Joe Sanok 00:00:00 The group practice boss. Conference tickets are on sale now. We expect them to sell out in just a couple days. There are only 120 of these available. Head on over to practice of the practice. Com forward slash conference to read more and grab your ticket. This is the practice of the Practice podcast with Joe Sarna, session number 123. Welcome to the practice of the Practice podcast. I’m Joe Sarna, your host, and I am so excited you are hanging out with me today. Today we are giving you behind the scenes in regards to our membership communities. And so a lot of our consultants are doing teachings every single week. every Tuesday, Wednesday and Thursday we have live teachings going on in our membership. So we wanted to give you a little behind the scenes. So we’re going to be hearing from Nicole Ball talking about what to do when referrals are slow. HR basics with Andrew. Client retention with Ashley. Scaling with Nicole Ball. Choosing the right project management systems and all sorts of other things over the coming weeks. Joe Sanok 00:01:16 I can’t wait to dig into this with you. If you want help from one of our consultants, please head on over to practice of the practice. Com forward slash apply. I’ll chat with you for 30 minutes to determine if one of our membership communities or consulting might be right for you. Now let’s get started with this episode. Ashley Mielke 00:01:33 So I would love to hear what is happening in your business. Something exciting, something new, something that you’re transitioning to right now that you can share with us. Sabrina, you want to kick us off? Yeah. It’s not necessarily like specific counseling, business related. but behind this wall is like a 12 by 11 safe. That is locked and we can’t get in, and I haven’t been able to use it for the last year. And the landlord is like, we don’t really want to pay for that to be opened. and I said, okay, well then I’m paying for the space. Can we take that square footage off? And so we’re we’re negotiating the next lease. Ashley Mielke 00:02:16 it’s not a new lease, but we’re going to take the space off. And I’m excited about that because that was my rent a little bit. Good for you. That is brilliant. I feel like, you know, that’s a skill set that we could all probably learn, of, like how to negotiate things like a lease, you know, and how to. And I mean, that’s like, I’m such a people pleaser. I’m like, oh, sure, you want me to pay an arm and a leg for that? No problem. Where do I sign rather than, like, trying to negotiate these things? maybe that’s something that we could do in group practice. Bosses like bring someone in who’s really good at that kind of thing, because I know I would certainly learn a lot. so that’s great. Thanks for sharing, Sabrina. Who else has something exciting happening in their business that they’d like to share? Or something that has happened that we don’t know about already? I can share. yeah, I would just say. Speaker 3 00:03:10 so I’ll be going on a maternity leave and, like the third week of July or something. And like, the closer we get to it, I’m realizing, like, oh, I’m pretty well set up for this and transitioning someone to take over supervision and, yeah, I’m kind of like, okay, like, this is going to be good and it’s going to be fine and it’s still going to be profitable. And yeah. So it’s kind of just getting exciting, working up to it and going like, this is going to be totally cool. Ashley Mielke 00:03:40 So that must feel so good Corey. Oh and you can just be totally present and not have to worry about what is happening and just be with your baby. Oh my gosh that’s amazing and wishing you all the best. So when are we? When are you going to disappear from the group? Like couple of weeks. Speaker 3 00:04:01 I mean, my hope is that I can still kind of join here and there. my due date is August 5th, but I think. Speaker 3 00:04:08 I don’t think I will last that long. I don’t think they’ll let me last that long, just based on a couple recent things. so I’m hoping that, like, I’m hoping that this can kind of, you know, be my hour of, like, adult, connection. so I’m hoping I’m just gone for, you know, a very brief time from this group. Ashley Mielke 00:04:26 Okay. Wow. What? We wish you all the best. If we don’t see or anything. Kind of comes a lot sooner than you expect. Yay! Great. Corey. Thank you. Who else would like to share? Speaker 4 00:04:39 I’ll jump in real quick. I, have I took the steps to. Well, I’ve. I’ve advertised and interviewed for an admin assistant, which was a big step for me because I was really, I’m having a lot of internal barriers around, like, I don’t have the time to figure out what I would give to an admin person to do, and yet I was there’s all this stuff that I’m just not getting done because I don’t have time to do it. Speaker 4 00:05:06 so, I had a really great interview with a candidate. I’ve in the process of checking references and, and likely looking towards extending an offer to that person. Ashley Mielke 00:05:20 That is. Speaker 4 00:05:21 Off the plate. Ashley Mielke 00:05:22 Is another, just like, like shoulders drop. Once this happens and the transition is there. That’s amazing. Milo, thanks for sharing. Hope that that works out for you. That’s such an exciting thing, and it creates so much more space for you to focus on what you’re good at and then also just your business. Right? So that’s wonderful. Okay. So what we’re going to be doing today is today is part three of the conversation on client retention. So if you if you weren’t able to attend either of the last two. I do encourage you to go back. The first meeting really did dive into client retention and why it’s important for our business, and how it’s actually something that I don’t think we spend a whole lot of time thinking about, but it’s something that we should prioritize and leverage for many reasons. Ashley Mielke 00:06:10 Today we’re going to talk about what that return on investment is when we do invest in client retention, focusing on that, especially as we grow and we want to have a sustainable business. and then the second meeting, we had Kristen Edmondson on where she was talking about leadership and just she’s so brilliant. And she really breaks down these concepts of how, just key things to focus on when we’re building relationships with our clinicians and we want to create that environment that’s really empowering and inspiring for them, because we know that if our therapists feel supported by us, they feel safe to do their best work. That’s only going to improve things like client retention, client Experience and everyone’s just going to be happier. So we’re going to talk a little bit about that. And then I kept, the PowerPoint brief today because I also just wanted to open up for conversation with us around what struggles are you having in the area of client retention, if