Remote Patient Monitoring, new CPT codes, and Integrating Tech to Improve Outcomes with Alex Theobald | POP 828

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A photo of Alex Theobald is captured. He is a family therapist and clinical data scientist. Alex is featured on the Practice of the Practice, a therapist podcast.

Are you providing telehealth therapy? Do you want to improve your tech hygiene? How can you stay HIPAA compliant while using remote patient monitoring applications?

In this podcast episode, Joe Sanok speaks about remote patient monitoring, new CPT codes, and integrating tech to improve outcomes with Alex Theobald.

Podcast Sponsor: The Receptionist

A photo of the podcast sponsor, The Receptionist, is captured. They provide a simple, inexpensive way to allow your clients to discreetly check-in, to notify providers of a patient’s arrival, and to ensure your front lobby is stress-free.

Are you tired of running to the lobby to see if your next appointment has arrived? Would you like a more discrete, stress-free way for your clients to check in?

Take a deep breath — The Receptionist for iPad empowers your practice to create a Zen-like check-in experience.

This episode is sponsored by The Receptionist for iPad. It’s the highest-rated digital check-in software for therapy offices and behavioral health clinics, used by thousands of practitioners across the country including many who are just getting started.

The Receptionist for iPad is a simple, inexpensive way to allow your clients to discreetly check in, notify providers of a patient’s arrival, and ensure your front lobby is stress-free.

The software sends an immediate notification to the therapist when a client checks in, and can even ask if any patient information has changed since their last visit.

Start a 14-day free trial of The Receptionist for iPad by going to the, and when you do, you’ll also get your first month free when you sign up.

Meet Alex Theobald

A photo of Alex Theobald is captured. He is a family therapist and clinical data scientist. Alex is featured on the Practice  of the Practice, a therapist podcast.

Alex is a couple, marriage, and family therapist who has been practicing therapy since 2017. He received his masters degree in MFT at Utah State University and is completing a doctoral degree in CMFT at Texas Tech University. He currently works as a clinical data scientist for Noble and has a private practice in Colorado. He has authored multiple peer-reviewed articles on topics such as sexual media use and infidelity. He has presented at national conferences on topics related to couples therapy, infidelity, sexual media use, and trauma.

Visit Noble and connect on Facebook, Instagram, and LinkedIn.

In This Podcast

  • Are you practicing good tech hygiene?
  • Improving your outcomes with tech
  • How to stay HIPAA compliant
  • New CPT codes
  • Alex’s advice to private practitioners

Are you practicing good tech hygiene?

A common mistake many private practitioners make is not ensuring good tech hygiene. To practice this, you need to:

  • Make sure that the applications you are using are reliable
  • Coach your clients through their experience of using your tech platforms
  • Teach your clients how to practice tech hygiene on a virtual call

There are all sorts of little steps that therapists can [take] to coach or train our clients to have strong tech hygiene around our [telehealth] psychotherapy sessions.

Alex Theobald

Improving your outcomes with tech

Remote patient or therapeutic monitoring helps clients to maintain treatment protocols in between sessions, and in addition, helps the provider have granular and rich data about the client’s experience between sessions.

How much more powerful could our treatment be if we integrated these subjective self-reports of the client with some kind of objective data point?

Alex Theobald

There are secure, safe, and well-researched data methods available for therapists and their clients to utilize between sessions to track valuable data about the client’s life.

This information can be vital in providing tailored and hands-on therapy and treatment modalities.

How to stay HIPAA compliant

Using tech with its benefits must be done safely so that the privacy of both the client and the therapist is ensured.

For Noble, our first priority is data security because we know that the moment that that’s threatened or outside the window, it’s done … it’s a massive issue both for the therapist and the harm that could be done from the client’s perspective.

Alex Theobald

With Noble, data is encrypted as soon as the app accesses it. You can make sure that the applications that you use have similar features so that both you and your clients can sleep peacefully at night, knowing your data is secure.

