Five Steps to Developing Your Brand Identity as a Therapist

The first step in developing your brand identity is identifying what your identity is. What makes you unique as a therapist?
  • Specific training or credentials
  • Working with special populations (i.e., disabled individuals, geriatrics, individuals with addictions, middle-aged women)
Next, identify the target audience for this brand. Who needs your help? What is their gender? Age? Work status? Where do they live? What do they read/watch? What other professionals or companies serve these clients? (Schools, churches/clergy, physicians, other therapists, nonprofit organizations)

Cultivate a list of outcomes these clients can expect -- what are the results?

Develop your message: What do you want to say to your target client? What problems can you help solve for them?

Next, develop your messaging strategy -- how do you want to communicate with your prospective clients? (website, brochures, newsletters, articles, public speaking engagements, fact sheets, fliers, posters, banners, magazine ads?).

Finally, develop your "product" -- what services or product will you deliver them to generate revenue? These can include: individual sessions, groups, phone coaching, on-site consultation, tapes, books/booklets, etc.

These are the first steps to marketing your practice online and offline.

Looking for EAP Affiliations?

I came across this website -- EAPBridge.com -- and found it to be an interesting concept. For $18/year, your application is submitted to EAPs across the nation for consideration to join their panels. While I'm generally not a fan of paying to join individual provider panels, you might find this a useful strategy to find out about a large number of panels at once. (Basically, it's like paying $18 for a mailing list of EAPs who have indicated an interest in receiving information about providers.)

There is at least one Omaha-area EAP on their list -- Best Care EAP -- which is affiliated with Methodist Health Systems. I'd be interested in hearing from therapists who may have used this service ... and please note, this is NOT an endorsement of this service, as I don't know much about them beyond what I read on their website.

Men & Anger Group Starts Nov. 12

'Men and Anger' is a structured, time-limited group therapy experience designed to explore individual and shared types of anger and anger expression in men. The program will be led by Jim Haley, M.A. and Tom Haley, Ph.D. of Psychological and Counseling Services, P.C. They will be discussing triggers, risks, benefits, consequences, and interventions. They will also examine learned messages about anger for men as a group as well as for the individual. A primary goal of the group will be to access complex emotions often suppressed or stunted by the anger response.
The group will meet Wednesday evenings from 5:30 p.m. to 7 p.m. for 6 weeks (Nov. 12 to Dec. 17). Referrals will ideally be individuals previously or currently in individual therapy, although this is not a prerequisite. You may refer prospective group members to either facilitator for a brief phone screening. For more information, call 330-1537.

Comments About Pricing

On the survey of private practice therapists related to pricing/fees, we also asked therapists to share their comments about the topic. Here were some of the responses:

  • "The cost of doing business is increasing, so even if the dollar amount of income hasn't changed, there is still a decrease in real income."
  • "We have to continue to work harder for less money. Insurance companies are less antagonistic, but still cautious in giving money."
  • "Tricare has reduced their rate of pay, which has counteracted my increased business."
  • Comment: "Only my pie-in-the-sky wish that insurance would use the same universal pricing and forms and processes. And that it would be a reasonable fee. Sigh."
  • I have considered going to a cash payment only, letting the clients complete the insurance paperwork, to decrease my time doing paperwork and billing, but I'm not sure doing this would work. I could reduce my fees this way and simplify my practice, leaving more time for therapy hours. In terms of pricing, I don't really have a standard fee since insurance plans pay differently. I reduce my fee for people who are financially strapped and I also do some pro bono work."
  • "Transportation has been a large issue for low income clients, which means cancellations and 'no shows.'"
  • "I do some pro bono (work) and also lower my fees for those without insurance, so I really don't have a "standard" rate, nor have I calculated my average fee."
  • I would hope that APPT and others across the nation would stand up to managed care companies and let them know with our education and licensing, we do not deserve to be paid less than our mechanics working on our cars!! Even the heating/plumbing tech and the man who cleaned our carpets made more than we as LIMHPs make per hour! Pretty sad, huh?"
  • Nebraska has a new law regarding not reimbursing provisional psychologists have made it nearly impossible to attain enough hours or income (forced to take sliding scale as low as $10!) to remain a psychologist in Nebraska.
  • "I think it would help if fees were standardized somehow. Also, it would be great if there were some way to provide services for those who are low income or uninsured that did not put us at risk for claims of insurance fraud. We really need some way to have a legal and appropriate sliding fee scale when in private practice."
  • "Tricare rates have plummeted the past two years and are now below the reimbursement level for both Medicaid and Cigna."
If you are interested in learning more about how to utilize a charity clause with your clients (to be able to work with clients who have difficulty paying, without running afoul of insurance regulations), be sure to attend the APPT Fall Conference on Friday, Nov. 7 and attend the breakout session with an attorney from Erickson & Sederstrom, who will address this issue.

