[ALISON]: Starting a group practice can be really overwhelming. So if you’re wanting some help to figure out how to start and grow a group practice, please go to practiceofthepractice.com and click on Work With Us. There you’ll find information about everybody on the Practice of the Practice team, including me. I specialize in helping people grow a group practice, and I would love to work with you. So please fill out the contact form on the website or email me, [email protected]. .
You are listening to the Grow a Group Practice podcast. Whether you are thinking of starting a group practice or in the beginning stages of a group practice, or want to learn how to scale up your already existing group practice, we have lots of great content for you. I am your host, Alison Pidgeon. I’m a serial entrepreneur with four businesses, one of which is a 15 clinician group practice that I started in 2015. I’m also a mom to three boys, wife, coffee drinker, and love to travel. I’m excited that you chose to listen to this podcast. .
Hi, welcome to a special episode of the Grow a Group Practice podcast. I wanted to put together a podcast even though it will be quite off the cuff about my experience with the coronavirus pandemic and the changes I’ve had to make in my own group practice. So forgive me if this is a little bit rambling but I just, I wanted to get this recorded and get it out because things are changing so quickly and I wanted to make sure you got it as soon as possible, so you could start potentially implementing some changes for yourself. So I kind of rewind a little bit and tell you where this all started.
So, way back a week and a half ago, it seems like seven lifetimes ago, the weekend of March 6th and seventh, I was talking to my husband. And just to give you a little bit of context, my husband is in public relations. One of his specialties is crisis communications. He’s also a former news reporter and he’s still quite the news junkie and had been following the story of the coronavirus going through China, going through Italy. And he said to me that weekend, “You know, this is definitely coming to the U.S., I think it’s going to be bad. Like we really need to start getting ready.” So I thought maybe he was like exaggerating a little bit to tell you the truth. He probably will listen to this and then maybe be upset with me, but then the more I thought about it, the more I was like, “Yeah, I think he’s probably right, because obviously we see in the news how this is playing out in these other countries.
So I go out on that Monday, so that must’ve been March 8th, I think it was, and I, or maybe it was March 9th and I buy a ridiculous amount of groceries and, you know, paper towels and toilet paper and diapers and wipes and all of that kind of stuff. Like I don’t usually go to the grocery store and fill my cart up to the very top, but it was like overflowing. So this was before and I realized like everybody’s experienced depending on what part of the country you’re in is probably different, but in Pennsylvania we had started maybe to have some cases out in Philadelphia, which is about an hour and a half East of us. So I knew it was, you know, creeping in. And it was sort of before everybody started like panic buying everything and like the shelves were really empty.
So, I went shopping on Monday and basically by Friday, like the grocery store shelves were empty. So if you waited till Friday, you were basically screwed. So I started thinking on Tuesday, like, you know, if we have to move to all telehealth, then we really need to make sure that the insurance companies are going to allow us to bill for telehealth, because we do take, the majority of our clients is insurance-based. So we call on Wednesday and the one insurance company is like, “Yep, we’re on top of it. We’re just trying to get our ducks in a row and you’ll be hearing from us soon. And the other insurance company was just like, “What? Huh?” Like acted like they didn’t know what we were talking about. So I was a little concerned about that and I don’t have any ability to just sort of like sit by and wait for them to figure out what the heck is going on.
So, you know, they said, “Oh, we’ll have somebody from provider relations call you in a day or two. Well, things were happening fast now by Wednesday and I wasn’t going to wait for them to give me a call back. So I started calling, I think it was Thursday. I started calling around to my representatives and my state senator to see if they could help me and one state senator in particular, his office did help me out. He said he had a contact at this particular insurance company and he’d reach out to them and see if he could help me. So he got in touch with them and got back to, and he was like, “Hey, they said, yeah. They’re changing their rules about telehealth and you can bill.” And I was like, “Oh great.
So basically, it seemed like the three insurance companies that we bill were good to go, and so I was then kind of agonizing over the decision of like, do I tell my, you know, all of our clients? So at this point we have 500 clients. I have 15 clinicians. So this is a big decision. This decision affects a lot of people and I was really wrestling with the decision of like, “Do I tell them we’re going to go to telehealth? Do I just tell them to get ready to go to telehealth?” So while I was wrestling with that decision, I did email the clinicians and I just said, “Hey, things are happening fast. You may be told kind of at the drop of a hat that you can’t come back to the office. So if you’re used to leaving your laptop in the office at night, during the week, because you’re coming back the next morning, don’t do that. Pack it up and make sure you have everything you would need at home to keep doing therapy.”
