Private Practice Olio

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Westbound2019 said:
Anyone have HIPAA compliant recs for phone service provider & telehealth platform that they like for a single-provider practice? I think I’m overpaying for bells and whistles that I don’t use, and am looking to switch providers.
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SimplePractice is a popular one. I am very happy with a free Doximity account to make phone calls and pay a My Clients Plus plan for telehealth.
 
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Gepetto said:
Hello, I am brand new to PP and in the process of paneling with insurance.

Im trying to figure out the rules around Medicare and I get different answers each time I call them.

As I understand it, I can’t see anyone who has Medicare at all until I either opt out or panel with them.

What I don’t yet know is how claims work with someone who has Medicare supplemental.
So let’s say they have commercial insurance that I am NOT paneled with, but also Medicare supplemental. Since I’m out of network with commercial, do I just bill Medicare ? Do I do a superbill for commercial and then bill Medicare for what’s not covered? Am I allowed to see these folks prior to being paneled with Medicare since their primary coverage is commercial ?

Thanks in advance and sorry for the naïveté- it’s been a struggle getting answers from the source!
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This might be a silly question - wouldn't it make sense to get credentialed with insurance companies?

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Mercury in Taurus said:
This might be a silly question - wouldn't it make sense to get credentialed with insurance companies?

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Depends on the insurance companies. Some have simply terrible rates. Some have a very onerous prior auth process. As demand is quite high, I choose not to work for lower than medicare rates, nor do I want to waste a good chunk of unbillable time jumping through arbitrary hoops. As to the Medicare question with supplemental. You do not need to be credentialed by the supplemental insurance to get reimbursement from them. You bill Medicare and then Medicare will send the remainder to the supplemental.
 
WisNeuro said:
Depends on the insurance companies. Some have simply terrible rates. Some have a very onerous prior auth process. As demand is quite high, I choose not to work for lower than medicare rates, nor do I want to waste a good chunk of unbillable time jumping through arbitrary hoops. As to the Medicare question with supplemental. You do not need to be credentialed by the supplemental insurance to get reimbursement from them. You bill Medicare and then Medicare will send the remainder to the supplemental.
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Got it. That is why they are called secondary insurance. All sounds awfully complicated. I use a billing company that does all of that. So far has been a blessing. They take a small cut of course and it is certainly worth it. Got enough white hair from graduate school and no need for more stress 🙂
 
Mercury in Taurus said:
Got it. That is why they are called secondary insurance. All sounds awfully complicated. I use a billing company that does all of that. So far has been a blessing. They take a small cut of course and it is certainly worth it. Got enough white hair from graduate school and no need for more stress 🙂
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I only see ~2 clinical patients a week, rest is legal/IME type work. And the billing for those clinical patients only takes about 10 minutes. If I were all therapy, I'd consider a billing company.
 
WisNeuro said:
I only see ~2 clinical patients a week, rest is legal/IME type work. And the billing for those clinical patients only takes about 10 minutes. If I were all therapy, I'd consider a billing company.
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That makes perfect sense. Billing is probably a really good skill to have. I actually don't know how much exactly the billing company is taking. Depending upon insurances, my payout is $97.57-151.28/initial session and $95-147.15/follow-up session.

During my training years, I fantasized about being my own boss doing testing and providing therapy in nursing homes. Now that seems to be too much effort in investing time and energy to entertain relationships with nursing home administrators, medical directors, nursing home contractor physicians... After being licensed, I just want to live a peaceful life, spend quality time with people I care about, and have some free time to watch some Australian and British TV shows on flixtor. Certainly not at the stage of life feeling ambitious about making a certain amount of money by filling my schedule as tightly as possible.

Therapy referrals kept on coming, and I limit the number of patients I see. Most are bi-weekly high functioning individuals who are telehealth-appropriate. Not renting an office at this moment. Professional liability insurance is priced very reasonably in my state. Therefore, less overhead. If I want to do testing in the future, I will probably wait for someone to retire to buy used testing kits in good condition that are not outdated. Definitely need to get more training if plan to do testing. Have not done any real assessments since the internship. Screenings only since then.
 