APPT Pricing Survey

Want to know what other private practice therapists in Nebraska charge? The Association of Private Practice Therapists conducted a survey of its members between July and September 2008, receiving 48 responses.

To give you an idea of the background of those responding, 30 percent of therapists have been practicing for 1-5 years; 20 percent for 6-10 years; and 17 percent for 11-15 years. Another 17 percent have been in practice more than 25 years. Please note that survey responses may be skewed towards younger, more technologically savvy therapists, as the survey was administered online.

The majority of therapists who completed the survey are masters degreed therapists -- 76 percent practice as a LMHP, LCSW, LMFT, or LIMHP. Another 14 percent have a Ph.D. but practice as a LMHP. Four percent practice as a Ph.D., while 6 percent are provisionally licensed.

The size of practice environments represented in the survey responses were quite diverse:
  • 27 percent are solo practitioners
  • 25 percent are in a group of 1-3 other therapists
  • 17 percent practice with 4-6 therapists
  • 27 percent practice in a group of 7-10 other therapists.
Nearly half of respondents (45 percent) rent their own office and practice independently. Twenty-three percent rent office space from a group practice. Another 21 percent share office space with a practice group but share expenses and have an ownership role.

Despite declining insurance reimbursement rates, therapists continue to rely on managed care and insurance for the majority of their practice income. Eighty-eight percent of therapists report that less than a quarter of their income is from private pay. Only one therapist derives more than 75 percent of his/her income from private pay sources.

Therapists reported an average fee of $107.34 for an individual session. Fees ranged from a low of $60 to a high of $150, with $95 as of the most-cited fee (23 percent).

When asked the highest fee they are paid by an insurance or managed care company for an individual session, the average was $97.69 (91 percent of the average "standard" fee).

With insurance or managed care, therapists report an average "lowest fee" of $53.05 for an individual session, just under half of the average "regular" session fee.

The "lowest" fee paid by an insurance or managed care company was reported to be $30, with $60 the most often-cited lowest fee.

When it comes to couples/family sessions, the average "standard" fee is $119.02, with a low of $65 and a high of $210.

The responses for the highest fee reimbursed by managed care sessions for couples and family sessions ranged from $65 to $175, with an average of $102.42 (86 percent of the standard fee).

The lowest managed care fee for a couple or family session was $59.45, with lowest fees ranging from $30 to $110.

Therapists were asked to describe changes that affected their change in income. Among those citing an increase in practice income, taking on more clients ("working more!") was the most often-given reason. To attract new clients, therapists report doing more consulting/supervision, incorporating in "niche" treatment options, doing more work in the legal system (especially DUIs), networking more, and generating EAP referrals.

For those who reported a decrease in practice income, higher operating expenses and lower reimbursement rates are the key factors, although variability in client load, an increased number of clients who are unable to pay copayments or deductibles (or without insurance entirely), and fewer private pay clients were also cited by numerous respondents. Other factors were therapists who were out of the office with an illness for a period of time and those who decided not to accept new Medicaid clients.