New CPT codes

There is a big shift coming up in January 2023 with a new set of CPT codes being released that cover remote therapeutic monitoring.

Six of those codes run from the initial client setup to maintaining their monitoring.

A therapist can start bringing in around $120 of reimbursable services per patient per month. So, for 50 patients, that’s an additional $72k annually … that’s a massive boost to services.

Alex Theobald

Alex’s advice to private practitioners

Your expertise as a provider is valuable. Step into your ability and confidence as a healthcare provider.

Sponsors mentioned in this episode:

  • Heard always has transparent pricing with no hidden fees. Sign up for a free, 15-min consult call today at
  • Start a 14-day free trial of The Receptionist for iPad by going to the, and when you do, you’ll also get your first month free when you sign up.

Useful links mentioned in this episode:

Visit Noble and connect on Facebook, Instagram, and LinkedIn

Check out these additional resources:

Meet Joe Sanok

A photo of Joe Sanok is displayed. Joe, private practice consultant, offers helpful advice for group practice owners to grow their private practice. His therapist podcast, Practice of the Practice, offers this advice.

Joe Sanok helps counselors to create thriving practices that are the envy of other counselors. He has helped counselors to grow their businesses by 50-500% and is proud of all the private practice owners that are growing their income, influence, and impact on the world. Click here to explore consulting with Joe.

Thanks For Listening!