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Mercury in Taurus said:
During my training years, I fantasized about being my own boss doing testing and providing therapy in nursing homes. Now that seems to be too much effort in investing time and energy to entertain relationships with nursing home administrators, medical directors, nursing contractor physicians... After being licensed, I just want to live a peaceful life, spend quality time with people I care about, and have some free time to watch some Australian and British TV shows on flixtor. Certainly not at the stage of life feeling ambitious about making a certain amount of money by filling my schedule as tightly as possible.
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I lived that life for several years. Unless you are at the top, there is not as much money in it as you think and with all the private equity money competing with you it can be exhausting. It was a constant game of stealing business from competing companies and having business stolen from you until the company is large enough to be acquired by a private equity group for millions. If you are not into doing that, the competition sure will be.
 
Sanman said:
I lived that life for several years. Unless you are at the top, there is not as much money in it as you think and with all the private equity money competing with you it can be exhausting. It was a constant game of stealing business from competing companies and having business stolen from you until the company is large enough to be acquired by a private equity group for millions. If you are not into doing that, the competition sure will be.
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Well said, Sanman! BTW, do know what happened to MedOptions? They were one of the biggest contractors in the long-term care business. Then they are gone, poof.
 
Mercury in Taurus said:
Well said, Sanman! BTW, do know what happened to MedOptions? They were one of the biggest contractors in the long-term care business. Then they are gone, poof.
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I believe they were the largest following their acquisition of Vericare. Not 100% sure, but I have a feeling that it was a combination of pandemic related things and private equity ownership. Management had been a mess for a while due the company selling and then acquiring Vericare, I am sure they were losing tons of money following the nursing home restrictions and staff quitting. I believe that much of their telehealth spun off and I am guessing the private equity folks saw no value in waiting out the pandemic and taking short-term losses, so they shut it down. The business growth was based on squeezing out volume (I think they were shooting for up to 17 visits/day per clinician) and that just wasn't possible during the pandemic. Here today, gone tomorrow.
 
Sanman said:
I believe they were the largest following their acquisition of Vericare. Not 100% sure, but I have a feeling that it was a combination of pandemic related things and private equity ownership. Management had been a mess for a while due the company selling and then acquiring Vericare, I am sure they were losing tons of money following the nursing home restrictions and staff quitting. I believe that much of their telehealth spun off and I am guessing the private equity folks saw no value in waiting out the pandemic and taking short-term losses, so they shut it down. The business growth was based on squeezing out volume (I think they were shooting for up to 17 visits/day per clinician) and that just wasn't possible during the pandemic. Here today, gone tomorrow.
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I think you are right, and I am not surprised to hear that they were the largest before going under. They were dominating all the nursing home contracts in my area around the time when I left my last facility. It is truly sad how this pandemic impacted residents in long-term care facilities. Many of my old friends had career changes during the pandemic. The sadness was becoming too much to tolerate due to staff shortage, restrictions on family visitations, zero to little recreational activities, calculating corporate culture...
 
For those who use Quickbooks, how do you use it in a way that is HIPAA-compliant? Do you need to use a separate de-identified coding system? I was under the impression that Quickbooks would not sign BAAs and wasn’t HIPAA compliant but I am also very new to this process. Any info into Quickbooks or recommendations for other accounting/billing software would be greatly appreciated!
 
R. Matey said:
Any guesses out there on how much time managing a small part-time PP would require beyond just seeing patients. I'm thinking maybe one or two insurance plans at the most that have a reputation in the community for being easier to work with.
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How part-time, and are you doing your own billing? All therapy?
 
WisNeuro said:
How part-time, and are you doing your own billing? All therapy?
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This is purely theoretical. I may have an offer to join an all psych PP in addition to my current job soon, but the split isn't the best and I'm wondering if it's worth it to just to strike out on my own. There are office space openings like every other day on the state org listserv.