anything, or just struggles with maybe difficult conversations with therapists on your team, or just anything that I’m able may be able to support you with some laser consulting today and the support of the group as well. Ashley Mielke 00:07:21 Okay, so if anything comes up, just please write it down. And, we’re going to spend some time just connecting today. And just a reminder, when I share my screen, I cannot hear you or sorry I cannot see you. So if you do have a question or something, just please interrupt me so that I will know. All right, so we are on part three today. So here’s a little reminder again of what is client retention. So client retention is the likelihood of a new client returning to work with a therapist. So after they come to us for their first visit, how many repeat visits does a client have and how many total visits do they have to the clinic? So I did in circle, provided some, calculations from Jane that you can use to calculate client retention in your visit in your business, repeat visits and total visits. And then I did find this one online, a HubSpot, calculator as well. So you can kind of look at what your client retention is. Ashley Mielke 00:08:26 If you don’t have an EHR that does the reporting for you. So Jane does that for us. So I don’t have to. But if you have like simple practice or some other EHR that doesn’t provide that data, you can it might take some time, but you can certainly go through and do it yourself. So let’s look at what the return on investment is for your business. So of course, the obvious is an increase in total number of return and repeat visits over time for each of your clients, which is really what we want. An increase in word of mouth referrals due to satisfied clients. So if our clients every single one of our clients matters, I think that’s really important. And it might be obvious, but it’s important to communicate that, especially as we grow, where the numbers start to grow and we can lose sight, right, of those individual experiences. If we have a volume of, say, over 100 new intakes a month, we can easily slip over the importance of each individual client. Ashley Mielke 00:09:28 So if every single one of our clients is having an amazing experience from the moment they connect with our administrative assistant to driving to our office, to parking, to finding our office space, to being greeted when they walk in, having a warm, professional, very inviting environment. You know, maybe they’re greeted with a snack or with a coffee or tea, and then they have a really exceptional, visit with their new therapist. That is, that is, that is gold for us as clinic owners, because those people are going to be our biggest advocates. They’re going to go and tell every person in their life about how amazing their experience was. And hopefully we will get, you know, a bunch of new, organic referrals. That way you’re going to save on client acquisition costs as well with the cost of Google ads, right? It’s becoming more competitive online. Or maybe you’re doing a social media campaign or just other costs and just the energy of putting your time out there to advertise for new clients, whether it’s in local Facebook groups, or maybe you’re pounding the pavement and dropping off letters and packages at doctor’s offices, whatever it is that you’re doing, that costs a lot of time, energy and money. Ashley Mielke 00:10:49 So when we have high client retention, that is much more cost effective than putting money into marketing. Decrease need to invest in ad spend. So again sort of goes along with the one before that. So we don’t have to spend as much on Google ads or other campaigns because we are retaining most of our clients. I’m getting feedback from someone’s camera, if you don’t mind muting yourself. That would be really appreciated. Thank you. And now you can allocate your financial resources, time and energy into strategic planning, the client experience, and other aspects of your business. Maybe you want to hire more clinicians now that your clinicians are full, they’re doing awesome. Maybe their retention is 90 plus percent, which would be ideal. I did read that in the professional services, which we would fall under, that a good retention rate is 84%, Our minimum requirement at our center is 85%. But the majority of our clinicians, their month to month retention is anywhere from 91 to 94%, which is outstanding. So they’re almost retaining every single client that they, that they, intake. Ashley Mielke 00:12:05 And as a clinic, our average per month is 91 to 92%, which I’m very, very satisfied with. But I’m always looking for ways to improve that, you know, how can we do better, increase in total revenue. So I did read this online. An increase of 5% in client retention can lead to 25 to 95% increase in profits, which is pretty incredible. And this is why this is really important that you know what your client retention rate is for each therapist and for your clinic in general. So you can really leverage that and work on building that so you can spend less money on marketing And, because if you’re if you’re really good at keeping clients, then that’s going to benefit you in the long run. Are there any questions or comments or feedback on this stuff? I’m just going to stop share here for a moment so I can see everyone before I move on to the next slide showing. Sorry. Actually, Tom, do you think like. Speaker 3 00:13:07 Looking at client retention monthly per clinician and then for the clinic in general is a good rule of thumb. Speaker 3 00:13:15 We don’t really need to be looking at it more frequently than monthly. Right? Ashley Mielke 00:13:19 No. And also it’s important that if someone is just starting out that’s brand new, it’s not a good gauge because they haven’t had the time to have those repeat visits. So their retention is going to appear very low because they haven’t had that opportunity. So I like to to look back over 12 months with a clinician to really gauge what their retention is and then month to month. Because Jane say for example, calculates that it’s it’s accurate. but yeah I yeah. So you want to make sure someone’s been with you long enough to have that opportunity to have the repeat visits or else again, it will appear very low. And if someone’s getting an influx of a whole bunch of new clients, that’s also going to make their retention seem lower as well. So you have to also look at the context to see what is actually accurate. Thank you. Great question. Anyone else? Anyone have any comments about that? I would love to know if you have spent some time over the last couple of weeks looking into your client retention, and you’ve maybe discovered some things. Ashley Mielke 00:14:32 I would love to hear. I’d love to hear from you. Speaker 3 00:14:36 so I just started taking insurance for myself at my practice, and my clinicians that I have