Podcast Transcription

[HEARD] It’s never too early to start thinking about tax season. Heard is the financial back office built specifically for therapists in private practice. They combine smart software with real humans to help you manage your bookkeeping, taxes and payroll. Regardless of whether you’re a seasoned clinician or are in the first year of private practice, Heard will identify areas of growth and streamline best financial practices for your business. When you sign up with Heard, you’ll connect your bank accounts so your transactions will automatically be pulled in and categorized. My favorite thing about Heard is their allocation guide, what helps you decide how much to pay yourself each month and how much to set aside for taxes. You’ll also receive financial insights such as profit and loss statements and personalized monthly reports. You can say goodbye to pouring over spreadsheets and guessing your tax deductions or quarterly payments. Focus on your clients and Heard will take care of the rest. Heard always has transparent pricing with no hidden fees. Sign up for a free 15-minute consult call today at Again, that’s joinheard, like I heard it, not like a herd of cattle, [JOE SANOK] This is the Practice of the Practice podcast with Joe Sanok, session number 828. I’m Joe Sanok, your host and welcome to the Practice of the Practice Podcast. I hope your week and your year is wrapping up well. It’s December now and we’re in the last month of 2022 and there’s probably a few conversations you should have with your accountant before year end. We’re actually talking about that in Group Practice Boss and in Next Level Practice, our two membership communities this month and we’re going to be specifically speaking about a bunch of those conversations you want to have. But if you haven’t met with your accountant, it’s probably smart to just make sure that you’re all set with your taxes, make sure you’re all set with those end of year conversations with your bookkeeper, your accountant, people like that. We’re so excited about what’s going on here at Practice of the Practice. We’ve got sponsors that are coming back next year. We’ve got some new sponsors coming and in March we’re doing another Level Up Week and having our communities open back up for Next Level Practice, Group Practice Launch, and Group Practice Boss. So a lot of fun stuff that’s happening. I hope that your year is wrapping up well, and that you’re really excited about things. Talking about New Year, next year there’s going to be some pretty big things in the CPT world. If that’s not one of the dorkiest sentences I’ve said in a while, I don’t know what is. But it’s good to talk technology, it’s good to talk CPT codes and insurance and billable things, and that’s what I’m really excited about today. We have Alex Theobald, who is joining us today. Alex is a Couple, Marriage and Family Therapist who’s been practicing therapy since 2017. He received his master’s in MFT at Utah State University. I didn’t even read that. I was born in Logan, Utah, and I’ll have to tell Alex that in a second. My dad got his Ph.D. from Utah State. He’s completing his doctorate degree through Texas Tech University. He currently works as a clinical data scientist for Noble and has a private practice in Colorado. Alex, welcome to the Practice of the Practice Podcast. How you doing today? [ALEX THEOBALD] I’m doing great, Joe. Thanks for having me. I’m excited to be here. I’ve been listening to Practice of the Practice for a while now. I have a colleague that’s passionate about the show and I’m just thrilled to be here. Thank you. [JOE] Yes, well, seeing that Utah State thing, I don’t see that very often in the bios and usually I read through the whole bio, but you caught me by surprise there because my dad, I was born in Utah while he was going to Utah State. [ALEX] Oh, that’s awesome. Yes, well, go Aggies. I loved my time there and I loved the training I got from both Utah State and Texas Tech. It’s been, yes, there’s some wonderful faculty there, just a great community. [JOE] That’s awesome. Well, let’s talk private practice. I want to hear your story in regards to getting into private practice specializing in couples. How did that unfold? [ALEX] I started, I interned at a place called Auto Recovery up in Logan, Utah and they focused on couples working through infidelity or other problematic sexual behaviors and that issue was something that I became really passionate about. The couple dynamic has been something that’s always been interesting to me both from a personal standpoint and then as well as a professional and academic point of view. There’s so much power that comes from a thriving and healthy couple, and there’s a lot of pain and struggle and issues that come where the couple relationship begins to deteriorate. So helping couples heal from some of the wounds they’ve incurred and also helping couples thrive beyond their wounds is something that just brings me immense meaning and joy in my life. [JOE] Yes, that’s awesome. Well, what were some of the challenges in setting up your practice and getting it going for you and what were some of the things that you did just get it going? [ALEX] So part of the challenges I saw were really being able to find a niche that I felt like I had something to offer. A lot of the training we get were designed to be generalists and I had these different passions and helping people with various specific issues and trying to brand myself in a certain way was probably one of the first challenges I faced. I had a lot of support from my supervisors and the companies I worked for, the people that contracted me. I’m incredibly grateful for their support. In addition to that, I found some of the challenges is, so I’m passionate about technology and psychotherapy as well, and learning how to integrate tech in a efficient and effective way, it’s kind of a wild, wild west. I mean, especially in the last few years, I think all of us therapists have had to learn through the school of hard knocks to how to integrate tech well into psychotherapy to deliver really quality services to our clients. I think that challenge that therapists are