So, I sent that email to them and I didn’t get much of a response, which I was kind of surprised. Maybe they were expecting it. But so then Friday rolled around and like, it seemed like Thursday things were really hitting like a fever pitch. Friday came, I actually met with my business coach that morning and was explaining the situation to her and she said, you know, it just probably is better if you just call it now, instead of going back and forth or saying, “Hey, we might do this. We might do that,” Sending in million emails about, are we going to do it, or we’re not going to do it. She said, “Just call it now and just draw the line in the sand. We are going to move to all telehealth. Tell the therapist. Just get it done. And that way you have enough time to make all the changes.’
So, I worked on writing up the letter to the client. So we were able to send like a mass email to all of our 500 clients through TheraNest. And I like when, after we had that conversation, I was like, “You know what, she’s right. Like I just need to like get out in front of this and if I do, we’re going to have some time to prepare.” So this is Friday. We have all weekend to get ready to switch over on Monday. So I was you know, really struggling with what to say to the clients. I had a migraine. I was still doubtful about my decision, but I just kept working on it. I ran out, I got some Tylenol, and I finally put this letter together and we sent it out about two o’clock on Friday afternoon. And at three o’clock, the governor of Pennsylvania came out and said all the schools in the whole state of Pennsylvania were shutting down.
And that was such a confirmation to me that I did the right thing, because I knew that if they shut the schools down, then that was like, it was over like people weren’t going to be coming to appointments. They were going to be at home with their kids. They were going to be canceling all over the place. So that was a really you know, it was really great that it happened at the same time because it was just validating to me that I was doing the right thing. And I basically told the therapists we’re going to have an emergency staff meeting Saturday morning and we’re meeting over Zoom and we spent an hour and a half talking about how they’re feeling about everything and how everybody’s coping with everything that’s going on. And we talked about, “Okay, how are we going to do telehealth,” because what had happened on Friday is we did a little bit of online counseling before, but because some of these insurance companies weren’t paying for it, we weren’t doing a lot of it.
And you know, people weren’t necessarily requesting it either. So some of my clinicians were doing telehealth on that Friday and they were noticing doxy.me was really slow or they couldn’t get in at all. And we always have had really good luck with doxy.me, it’s been great, the clients like it, we like it, but now all of a sudden it seemed like it was overwhelmed, obviously because all the therapists in the world figured that they needed to be on telehealth at the same time. So yeah, so unfortunately it just seemed like it wasn’t working. So we looked into the paid version of the telehealth platform through TheraNest, which is our EHR. So that way it would be all integrated. So we decided to sign up with that. So then we had to go back and email the clients again and explain to them that we weren’t going on doxy.me, we’re going to be on TheraNest and this is how you log in to get onto the TheraNest platform.
So that was a bit of just changing things around, because of extra work and a little bit of confusion and that kind of thing, but I didn’t want them to have only doxy.me and then have it not work. So what we decided to do was have TheraNest telehealth as primary, and then they could use doxy.me as a backup. That way, you know, if for whatever reason option A didn’t work, they could go to option B. There’s nothing worse than, you know, when your tech isn’t working for an online session and you get panicked and then there’s no other options. So one of them to have an option A and option B. So we sorted all of that out and how that was going to work and how they have to, you know, choose a different place of service.
In TheraNest, you have to choose 02 for online versus 11, which means the office and that obviously translates to how it shows up on the claim form when you send into the insurance company. So we got all of that sorted out and I put together a therapist, like tip sheet about how to do telehealth. Some of them hadn’t done it before, some of them had been doing it for a while, like I said, but just, you know, really simple things, like make sure the background behind you isn’t cluttered and make sure you have ear buds in. And I asked them in that meeting, “Hey, if anybody doesn’t have earbuds, let me know.” And I ordered them through Amazon Prime and they got to their house within one day. So they had them for their sessions on Monday. You know, just all these little things that you may not think about when you’re doing a regular online session or in a regular session in the office, I should say.
