[ALISON PIDGEON]
I’m Alison Pidgeon, and along with Whitney Owens, we are business consultants for Practice of the Practice.
[WHITNEY OWENS]
And we’re here to tell you about Group Practice Boss. If you have a growing group practice and are looking for ongoing business support, we have a new membership community, especially for you.
[ALISON]
Every month, we’ll be taking a deep dive into topics like group practice owners need to know like how to manage people, how to manage your money and marketing and branding.
[WHITNEY]
For more information, go over to www.practiceofthepractice.com\grouppracticeboss.
[ALISON]
This is the Practice of the Practice podcast, episode number 561. Welcome. So we’re in the middle of a podcast takeover. I’m Alison Pidgeon, your host. I’m one of the business consultants here at Practice of the Practice and I am doing a five-part series talking to folks from our Group Practice Boss membership community, and we’re doing live consulting sessions, which is really fun. And today I am talking to Anna Saviano. She has a group practice in Kansas City, Missouri called Heartland Therapy Connection and she is really just in the first few months of starting up the group practice and has a typical questions about getting started and we have a really good conversation. So if you are thinking about starting a group practice, or if you’re just in the beginning stages, this would be a great interview or consulting session for you to listen to. So here is my consulting session with Anna Saviano. Hi, Anna. Thanks so much for joining me on the podcast today.
[ANNA SAVIANO]
Yes. Thank you so much for having me. I’m excited.
[ALISON]
Yes. Can you give us a little bit of a brief introduction about your practice and just kind of the different components of it so people have an idea of what your practice is like?
[ANNA]
Yes, sure thing. So I own a small private practice, group private practice. Right now we have three clinicians, one admin. I’ve been in practice over 10 years and in private practice, like eight, but this is my first group practice. I hired my first clinician as a contractor in January of 2020, and then rolled her into a W9 in the fall of last year, I think around the time I was looking also to hire a couple of other people that I hired as W2’s straight out of the gate in January of this year, 2021. So they were kind of onboarding in the winter and then started taking clients in January.
[ALISON]
Nice. So they’re all W2 employees?
[ANNA]
Yes.
[ALISON]
Perfect. Okay and do you take insurance or are you are self-pay?
[ANNA]
Self-pay. Yes, I do contract with the VA, but that’s just me. So everybody on my team is only self-pay.
[ALISON]
Cool. And does your practice have a particular niche?
[ANNA]
We are trauma focused and really wanting to serve like our immediate community. We work in kind of the middle of the city more or less, and we’re pretty close to the university. So we partner a lot with them. In fact, all of our team went to UMKC and so we focus a lot on the kind of community aspect and then also trauma.
[ALISON]
Excellent. So the purpose of our podcast episode today is for you to get some consulting. So you’ve prepared a list of questions and I actually haven’t seen them ahead of time so it’ll be just like a real consulting call.
[ANNA]
Yes. So I’ve done some consulting with Whitney and I’m in the Group Practice Boss group. So there’s a lot of information and it feels like my current state of things is that I’ve been like hardcore hustling, overwhelmed, a million things all the time to do, trying to get processes and all that stuff in order. And now I think there’s like a little bit of space on the horizon.
[ALISON]
Excellent.
[ANNA]
I haven’t taken, yes, it’s exciting for me. I haven’t taken any new clients in a long time, but I have a couple of things going on. One is returning clients folks that I saw two years ago or whatever that want to come back. I’m trying to figure out how to navigate that as well as just get my caseload into the space that I needed to be, to do everything else that I need to do, but then also needing help kind of identifying how to spend my work hours most effectively because I’ve always just seen a ton of clients and then done whatever other little things outside of seeing clients that I could make happen. But now I have probably more time and need to allocate it wisely and have the processes in place to support that.
[ALISON]
Ah, yes. Great question. So kind of, instead of being reactionary, being more proactive?
[ANNA]
Exactly.