facing and are continuing to wrestle with is something that I really care a lot about and something I’m still learning myself. [JOE] What would you say people, when they integrate tech, whether it’s telehealth or other things that they do wrong or maybe don’t even understand they’re doing wrong? [ALEX] I think one of the first things is there’s a certain amount of tech hygiene that’s required to provide quality care. This is things like making sure the applications you’re using are solid and reliable, and then helping coach your clients through their experience. Some of the things I do when I start a telehealth session is I’ll ask about are they using a direct line to internet or is this Wi-Fi? If so what is our plan if Wi-Fi goes out or where are we at in the home? Are we in a secure location? I’ll even show my office, I’ll spin my camera around to show them, “Hey, look, this is a secure space.” I talk about confidentiality and how they’re sharing the responsibility of their confidentiality with me in that they have to protect their space and they’ll show me their space to make sure that they’re in a therapy conducive environment. There’s all sorts of little steps that therapists can do to coach or train our clients to have strong tech hygiene around our psychotherapy sessions that are telehealth. Iin my experience, observing a bunch of different therapists, part of my training at Texas Tech was to supervise therapists in training. That was one of the main things we talked about through the pandemic was like, how do you help your clients have a positive telehealth experience? Well, you have to teach them. It’s not totally intuitive. This isn’t the same as a Marco Polo with your family or friends. This is, if we want it to be truly therapeutic, you have to co-create that safe environment and to maintain a stable tech connection. [JOE] Yes, to even just think through intentionally, like, where are you going to be in the house? Where are the kid’s going to be? Are you fully going to be able to talk about the things you want to talk about, in the same way that a counseling office would be secure and safe and your kids aren’t sitting right outside the door. That’s great that you start, I love that term tech hygiene, I mean it’s like you hear sleep hygiene, things like that, but I haven’t heard that before. I think that’s a great way to frame it. Now there’s certain baseline technologies that I would say most people that are in private practice and that value growing their business maybe understand. They understand they shouldn’t use Skype for therapy, that they need to use a secure system like Therapy Notes or things like that. They understand that they should have an EHR, they probably understand some basic SEO, (Search Engine Optimization) around tech, but what are the things that maybe in technology regarding improving outcomes in regards to using technology in unique ways that maybe the average therapist has no idea is out there? [ALEX] This is where, like, I’m going to nerd out. This is where I get excited. So there’s an, it’s not a completely new approach to treatment, but it is relatively new for psychotherapy. That’s called remote patient monitoring or remote therapeutic monitoring. Just quickly, the essence or the purpose of remote patient monitoring is to help clients maintain treatment protocols through in-between visits and in addition to help the provider, or in our case the psychotherapist, have really granular and rich data on what the client’s experience is between sessions. One of the challenges of psychotherapy that we face all the time that I’ve noticed in myself is we rely heavily on our client insight to report to us what happened between this session or last session, or how their symptoms are improving. Therapists and psychotherapy in general we really struggle to integrate objective data points. Like when we go to our doctors, I think every standard doctor visit, they take our blood pressure, they look at our blood oxygen levels, they look at a variety of different objective measures of our health and use that as a baseline and they track that over time. But therapists don’t really do that. We have psychometrics. We we might have an assessment a client might take at the beginning to, again, self-report what their experience is like. Now, and I don’t want to talk down the self-reporting, I think it’s critical, but how much more powerful could our treatment be if we integrated the subjective self-report of a client with some an objective data point? So what remote patient monitoring does is it leverages a variety of different technologies as common as a mobile device or a wearable device, like a wearable technology like a watch of some kind, a smart watch or a tracker. It leverages that data to provide the therapist some insight into what the client’s experience was. Yes, you might have multiple questions here, I’ll pause here but I could keep going. This is, but that’s the essence is to help essentially help the therapist see both from what the client’s perceiving and from what the objective data reports, how the client is doing. Then we can increase the efficiency of our sessions and provide a stronger, I say a stronger treatment or stronger intervention to ensure that whatever we’re trying to do to help our clients improve, that they’re actually adhering to that protocol in between sessions. [JOE] So what is, so I understand the self-report of the client, when we’re talking objective data, walk through what that looks like when people are using remote patient monitoring. [ALEX] Sure. So here’s a little use case. I have a client with major depressive disorder and we talk a lot about, I work personally from a bio-psychosocial spiritual model as like a framework for understanding health. There’s a variety of different words that people might use to describe that but so I go through each of these areas and I look at some of their biomarkers, some of the biological factors that are playing a role in their depression. One of the strongest indicators of depression is poor sleep hygiene. When people have low energy or are not essentially helping themselves sleep well, or if they have some sleep