Another piece. So you've got the, Hey, what does my work look like now? What are all the responsibilities someone would have to take over? There's the identification of who that team is. And then there's the laying out of what they're supposed to do. So you already have some of that covered in the, Hey, here's the day to day things that I do. You know, I do payroll, I take care of my bank accounts, I file insurance claims, but then you have the, okay, but what other things need to be done now that I'm not in the picture?
Rob Reinhardt:
So some of that may depend on why you're not in the picture. But you may want to already have drafted some sample letters for if you have passed away or are incapacitated or, or what have you. That can be quickly and readily sent out to clients to say, Hey, here's the situation and here's how it's going to be handled. So, Hey, we're, we're going to talk to you, we're gonna help you transition to a new counselor. We already have a plan for this because this, depending what exactly has happened, it can have a significant impact on these clients. Which is another reason why it's important to have a mental health clinician involved in this emergency response team because they may be providing some ad hoc counseling here as they help transition people to a new care provider. Correct. So, you know, having late, you know, the next piece in this is laying out the plan of, okay, what does this emergency response team need to do? Apart from my day to day normal activities, how are they going to communicate this to clients? Who do they transition care to? You know, it's important to already have identified some clinicians that would be a good fit, fits for the particular clients that you work with and making sure those clinicians are aware that you're a part of your transition plan and saying, okay, here's how to contact our clients, here's what to tell them, here's the list of providers to make them aware of and things like that.
Gordon Brewer:
Right, right. Exactly. Yeah. It's yeah, it's the, the other thing that I know that we, I had had in mind, you know, too, we talked about a little bit about the professional will, but you know, what happens to, you know, with counseling practices, usually there's not just a whole lot of assets in terms of you know, unless you're, you know, like me, I own a building and got the furnishings of the building and all of that sort of thing. But, you know, being able to think about, okay, what do you want to see happen with that? Yeah. In terms of just that part of it. I mean, most of us are familiar with wills, you know, and in terms of something were to happen to us, what happens to, you know, our, our house, our, you know, cars, all of those kinds of things are all of our stuff. That is of of monetary value. You know, what happens with that money. So that would be another piece to this as well.
Rob Reinhardt:
Well, and you have some crossover with personal and professional will, because you know, there may be some aspects of the business side that the family does need to be involved with depending on your financial situation, how successful the businesses and you know, you have the whole other aspect of, okay, well maybe B, I have a clinician in my practice and when I've already established a plan for how they can take over the business by compensating my family you know, basically buying, buying me out. And, you know, you can, that can be part of your contingency plan. Yeah,
Gordon Brewer:
Yeah, exactly. Well, Rob, I want to be respectful of your time and just you know, I know we've, we've, we've covered a lot here in this short really kind of short conversation and there I'm sure people will, lots of questions about this. And they're certainly free to contact me, but tell folks the best way to get in touch with you also where they can get your book. And the other thing I want people to know about this, we didn't even talk about this, but we have on the previous podcasts are your clinical tools, the described cards.
Rob Reinhardt:
Oh yeah. So describe cards. You can find it. Describe cards.com. Everybody knows me as the techie, but you know, describe cards is a tool you can actually use in just about any session. There's over three dozen activities that you can use with those cards and there's some videos and stuff there that people can learn about. You can even download the instructions before you buy. If you want to check those out. You can find me at Tamia, your practice.com. That's where you can find all my consulting work in the EHR reviews in the book. You can find all the links for the book at private practice preparedness.com. And there is both an ebook that's available on Smashwords as well as a hardcover book. It's available on Amazon and either will allow you to come back actually the private practice preparedness.com site and download templates.
Rob Reinhardt:
There's multiple templates including not just the contingency plan itself that guides you through, Hey, you know, what technology are you using and what things do you need to make somebody aware of. But also a sample letters to give to records, custodians to give to clients, all of which can be you know, are in Microsoft word format or Excel and can be modified for your use. Have a coupon code. You want me to throw it out? I couldn't customize it unfortunately and make it really cool like Gordon or something like that. But it's w F four for M, that's w F four for M and that'll get you 15% off the ebook at Smashwords. Unfortunately, we don't have a way to do discounts on the hard covered Amazon, but okay. One, either one gets you the downloadable templates,
Gordon Brewer:
Right. And we'll be sure to have this in the, in the show notes and in the show summary so you can quickly access that, all those links.
Rob Reinhardt:
And I want to throw one more thing out regardless of how you get this done, get it done. You know, this is one of those things that we as counselors tend to put our heads in the sand about. I'm, I'm, you know, not immune to this as well. You know, we're helpers. We want to be in there helping people. We don't like being distracted by all this extraneous work we've got to do, whether it's documentation or filing insurance claims or, you know, doing other things that takes us away from helping people. We tend to avoid many of us tend to avoid things like that.
Gordon Brewer:
Yes. But it is required by our codes of ethics that we do have these contingency plans in place. So however you get it done, I encourage everybody to make sure. Right. Yeah. And especially for the way I think about it is do it for the sake of your clients. Do it for the, for the psych of your families. Yeah, absolutely. Absolutely. So, well, Rob, thanks again for joining me again on the podcast and I'm sure you'll be on here many times in the future as well. So that's just always happy to be sure to check out Rob's things over@tameyourpractice.com. He's got some wonderful resources and he's one of my go to resource people, so thanks again, Rob. Thank you Gordon.