But, yes, I was thinking all therapy to start just because it's less expensive to offer right away and demand in my area appears to be very high. I haven't thought about doing my own billing, but I guess that would probably a significant portion of time even if the companies are easy to work with, yeah?
 
R. Matey said:
This is purely theoretical. I may have an offer to join an all psych PP in addition to my current job soon, but the split isn't the best and I'm wondering if it's worth it to just to strike out on my own. There are office space openings like every other day on the state org listserv.

But, yes, I was thinking all therapy to start just because it's less expensive to offer right away and demand in my area appears to be very high. I haven't thought about doing my own billing, but I guess that would probably a significant portion of time even if the companies are easy to work with, yeah?
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Honestly, depends on your payer source. For example, I can enter a couple weeks worth of evals in medicare's portal in about 10 minutes. BCBC's portal may tale 20-30 mins for a few weeks of patients. But, it's easier for npsych evals, as I only have to enter in a couple per week, as teh rest of my work is legal and billed another way. Just depends on how much time you;d spend in billing, and if giving up about 10% of that is worth hiring a billing service, or giving up a percentage for an EHR to do it.
 
R. Matey said:
This is purely theoretical. I may have an offer to join an all psych PP in addition to my current job soon, but the split isn't the best and I'm wondering if it's worth it to just to strike out on my own. There are office space openings like every other day on the state org listserv.

But, yes, I was thinking all therapy to start just because it's less expensive to offer right away and demand in my area appears to be very high. I haven't thought about doing my own billing, but I guess that would probably a significant portion of time even if the companies are easy to work with, yeah?
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I think there’s a learning curve at which you’ll be spending a ton of time applying to be paneled and then figuring out exactly what insurance companies want in terms of documentation and a potential delay in pay for awhile, but it would decrease in terms of time commitment over time up to a point. It also depends on the number of panels.

A lot of folks in PP are paneled on just one or two panels at most. But you could hire a biller to fill in the gaps for you and save time. But the more panels you’re on, the less money you’ll make in terms of earning potential, so it’s important to strike a balance between cash pay and insurance.

Some folks I know say it’s relatively easy to do your own billing if on one or two panels after awhile depending on the insurance company, and some complain about spending extra time justifying their pay if something is rejected and don’t like having to chase after that money from time to time. It seems to vary.

But starting out, it is “safer” to get paneled on one or two just to have steady referrals more quickly while your cash pay clients are building up. But depending on your specialty and demographics of where you practice, it may be a faster or slower buildup than you’d expect. Right now, demand for therapy is high, which would work in your favor as long as you practice in an area where folks can afford full fee.
 
Thanks for the advice, I appreciate it. I was just thinking one or two panels for now in addition to cash clients. My area is pretty high COL and the demand seems to be fairly high for therapy so I can imagine a quick build up. You never know though. It does seem like managing expenses on your own if preferable to taking a say 65-35 split? I've been looking for months for a decent group practice to join, but they seem to be few in number.
 
R. Matey said:
Thanks for the advice, I appreciate it. I was just thinking one or two panels for now in addition to cash clients. My area is pretty high COL and the demand seems to be fairly high for therapy so I can imagine a quick build up. You never know though. It does seem like managing expenses on your own if preferable to taking a say 65-35 split? I've been looking for months for a decent group practice to join, but they seem to be few in number.
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You can run the numbers. Monetize everything that they may offer in that split (e.g., scheduling, billing, office space, utilities, etc) and roughly estimate what those costs would be on your own, including your time per hour to manage things that they may take on, and see what's worth it. If you are thinking of PP FT eventually, I wouldn't look at it as sunk time costs, rather learning how business is done. Even if you hire someone else to eventually do your billing and such, you should still actually know how that stuff is done.
 