So we kind of went over all of that and then I made like a little tip sheet and send it out to them so that they could just, you know, keep all of those little things in mind about, “Okay, this is how, you know, online session runs a little bit differently even, you know, the facts that you have to sort of look at the camera rather than looking at the screen where you think you’re making eye contact with your client, but you’re really not making eye contact because you need to be looking in the camera to make eye contact.” So, yeah, so just like these little nuances with teletherapy that, you know, some people might not have thought of. So we got everything sorted out. I had my admin assistant call every client and explain to them like, “Hey, we changed the platform. Did you get the email? Do you have any questions? If you have questions, call us back.”
I actually had her work for a four-hour block of time on Saturday and four-hour block of time on Sunday and we put that in the email we sent out on Friday. We said, “If you have questions about what’s happening, how to get on the telehealth platform, our administrative assistant will be answering the phone on the weekend.” And I actually was the backup person on the phones as well. So we are in the process of hiring a second administrative assistant, but we haven’t gotten there yet. So just to make sure we covered all the calls, we have the ability in our phone system to set it up so that when somebody calls in and they dial the administrative assistance extension, it dials her first and if for some reason she doesn’t answer, like she’s already on the phone, it will dial another number.
So I was the second number and yeah, so we didn’t, we had that set up just so that people felt like, okay, if they really wanted their questions answered or they were really confused or whatever, then they have that opportunity before Monday came around because Monday was the day that we needed the total switch to a hundred percent online sessions. So just to back up for a minute, this is where I’m getting a little tangential, I was really worried about making that decision on Friday to switch everyone to telehealth because I had no idea what kind of reaction I would get. I was afraid the clients were going to cancel, I was afraid that therapists were going to be mad, but one really cool thing that came out of all of this was that my staff was like so supportive of that decision. And they, you know, we talked about it in the meeting. Some of them called me, not called me, texted me later and emailed me later and said, “Hey, like I know this is tough and I think you’re making the right choice. And I’m like really glad that we can work from home.”
So that was really a really cool thing that came out of this whole kind of bad situation. And the other piece of that too, is like some of the clients, well, a lot of the clients were really appreciative to that we didn’t close our doors, we didn’t stop providing services, that we switched to telehealth and they still had the option of meeting with their therapist. And you know, that when somebody gets used to their therapist, like they don’t want to move or switch or whatever. And obviously too, when you’re in the middle of going through that, you don’t really want to like, you know, necessarily take a big break from going to therapy. So that was cool that the clients were telling the therapist how much they appreciated that. They were able to still come to therapy, even though we’re basically kind of all quarantine in our houses.
So, I will say that one thing that did happen was that some of the clients said, “You know what? I don’t really want to do teletherapy. I’ll just wait until you open up again and I’ll come then. So, let me schedule out three weeks or four weeks or whatever.” So when the governor of Pennsylvania shut down the schools for two weeks, I think that sort of planted this idea in everybody’s mind, like, “Oh, the schools are going to be closed for two weeks and then everything’s going to open it back up again and it’s all going to be fine.” Well, obviously we’re still in the middle of that two weeks so that remains to be seen. I don’t think it’s going to be that short of amount of time. I think it’s going to go on longer than that. So I do think in this initial sort of wave of like cancellations that we got or people saying, “Oh, I don’t really want to do telehealth. I’ll just wait.” I think it’s going to be a longer period of time than people think it’s going to be and I think they will come around to the idea of trying telehealth because really they have no other option at this point.
So all that being said, if you’re having that experience too, take heart that, you know, I think those clients are going to come back around and they are going to be more willing to try telehealth, especially if this gets to be a pretty extended period of time that we’re all quarantined or supposed to be social distancing or whatever you want to call it. So, yeah, so we started on Monday and there were quite a few tech issues that we had to work through. It was a pretty steep learning curve because we threw all of this together in 48 hours and we have never used that platform before. So I was available to help troubleshoot and my administrative assistant was available.
So, we just spent our day trying to help the therapists and for the clients who, excuse me, who were calling, who, you know, maybe their work schedule got changed at the last minute or they were sick and they couldn’t come. Like I was taking some cancellation calls as well. So we ended up having a staff meeting again on Monday evening at like 8:00 PM, that was optional. I just said, “Hey, if you want to come and like give me feedback about how your day was, how things went with the platform, show up to this Zoom meeting and, I want to hear how it went.” So, a fair amount of them did show up and kind of told me about the tech issues they were having and told me about their experience with doing telehealth, many of them for the first time. and I was really there to support them and answer any questions that I was able to answer at that point and just kind of let them know that I was really, really happy that everybody just sort of rolled with the punches and even though it was hard and they got frustrated by the tech issues and all that kind of stuff, like we’re all in this together, I’m here to support you.
