Katie Bailey on Having a Practice in Two States | GP 99

Image of Katie Bailey. On this therapist podcast, Katie Bailey talks about having Practices in Two States

How would you set the hourly rates of your practice in two different states? What are the first steps to registering your practice to work in another state? How do you unify your staff in two states?

In this podcast episode, Alison Pidgeon speaks with Katie Bailey about Having a Practice in Two States.

Meet Katie Bailey

A photo of Katie Bailey is captured. She is a professional counselor and group practice owner at Lime Tree Counseling. Katie is featured on Grow a Group Practice, a therapist podcast.

Katie started Lime Tree Counseling in 2018, and her husband Nate has now joined her in running the practice. With a growing team of six clinicians, Lime Tree’s team sees clients in PA, CO, and NC. Working together in private practice allows Katie and Nate to do what they love and have a wonderful work-life balance!

Katie works with people who struggle with anxiety, both those who have elevated anxiety that is connected to trauma and those whose anxiety comes from other sources. Constant worry and panic attacks are no way to live. Her goal is for clients to reclaim their peace and enjoy life again.

Visit the Lime Tree Counseling Website. Connect with them on Facebook, Instagram, and LinkedIn.

In This Podcast

  • Tips on running a business with your spouse
  • One practice in two states
  • Setting rates
  • Katie’s advice to practice owners

Tips on running a business with your spouse

  • Communicate clearly: both in the marriage and the business, help one another out by practicing clear communication. Ask questions to fully understand one another.
  • Divide and conquer: set up the business so that you each work with your strengths in different areas of the company.
  • Be proactive: if something is coming up in the business – or marriage – that needs to be addressed, be proactive. Initiate a conversation to be on the same page.

One practice in two states

Katie Bailey had a valued staff member move to a different state and therefore decided to expand the practice so that the employee could remain a part of the business.

I learned a lot and I think the decisions and what you need to do are different based on where the clients are going to be seen. (Katie Bailey)

First steps to working in a second state:

  • Consult with an attorney from the new state to set up the paperwork. Each state has different requirements.
  • Consider working with a business attorney to make sure the business is properly registered in the new state.
  • Speak with your payroll company to make sure that you are registered properly so that you can pay taxes correctly.

It is not difficult, but sometimes it’s tedious with all the different account numbers. But that’s what you have payroll companies for and people to help you walk through [this process]. (Katie Bailey)

Setting rates

Research the new state to see what the general rates are for the work that you want to do in your field.

You can change your rates to suit those of the new state that you are doing business in, or keep your rates the same as your practice in the original state.

For simplicity’s sake I kept [the rates] the same [because] it felt complicated … I wanted to keep it consistent because … it felt better ethically to me. (Katie Bailey)

Katie’s advice to practice owners

Keep your values consistent and make your decisions in alignment with your values.

By sharing the goals with the team, you help your staff feel included and a part of the growth of the company.

Useful links mentioned in this episode:

Check out these additional resources:

Meet Alison Pidgeon, Group Practice Owner

An image of Alison Pidgeon is displayed. She is a successful group practice owner and offers private practice consultation for private practice owners to assist in how to grow a group practice. She is the host of Grow A Group Practice Podcast and one of the founders of Group Practice Boss.Alison Pidgeon, LPC is the owner of Move Forward Counseling, a group practice in Lancaster, PA and she runs a virtual assistant company, Move Forward Virtual Assistants.

Alison has been working with Practice of the Practice since 2016.  She has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting.

Transformation From A Private Practice To Group Practice

In addition, she is a private practice consultant for Practice of the Practice. Allison’s private practice ‘grew up.’ What started out as a solo private practice in early 2015 quickly grew into a group practice and has been expanding ever since.

Visit Alison’s website, listen to her podcast, or consult with Alison. Email Alison at [email protected]

Thanks For Listening!

Feel free to leave a comment below or share this podcast on social media by clicking on one of the social media links below! Alternatively, leave a review on iTunes and subscribe!