WisNeuro said:
You can run the numbers. Monetize everything that they may offer in that split (e.g., scheduling, billing, office space, utilities, etc) and roughly estimate what those costs would be on your own, including your time per hour to manage things that they may take on, and see what's worth it. If you are thinking of PP FT eventually, I wouldn't look at it as sunk time costs, rather learning how business is done. Even if you hire someone else to eventually do your billing and such, you should still actually know how that stuff is done.
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Good points all around. I'm planning on writing a budget for a prospective practice this weekend. Tbh, I'm a bit uncertain on whether full time PP is my goal, but I think it's probably worth my time to minimize my expenses in the beginning.
 
WisNeuro said:
You can run the numbers. Monetize everything that they may offer in that split (e.g., scheduling, billing, office space, utilities, etc) and roughly estimate what those costs would be on your own, including your time per hour to manage things that they may take on, and see what's worth it. If you are thinking of PP FT eventually, I wouldn't look at it as sunk time costs, rather learning how business is done. Even if you hire someone else to eventually do your billing and such, you should still actually know how that stuff is done.
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I would add to this that you should think about if you will compete with them directly in the future. Many people I know do PP in one area and work for an agency or PP in another area of practice to keep a steady income. This may be a way to go if you are unsure of your goals.
 
Sanman said:
I would add to this that you should think about if you will compete with them directly in the future. Many people I know do PP in one area and work for an agency or PP in another area of practice to keep a steady income. This may be a way to go if you are unsure of your goals.
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Thanks, I'm in a non-clinical position now so I wouldn't be competing directly with my employer. That's actually the issue: I have (and am paying) for a license that I'm not actively using. The initial plan was to join a group practice, but no one seems interested in less than a half-time position or, if they are, the split isn't optimal. So I'm weighing striking out on my own so I can control the amount of hours I work, but I'm trying to figure out whether it would be better to just take the split time-wise.
 
WisNeuro said:
You can run the numbers. Monetize everything that they may offer in that split (e.g., scheduling, billing, office space, utilities, etc) and roughly estimate what those costs would be on your own, including your time per hour to manage things that they may take on, and see what's worth it. If you are thinking of PP FT eventually, I wouldn't look at it as sunk time costs, rather learning how business is done. Even if you hire someone else to eventually do your billing and such, you should still actually know how that stuff is done.
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Adding to this, I would encourage @R. Matey to get a list of possible expenses that you'd be paying for as a psychologist. I have an old excel template I created as my expense sheet (Has gotten longer and more complex over time, but is a good reference) if you want for your own estimates--feel free to PM me.
 
foreverbull said:
Adding to this, I would encourage @R. Matey to get a list of possible expenses that you'd be paying for as a psychologist. I have an old excel template I created as my expense sheet (Has gotten longer and more complex over time, but is a good reference) if you want for your own estimates--feel free to PM me.
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I'll take you up on it.
 
R. Matey said:
Thanks, I'm in a non-clinical position now so I wouldn't be competing directly with my employer. That's actually the issue: I have (and am paying) for a license that I'm not actively using. The initial plan was to join a group practice, but no one seems interested in less than a half-time position or, if they are, the split isn't optimal. So I'm weighing striking out on my own so I can control the amount of hours I work, but I'm trying to figure out whether it would be better to just take the split time-wise.
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Yeah, the problem with less than half time is there is very little profit in it for them because they are paying are larger percentage for hard fixed costs (business cards, website updates, office space, etc) due to the low volume. You may be better off going at it yourself in cash if it is going to be low volume unless you want to learn the ropes from someone experienced first.
 
Sanman said:
Yeah, the problem with less than half time is there is very little profit in it for them because they are paying are larger percentage for hard fixed costs (business cards, website updates, office space, etc) due to the low volume. You may be better off going at it yourself in cash if it is going to be low volume unless you want to learn the ropes from someone experienced first.
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I think it may be also worth it to me to just learn the ropes since a low-volume side practice is my goal for the time being.
 
R. Matey said:
Dumb question that I should know the answer to, but paneling: I get paneled at one practice location and I can take those panels to another practice location if I want to?
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I believe that you need to have both locations registered with the payer. If you are billing under another entity at both locations, you'll have to go through credentialing again.
 