[ALISON]
Exactly. Okay. So it sounds like you have a couple of questions in there, but let’s start at the beginning where you asked about how you kind of reduce your own caseload. if you could give us like a little snapshot of how many people do you see now, how many people do you eventually want to see, what would be more ideal for you?
[ANNA]
Well, I see probably in like 20 to 24 now. It varies there, like, because I haven’t taken him any new, there are people that I see every other week. So I have kind of like an every other week more busy than the alternate weeks kind of happening, but I’ve shifted a lot to not seeing anybody after school on Tuesday, Wednesday, Thursday because I pick up my kids those days and it’s like, that’s a boundary. So Monday is a long day and then just school hours during the week, Tuesday, Wednesday, Thursday, like I said, and then some people on Friday. Probably it should be closer to like, I don’t know, 15, maybe 12. I’m not even sure what the, I don’t even, that’s kind of, part of the whole thing is like, what should I even be aiming for and how do I get there when I have twice that many people more than twice?
[ALISON]
Right. Yes, and so I think 20 to 24 clients a week is really a full-time caseload. And then obviously to have, starting group practice on top of that probably feels like a lot.
[ANNA]
It does feel like a lot.
[ALISON]
Yes, I think it’s smart that you’re thinking about how do I kind of reduce my caseload and be more proactive about spending my time building up the group? So I think there’s not necessarily like one right answer. It probably comes down to somewhat of your preference and your own comfort level with how quickly you want to shed some of those clients. I know some practice owners that will basically just say I’m shrinking my work hours and I don’t have time to see you. I need to transfer you to another client. I know for other people, they don’t feel very comfortable with that. When I was shedding clients, I did it very slowly over a period of time. So as people finished up, I just didn’t take any new clients.
New Speaker:
An interesting thing too, with the pandemic is that obviously clients who were doing really well and sort of graduated from therapy are coming back, because now they have this new stressor that’s been introduced into their lives. And so while it’s great that you’re getting those return clients at the same time, not so great when you’re trying to free up time to do practice building stuff. So in that situation again, I think you’d have to decide if they’ve been out of treatment for awhile, would it feel comfortable to you to recommend one of your other therapists say like, “I’m so glad you reached back out for therapy, but I’m like book solid right now. But you know, my associate has openings,” and really kind of sell them going to see the other therapist. What do you think about that?
[ANNA]
There are definitely, there are people I’ve done that with, there are some that I could probably do that with. I’ve tried that for a little while where it was like, “I’m happy to wait.” I was like, Okay. So I need to be a little firmer on what that means.
[ALISON]
Yes, I think too, I mean, I don’t know what role your administrative assistant plays, but I know when my administrative assistant took over answering the phones, it was a lot easier for her to say no than it was for me to say no.
[ANNA]
Sure.
[ALISON]
So maybe being really clear with her, like, “There is no waiting list. Like they either see somebody else or we need to refer them out.”
[ANNA]
Yes. So I should maybe have her follow up, because these are folks that reached out to me directly because I didn’t use to have an admin person. So everything came to me. So they just have my direct contact information, but maybe have her follow up with them and then she can get them scheduled with one of my people.
[ALISON]
Yes. I think that’s a fantastic idea.
[ANNA]
Yes. What about the folks that are currently seeing me and doing that —
[ALISON]
Yes, I guess my other question is like how long has it been since you raised your rates because it sounds like if you’re overwhelmed with clients, you’ll probably do.
[ANNA]
I raised them in January of last year or sometime. No, I think it was in the fall of last year, sometime last year. I can’t remember when. It was kind of like —
[ALISON]
Okay, so it has been six or seven months?
[ANNA]
Yes. It hasn’t been, well, I don’t know. It’s been that long. I don’t know how often people do that.
[ALISON]
Yes. I mean, typically at least once a year we recommend people raise their rates, but if you’re overwhelmed with clients and obviously you, as the owner are going to be preferable, so we always recommend the owner sets their rates higher than the other staff in the practice. So I don’t know how much higher you are compared to the other therapists, but —
[ANNA]
I’m 50% higher.
