From May 18 to June 14, 2009, APPT conducted a survey on therapist fees. The survey received 31 responses. The responses were fairly similar to the 2008 survey results (reported in the Fall 2008 issue of The Compass). Comparisons to 2008 results were included, where applicable.
Thirty percent of therapists responding have been practicing for 1-5 years; 17% for 6-10 years; 17% for 11-15 years; 10% for 16-20 years; and another 16% for more than 20 years.
Thirty-seven percent of respondents spend 31-40 hours in their practice each week.
Number of hours (on average) therapists report seeing clients and performing administrative work):
Fewer than 10......................3%
11 to 20 hours......................10%
21 to 30 hours......................17%
31 to 40 hours......................37%
41 to 50 hours......................33%
More than 50 hours..............0%
Compared to 2008 figures, therapists are working longer hours than they were in Fall 2008.
The majority of therapists who completed the survey are masters-degreed therapists — 87% practice as a LIMHP, LMHP, LICSW, LCSW, LMFT, LADC, etc. Ten percent have a Ph.D. but practice as a LMHP. No psychologists or psychiatrists responded to the Spring 2009 survey.
Groups of all sizes were represented in the survey:
• 40% of respondents reported they have a solo practice.
• 7% are in a group with 1-3 other therapists.
• 23% practice with 4-6 other therapists.
• 23% are in a group with 7-10 other therapists.
• 3% practice with more than 10 other therapists.
More than half of respondents practice independently, renting an office space (53%). Another 23% share office space with a practice group but share expenses and have an ownership role. Thirteen percent simply rent space from a practice group.
Therapists continue to rely heavily on insurance and managed care for practice income. Sixty-three percent of respondents report that less than 10% of their practice is private pay. Approximately one-third of therapists report that less than a quarter of their practice income is from private pay.
When asked to compare practice income to 2008 figures, therapists reported:
No charge in income..................20%
Decrease of 1-25%.....................47%
Increase of 1-25%......................23%
Increase of 25-50%...................10%
Top factors cited in a therapist’s INCREASE in income:
• Seeing more clients than previous year.
• More referrals (becoming better known)
• “Being more selective with clients I work with — keeping the cases that I can really do a good job with, and referring ones that others could excel with — results in client satisfaction and their continuing in therapy.”
• Raised fees.
• Doing more private pay work versus insurance/managed care.
For therapists who cited a DECREASE in income, factors included:
• “The economy affecting client’s ability to pay or seek out mental health services or pay their deductible or copay.”
• Managed care reducing fees and insurance reimbursements decreasing.
• “Saw fewer clients due to increase in time required to do paperwork for Medicaid/Magellan.” Another therapist also mentioned a reduction in profitability, due to “increased costs to ‘manage’ managed care.”
• Loss of state contract.
• Private pay clients not paying.
• Clients losing insurance benefits or changing insurance carriers.
• Fewer new clients to replace those who have completed therapy.
With declining reimbursements squeezing therapist pay (and profits!) therapists are implementing systems to reduce their receivables. One noted, “I collect co-pays and deductibles via credit card so I carry no balances anymore.”
Survey respondents reported an average fee of $106.13 for an individual session. Fees ranged from $90 to $150, with $100 as the most-cited fee (26%). Compared to 2008, the average fee dropped $1.21 (from $107.34 to $106.13), although the most-cited fee in 2008 was $95. Due to the small sample size, the drop in average fee could be accounted for by the lack of psychologists and psychiatrists responding to the survey, since their average fee is higher.
Anecdotally, it appears that several therapists may have raised their rates between Summer 2008 and Spring 2009, accounting for the increase in the “most-cited” fee.
When asked the highest fee they are paid by an insurance or managed care company for an individual session, the average was $98.00 (or 92% of the “standard” fee). This is right in line with last year’s results, where the highest fee paid by an insurance or managed care company for an individual session was 91% of the average “standard” fee.
The lowest fee paid by an insurance or managed care company was $20, with $60 as the most often-cited “lowest” fee, followed closely by $40. In 2008, $60 was also the most-often-cited lowest fee paid by an insurance or managed care company for an individual session.
When it comes to couples/family sessions, the average “standard” fee is $121.72, with a low of $90 and a high of $175. The average fee is a small increase from 2008, when the standard fee was $119.02. Most responses (59%) ranged from $100-$120.
The response for the highest fee reimbursed by managed care companies for couples and family sessions ranged from 65 to $143.91, with an average of $104.71 (86% of the standard fee, the same as 2008 figures).
The lowest managed care fee for a couple of family session was $59.45 on average, with the lowest reimbursement ranging from $27 to $110.
One therapist who was frustrated by managed care companies reducing their reimbursement rates noted, “My plumber, housekeeper, mechanic, HVAC guy, and gardener make more an hour now than I do.”
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