hired on aren’t fully licensed and they can’t take clinicians. and I had a lot of spots opened up because I was working in the school. So I opened up like ten slots and I filled them like incredibly fast with like my admin. She filled it up. But then like the retention rate for myself on that, like they’re canceling before they even show up. And so it’s just like a different thing. Whereas with like private pay, like once they commit, like they committed, and so like even before they come, I’m just like, what? Like what’s going on here? so I guess it’s like a different thing that I’ve noticed with insurance that I maybe need to pay attention to because I want to switch to more of an insurance based practice of I might not stay signed on, or they might back out a little bit. Ashley Mielke 00:15:25 That’s really interesting. Ashley Mielke 00:15:26 Thank you for sharing. I’d love to hear other people’s feedback on that. I, I find it when when we think about the exchange of money for a service, I think it’s there’s really this idea of this perception of value like people. Right. When people have to pay, they pay attention. They’re going to show up. They they like even on a sliding scale. Like we just don’t do that anymore. Like we have interns that offer it. But as fully registered psychologists, we just don’t offer it because it’s like if you don’t see the value in investing in yourself. and I understand there’s barriers that a lot of different populations have. But in the private practice world, if people aren’t seeing the value of investing in themselves, then that those aren’t the clients we want to work with. So I do wonder about, you know, you know, if I’m expecting a free service, how important is it actually going to be for me? I’d love to hear your thoughts on that. Michelle. Speaker 3 00:16:22 I with my solo. Speaker 5 00:16:25 Private practice, started with insurance and then I, dropped all of them except one insurance. And now I have a group practice, and we’re actually looking to have a couple of clinicians come on and be networked. go and network with them. And I found that probably like, oh gosh, the vast, vast, vast majority of my insurance clients were excellent. They showed up on time. They were regular. I met with them every single week. They were. And it was it was fun and different than my cash clients, because some of my cash clients will meet weekly. But not everybody. they can’t all swing that with, the finances. And so I thought there was a neat rhythm I would get into with the insurance people, because I was seeing them every single week, and they would be really good about. And for them, they don’t want to, because they’re paying their copay. They don’t want to pay that late cancellation fee. So actually, they might have been a little bit better about keeping their appointments, but that was just my experience. Ashley Mielke 00:17:24 Thank you for sharing, Michelle. But they still had that investment, right? There’s still that personal investment piece of a copay. And knowing that, you know, I have to support this, therapy journey as well, which I think is important. Anybody else? Okay. Thank you for sharing. So now what is the return on investment for your therapists? Well, they’re going to build stronger relationships and have better rapport with clients if they’re really focusing on that client experience. Last week, Kristen talked a lot about that leadership and mentorship piece around building their confidence in private practice, helping them to, you know, feel confident going into those first sessions, how to build rapport, how to build great treatment plans, and how to be present with their clients. another ROI is full caseloads. If they have a high retention rate of over 85% or 90%, they’re going to need less and less new clients. And now it also does depend, of course, on like what your approach is to therapy. Right. Ashley Mielke 00:18:32 we specialize in grief and trauma. So we tend to see clients over a longer term period. that could be like over 30 sessions for some clients. Not everyone comes that long, but certainly they tend to stay with us longer. more predictability with their schedules. So again, it’s like, okay, I can see that for the next 3 or 4 weeks, most of my opening or most of my schedule is full, and you can just start to see where maybe you could stick in some new clients along the way, but that also just creates less stress for therapists. In private practice. They tend to be happier and fuller. Right? Just, alluding to their schedules, increased confidence in their work and less of a need to spend time marketing themselves so they don’t need to be on social media so much like posting videos or writing blogs or going into local Facebook groups to advertise themselves. That is what I see with our clinicians. The ones that are very successful in private practice really don’t have to advertise or market themselves. Ashley Mielke 00:19:33 Their clients are such strong advocates for them that they get so many word of mouth referrals directly to them that that essentially is their marketing. So if we can help our therapists to be more confident in their roles, get the training they need, have that supervision and consultation they need, then this is going to be a huge return on investment for them. And then another thing they can do, as well as they build that confidence and that kind of awareness of the work they’re doing, is that they could even increase their rates as well. So I don’t have that on here, but it’s just something that came to mind that maybe, you know, in a year’s time, they say, I want to increase my rate by $10 an hour or $25 an hour, and that might be something that you’re open to as a practice owner, and that means more money for them. And then lastly here, the return on investment for clients, stronger loyalty and connection to your practice and therapist, higher commitment to their treatment plan. Ashley Mielke 00:20:32 Right. If it feels like it’s aligned with their with the issues that they brought forth and the goals that they have for therapy. They’re more likely to refer friends and family. Hopefully they have an improved mental health condition, right? Or they’ve really met the goals that they hope to achieve, and they’re more likely to come back to address future concerns when they arise. it was interesting. My one of my clinical directors let me know the other day that a client of mine came back, after it was someone that I that I had worked with. I’ve been in business almost 11 years, and I think it was about nine years ago. I had seen her and she came back to address something new. And she’s now working with, someone else on the team. But we just thought that was really neat, that even after all of this time, when she needed this level of support, she knew where to reach out. And that just felt really good. because that’s what we