And then Tuesday, it seemed like there were less issues and then Wednesday, even less issues. So I barely heard anything at all today. So today is Wednesday, March 18th. So that’s all going really well now, I should say. So the other piece that has been happening is when we switched to all telehealth, I realized that we also have to change our marketing strategy because obviously we were marketing to our local area. We have three offices obviously brick and mortar. People call and they want to come in and see a therapist. They don’t hardly ever request online therapy. So I realized too, part of my job in this whole situation is really now to pivot, to figuring out how do I market the telehealth and then also, how do I now market to a much bigger audience, which is really all a Pennsylvania because we’re licensed in Pennsylvania so we could see anybody in our state, which is millions upon millions of people, a lot of whom live in rural areas and desperately need mental health services.
So that has been quite the process as well, figuring all of that out. So the one thing that I did recently is I set up Google ads for the practice. So I contacted Kevin, who’s doing my Google ads, and if you’re interested, his businesses called Ardent Healers and he is a clinician. He’s also one of my past consulting clients and he started a kind of side business where he helps therapists that have Google ads. So I called Kevin when I was ready to do my Google ads and he set them up for me. And so I called him the other day and I said, “We have to sort of figure out now, how are we going to you know, really emphasize this online therapy, because this is all we’re doing right now. And this is all we can do until like Pennsylvania lifts all the restrictions they have right now because of COVID-19.”
So, he had some really good suggestions, one of which was to put like a popup or like a bar at the top of the website that basically said like, ”During this time period, we are only doing telehealth.” He said, because most people looking for a therapist aren’t necessarily searching for online therapy or telehealth he said, but if they click on your ad and they go to the website and see, you’re only doing telehealth, you know, like maybe they’ll just, there’ll be okay with it because that’s really their only option right now, or they’ll just move on. So all that being said, he has some good related to that and he’s optimizing our Google ads to help with that.
Something else that we are doing related to marketing is we’re getting on the onlinecounseling.com directory, which was started by Clay Cockrell. He just did a really great podcast episode with Joe Sanok all about online counseling especially related to the COVID-19 pandemic because so many people are switching over right now. So if you haven’t checked that out, definitely listen to that. And then I was also considering setting up Psychology Today profiles in different parts of the state. We’re in the process of doing that now. I have no idea if that’s going to work or not, but that was just my idea. And then I was talking to Jessica Tappana who owns Simplified SEO Consulting. She was on a call that we were doing the other day in our Next Level Practice community. Or was that Next Level Practice or was it something else? I forget now.
Whitney did a kind of like a live Zoom call with a bunch of people and I was on there for a little bit too, just about like how people were coping and what they were doing in their business to sort of, you know, change their services in response to everything that’s happening with the coronavirus. So Jessica Tappana was on there and I was asking her like, “What do we do in terms of SEO, if now we’re sort of doing telehealth and we can’t advertise to everybody in the state of Pennsylvania?” So she was saying that one suggestion would be in your blog posts, or maybe on a services page or something like that, you start naming those different cities or towns or areas of your state, because that would help you start to rank with SEO in different parts of the state. Because everything that I’ve ever done has been related to you know, like our local area, like our county.
So yeah, so I thought that was a really cool suggestion as well. Something else that we’re going to start doing is we’re going to run a free support group on Zoom. So it’s not going to be a therapy group. It’s going to be a support group and it’s going to be open to any adult in our kind of local-ish area who’s kind of struggling with things related to COVID-19. And my hope is that you know, part of it is to give back to the community and support people, but also to help people sort of become familiarized with the idea of being online and seeing a therapist and interacting with people and maybe then they’ll sort of see like, “Oh, online therapy, maybe it isn’t so crazy of an idea. Maybe I would want to try online therapy.” So that’s just another idea that we’re going to try again. I have no idea if it’s going to work or not, because we just started trying it.