Other relevant statistics:

Number of hours (on average) therapists report seeing clients and performing administrative tasks:
  • Fewer than 10 hours - 6 percent
  • 11-20 hours - 10 percent
  • 21-30 hours - 27 percent
  • 31-40 hours - 21 percent
  • 41-50 hours - 21 percent
  • More than 50 hours - 13 percent
  • Other - 2 percent
Changes in practice income during the past two years (2006-07):
  • No change - 27 percent
  • Decrease of 1-25% - 23 percent
  • Decrease of 25-50% - 6 percent
  • Decrease of over 50% - None
  • Increase of 1-25% - 38 percent
  • Increase of 25-50% - 6 percent
  • Increase of over 50% - None
Average "standard" fee charged:
  • $90 - 9 percent
  • $95 - 23 percent
  • $100 - 11 percent
  • $110 - 19 percent
  • $120 - 9 percent
  • $125 - 9 percent

© 2008, Association of Private Practice Therapists. Please contact the APPT Administrator at (402) 393-4600 if you would like permission to reprint these results. For membership information, visit privatepractice.org.

Magellan Announces Provider Changes

In June, Magellan announced changes to their provider contracting system primarily affecting provisionally-licensed therapists. Here is the text of that letter:

Dear Provider:

As you are aware, Magellan Behavioral Health* (Magellan) manages mental health and substance abuse services for Nebraska Medicaid Managed Care Plan (NMMCP) members. In collaboration with the Division of Medicaid and Long-Term Care, Magellan is implementing changes in policies regarding the inclusion of provisionally licensed clinicians for the NMMCP provider network. These changes are applicable to provisionally licensed psychologists, provisionally licensed mental health practitioners (PLMHPs), and provisionally licensed alcohol and drug abuse counselors (PLADCs).

Effective July 1, 2008, we will implement the following guidelines regarding the inclusion of provisionally licensed clinicians for the NMCCP provider network:

  • Provisionally licensed clinicians who are currently NMMCP network practitioners in private or group practices will be "grandfathered in" and will remain in active status in the NMMCP network for up to two years, or July 1, 2010. As of July 1, 2010, practitioners must be fully licensed to continue network participation in private or group practices.
  • Provisionally licensed clinicians who are employed by an NMMCP-contracted organization will continue to be accepted for network participation. However, provisionally licensed clinicians who terminate their employment from an NMMCP-contracted organization will not be eligible for network participation in group or private practices until such time they become fully licensed.
  • Provisionally licensed clinicians who are not currently credentialed and contracted for the NMMCP provider network will not be accepted for network participation in private or group practices.
  • In order to remain in active network status, existing NMMCP network practitioners in private or group practices who have a provisional license due to expire prior to July 1, 2010, must become fully licensed prior to the expiration of their initial provisional license. Practitioners will not be allowed to continue network participation on a renewed provisional license.
Thank you for your cooperation with this matter. If you have any questions, please contact Teresa Danforth at (402) 437-4241 or Kathy Dinges at (402) 437-4214.

APPT Survey: After-Hours Emergency Policy

Recently, the Association of Private Practice Therapists conducted a survey of its members to determine if there is a local standard for how after-hours emergency calls are handled.

The survey was commissioned by the APPT Board of Directors in response to an insurance/managed care company's request for a therapist's after-hours emergency policy.

The full results of the survey will be reported in the October 2008 issue of The Compass, the newsletter of the Association of Private Practice Therapists. Beyond the results, however, it appears as if therapists may be struggling with their ethical requirement to serve clients with the practical applications of after-hours service -- of particular issue with sole practitioners.

"We have maintained the cost of a 'company' cell phone and a live answering service for many years," one therapist writes. "We have begun to question the need and utility of this, and will likely drop this soon. At the end of the day, if someone has a crisis that is life-threatening, talking to us just delays going to the hospital."

Magellan Health Offers Online Learning Tools

Magellan Health Services Inc. is offering therapists a new online learning center designed to reinforce resiliency and recovery principles. The Magellan Resiliency and Recovery e-Learning Center enables consumers, families, and providers to effectively apply the principles of hope, choice, empowerment, and education to help achieve individual behavioral health goals.

The e-Learning Center offers broad access and greater convenience than traditional on-site learning programs, and without the expense. It's a free resource that currently hosts 10 interactive "e-courses" in Spanish and English, offering in-depth strategies and techniques for promoting resiliency and recovery. The e-courses include testimonials of personal experiences that provide motivation and each can be completed in 30-45 minutes.