want, right? We want them to come back if they ever need us again in the future. Ashley Mielke 00:21:30 Studies on effectiveness of therapy. Quality of the relationship between the client therapist is the most important factor. I know we have learned about this in school, but it’s important to reiterate again that it really is the relationship that is the most important factor in the effectiveness of therapy for a client. When the therapist is in sync and listening presently and empathetically. Okay. So that’s what I had for today in terms of just talking about that ROI on client retention. And I wanted to use the rest of the time today to do some laser consulting. So maybe you have some specific questions or concerns in your business right now that might be related to client retention or not, but let’s spend this next half an hour together just troubleshooting some of these questions. So feel free to put them in the chat if you’d like, or just unmute yourself and we will just dive right in. Speaker 3 00:22:28 I’m just having a hard time just, figured out how to, I know that the other seminar we talk about the numbers, but how to, get that implemented? So my, admin have a system to run through. Speaker 3 00:22:48 Do I do it weekly? Do I do monthly, do I, and, and. Yeah, just not having a system. Ashley Mielke 00:22:58 And are you talking about just gauging what the client retention percentage rate is? Barbara. Speaker 3 00:23:02 Yes. Yes. Correct. Ashley Mielke 00:23:04 Okay. So on this PowerPoint, I did put a calculator on there, a basic calculator again that you can use to determine what the client retention is, at least as a starting point. but yeah, it makes it tough if your EHR doesn’t have a reporting tool, because it might take some time to really determine what that is if you have to do it manually. But there is a way. So on this PowerPoint, which is now attached to this event in circle. you can use that calculator and give that to your admin person and just pick a time like maybe I think a good a good gauge would be like, say, let’s do six months of retention. Go back to January 1st. Wait till the end of the month and do the first six months of the year. Ashley Mielke 00:23:50 So how many new clients, how many return visits? There’s a there’s a calculator that you can use to determine the percentage. Exactly. Perfect. Thank you so much. You’re so welcome. 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Joe Sanok 00:25:05 Trust me, don’t waste any more of your time and try therapy notes. Just use promo code Joe at checkout. Ashley Mielke 00:25:14 Who’s next? Who’s got some. Speaker 3 00:25:16 Questions? I am curious to see what other people have done about with when it comes to client retention of how important it is it to have like the warm, inviting, coffee like thing and like when you welcomed clients in as opposed to making that focus, being more about like, if they’re feeling welcome from like their counselors. Because right now, the way my office is set up, we’re very, we don’t have a main waiting room. So her office is, like, upstairs for me. My office is downstairs. I have a waiting room. She has a waiting room. and so we don’t have a central person who’s, like, welcoming everyone and telling them where to go and what to do. And so I’m just kind of curious what people think, what experience they have of, like, how important is that for an ROI? or is it just like how we as a counselors are welcoming our clientele? Ashley Mielke 00:26:14 That’s a great question. Ashley Mielke 00:26:15 Thanks for bringing that up, Esther. I’m happy to share, but I would love to hear what other people’s thoughts and experiences are or have been. Speaker 3 00:26:23 I can share a little bit. So I mean, not to everything that you said, but like, I’m thinking about, like, the warm, welcoming space, having, like, coffee, stuff like that. So, I mean, I guess the first thing I’ll say is that, like the first office I had was like, in like, what felt like a murder dungeon. And so, like, people still came. So I will say that I think a lot of it really is the the vibe and the session and the relationship with the therapist. but then when we moved into another office, we did do sort of the coffee and water and had that all set out for everybody. And it was, much more inviting vibe. and people, people liked it. But when we moved into the office that I’m currently in now, we took away the the coffee, the water, the sort of the extras. Speaker 3 00:27:13 So there’s still a really good office vibe and nobody has seemed to care. I’ve probably we’ve been here for almost two years. I’ve probably had like four times where someone asked if I had water and I just got them some water. And so that’s like really that that was a really cost cutting. So we still have a coffee machine for like the therapists and stuff like that. But and we like provide water for them. But it’s been really cost cutting not just having it. And then also like not wasting not having to do dishes or waste paper product. so I found that really helpful. But overall, you know, I think I found that it’s important to have a welcoming space, but welcoming doesn’t mean like bells and whistles, in my experience. It’s that, you know, they want to know that they’re walking into somewhere that feels comfortable. And then when they’re sitting with their therapist, they feel heard and understood and that things are happening for them. So that was that’s been my experience. So good. Ashley Mielke 00:28:08 Great. Corey. Thank you. I, I do agree with what Corey is saying, that it really is about added value. So I don’t think it’s necessary that we have to do it, but it’s an added value that I’m in. They can help themselves to coffee or they’re whether it’s the therapist or the admin person saying, can I get you something to drink? And not everyone’s going to? Right. Most people won’t. But some people love that, that feeling that when they come in, they get to make their cup of tea. And it’s a part of the experience that they have. So it is something that we do offer. We don’t offer snacks or anything because again, it’s like that’s a super high cost when you add it up, if every if you have 50 sessions in the day or something. but certainly isn’t, it is an added value if that is an experience that you want to provide for your clients. I hope that helped answer your question too. Speaker 3 00:29:01 Yes. Yeah, it does, because it goes to show it’s not really an ROI. Speaker 3 00:29:05 It doesn’t have a good ROI because it doesn’t necessarily retain customers to have it or not. It’s an added bonus to their experience. Ashley Mielke 00:29:15 And it might. Right. We don’t know for sure unless we survey every single client. One thing I did though, what I did ask my admin people is what are the comments that you often hear from clients when they come in? Because the stuff that we don’t