Podcast Transcription

[ALISON PIDGEON] You are listening to the Grow a Group Practice podcast. Whether you were thinking about starting a group practice or in the beginning stages, or want to learn how to scale up your already existing group practice, you are in the right place. I’m Alison Pidgeon, your host, a serial entrepreneur with four businesses, one of which is a large group practice that I started in 2015. Each week, I feature a guest or topic that is relevant to group practice owners. Let’s get started.

Hi, I’m Alison Pidgeon, your host. I am excited to talk with you today. We have a great interview and we are in the midst of holiday season here at my house, so lots of cookies and wrapping paper and talking about Santa. Definitely having three kids under the age of 10 makes this time of year very fun, but also a little bit stressful at this same time. So we’re just trying to enjoy the moment and just be together as a family and experience everything that the season has to offer. So I hope you are finding some of the beauty in the season that we’re in right now.

I have an interview for you today with Katie Bailey. She started Lime Tree Counseling in 2018 and now, she and her husband, Nate run the practice together. They have a team of six clinicians and growing. They see clients in Pennsylvania, Colorado, and North Carolina. I talked to Katie about what it’s like to have employees and see clients in multiple states. That is the main reason why I wanted to have Katie come on the podcast. She’s going to explain all about how they came to decide to see clients and have an employee in Colorado and what their future plans are.

We also talk about what it’s like for her to run the practice with her husband, but she said, it’s great. They are doing what they love and they have a wonderful work life balance. So that’s also always interesting to hear how spouses work together in practices. So yes, if you’ve been wondering, especially with the prevalence of telehealth now and folks starting, especially online practices and with staff in different states, this is definitely a good interview to listen to.
[ALISON] Hi, Katie, welcome to the podcast.
[KATIE BAILEY] Hi Alison. Thanks for having me.
[ALISON] I’m excited to talk with you today. So before we get started with our questions, how about you introduce yourself in your practice?
[KATIE BAILEY] Yes, absolutely. I’m Katie Bailey. I live outside of Philly in the suburbs in Montgomery County and I own Lime Tree Counseling. We do online and in-person sessions. We’re a small group practice. There’s seven of us right now and we’re growing and it’s been great.
[ALISON] Nice. So you also work alongside of your husband and he’s a clinician as well?
[KATIE] Yes. So he started just working part-time with me when I started the practice and then when COVID came and life got really crazy and our kids weren’t always in school, he actually got furloughed from his job. He was a corporate trainer and a behavioral health company nearby. So we made sort of a leap of faith and decided he would leave that once that happened and join me full-time and it’s been the best decision we could have possibly made for our business and for our family. The business has grown since he’s joined me and we have the flexibility to be with our kids and all the demands that come with that. It’s been really great. We really enjoy working together.
[ALISON] Nice. So obviously working with your spouse could be great or it could be not so great. So do you have any tips for people if there can considering working with their spouse, like how you made it work or what’s kind of, maybe if you had conversations in the beginning about expectations or what did you do?
[KATIE] So well, just like in your marriage, in your business marriage, I guess is communication. So we talk clearly about all the things and make sure we’re on the same page with stuff. We also just sort of divide and conquer really well. There’s things that Nate is really good at that are not in my skillset and vice versa. He does a lot of the training of our staff and sort of the HR kind of things that he’s just had more experience with. I tend to do more of our finances and that kind of thing, but we both know what’s going on in all the realms. Like we’ll sit down and have meetings and just sort of review everything and make decisions together. There’s not one of us that’s just totally making decisions. We do it all together. So it really kind of comes naturally. We just really enjoy doing all those things together.
[ALISON] Nice. So how do you kind of deal with, if there’s a disagreement or a conflict about something, like you feel really strongly about doing it one way and he wants to do it a different way?
[KATIE] That’s funny, Alison, I don’t know that we’ve ever had that happen. I mean, I think we have enough understanding and respect for one another. I kind of know what Nate is better at than me and vice versa. So I guess if we really sort of butt heads on something, one of us was sort of acquiesce to the other, knowing that they kind of know more about that area, but we really don’t have, we haven’t, I mean, not, I don’t want to say we never disagree because that’s not realistic, but we haven’t had any huge major decisions to be made where we really were on opposite ends. So for the most part, we just figure it out.
[ALISON] Nice. So it sounds like maybe you have complimentary strengths and weaknesses and you just recognize and the other person, oh, this is their strength and you trust their judgment that they’re making a good choice about that?
[KATIE] Absolutely, yes. It’s not just trusting them blindly to make this choice. I’ll know about it. Because it’s one big unit that all has to work to together. So he tells me things he does and I tell him, and so there’s never a surprise. We know what each other’s doing.
[ALISON] Nice. Well thank you for sharing that, because I’m always really fascinated by spouses who work together because I’m not sure my husband and I can work together.
[KATIE] Yes, we get that question a lot how do we do it? But like I said, it’s been the best thing for our family. It’s given us a lot of flexibility that we needed over the last couple of years. If you’re not with the kids you’re working and we just sort of flopped those roles and it works out really well for all of us.
[ALISON] So I wanted to talk to you about your practice and how it is located in two different states. So tell us about where it is located and how you kind of came to that decision to have it in multiple states.
[KATIE] Well, it wasn’t really a conscious decision, Alison. We kind of fell into it. So we’re based here in Ambler Pennsylvania and as you probably know, finding good people to join your team, isn’t always the easiest thing. We had a clinician with us for just a short while and when the pandemic hit, I mean everything changed and we all had to be flexible and adjust to things. She needed to make a move to Colorado know and I didn’t want to lose her on our team because we really valued her and she did great work. So with the influx of telehealth, I mean that was all people did for a while, I asked her if she would stay on with us from Colorado. So she obviously could still see clients in Pennsylvania online, but she had also expressed interest in seeing clients in Colorado as well. So I got licensed in Colorado to be able to better support her there as well.