Magellan providers are able to receive Continuing Education Units (CEUs) for completing the e-courses. Magellan is approved as a continuing education provider/sponsor by the American Psychological Association, Association of Social Work Boards, National Association of Alcohol and Drug Abuse Counselors, and the National Board of Certified Counselors.

August 15, 2008 Meeting Agenda


Conversation with Medicaid/Magellan for Private Practice Therapists:
What the LIMHP means to you, Documentation and other Requirements, 
Impact of LIMHP on other Insurance Panels, and More

Mahoney State Park
August 15, 2008
8:15-12:15 PM

8:15 – 8:45  Networking and check-in

8:45 – 10:00 Medicaid/Magellan speakers
A.    LIMHP versus LMHP
B.    Definition of “supervision” versus “consultation” in private practice
C.    Documentation and bookkeeping requirements for Medicaid/Magellan
D.    Definitions unique to Medicaid (ie. family therapy)

10:00 – 10:45 question and answers

10:45 -- 11:00 Break

11:00 – 12:00  Erickson & Sederstrom: Legal issues
A.    Medicaid Federal Audits
B.    What does the LIMHP status mean for private practitioners in Nebraska
C.    LIMHP versus LMHP and provider panels
D.    Good Documentation

12:00 – 12:15  Q & A

Don't Need Any New Clients?

Congratulations. You don't need to read this post.

For everyone else, you may already know that as soon as you stop seeing new clients, your practice begins to stagnate and die.

Even if you have clients who are committed for life -- things change. People move. People die. People are "cured" and no longer need your services. Natural attrition is reason enough for you to continually seek out new prospects for your services.

Your success as a private practitioner depends on five things. They are:
  • Your ability to assess the needs of your clients.
  • The ability to provide services that meet your clients' needs.
  • Skill in communicating the benefit of your services.
  • Providing follow-up to keep a loyal and satisfied clientele.
  • Developing and maintaining a professional network as a referral and support system.
How are you doing in meeting your goals in all five of these areas?

Using Your Mailing List Effectively

Mailing lists are an excellent way to increase your referrals.

  1. Build a mailing list of all past and present clients and referral sources. Also consider adding your suppliers (vendors) and members of the media.
  2. Send a mailing to everyone on your list at least quarterly, whether it's a newsletter, copeis of news clippings or articles, announcements of TV or radio appearances, workshop or group notices, special offers, or just general information about your services.
  3. Keep your mailing list up to date -- add the line "Address Correction Requested" below your return mailing address. You'll have to pay for the address correction notice you receive, but it's cheaper than undelivered mail.
  4. Include a request for more information in all your mailings. This can be a simple box that asks "Want More Information About Our Services? Call 000-0000" or it can be as elaborate as a postage pre-paid postcard.
Interested in mailing to other mental health practitioners? Call APPT at 402-393-4600 on how to get a list of all licensed mental health practitioners in the state, or just those in our database.

The Cost of Mental Illness

The National Institute of Mental Health just released a study that quantifies the cost of lost productivity due to mental illness at more than $193 billion annually.

A key finding:
Mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.

The bad news is that suffering from a serious mental problem also affects a person’s ability to work, thus leading to earnings lost for those involved and for the U.S. That was exactly what researchers at the NIMH wanted to underline in their study.

Mental Health Issues of Iraq Vets

Up to 20 percent of Iraq and Afghanistan veterans may have mental health issues, according to a Rand study. The article on the U.S. News blog reports that some 300,000 troops report symptoms of post-traumatic stress disorder or major depression. Slightly more than half have sought treatment, according to the study by Rand.

Rand researchers estimate that PTSD and depression among returning U.S. troops will cost America some $5.2 billion in the first two years after their return. Since 2001, about 1.6 million U.S. troops have been deployed to Iraq or Afghanistan.

Researchers surveyed 1,965 U.S. troops across the country. Half said they had a friend who was seriously wounded or killed, 45 percent said they saw dead or seriously injured civilians, and more than 10 percent said they were personally injured and required hospitalization.