hear, what is it that they love about what we offer? And I actually asked this only a couple of weeks ago, because our marketing team wanted to include certain things in our ad, in our ads, like kind of update some stuff, and then what are the challenges that they often say when they come in? Right. So the big things were someone greeting them and offering them beverages. And then the challenges were, oh, we don’t see any signage on your building. So sometimes, you know, I found it hard to find you guys the first time. So little things like that. So if you do have an admin person or ask your team if they are the person, what are what’s the feedback you’re getting from your clients about the experience at the office? Positive. Ashley Mielke 00:30:11 And then any challenges that they’ve had, things like, yeah, they’re parking with socks in this area or couldn’t find your building or the elevator was broken. This is really good feedback for us so that we can improve and also build on those things that our clients love. So it could be an ROI. Speaker 6 00:30:29 Would you do that just asking or would you send them a form? Ashley Mielke 00:30:33 The the clients or the. Speaker 6 00:30:37 The what they experience about the office? Ashley Mielke 00:30:40 I asked my admin team what clients just feedback they provide. Like we don’t even ask for it. They just it’s things that clients have just said to them when they’ve come in. Speaker 3 00:30:51 Okay. Ashley Mielke 00:30:52 but you certainly could. You certainly could ask your clients like, hey, you know, we want to we’re looking to improve our our client experience. You’ve been coming here a while. Is there anything that we could do differently, better or more? Why not just ask? Speaker 3 00:31:08 Yes. Ashley Mielke 00:31:09 Thank you. And then that, you know, and maybe it sets you apart a little bit from the clinic down the street. Speaker 6 00:31:15 Absolutely. Ashley Mielke 00:31:17 Any other questions, challenges, things that you’re facing in your business that we can support you with today. Speaker 3 00:31:22 So a question that I have is like with payroll, like figuring out like how to keep track of hours, because our EHR doesn’t automatically tell us how many clients each clinician sees. So we’re having to go in, you know, every, you know, whenever it’s payroll time, like I’m looking at all of their hours. So who is I guess who keeps track of hours because like our system is not working for us to do it every time. so is it something that the admin does or like the clinicians do and send in? what’s your experience on that? Ashley Mielke 00:31:56 We have a Excel spreadsheet that’s locked with dropdowns for specific insurance providers, full pay that our clinicians fill out and submit their invoice to our billing person. And then our billing person reconciles that on Jane, because our EHR does provide a monthly breakdown for each therapist. And that’s how we do it. I’m happy to attach that to this event and circle. Ashley Mielke 00:32:23 So you can see the the spreadsheet, how we’ve built that. And it’s if you can create one that’s locked and is really simple for your clinicians to use, it’s almost foolproof. They just fill it out every single day that they work and then submit that before the payroll periods. And then I. Speaker 3 00:32:43 I get I asked my next question with that is do you pay your clinicians like based off of insurance? Because like, you know, I’m switching to insurance also. So I’m like, you know, some insurances pay really well, some don’t. And then we also have our private pay rate. So do you do a different rate based on private pay versus and. Ashley Mielke 00:33:03 yes we do. Yeah. And so everything is automatically calculated based on their percentage in each of their invoices. So they can even screw it up. So whatever they put in it’ll automatically calculate the rate that they will be paid. So you could definitely create something similar to that for yourself. How does how do other people do it? I’m curious, are they creating their own invoices? Is that something you’re doing for them? Speaker 3 00:33:29 I think it probably depends if you have a W-2 or a 1099 model, but I have a W-2 team and they fill out a Google form, a timesheet with lots of dropdowns on how many sessions, how many, no shows. Speaker 3 00:33:43 And then I take that, that Google form, data, which gets just rolled into a spreadsheet and enter, and I enter that into Presto, they get a flat rate. So it’s a lot easier then it doesn’t matter whether it’s insurance or private pay, their rate is their rate. so they’re really just logging hours, sick time, no shows, and any meetings or anything else that they attended. It’s very quick and simple. Ashley Mielke 00:34:08 That’s perfect. Kimberly. Thank you. That’s good to know. Speaker 3 00:34:13 I’m not quite sure if I understand, like what you’re asking for, but the way I pay my clinician is I just look to see how much money has come in that they’ve collected in that period of time. So between this time, this date and this date, what money has come in from insurance, what money has come in from copays and they get a percentage of that. and then if they see over X amount of clients, I give them an extra X like a standard fee. because so I, so that I like, I want to make sure that my, my practice is sustainable with my clients only seeing 15 clients a week. Speaker 3 00:34:50 And so I want to make sure that that’s sustainable. and if they choose to see more than 15 clients week, I really don’t need that money to be put back into my into EAP counseling. So then I give them an X amount of money for any anything they do over 15. But it’s all based on what copays and insurance things have been collected during those dates. And then I pay them out of that and. Ashley Mielke 00:35:15 They have a flat rate so that you can just quickly calculate. Speaker 3 00:35:18 It’s a it’s a percentage. So depending on what the contracted rate with the insurance company or the rate that we’ve decided with that specific client for self pays. Yeah. Okay. Ashley Mielke 00:35:28 And you break down each of those hours on a spreadsheet. Speaker 3 00:35:32 They can look at. They can look it up on the EHR, like how much money came in for their for the month and where, where, where each money came from, what client paid, what client didn’t. All those kinds of they can look all that stuff up themselves. Ashley Mielke 00:35:48 and so how do you break down each of the sessions to make sure the rates are, are proper for each payer? Because you said they get paid differently per. Speaker 3 00:35:57 Yes. Each insurance company has. They, they they have a different rate that I’m contracted with. Right. So each insurance company I have, they they’ve actually a lot of them, they’re like, this is what we’re willing to pay you. And if you fight back a little bit, they’re