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.”
Showing posts with label Pricing Survey. Show all posts
Showing posts with label Pricing Survey. Show all posts
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."
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:
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:
© 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.
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.
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
- 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
- $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.
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