So it was really that to just keep good people on the team. We have done marketing Colorado, we have clients from both states now online. Ideally eventually we’d like to get her an office space there and maybe add some other team members out there. The time just hasn’t come for that yet with this whole like people online or in-person, still thing kind of figuring out what most people want to do. But that’s a longer term goal, but it’s been great and it’s really been a joy to be able to expand our reach, to support and serve people. Honestly, the biggest challenge has been the time difference because the our EHR only schedules in one time zone. So we do it in the Eastern zone. So she just has to be really conscious. I do too with my Colorado clients. I have my computer tell me the time in both time zones to make sure I get it right. But aside from that, it’s been pretty seamless and it’s been a really great experience.
[ALISON] Nice. So it wasn’t necessarily a conscious choice. It was a, we really want to keep this person on our team, so let’s figure out how to make it work?
[KATIE] Yes. And keeping in mind that came in the midst of the pandemic when you don’t know what, I didn’t really know is telehealth all we’re ever going to do again. We were just trying to be adaptable to the situation that we found ourselves in and it’s been a win for her. It’s been a win for us and yes, it’s been very overall.
[ALISON] Nice. I think more and more of that is going to happen for sure as people are able to work from home and really then can live anywhere. I actually have a similar situation potentially with a therapist of mine who maybe moving to Florida because of her husband’s job and said I’d really love to keep working here, like can we make that work? I was like, yes, absolutely. We can make that work. We’ll figure it out. So it sounds like a very similar story to yours. So I’m curious when you knew that you were going to do this, like still have her on staff, even though she was going to be in the Colorado, what was some of the first steps that you took? Did you consult with a lawyer or like an accountant or what are those foundational things that you started with?
[KATIE] Sure. Well, I learned a lot and I think the decisions and what you need to do are different based on where the clients are going to be seen. So if she had just stayed seeing Pennsylvania clients, it really would’ve just been a tax issue to make sure I was set up to pay her payroll taxes in Colorado. Because we also wanted to see clients in Colorado I consulted with a Colorado attorney to set up all the paperwork there. So we have two different sets of intake paperwork, one for PA and one for Colorado because each state has different requirements of what you have to include in an intake. They even call the forms, different things and that kind of thing.

So on the clinical side, I did consult with her and made sure we had Colorado approved paperwork. She also had a colleague that was a business attorney and she made sure we were registered appropriately with Colorado. I consulted with my accountant. He was real like, “Oh yes, it’s easy. Just make sure you’re paying your taxes there.” So I worked with my payroll company to make sure we were registered there. And each state’s different. We have an admin in Texas and so I pay her. All my, I should say everyone on my staff is a W2 employee as well.