Neurofeedback/Biofeedback Presentation-February 2008

Mary Glassman, RN, LCSW and Dr. Lisa L. Merrifield presented a mini-series workshop on Feb. 4 on biofeedback and neurofeedback.

Biofeedback and neurofeedback are tools that assist individuals with improving functioning in areas such as education, performance, and disease management.

Mary Glassman graduated with a R.N. degree from the University of Nebraska Medical Center and she has a Masters degree in Social Work from UNO. She has been certified in biofeedback for over 25 years. Mary has a private practice in Omaha in which she specializes in chronic pain and anxiety, utilizing biofeedback and neurofeedback.

Contact information for the two presenters:

Mary Glassman, RN, LCSW
702 N. 129th Street, Suite 105
Omaha, NE 68154
Phone: 402.898.3141
Fax 402.431.1535

Dr. Lisa L. Merrifield
1941 S. 42nd Street, Suite 539
Omaha, NE 68105
402.345.2374

How to Write a Letter to the Editor

One way to increase your visibility and credibility as a mental health therapist is to write a letter to the editor for your local newspaper.

A letter to the editor is your chance to inform the public about an issue that is of concern to you. Letters to the editor are one of the most frequently read sections of the newspaper, and your contribution can help increase public support for mental health care issues.

Here are some tips to help you with the letter writing process:
  • Always address your letter to "Dear Editor"
  • Letters to the editor should be short -- a maximum of three to four paragraphs (100-200 words)
  • Keep your sentences short and to the point.
  • Stick to only one theme per letter (for example, "confidentiality" or "reimbursement")
  • Use your letterhead, and make sure to include your full name, credentials, and a contact phone number
Format:
  • If your letter is about a controversial issue, start your letter with your credentials. If you're responding to an article or another Letter to the Editor, be sure to reference it in the opening paragraph.
  • The next paragraph should convey some brief background material. Use the APPT handouts for statistics, facts, and figures regarding the issue (when applicable).
  • State your opinion (pro or con)
  • Tell the reader what you want him/her to do.
Sample Letter:

Dear Editor:

As a licensed mental health practitioner in private practice, I am writing to express my concern about the lack of confidentiality for clients who seek medical and mental health services.

Most people don't know that when they visit their health care provider that a lot of sensitive material is provided to their insurance company as part of the claim filing and reimbursement process. More than just the date of service and a description of the procedure is often required before payment is made. Many times, insurance companies want more -- much more -- like treatment reports, x-rays, chart notes, even copies of your entire file, before they'll pay on even the simplest claim.

I believe that an individual has a basic right to privacy. Insurance companies have not been able to guarantee that they can keep the information that is provided to them safe and secure. I support LB xxx, the healthcare patient protection act, to keep your personal information personal. It's a basic patient/physician privilege, and it doesn't exist right now.

Sincerely,

John Doe, LMHP
Licensed Mental Health Practitioner
Public Counseling Center
Lincoln, Nebraska
402.555.9202

Quench Your Thirst for Knowledge with Paperspine

Paperspine | Changing the way book readers enjoy reading. Why buy when you can rent?

Like to read books, but don't want to invest in creating a permanent library? There's a new service, Paperspine, that is like a Netflix for books.

For as little as $9.95 per month, you can "rent" books like: The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients, War and the Soul: Healing Our Nation's Veterans from Post-Traumatic Stress Disorder, and Minding the Body, Mending the Mind.

There are older books, as well as many new books (published in 2007). The categories of Psychotherapy and Psychology are particularly relevant for therapists.

The subscription may also be tax-deductible if you use it for business books.

Your 2008 Business Plan

December is traditionally the time for private practice therapists to put together their 2008 business plan.

The first step is anticipating revenues. Calculate your hourly rate (not how much you bill, but how much you expect to collect), how many clients you will see, and how many days you will work per year and multiply these amounts. This is your projected revenue per year

From that, you'll need to calculate your expenses--malpractice insurance, rent, electricity, materials, association dues, and marketing. Your overhead will likely equal 30% of your income. Also calculate projected taxes and set aside funds for retirement and capital improvements (new office equipment or furniture, etc.).