like, sorry, no can do. And so they set that, to what it what it it it is. Ashley Mielke 00:36:20 So how do you break down like, if they do 100 sessions in a month, but every session is going to pay them differently. How do you calculate that? What do you do on your end? Speaker 3 00:36:30 I don’t do anything because I’m just going from the total that was collected for the whole month. It’s not by I’m not necessarily breaking it down. I’m like, okay, you you saw clients with this insurance company. They pay us this much, I you get 60%. Speaker 3 00:36:45 Okay. Like, I just added up. There’s a percentage of what we collected from you. You get 60% of it. Oh. Ashley Mielke 00:36:52 Easy peasy. So 60%. No. It was. Yeah. Okay. Speaker 3 00:36:56 And every time I mean depending on what’s going on, each each clinician might have their own rate depending on whether they’re receiving certain perks. Some people might come in like I don’t really need a phone system. I’m like, okay, I won’t I don’t need to give you a phone number because you want to do something else. Okay. We’ll give you a different percentage because you don’t need a phone number. Something like that. Ashley Mielke 00:37:17 Oh, well, that makes it very easy when it’s sort of like a flat percentage or flat rate. It’s when when everything’s every session is different. That’s where you run into, you know, it takes a lot more time. Yes. So that is so nice for you. Speaker 3 00:37:32 I think at this point in time, I just want to keep it super easy so that I can get them paid as quickly as possible. Ashley Mielke 00:37:37 Yes. Oh my gosh, if we could just have it that simple. Yeah. That is definitely the way to go okay. Thank you. All right. Any other questions challenges you’re facing right now that we can support you with. This is definitely the time. Definitely a time to bring it up. Speaker 5 00:37:55 In regards to client retention. Speaker 3 00:37:59 maybe I’m looking. Speaker 5 00:38:00 For some. Speaker 7 00:38:00 Feedback, guidance on how we discern like what is actually like. Speaker 5 00:38:05 Quality. Speaker 7 00:38:06 Therapists who are keeping clients or like personality fit. Ashley Mielke 00:38:12 That’s tough, isn’t it? That’s really tough. because I think, unfortunately, not everyone is is cut out for private practice. I feel like it’s a combination. I’ve had this conversation with my leadership team many times that it’s a combination of clinical skill set and experience, but even more so, personality fit and being able to build rapport with people and be flexible and, you know, be able to work with different types of personalities and clientele. And, you know, unfortunately, we can’t really teach that so much. Ashley Mielke 00:38:46 Like, certainly we can go through the technicalities of here’s how we can build rapport and here’s how we go through a first session. But if someone is just not a fit, they might not be a fit. Is there someone on your team, Sabrina, right now that you’re struggling with? Speaker 7 00:39:02 Yeah, it’s and she’s a lovely human. And that’s that’s part of my problem. And I’m like, you like people pleaser. Like she’s. I really like her, but we’re just struggling to grow her caseload, and I’m having a hard time referring to her because the feedback that I’m getting just isn’t like, she’s phenomenal. She’s doing all the things that you’ve taught her to do. It’s, well, she’s she’s nice. Ashley Mielke 00:39:26 So, what do you think she might need? Like, what do you see as some of the needs for her? Like, is she a newer therapist? Is it a confidence issue? Is it a personality thing? What do you think? Speaker 7 00:39:36 I think more of a confidence issue. And I think it was, I had unfair expectations going in because she had been in the field for a while and then had taken some time off and did like some social work specific things with an insurance company. Speaker 7 00:39:53 So I was assuming she was coming in with a lot more experience than she presented with when she was finally in. And so I was treating her like somebody who had been in the field for ten years, and I should have been treating her like a student that had just graduated. Okay. Ashley Mielke 00:40:07 Do you feel like this is something that you could support her with. Or she could have, like an external supervisor support her with. Speaker 7 00:40:16 We’re working on that. We’re working a lot more closely on, like, building more of a skill set, especially around treating eating disorders, because that’s that’s what we do. And she didn’t have much experience with that. I guess maybe more of a specific question is like, how long do I continue to do this, like coaching, mentorship and then or just go, you know, we we both need to go our separate ways. Yeah. Ashley Mielke 00:40:41 So this has happened twice in my practice. I recently just, terminated a contract for the second time for this similar. So I had I waited like a 12 month, 12 month period, which I don’t know if some people might think think that’s too long. Ashley Mielke 00:40:58 The feedback was never negative. Like what you said, like, oh my gosh, this person is horrendous. They you know, it’s just they’re just not effective for whatever reason, there’s stuff going on. So, I had multiple conversations with them about it. had conversations around, what do you need? What can support, support can I offer? Here’s our goals, here’s your retention, here’s what we’re going to do. And the situation just didn’t improve. So I just when their contract was up for renewal, I just told them I wouldn’t be renewing. And I do an annual renewal. Not exactly sure how you do it, Sabrina. Speaker 7 00:41:35 So we’re W2 at will. Ashley Mielke 00:41:37 Okay. Speaker 7 00:41:38 yeah, I’ve been with me six months. So part of my thought was like, yeah, let’s let’s do a good like six months concerted effort of coaching, really direct mentorship and then see where the next six months go. But I also don’t like and I’ve had conversations with her because I don’t want her to feel like she has to stay here if she needs a bigger paycheck. Speaker 7 00:41:59 Like, I understand if you need to leave because I don’t I don’t know what else to do at this point. Ashley Mielke 00:42:04 Right? Yeah, exactly. Like if you really. she’s getting new clients, she’s not able to keep them or people aren’t wanting to book with her like it does happen to every practice owner like it does. I’ve talked to so many group practice owners, I’m like, oh my gosh, do you have your your A players? You have your people who excel and then you have a couple that just struggle and it’s like, gosh, what do we do? And we can only do so much on our end. And in these cases, what I also said to them, Sabrina, is because there is this struggle, I won’t be giving any new clients. So we’re going to see how this goes over the next three months, we’re going to work on