[ALISON]
50% higher? Wow. Okay.
[ANNA]
Yes. The folks on my team are provisionally licensed, so they’re under supervision. So they’re all kind of like on the low-ish range.
[ALISON]
Got it. Yes. I mean maybe another solution would be, maybe it’s time to look for somebody who can sort of be your clone, right? Like a fully licensed person who does very similar work to you. So that way, when people do call who obviously want to work with you, because you’re probably the best known clinician in the practice, you can say, “Well, I’m full, but so-and-so has the same expertise in the same niches I do. I recommend you see them.”
[ANNA]
Right. Yes, my first hire is kind of that person, but she’s not finished her licensing. She’s like a little over halfway there. So a lot of people, it’s easy to send to her because we have a lot of the same credentials and that kind of stuff and so I can do that pretty smoothly. It’s the folks that I’ve been seeing probably for a longer amount of time and they just want to keep seeing me forever.
[ALISON]
Right. Right. So I guess that means that, you know, you have a few different choices, right? Like you could just decide, “Okay, I’ll just keep seeing these folks until they are done with therapy and then I just don’t take any new clients and that’s naturally how I’m going to widow my caseload down.” Or maybe you want to give them a 90 day, 120 day window just to say, “Hey I’m changing my schedule based on my family’s needs or my different priorities with being the owner of the practice.” And starting in typically when the school year changes is always a good time to change schedules because people are used to schedules changing anyway. So like I don’t know when school lets out where you are, but here’s the beginning of June. So that’s usually a good time to change schedules or like when school starts up again in the fall. So you’re giving people ample time to basically say like, so it’s not so abrupt that you’re just like tomorrow you’re like, “Oh, by the way, I’m not, can’t be your therapist anymore.” It’s funny how when you put a deadline on that kind of thing. It really helps propel people to get better, like faster, because they know that there’s an end date.
[ANNA]
Yes. I think a lot of the folks that I’ve seen for a long time are people that probably figure there’ll be in therapy kind of like forever-ish. And so that’s kind of shifting the narrative that they have around it. But that feels like a good plan to say at the end of the school year or at the end of May or something.
[ALISON]
Or, “The end of the summer or beginning of the summer, my schedule is going to change and I’m just going to have less spots open for therapy clients. And so here’s your options. We can sort of try to get all of your goals completed by that time so you can be done with treatment or we can transfer you to somebody else.” Obviously it gives them time to think through the options and also wrap their head around the change.
[ANNA]
Yes. I like that idea.
[ALISON]
So may not be a short term relief of, “I can work less hours,” but at least you’re like moving in the right direction.
[ANNA]
Yes. That’s really helpful because I’ve been doing this, but it’s going really slowly, which is fine, but there’s just not quite enough decrease in clients, hours, so —
[ALISON]
Right. Yes. And so then your next part of your question was about how do you start to maybe be more intentional around planning out your time?
[ANNA]
Yes.
[ALISON]
Yes. So a good thing to think about, and this is something you don’t necessarily need to answer right now, but good thing to think about and actually write down would be, what do you want to do in the practice and what would you prefer to delegate out? I think a lot of times we just get you so used to doing everything ourselves that we don’t stop to think like, “Oh wait, I don’t need to be the one building the website and cleaning the office and running the errands and, and, and. So you know, you may not be able to delegate absolutely everything right now just because of money or maybe it takes time to find the right person or whatever, but I think at least to have that on your radar and then like take it out periodically and look at it and see, “Oh, am I in a place now that I can delegate out this other thing that I had written down?”
[ANNA]
Yes. That feels helpful on kind of like a high level way to think about it. I think right now, the way that this shows up most for me is that like, if I have a couple hours, a time that I’ve allocated to work, how do I best determine what needs to get done when all of the like little fires are dealt with? What’s the next level of prioritization?