One CPA company offered to do all my insurance billing for 5% of what I bring in. If they have to mail something to get my claims processed, the postage is on me too. Is this a fair rate?
 
eeor1006 said:
One CPA company offered to do all my insurance billing for 5% of what I bring in. If they have to mail something to get my claims processed, the postage is on me too. Is this a fair rate?
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I've seen anywhere from 3 to 15% for billing. Always good to get a few quotes.
 
Does anyone know if I can have different providers at my company contracted with different insurance panels? I don’t want to take insurance myself, but as I bring other people in, I might want some of them to take insurance. Also, it seems someone can contract as an individual provider with their NPI or as a business entity with its NPI. I know that claims still are submitted by the individual provider who would have to be credentialed, but does the business have contracts and then I credential different providers? I also have opted out of Medicare, but that clearly seems to be tied to me as the individual so in theory, i could have an employee who takes Medicare? File this question under things I didn’t learn in grad school.
 
Update on the private practice. I mentioned that last month revenue was flat and expenses higher. This month things are looking up. Just got three new solid clients today and one more for Friday. Have a new patient that will be coming to town as part of my budding aftercare/intensive outpatient program and family has agreed to a monthly fee that will increase my monthly gross revenue by about 85%. Of course, that also means I need to hire some more folks asap, but that was my plan all along. It’s just accelerated a bit. I was actually seriously reconsidering contracting with insurance companies last week, but it looks like I won’t have to now.
 
Testing Only Practices:
What is your ideal schedule and/or current schedule? I'm trying to design my ideal schedule and always wondering if there's a better way and how much volume people feel comfortable seeing without psychometric support.

Right now I only do 3-4 neuropsych evals/ week, and have the current schedule (I do my own testing).

Monday intake interviews/feedback telehealth (starting 9AM, ending by 4PM) (WFH)
Tuesday- writing /admin day/ do whatever I want (WFH)
Weds- Test 2 pts (2-3 hrs each) in the office all day
Thurs- a repeat of Tues (WFH)
Fri - either a repeat of Weds in the office , or telehealth intake/feedback from home if needed.
 
Depends on what kind of cases you see and if you do IME/forensic work as well, as these all require very different time commitments. On a non-travel week, 2 clinical patients and a range of IME/forensic cases. I don't have a set schedule, just schedule when I feel like it.
 
I'm 90% assessment / 10% intervention...I have a psychometrician for my neuropsychs, my other testing cases I tend to do, but i may have my tech do if I get too busy.

Mon: Meetings in AM, Intakes in the afternoon (I will sometimes take Mondays as a travel day)
Tues: Intakes in AM, report writing in the afternoon (or golf if not on deadline)
Wed: Follow-ups in AM/PM, IME report writing the rest of the time.
Thur: Follow-ups in AM (if needed) , IME report writing.
Fri: IME Report writing, usually a full day, but I take off sometimes for travel (Thur/Fri to Mon)

Sat/Sun: Usually 2 out of the 4 wkends I end up working at least one day, sometimes both...bc I'm on deadline. The tradeoff is I work 20-25hr/wk on my slower weeks and 40hr-50hr on my busier weeks. I purposely do it like this because I don't want to burn myself out. If I get too busy with clinical work and I have (existing) legal work pop-up, those are when I get squeezed. So instead of packing my schedule w clinical work, I will see referred cases, but I'm not looking to expand my offerings. The expert/IME work allows me flexibility on the clinical side when I want it, so I can offer some discounted/pro-bono slots to patients who need them.
 
Westbound2019 said:
Testing Only Practices:
What is your ideal schedule and/or current schedule? I'm trying to design my ideal schedule and always wondering if there's a better way and how much volume people feel comfortable seeing without psychometric support.

Right now I only do 3-4 neuropsych evals/ week, and have the current schedule (I do my own testing).