So we pay her taxes in Texas and that experience was different than Colorado just because each state has different requirements and that kind of thing. It was a lot easier in Texas. Colorado wasn’t difficult, but Texas just made it really easy. But yes, so we worked with the payroll company, made sure we got everything set up with that and it’s not difficult. Sometimes it’s tedious, just all those sort of different account numbers and all that sort of stuff, but that’s what you have payroll companies for and people to help you walk through that. So once we got that set up and the clinical paperwork, well that was pretty much it. We were pretty much good to go.
[ALISON] Okay, great. So let me just clarify, because I think this is a really important point for people to take notice of like there’s a process where you have to kind of register with that state’s government to say, I am now doing business and the state of Colorado. So any business would need to do that and then on top of that for our field, we need to make sure if you’re seeing clients in that state, you also have to be following all of the laws and ethics of that state, of their mental health board, whatever that’s called. So she had only even seen clients in Pennsylvania. You wouldn’t have had to worry about the part of making sure you were following like the legal ethical —
[KATIE] That’s right. It would’ve just been that tax issue and the payroll issue. Then once you make that decision to see the clients in the other state, in our case, Colorado, yes obviously you have to be licensed in that state, but then you had to make sure that all the paperwork is also up to snuff with what they require and all that stuff. So yes.
[ALISON] Okay. I think that’s really helpful because I think people don’t always realize that there’s two, there’s kind of two pieces to that. So definitely, yes. If you’re planning to see clients in that state, then there’s a whole nother layer of stuff that you have to make sure you’re being compliant with. So was there a cost associated with like registering to do business in the state of Colorado or was it just making sure you were paying taxes to the right place through payroll or?
[KATIE] Yes, there was no cost now. Again, I can’t promise it’s going to be like that in other states because every state’s different, but for Colorado they have a pretty well set up website. So between my payroll company and the Colorado website, I was able to navigate it pretty well. I did also have this attorney in Colorado who was helping me make sure I registered properly with their, I forget what they call it, department of state, something like that. So I have an LLC here in PA of course. So I didn’t have to change the LLC in any way. It’s just registering the LLC to do business in Colorado.

Once I did that, I was then able to get my tax withholding withdrawal account and my unemployment insurance account number. Really once you have that, it’s just a matter of plugging that into your payroll system and make, hopefully if you have a good payroll system, they can handle that and they just take out the taxes for that state. There was no cost associated with that other than the time. I guess that’s a cost the time it took to sort of figure that out. I did since realize, I use Gusto now I switched in the middle of this. I had started with ADP and that was not helpful. Gusto has been better.

When I set up my admin in Texas they have, you can pay them money, but there’s a service they contract with to get all that set up for you. So I think I paid like a hundred dollars and they set us up in Texas and I didn’t have to invest that time. So either way you could do it yourself or find a company similar to set you up, but it’s really just a matter of time to make sure you got all the details right away.
[ALISON] Right. That’s really good information. So were there also considerations for your clinician now in Colorado in terms of like setting different rates or like obviously the cost? I mean, I’m assuming the cost of living there is a bit different than it is near Philadelphia. I’m not really sure, but what did you find in terms of that and how to set rates?
[KATIE] I did a little bit of research to see what rates were like out there and they were pretty similar. And just for simplicity’s sake, I kept it the same. That felt complicated to me to say, oh, you live here? I’ll charge you this rate. You live there? You get this one. So I really wanted to keep it consistent because that just felt that more simple, but that just felt better ethically to me too. So since they were pretty comparable, yes, we just kept it the same.
[ALISON] Okay. So then that eliminates that confusion. Then are you paying your Colorado clinician the same as you’re paying your folks in Pennsylvania then?
[KATIE] Yes. I’m paying her the same as well. I mean really right now her work is no different. She works all online and sees PA clients, but she’s only seeing Colorado clients online as well.
[ALISON] Okay. So if anybody listening is considering operating in multiple states, is there anything else that you learned through this process that you wish you would’ve known or maybe a mistake you made that you would like to share just so other people can avoid making the same mistake?
[KATIE] Yes. I would say just prepared. Whatever state it is you’re thinking of expanding, do some research first in terms of what their requirements are. I know there’s been a lot of discussion in our area, Alison lately about New Jersey. Aren’t they charging like $1,500 or something to do business?
[ALISON] If you don’t have a physical address, I guess.
[KATIE] Something like that. So before you even jump into the process look at their website, ask your accountant, figure out what’s involved so that you can make an informed decision. Is that an investment of time and money and resources that I want to make? You don’t want to start that process and then suddenly realize it’s more than you can take on. I kind of wish I’d done that a little bit more, but it worked out for us in Colorado and I was really committed to keeping this person on our team. So yes, for us it went well, but I think I would’ve liked to understand more what unemployment insurance was and all these sorts of different details. yes.
[ALISON] Do you do anything differently with the marketing in Colorado versus Pennsylvania?
[KATIE] Well, so we’ve had to put a little more effort into it because we’ve been in Pennsylvania longer and just have more contacts here. We’ve sent out some care packages to local colleges and some churches out there to try to network with them, just let them know who we are and what we can offer. We changed her business cards to say that she offers online counseling in Colorado and Pennsylvania. You can’t hand out a business card there with the PA address on it to people. That makes no sense. So we’ve changed some wording on some of our marketing materials and she has those and hands them out and mails them out and that kind of thing.