So those are just marketing ideas off the top of my head. I am in the process of also looking at running Facebook ads. I have tried to put some Facebook ads out there, but I don’t know, Facebook keeps rejecting them. So I got to go back to the drawing board. But in short, I just wanted to kind of like explain like this whole sort of process that my practice has gone through in response to COVID-19. I really feel like even though I’m six days out from my decision, I feel like going to all telehealth when I did was a really good decision. So basically, you know, like I said before that Friday, the governor had said all the schools were shut down and then that Monday, he basically said all non-essential businesses were shut down.
So basically, anything other than like a pharmacy, a grocery store, obviously healthcare can stay open. We would be considered in just like essential business, but I just felt like it wasn’t worth taking the risk. Obviously I don’t want my therapists getting sick but I also don’t want the clients getting sick. And I think that as therapists, we have this ethical code and we take the oath to kind of do no harm to our clients. And I just felt like there’s no way I can assure that we’re not doing harm by meeting with clients in the office anymore just given how rapidly the coronavirus is spreading and how you don’t know for 14 days, if you have symptoms. And I just, you know, I couldn’t in good conscious keep letting their best meet with clients, knowing that we might be infecting people, they might be infecting us and we may not know it.
So, I really took that very seriously and I had one therapist who was sort of wrestling with like, “Well, maybe I could see a few of my clients in person,” because she does EMDR. And if you know anything about EMDR, it’s very hard to translate on a virtual session as opposed to, and it’s really meant for in-person. And we kind of, you know, had a discussion about that and I said, “You know, I really just don’t feel good about you taking that risk.” And I think it took her a couple of days to wrap her head around that and I think she finally said, “You know what? I agree with that. I think it’s not worth the risk and we’re just going to have to sort of see what we can do in the meantime.” And we were able to find a kind of online tool that can be used with EMDR that she might use in her sessions.
But anyway, I think this is all part of just having to think through you know, does the benefit outweigh the risk or does the risk outweigh the benefit kind of thing? And I think for me too, having W2 employees you know, I’m taking on that liability. Again, if they were to get sick, if the client was to get sick, if the therapist was to get sick, they could file a workman’s comp claim. So obviously that goes, you know against me, I guess, so to speak. So just all those factors, it just felt safer to just say, “Okay, we’re going to switch to all telehealth, there’s not going to be this sort of like half and half or back and forth or whatever.” And I realized that everybody has to make their own decision based on their own practice, their own set of circumstances what’s happening in their local community, all of those kinds of things.
But I just wanted to share my own experience just to give you some food for thought. So I hope that you are staying safe and healthy, and if you have made this transition to telehealth, let me know how it’s going, and if you found any cool marketing strategies for now having a hundred percent online practice. Because I had never thought that I was going to be in this place of, I never, never knew in a million years that I was going to have on her present online practice. And I have these beautiful office spaces that are totally empty right now. So yeah, so it’s a whole new world and a whole new sort of set of challenges and things to think through and problems to solve. So, you know, if you have ideas definitely let us know.
If you’re a group practice owner, think about checking out my Facebook group for group practice owners. It’s called PoP or Practice of the Practice Group Practice Owners. You just have to answer a couple of questions and you can join that group. So looking to sort of add more members, so we can have some more dynamic conversations and we can share more resources and things like that. So definitely check that out again. It’s PoP Group Practice owners, on Facebook. I’d be happy to have you join the group and yeah, I think that’s about it for my whole long saga about coronavirus and how I had to at the drop of a hat really pivot my business to sort of keep things afloat, keep serving clients, keep therapists employed. I think it was the best option given the whole situation.
So yeah, let us know how we can continue to support you in this whole process. I know it’s not been easy for a lot of people, but I’m trying to see the silver linings in this whole situation. I think one of the silver linings is that you know, I think now that insurances are approving telehealth like, there’s no going back. Like after this whole thing is over, I don’t think insurance companies are going to come back and say, “Oh, never mind, you can’t do telehealth anymore.” Like I think the flood gates are open now. And I think that’s really cool. And I think too, you know, clients are being forced to do telehealth right now and they’re going to get used to it. And then it’s, again, going to become more commonplace. You know, clients are going to maybe start to request it or just be more open to it in general. So I’m trying to see, see the positives that are happening as well. So I hope that was helpful. Yeah, please again, please let us know how we can support you and keep on keeping on.
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