Monday intake interviews/feedback telehealth (starting 9AM, ending by 4PM) (WFH)
Tuesday- writing /admin day/ do whatever I want (WFH)
Weds- Test 2 pts (2-3 hrs each) in the office all day
Thurs- a repeat of Tues (WFH)
Fri - either a repeat of Weds in the office , or telehealth intake/feedback from home if needed.
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Like WisNeuro mentioned, a lot depends on the types of evals you're doing. I might not do more than 1 or 2 IMEs in a week (or fewer, depending on characteristics of the cases), whereas if I were 100% clinical, I would probably see 4 or 5 patients/week if doing all of my own testing. I personally would not want to be seeing more than 4-5 clinical patients/week without psychometrist support. This is assuming the clinical evals are all relatively standard outpatient neuropsych cases.
 
What do people in private practice do about Continuing Education credits? My recollection is that people here had clever methods for conveniently gaining CEs at low cost, but I don't recall the details and can't find the discussion elsewhere.
 
Therapist4Chnge said:
CEU4Less, I'm 98% sure that is the name. They offer pdf reading material, a self study exam, and then you take the real exam after each module. Cheap, efficient, and there are actually some useful presentations.
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There are a number of them like that. For any live CE requirements, there are many affordable lunch and learn options to attend virtually. Once COVID is a bit farther in the past, there are a few CE companies doing Caribbean cruises and the like I would be interested in trying.
 
beginner2011 said:
What do people in private practice do about Continuing Education credits? My recollection is that people here had clever methods for conveniently gaining CEs at low cost, but I don't recall the details and can't find the discussion elsewhere.
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I usually get all that I need for my 2 year cycle during my usual neuropsych conference. Also, my state allows some credits from being an article reviewer, which I do several times a year. Also, some states allow credits for doing presentations. See if your state association needs presenters for CEs and you may be able to snag several hours there.
 
beginner2011 said:
What do people in private practice do about Continuing Education credits? My recollection is that people here had clever methods for conveniently gaining CEs at low cost, but I don't recall the details and can't find the discussion elsewhere.
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1. AMC psychiatry departments sometimes offer CEUs for attending their grand rounds.
2. Reviewing articles
3. Reading journal articles can count for some (it's free if you already have institutional access)
4. Train.org
 
I’m considering taking on just a few telehealth private practice therapy patients (3-4 max to start) in order to earn some side income to supplement my full-time gig (9-5 m-f). My preference would be to limit to private pay only at first, as this seems to be rather easily attainable from what I’ve heard from colleagues in my area.

Given the super low overhead and accessibility, seems like a no brainer in many ways. Very much trying to not add many more working hours, hence starting small.

Has anyone gone through this process recently? Any tips? Resources? Must-reads? Must-haves in terms of EMR/billing? Leaning towards therapynotes.

Thanks in advance.
 
Harry3990 said:
I’m considering taking on just a few telehealth private practice therapy patients (3-4 max to start) in order to earn some side income to supplement my full-time gig (9-5 m-f). My preference would be to limit to private pay only at first, as this seems to be rather easily attainable from what I’ve heard from colleagues in my area.

Given the super low overhead and accessibility, seems like a no brainer in many ways. Very much trying to not add many more working hours, hence starting small.

Has anyone gone through this process recently? Any tips? Resources? Must-reads? Must-haves in terms of EMR/billing? Leaning towards therapynotes.

Thanks in advance.
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Therapynotes is what I use currently. It’s very easy to use and would probably work better for you than the direction I’m going. In other words, it is completely optimized for a very small practice. There isn’t that much to getting started in a solo practice and you will learn quickly. The first thing I did was setup an s-corp, then a business account, and then started rolling with it. You probably don’t have to do that, but why not get started learning the business aspects. I wish I had done some of that earlier. That way when you realize that it’s time to work for yourself fulltime, you’ll be ready to go. Good luck.
 