[ALISON]
Yes. That’s a great question. And it is really easy to get sucked into those little fires too, or get sucked into answering a bazillion emails. So that would be another recommendation I would have is like, whatever time this is that you set aside to do these other things, like definitely turn off those distractions or those little fights. Like close down your email browser because that can suck you in really quickly and then you don’t get done what you had planned to get done. So to answer your question, something that I would recommend is making what’s called a strategic plan and we actually have a form, like a template kind of worksheet around this in Group Practice Boss. I don’t know if you were in that webinar that we did. So I’ll explain what a strategic plan is for everybody else if they haven’t seen it.
New Speaker:
But essentially what you’re going to do is plan out your whole year. And so the you’re going to talk about what are your mission and your vision and your values because you want that to kind of be a guiding light around the goals that you make for the year. You don’t want to get distracted by the next shiny object and sort of lose sight of what was my original intention here. And the first part of the document is just doing like a brain dump of like all the things you want to do. Like I want to make sure we do this training or we fill up everybody’s caseloads or whatever that is. And then the last part of the document is kind of, helps you sort of clean up your brain dump and organize things.
New Speaker:
Because typically what happens is there’s a bunch of stuff that all kind of ends up going together and like categories. So let’s say one of your big goals for the year is, “I want to expand. Right now I have three clinicians. By the end of the year, I want to have six clinicians.” Well you really have to then break down the little baby steps that it’s going to take to get there. Like if I want to have three more clinicians between now and the end of the year, I have eight months. So that means April I got to hire one, maybe July I’m going to hire another one, maybe September I’ll hire another one. So you’re sort of like breaking down the little baby steps that it’s going to take to get there, if that makes sense. So I think if you did something like that, then when you have your time set aside to work on the business and work on those bigger goals, you’ve set those bigger goals, but you’ve also broken them down into little micro goals. And so you know like, “Okay, if I’m going to hire in April, by this date, I need to put up a job posting. By this date I need to do all my initial screening calls. By this date I need to start scheduling interviews.” Does that make sense?
[ANNA]
That’s perfect. That’s super helpful. I’m just writing things down.
[ALISON]
Okay. So if you could state one goal that you have for yourself this year, what would that be? And then maybe we could sort of walk through how to break it down, if that would be helpful.
[ANNA]
Well, my biggest goal is to decrease my caseload. Two of the folks on my team are not yet maxed out and so getting the referral flow more predictable, I guess, more solid. We’ve done like a lot of little things here and there. I mean, not all little but that has been pretty slow, I think. And so working on that, generating referrals and having that really going well so that I can probably hire one or two people. I don’t know if by the end of the year space becomes like a thing that we’ll have to figure out because we have four offices right now.
[ALISON]
So I think, yes, that’s a great goal. So you’re basically realizing that in order to fill up the other therapist caseloads and have them become more known in the community, you obviously need to do some more marketing. So if we were going to, I don’t know how much you’ve done with marketing already, but if we had to break that down a little bit, I would say one recommendation I would have for you is work on cultivating at least 10 to 15 different referral sources. I think a lot of people don’t realize kind of the variety and the breadth of referral sources that they’re going to need for group practice. And there’s just periods of time during the year where like one referral source might dry up and then you still have like 10 more who are still sending you clients. Does that make sense?
[ANNA]
Yes, totally.
[ALISON]
Is that something that would be a good micro goal to work on?
[ANNA]
I think so. We just, like, I’ve had a list going for two years of who I want to be connected with in that kind of way and have done different things, but nothing super official. And then actually just this week we sent out like an intro to us with a note pad, all of our contact information and names and all that stuff. And really working on Google My Business at our website so that there’s like Google content happening, but that’s not obviously direct referral source, but trying to get our internet SEO stuff more productive, I suppose.
[ALISON]
Yes. That’s great. And I think that could be considered one referral source, because we know that SEO can have a pretty dramatic impact on the amount of referrals that you get. But I think too, a lot of people make the mistake of either trying to do all digital marketing and then they don’t do enough kind of in-person or face-to-face marketing. So maybe looking at what you already have happening and seeing if one or the other is kind of being neglected to make sure you’re ramping up the marketing and the other so to speak.