nurturing those current clients, try and get them in the door, really work on building that confidence so that you’re not continually losing clients that you’re acquiring. Speaker 7 00:42:51 Yeah. One of my fears is that because we are like, I’ve been in private practice for the last seven years and then switched to group practice last year of like, I have a really good name for myself in the community and my business name, and I my biggest fear is that that’s going to start to get tanked. Ashley Mielke 00:43:09 Well, we don’t want that. And if that’s the level of concern you’re at, like if you if you have to give your notice, give your notice like don’t wait if you already know. Thank you. No. Speaker 3 00:43:22 I say I got a question for you, Sabrina. Have you chatted with her about how she thinks she’s doing in this climate? Does she enjoy working with eating disorders, or is she finding this is not necessarily what she was thinking it was going to be either? Yeah. Speaker 7 00:43:37 No. She has like all positive feedback of she she really is enjoying learning about eating disorders and treating them. she’s really loving working with adolescents, which is the population. But I wanted to fill up and learning how to work with the families. Speaker 7 00:43:52 With that, she’s like, I love working in this practice. I love working with you. I don’t want to go anywhere. Which then also is like, okay. Speaker 3 00:44:01 Well, it’s a bummer too, because you’re like, I was really kind of hoping you would have the insight to know this isn’t going well, because I know for me, when I switched over from working with mostly adults to kids, like, that’s when things changed. And I think sometimes when you have like such a concentrated niche and then you bring in a clinician and then come to find out, it’s not so much of a niche for them. What do you do with that? I never thought about that kind of problem, but. Well, I was hoping my question would help you, but it doesn’t. But thanks anyway. Ashley Mielke 00:44:32 It’s a great question, though. Really great question. Yeah. It sucks. It sucks when these things happen. Thanks for bringing the arena. All the best with with next steps. Anyone else got something going on they want to bring up? Speaker 3 00:44:47 I have a question. Speaker 3 00:44:48 If anyone has ever like in the in the process of bringing on like interns seeing ROI type thing like happen because of that coming in like I’m thinking about bringing on a new one. So pitching to the idea of seeing an intern instead of somebody who is fully licensed. do we do people find that people don’t stick around as well? I know I had an intern last year, and I was actually kind of surprised at when she moved on, and because she ended up deciding to go to another state, I, I only retained one of her clients, which I was kind of surprised at, which kind of hits me of like, whoa, that that’s a pretty big like ding to my ROI. When you lose a commission and like, you lose all the clients that were seeing them pretty regularly, didn’t know what other people’s experience with that was. Ashley Mielke 00:45:42 Anyone have any feedback working with did you. Speaker 3 00:45:45 Mean, student interns like, graduate level or or did you mean like, provisionally licensed? No. Student interns? okay. Speaker 3 00:45:53 Yeah. We don’t I don’t I’m sorry. I can’t help with that. Ashley Mielke 00:45:56 In our experience, when we’ve had really strong interns, Esther and they stay with us, which is usually the case, then they will continue with the, the intern as they move up in terms of their designation. I would say if if this would happen, is it because there’s now a financial barrier for those clients? If the intern has left and they can’t afford maybe the full fee? Is that what might be a barrier for those clients? Speaker 3 00:46:27 I, I’m going to say no for what I just went through because they actually decided to not use insurance and go for a cheap rate with her. If they would have switched to my caseload, they would have been able to use their insurance. Okay. And so that was probably not the reason that they didn’t continue on with me, or at least with EPP counseling. Ashley Mielke 00:46:49 Interesting. I mean, there’s so many reasons for this. When someone leaves the practice, I think whether it’s an intern or a therapist. Ashley Mielke 00:46:56 Unfortunately, when a therapist leaves, I think regardless of who they are, a lot of clients will go with them or they will just terminate, you know, and they’re kind of done. And and then maybe a handful will stay and, and doing an internal transfer or internal referral. I think that’s a. Speaker 3 00:47:13 That’s a pretty normal thing that when clinicians leave that you do end up losing not just yeah, because I know they didn’t leave with her because she went to West Virginia. Right? I don’t know. Yes, I know they didn’t leave with her, but. Ashley Mielke 00:47:26 Yeah, it is it is one of those hard things. And at least for us ethically, we cannot tell a client what to do. We give them choices. They do always have a choice to go and follow their therapist if that’s what they want to do. And it sucks when that happens. And it’s like, you know, it’s maybe a rough couple of months financially losing an entire caseload of billings, essentially. And then you just sort of build your way back up. Ashley Mielke 00:47:53 Yeah. One of the realities of private practice, that we do face. So you’re definitely not alone. Speaker 3 00:48:01 a question I have. Speaker 7 00:48:02 Is with employees, like, with, like. Speaker 3 00:48:05 Helping them. Speaker 7 00:48:05 Stay happy. Speaker 3 00:48:06 I feel like. Speaker 7 00:48:08 I’ve built like. Speaker 3 00:48:10 I’ve done a good job. Speaker 7 00:48:11 With leadership. Speaker 3 00:48:12 I feel like. Speaker 7 00:48:14 for the beginning stages. Speaker 3 00:48:17 but, like. Speaker 7 00:48:18 My therapist, they mostly work. Speaker 3 00:48:19 On the weekends. Speaker 7 00:48:20 So there’s. Speaker 3 00:48:21 Not a lot of interaction that I get with them. And I want to make sure, like I’m keeping them happy. Speaker 7 00:48:27 So, like, what are some small ways or like, just ways to keep employees happy in this environment? because I do like my clinicians. Speaker 3 00:48:35 And I do want them to stay. Speaker 7 00:48:36 On, Speaker 3 00:48:37 You know, I. Ashley Mielke 00:48:38 Would ask them. Speaker 3 00:48:40 Okay, that’s awesome. Ashley Mielke 00:48:44 Because everyone is going to be each clinician will be motivated by different things. So have an individual conversation with them and say exactly that. Christina, I care about you. I want you to be here long term. Ashley Mielke 00:48:56 Why do you love working here? What’s going to make you want to stay long term? Someone is going to say financial goals. Someone’s going to say, I love the culture. I just love