So we’ve had to adjust a little bit, but those are minor changes. I mean, most of the copy is the same. It’s just making sure that the geographical details are different. I’m currently working right now on our website for Colorado. We have a separate Colorado page and we’re working on targeting some keywords specific to that Colorado area and to build our SEO for that. So really it’s just taking a little bit more effort which we would, you know that’s okay. It’s worth it. We know that process because we did it for PA, so it’s just applying it elsewhere.
[ALISON] Okay. Nice. So you have the same website, you just added a page for the different location?
[KATIE] Yes, correct.
[ALISON] Got it. So I think that’s another really important point because I mean, we could probably get into a whole thing about SEO, but yes, having a whole separate page when you have, especially when it’s that different of a location I think is super important.
[KATIE] Right.
[ALISON] It’s not the next town over.
[KATIE] That’s right. So that’s been a learning curve too. But I had taken a deep dive into SEO when I first started with my website. But I think, I mean I’ve been reading and learning all kinds of things. I think a lot of people are finding that shift just with online being so prevalent these days. People are expanding and doing this more often. So learning how to make your website rank for various states, I think is going to be a more common challenge that people have.
[ALISON] I think especially with side packed psychologists can get licensed in multiple states now and something similar is coming down the pike with master’s level. So yes, it’ll be interesting to see what happens with all of that. Then obviously the marketing will go along with that. We’ll all have to adapt to say, “Hey, we’re now licensed in all these different states.” So hopefully it’s coming down the pike too, that it’ll just eventually be like a national licensure. Then there will be all these sort of arbitrary rules about you can’t see these people because they are in a different state, which is 15 minutes down the road from you.
[KATIE] Exactly. I find it frustrating, Alison because of course, and the clients don’t understand that and they shouldn’t, but we’ll have people find our blog posts on different topics. I mean, last week we had someone email us from Kansas and wanted to see me online. It’s hard to explain to her, I’m sorry, I can’t see you, I mean, because your average person who’s looking for counseling, isn’t going to understand the licensure laws. So I’m ready for that so we can see anyone anywhere.
[ALISON] Me too. Me too. I think the pandemic and telehealth just accelerated that whole thing.
[KATIE] Yes. Agreed for sure.
[ALISON] So what is your kind of future plans for expanding your two different states locations? I know you said you eventually want to get to the point where you maybe hire more people in Colorado. What is your end goal with all of that?
[KATIE] I don’t know if I have a specific end goal. I mean we always, our big goal is just to create a business that is a great work environment for people and supports our team that also provides great counseling and supports people in whatever community we’re able to reach. So right now we’re going to roll with it and just see what happens and we’ll take it from there. We’re hiring in both places and continuing to up our marketing and if and when it makes sense to jump in another state, maybe we’ll do that too. We’ll see.
[ALISON] Nice. How do you keep your clinician out in Colorado feeling like they’re a part of the team and that they don’t feel isolated, especially, I know you said the time zone issue can be a challenge?
[KATIE] That’s a great question. Well, we do, we have regular staff meetings that we do online anyway because some of our staff, well, all of our staff have a hybrid schedule. Some of them work more online than others, so we always do our staff meetings online anyway. So it’s not like she’s the only one on the computer and the rest of us are in person kind of thing. So really I don’t, I mean, it’d be interesting question to ask her. I don’t think she feels excluded from the team because of that. That’s sort of the nature of how a lot of our meetings go anymore. I was sort of, so we were both going to go to Killin’It Camp in person this year. I had planned to meet up with her in Colorado. So I was sad sort of when that didn’t happen. I’ll have to make another trip out there. But really, it hasn’t been much of an issue because our team is constantly supporting each other and texting each other and in contact. So I it’s been pretty easy.