[ANNA]
Yes. I mean, my experience in it is so minimal because of just where I have worked and how I came into like being a therapist in my community was at the beginning, like places that had a lot of referrals and then it was just me. And so I’ve never really had to do this, so it’s a very steep learning curve. So when you say like face-to-face marketing, what does that look like, especially right now when face-to-face is not really that cool. Although I’m also in the Midwest where there’s plenty of places that people are vaccinated and, or not wearing masks.
[ALISON]
Yes, yes. So I mean face-to-face marketing can be a variety of things. It can be giving a talk in the community. It could be a coffee date with other therapists or a healthcare professional who would be an obvious referral source. It could be going into a doctor’s office during lunchtime and trying to meet those providers. So it could mean lots of different things, but I feel like our profession is one that is so personal that other providers really want to sort of meet you and vet you before they feel comfortable, like referring their clients or patients to you. So I think more so than another business, like we really just have to you know, put ourselves out there and make those connections in the community.
[ANNA]
Okay. I actually, like I did this a little bit informally with my pediatrician, my kids’ pediatrician and so probably making a more official hand-off of information and that kind of stuff with her would be a way to do this because one of the people, two of the people on my team see kids, work with adolescents, teenagers.
[ALISON]
Yes. Great.
[ANNA]
And so making that more of a concerted effort sounds like what needs to happen.
[ALISON]
Yes. And I would say too, obviously now with COVID you can set up Zoom meetings or phone calls. People are very used to that. So that just kind of took the place of actual in-person meetings. But the other thing too, that I think people forget about is that you may have to kind of nurture that relationship. You know, you might have to reach out a few times before they start sending you clients. And then as well, we found that the referral sources would kind of forget about us after like three months went by. So we have to go back on a regular basis and like remind them that we’re still there. So consistency is really important with marketing too. And so these are the kinds of things that you could do in that time that you have set aside. Like when the practice was smaller, I would take, let’s say a Friday afternoon and I’d actually drive around to the different doctor’s offices and like hand out our marketing materials and try to say hi to the office manager or say hi to the referral office or whatever, just to kind of put a face to a name and see if there was anything they needed and continue nurturing that relationship.
[ANNA]
Okay, cool.
[ALISON]
So that would be a super good use of your time
[ANNA]
This is where I get slightly neurotic when it comes to like processes and such thing. Do you like put that on a calendar or keep it in a spreadsheet or something like that to keep track of who you’re reaching out to, when and how and all of those things?
[ALISON]
Yes, yes. We have a spreadsheet. So if we want to, we kind of switched to sending out mailings once we got enough people on that list that it became impractical to like drive to all the offices. So we keep a spreadsheet so we can easily like send out the mailings and then yes, we also have, it’s not me anymore, but somebody who keeps track of the fact that that needs to happen every quarter and actually has like in their calendar a reminder, like we need to send these marketing materials out again.
[ANNA]
Yes. Okay, that sounds good.
[ALISON]
Yes. So is that helpful? I know we obviously didn’t get into too many specifics, but at least gives you a direction for how to start planning your time.
[ANNA]
Absolutely. The strategic plan I think, is going to be really helpful because I think, you know, knock on wood, I’m getting caught up on some of the just hustley stuff that I’ve had to spend the last six months doing, just getting all of the things in place, like payroll and all that kind of stuff. So I’m feeling good about having a little bit of time to organize things now and wanting to have the proper processes in place so that, so the things are scalable.
[ALISON]
Right. Yes, so something else too, just to keep in mind is you’re in the exact right stage to really start looking at keeping track of data to make sure things are running well. Like before you add any more people or add more clients, especially now that you have the administrative assistant, really looking at what types of things do I need to be looking at on a regular basis, just to make sure things aren’t falling through the cracks or small problems are getting caught before they become big problems.