being with people. Someone’s going to say it’s the it’s the work we do. But just ask them. Speaker 3 00:49:13 Okay? Speaker 7 00:49:14 All right. Fair enough. Ashley Mielke 00:49:15 Anyone else have ideas for Christina? Speaker 3 00:49:19 Some of them might even say, I love the fact that you don’t have contact with me. And you’re a hands off. Ashley Mielke 00:49:24 Yes, totally. Speaker 3 00:49:27 I hear a lot about flexibility. They really value, you know, the flexibility in their scheduling. and that were, you know, myself and, my business partner who were both the owners and supervisors were always accessible, but we do not we’re not too much. We’re not everywhere all the time. and I think one thing that has really turned out in the last 18 months or so, it’s been really fun is we do a monthly book club and you don’t not everybody has to join it. Speaker 3 00:49:56 So if it’s like a bad month for them, they don’t have to. But it’s usually a book somewhat related to the industry. sometimes fun, sometimes more serious or clinical, and then they get paid for that time when they come to the meeting at the end of the month to discuss how, you know, how they felt about it, how it might relate to clients, or help give us content for clients. And it’s just a nice way to connect. But it’s not like I know for me personally, I didn’t really back when I was a younger years, I didn’t want to be part of groups that were doing like late nights and nights out. I just like really didn’t want to do that. So it’s a nice way to connect a little casually, but it’s still virtual. It’s still during the weekday. and it’s not it’s not like a get out of your house, find a babysitter and come to an event type of get together. and we’ve had a lot of positive feedback about that. And then they’re learning too. Speaker 3 00:50:42 So that really helps me then, because it gives out a lot of content. That is. Ashley Mielke 00:50:46 Awesome. Kimberly. I love that. Speaker 6 00:50:49 Kimberly. I do that too. And I, get a feedback from my clinicians that they love it. Ashley Mielke 00:50:55 That’s great That is so fun. Something we love to do is, not like a book club style, but just socials. So we just book social events to go out and do fun things together as a team that isn’t related to work stuff. So, you know, just an opportunity to connect more on a personal level, whether it’s just like someone hosting a barbecue or a wine night or going to like an event that’s happening in our city that we can purchase tickets to, or going bowling or something, just like a good reason to get out and have fun. And, you know, not everybody is driven by that sense of culture, but it is nice when you do have a team that’s cohesive and they’re sort of interested in that, wanting to be together and that sense of belonging as a group. Speaker 6 00:51:43 Actually, when you, do those events, do you is that for the clinicians only or clinicians and their spouses? Ashley Mielke 00:51:53 We only do with the clinicians. Okay. Yeah. You’ll have to report back to us, Christina, when you have these conversations. So here’s what I learned. So love for you to just reflect on one thing that you’re going to integrate into your business. It might be based on this conversation or just something that like, you’ve been spending a lot of time thinking about something like just something actionable that you want to do in your business. Something you can commit to doing this week or next week to growing, expanding, connecting with your teammates, taking that next step in the growth of your business. I think oh, yes. Speaker 5 00:52:31 Michel. one of the things that you, I think mentioned this in the first part of this series, I think it was the first week, just the direct link between, it’s cost effective, to really put so much energy into this because, you’re maximizing whatever it is that you are spending in terms of marketing. Speaker 5 00:52:50 And so being able to just have that reframe for myself, linking it to the marketing and linking it really to to cost, I think has been really helpful for me. So I don’t have a thing that I’m going to do today, but I really am starting to think differently about it, which I think has been very helpful. Ashley Mielke 00:53:08 That is so wonderful. Great takeaway Michelle. Thank you. Hopefully this series has been helpful for you. If you haven’t been able to participate in all three weeks, definitely check out the recordings though. Hopefully be some little nuggets. Some takeaways for you that would be valuable for where you’re at in your business. Even just thinking long term sustainability and growth, keeping your overhead down and really leveraging the strong team that you are building and hiring for fit so that you can have awesome client retention and a really strong brand awareness. Because our people are our business and our clients, and we really want to make sure we’re prioritizing that as we grow. So wishing all of you a wonderful rest of the week, and I will look forward to being back in the group practice boss community very soon. Ashley Mielke 00:53:59 Thanks everyone. Appreciate your participation today. Bye. Joe Sanok 00:54:11 Well, thank you so much for listening to the practice of the Practice podcast today. These trainings are available in our membership communities. Now we’re going to be opening up our membership communities more than just when we’re opening Level Up week. So if there’s one that you are interested in, I would love for you to head on over to practice of the practice. Com forward slash membership where there’s more details and you can get notifications when those open up. So if you are in solo practice just getting going, if you are building and sustaining a sustainable solo, practice, next level practices for you. If you are looking to launch a group practice, group practice launch is for you and group practice boss is for all those group practice bosses out there. You know we also couldn’t do this show without amazing sponsors like Therapy Notes, therapy notes is the best electronic health records out there. They will help you switch over from your current EHR. they also give you two months for free or just money off if you use promo code Joe at checkout. Joe Sanok 00:55:07 they are phenomenal. They help with automated billing. it’s going to make it easier to outsource your billing. So many reasons to switch to therapy. You know, just head on over to therapy notes.com. Read about it and at checkout just use promo code. Joe, thank you so much for letting me into your ears and into your brain. Have a great day. I’ll talk to you soon. Special thanks to the band silence Sexy for that intro music. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the producers, the publishers or guests are rendering legal, accounting, clinical or other professional information. If you want a professional, you should find one.