[ALISON] Nice. It sounds like you had a good kind of culture already and it probably helped that she started out in the office in person and got to know all of you and then when she moved, it probably didn’t feel so —
[KATIE] That’s a really good point. She had already met people in person. It wasn’t like she came on from a distance. So yes, that’s a good point.
[ALISON] Which is like a whole nother thing that I feel like has happened. Since the pandemic, like some of my staff have never met each other in person.
[KATIE] That’s a new challenge.
[ALISON] Yes, yes. A new challenge as a business owner. That’s right. Well, it’s so great to hear about all the things that you’re doing, Katie, and to hear how your practice is growing. Any other thoughts about just your experiences so far with managing people in two different states and what it’s been like to navigate through all of that?
[KATIE] I think if you keep your values and your goals of your business consistent and just make sure you are making your decisions and align with all of that, it’s going to grow on its own. People are going to feel included and that kind of thing. We’re not running two businesses here. We just have an annex location kind of. And our goals there are the same as our goals here and everyone’s a part of the same team. That’s how we decide what we’re going to do, is to make sure that we’re still ultimately going to the value of our business, which is to offer awesome counseling services and a great supportive work environment.
[ALISON] Nice. So if folks want to check out your practice website or if they want to get in touch with you, what’s the best way for them to connect?
[KATIE] Yes, sure. Our website is limetreecounseling.com, like the fruit L-I-M-E. I know it’s a little bit of a quirky name, but we like it.
[ALISON] Where did you come up with that name?
[KATIE] So when I was naming the practice I wanted, I knew I didn’t want my name. Not because I knew I’d have a group practice, but I just, I don’t know, that’s not how I roll. I didn’t want my name on it. There’s a poet, Pablo Neruda that my husband and I really like, and he has a poem about a lemon tree, but believe it or not, there is a lemon tree counseling already. So I happen to like all things, lime, Alison. Anything lime flavored is my thing. So we switched it to Lime Tree Counseling. So that’s how we came up with it. So that’s our website, limetreecounseling.com. People are welcome to go there and check it out and they can contact me through that.
[ALISON] Okay, awesome. I think having a unique name is good, because it helps you stand out. I feel like there’s so many counseling practices that are just like Jones counseling associates or just some like super generic name and it’s like —
[KATIE] You don’t remember it.
[KATIE] You don’t remember it. You drive by the sign and you’ve already forgotten the name.
[ALISON] That’s right.
[KATIE] But Lime Tree definitely sticks out.
[KATIE] Well good. That was the idea. yes.
[ALISON] Good. Well, so nice to talk to you, Katie and I hope one day we can see each other at Killin’It Camp again.
[KATIE] Yes, that would be great.
[ALISON] All right. Thanks.
[KATIE] All right. Thanks Alison.
[ALISON] Thank you so much for taking the time to listen today. If you are wanting more support as a group practice owner, if you are wanting to do cool new, innovative things like Katie has done in her practice, and you’re wondering how you can find out some of those answers definitely check out our program called Group Practice Boss. You can find all of the details over at practiceofthepractice.com/grouppracticeboss. It’s a membership community for people who have an already established group practice who want a sense of community with like-minded practice owners, who want to learn new things, who want to make their practice more efficient, who want to grow. It’s so cool to know the practice owners in that group and see what they accomplish over a period of months and years. So definitely check out practiceofthepractice.com/grouppracticeboss. I will talk to all of you later.

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