Update. Got my professionally designed website up and running - finally! Phones are ringing, going to hire some office support so that my wife doesn’t blow a gasket trying to do two and a half full time jobs at the same time. New clients from last week are sticking and it looks like the bridge to independence program is coming together. Going to add a specialty group in a few weeks as I have three clients already committed to it. Reminds me, got to advertise that group to see if I can get any outside interest. My own personal revenue generation from therapy sessions, which is what is keeping the business going while I develop other aspects, is definitely going to be up this month. The addition of two new clients in the bridge program about equals my revenue from that so that’s good. Of course, at least one of them Is going to be a 2x per week therapy client of mine so it gets a little confusing as to where to put my efforts.

It would be so much easier to just do a solo practice and last month I was thinking financially it might make more sense. After all, I am confident that I could get to a point where I would generate at least 20k a month with therapy and some testing. Even with my overhead, that would put me way ahead of the game. Now it is starting to get a bit more complicated as I have to calculate more payroll expenses as the revenue is right at what I could do just by myself. The hope is to keep revenue increasing, which it should since I’m still less than 5 months in and have a number of means of generating business, and still keep expenses low enough that it is worth it for us. As I move into this next phase, that net is going to key. If I hit 30k but my expenses are at 20k, then I’ll be just treading water. I should add my salary into the expenses too just so that I err on the side of more money in pocket than I think.

Hope you all don’t find this too boring, but it’s not like I can sleep much these days so might as well put my thoughts down. At this point it looks like my goal is to have a transitional program with maybe 50 young people. Probably about 200k a month in revenue for that, five therapists, eight mentors, three office staff. 50k for therapists, 40k for mentors, and 20k for office support, and 5k for a house for the initial phase. That could work.
 
smalltownpsych said:
Update. Got my professionally designed website up and running - finally! Phones are ringing, going to hire some office support so that my wife doesn’t blow a gasket trying to do two and a half full time jobs at the same time. New clients from last week are sticking and it looks like the bridge to independence program is coming together. Going to add a specialty group in a few weeks as I have three clients already committed to it. Reminds me, got to advertise that group to see if I can get any outside interest. My own personal revenue generation from therapy sessions, which is what is keeping the business going while I develop other aspects, is definitely going to be up this month. The addition of two new clients in the bridge program about equals my revenue from that so that’s good. Of course, at least one of them Is going to be a 2x per week therapy client of mine so it gets a little confusing as to where to put my efforts.

It would be so much easier to just do a solo practice and last month I was thinking financially it might make more sense. After all, I am confident that I could get to a point where I would generate at least 20k a month with therapy and some testing. Even with my overhead, that would put me way ahead of the game. Now it is starting to get a bit more complicated as I have to calculate more payroll expenses as the revenue is right at what I could do just by myself. The hope is to keep revenue increasing, which it should since I’m still less than 5 months in and have a number of means of generating business, and still keep expenses low enough that it is worth it for us. As I move into this next phase, that net is going to key. If I hit 30k but my expenses are at 20k, then I’ll be just treading water. I should add my salary into the expenses too just so that I err on the side of more money in pocket than I think.

Hope you all don’t find this too boring, but it’s not like I can sleep much these days so might as well put my thoughts down. At this point it looks like my goal is to have a transitional program with maybe 50 young people. Probably about 200k a month in revenue for that, five therapists, eight mentors, three office staff. 50k for therapists, 40k for mentors, and 20k for office support, and 5k for a house for the initial phase. That could work.
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FWIW, I have been appreciating these posts, finding them pretty informative. If you were writing regular full blog posts about the process you’re going through, I’d read that. Not all that easy to find specific examples of people building a mental health businesses from scratch in general let alone one that isn’t just a run of the mill solo/group practice.
 
smalltownpsych said:
Update. Got my professionally designed website up and running - finally! Phones are ringing, going to hire some office support so that my wife doesn’t blow a gasket trying to do two and a half full time jobs at the same time. New clients from last week are sticking and it looks like the bridge to independence program is coming together. Going to add a specialty group in a few weeks as I have three clients already committed to it. Reminds me, got to advertise that group to see if I can get any outside interest. My own personal revenue generation from therapy sessions, which is what is keeping the business going while I develop other aspects, is definitely going to be up this month. The addition of two new clients in the bridge program about equals my revenue from that so that’s good. Of course, at least one of them Is going to be a 2x per week therapy client of mine so it gets a little confusing as to where to put my efforts.