[ANNA]
What is on that list of the things that need like weekly attention? Is that kind of the —
[ALISON]
Yes, so, and not necessarily weekly attention from you, but just somebody needs to be kind of keeping eyes on it. I would say for example, like when my practice was your size we would like look at the aging report every two weeks just to make sure there weren’t any outstanding balances. Once a month we’d check to make sure all the progress notes are done for the previous month. You might want to keep a pretty close eye on the, we keep a call log and see what is the conversion rate, like how many people, all your administrative assistant scheduling versus not, and are the calls being answered right away or how long is it taking them to get back to the person? That kind of thing that, looking at the call log actually tells me a lot about marketing as well. It tells me do I need to ramp up the marketing because there’s not enough calls, are there plenty of calls and I can pull back on something? Is there a new referral source that I had never heard of before that now is sending us a bunch of clients and I want to reach out and thank them? So I would say, I look at that the most, I look at that every single day.
[ANNA]
I’m happy to say that we’re doing all three of those things, as far as the aging and the progress notes, either me or my assistant or both of us kind of. She’s still figuring stuff out. So yes, that’s reassuring.
[ALISON]
Good. So there’s actually a whole bunch of different data points that you could track. And again, that’s information we have in Group Practice Boss, and we did a webinar on it. So if you really want to dive into the nitty gritty of the like numbers and spreadsheets, it’s all there.
[ANNA]
Is that a tool or is that in the, is there a webinar you said?
[ALISON]
Yes, it’s a teachable they’re recording. And then also, I think I had made a spreadsheet to show as an example. Yes. So was this helpful for you today, Anna?
[ANNA]
Yes, definitely.
[ALISON]
Good. Do you want to kind of maybe just give us a kind of summary of what you’re going to plan to do for homework or what you mean to —
[ANNA]
Yes, for sure. Definitely I have not spent enough time on Teachable, so I’m going to look at that, probably put that at the top of the list of what I can do during those downtimes for the moment. And I like a lot, the idea of how to start shrinking my caseload by giving folks like long-term sort of end of summer, probably this will shift so that the people who need that long runway to adjust. We’ll have the time to do so and really work on getting the people that are coming back onto the schedules of my teammates and, or getting their loads built just in general. So really probably starting with a couple of referral sources and delegating some of that legwork to my assistant and to follow up with some of those too, and just see about, if we can pop in or do a Zoom call. I feel like it’ll be helpful if I pick a couple doctor’s offices to start with and kind of, because this is not my comfort zone, really, that marketing piece or like selling things, but there’s a couple that I know will feel okay. So I’ll start there.
[ALISON]
Yes, and I will just jump in there and say, you don’t have to feel like you’re selling something. I always go in and just ask them lots of questions about what their pain points are around mental health resources for their patients. So I’ll say, “Tell me what you’re seeing among your patient population. What mental health issues are they struggling with? Do you have places to send them? Is there a lack of places to send them?” Like very much make it focused on, what are your pain points and then hopefully the conversation becomes a reciprocal and then they say, “Tell us about what you do and what kinds of clients do you work with,” and that kind of thing. And it just kind of flows more naturally from there. So you’re making it obvious from the beginning, like, “I’m here to help you and provide something that is going to be a resource to you and your patients,” not like you’re immediately just talking about yourself and your practice.
[ANNA]
Yes. That’s cool. And then also that strategic plan, definitely. Get that sheet filled out.
[ALISON]
Yes. So, yes, it sounds like you have a lot of homework to do.
[ANNA]
I got plenty to do, yes.
[ALISON]
Okay. Good. Well, thank you so much for coming on the podcast today. I really appreciate your time and I’m glad it was helpful.
[ANNA]
Yes, me too. Thank you very much. I appreciate your time as well.
[ALISON]
Yes. See you later.
[ANNA]
All right, thanks a lot.
[JOE SANOK]
Special thanks to the band Silence is Sexy for your intro music. We really like it. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.