It would be so much easier to just do a solo practice and last month I was thinking financially it might make more sense. After all, I am confident that I could get to a point where I would generate at least 20k a month with therapy and some testing. Even with my overhead, that would put me way ahead of the game. Now it is starting to get a bit more complicated as I have to calculate more payroll expenses as the revenue is right at what I could do just by myself. The hope is to keep revenue increasing, which it should since I’m still less than 5 months in and have a number of means of generating business, and still keep expenses low enough that it is worth it for us. As I move into this next phase, that net is going to key. If I hit 30k but my expenses are at 20k, then I’ll be just treading water. I should add my salary into the expenses too just so that I err on the side of more money in pocket than I think.

Hope you all don’t find this too boring, but it’s not like I can sleep much these days so might as well put my thoughts down. At this point it looks like my goal is to have a transitional program with maybe 50 young people. Probably about 200k a month in revenue for that, five therapists, eight mentors, three office staff. 50k for therapists, 40k for mentors, and 20k for office support, and 5k for a house for the initial phase. That could work.
Click to expand...

The hardest part about such a program is the floating the overhead while you get started. A solo practice is definitely easier to establish in terms of overhead costs and time to return on investment. The advantage you will have is that long term there will be less competition if it works out and is established.
 
Harry3990 said:
FWIW, I have been appreciating these posts, finding them pretty informative. If you were writing regular full blog posts about the process you’re going through, I’d read that. Not all that easy to find specific examples of people building a mental health businesses from scratch in general let alone one that isn’t just a run of the mill solo/group practice.
Click to expand...
Glad you find it helpful. I have always found that I get more from hearing others process much more than their advice. Some of that is because I’m naturally a bit defiant and some of that is because people often give advice that is theoretical and in the gist of do what I say not what I do.

One thing I have been running into as I started this are the networkers. Very social people who think networking is everything and that is what I need to do. Initially, I thought they might be right, now I am realizing that is just one small piece of successful business strategy. I’m actually way better at some of the other aspects than I am at networking. I am really good at strategic planning and when I use that skill I can see where I need to put my energies and it is not effective for me to be hanging out with groups of people unless it very specifically ties into what I am doing and or creating. I am also good at logistics and customer service so my business works for people. I learned a long time ago in sales that increasing retention beats increasing acquisition all day long. I am also good at listening to what the customers are saying and figuring out how to meet those needs or if it fits with what we are doing. Sometimes it is hard not to try and be everything to everyone, but that is not an efficient strategy.
 
smalltownpsych said:
Glad you find it helpful. I have always found that I get more from hearing others process much more than their advice. Some of that is because I’m naturally a bit defiant and some of that is because people often give advice that is theoretical and in the gist of do what I say not what I do.

One thing I have been running into as I started this are the networkers. Very social people who think networking is everything and that is what I need to do. Initially, I thought they might be right, now I am realizing that is just one small piece of successful business strategy. I’m actually way better at some of the other aspects than I am at networking. I am really good at strategic planning and when I use that skill I can see where I need to put my energies and it is not effective for me to be hanging out with groups of people unless it very specifically ties into what I am doing and or creating. I am also good at logistics and customer service so my business works for people. I learned a long time ago in sales that increasing retention beats increasing acquisition all day long. I am also good at listening to what the customers are saying and figuring out how to meet those needs or if it fits with what we are doing. Sometimes it is hard not to try and be everything to everyone, but that is not an efficient strategy.
Click to expand...

If you realize this is really a customer service business, you are already ahead of most folks I know.
 
Are there any rules of thumb for how much you actually make in a private practice? Like let's say you net 200k a year...
 
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