disorder like insomnia, narcolepsy, sleep apnea, or whatever else, those are correlated with depression. That’s one of the first areas I’d look at and I ask them, how is your sleep hygiene? They say, oh, I don’t sleep that much. I don’t sleep that well. It’s hard for me to know what that means. As we dig deeper, they might be able to provide some information, well, I go to bed pretty late and I wake up early, or they might provide, yes, I nap a lot throughout the day. But often my clients do not give me the heart of the objective data. With some of the sleep apps we have, I could leverage that information of obviously with the client’s support and consent. That I could see, man, actually, you’re never hitting enough sleep. You’re never getting into deep sleep. I would, I strongly recommend seeing a sleep doctor or a sleep specialist to have them do a sleep study on you and see if there’s some way to help you get the rest you need. Or man, like, you’re not going to bed until 3:00 AM but your workday ends at 5:00. What’s happening between 10:00 PM and 3:00 AM? Oh, based on what your mobile device is reporting, you’re using social media or games or Netflix on your phone in bed. Well, that’s a sleep hygiene issue. All of a sudden I’m leveraging these different objective data points to triangulate what the behavioral or systemic problems might be to better support and aid my client in finding a solution that’s really going to help them. [JOE] Wow. So I guess from a data security standpoint, I know that that’s your whole jam, what do clients have to opt into and how do like, I know that you work with Noble, but yes, I’m thinking there’s all these apps out there that track these different things and if you’re pulling from one app for this data and others that it brings it all together, like, just from a security and a HIPAA and privacy standpoint, how does that, I don’t, know that world, so I wouldn’t even know where to start. How do you make sure that, I don’t know, there’s all these apps that after six months you find out that it’s, some foreign government’s been using that app to track things for something. I don’t want to, I don’t need to, but then it’s like there’s a therapist in Traverse City, Michigan, I want to do this work. I want to also feel like I’m not screwing over my client’s data. What backend things are happening to make sure that the average therapist doesn’t have to worry, that they’re not staying up at night, that their REM sleep isn’t disturbed because of the apps that they’re using with their clients? [ALEX] Absolutely. This is so critical, and I think this is, cars need gas in order to run, and tech needs HIPAA compliance in order to be secure. It needs a certain amount of protocol and encryption to make sure that the data we’re using is psychotherapist friendly. For Noble, I can’t speak to all the other apps, but I know that there are a variety of different applications or approaches out there. For Noble, our first priority is data security, because we know that the moment that that’s threatened or outside the window, it’s done. Like it’s a massive issue both for the therapists and the harm that could be done from a client’s perspective is massive as well. So we want to be able, able to secure that as like a baseline mandatory function of what Noble offers. So what happens on the backend is as we integrate one, just like you’ve probably, for myself, or maybe you have it, I don’t know, but for myself, I’ve allowed Apple Health to pull data from like, let’s say Strava or Headspace or some other app that I use to track mindfulness or track my activity or whatever else. That’s the type of consent that I offer Apple Health to gather that. Now for us, what we would do is we just like those types of systems, the client would consent to share their data, whether it’s from Google Health applications, Apple Health Fit, whatever their application they might be using to integrate that with Noble. Once it hits Noble it goes through an encryption process where it meets HIPAA compliance demands, and it is then placed into their client profile on Noble, which is only accessible by their psychotherapist. That’s how that works. It’s not like, Noble isn’t a social platform, it’s a relational platform between the psychotherapist and the client and that data is siloed and encrypted in a way that’s HIPAA-compliant. [JOE] Awesome. So I’m thinking about the new CPT codes coming out and would love to just talk through that side of things, because I think that to just understand how often therapists that start a solo practice, they’ve exchanged one job for another. They used to work for community mental health or community college, non-profits, whatever, and if they don’t work, they don’t get paid and then they go into private practice and they’re in that same situation, if not worse, where they’re then paying for a vacation and then they also aren’t getting paid on top of that. Talk to me about how remote patient monitoring works in regards to an income perspective with new CPT codes and what insurance companies are allowing therapists to monitor outside of the typical session [ALEX] Right. Now there’s a big shift that’s happening in January, 2023, where a new set of CPT codes are coming online that covers what’s called remote therapeutic monitoring, and there’s a list of CPT codes, six of them that run from the initial setup of setting a client up on remote patient monitoring, all the way to maintaining their monitoring. In terms of the fiscal opportunity, at least for, I’ll speak to CMS, which is Medicare or Medicaid, for CMS, on average, a therapist can start bringing in around $120 of reimbursable services per patient per month. So for 50 patients, that’s an additional $72,000 annually. That’s a massive boost to services. The nice thing about remote therapeutic monitoring is that you don’t need 60 minutes to perform the services. What you need is 16 touchpoints throughout a month that there’s a 20 minute, there’s like a you need 20 minutes per patient per month with 16 different data points to reflect that you understand what’s happening within that reimbursable month. [JOE] Okay, so we’re talking 20 minutes divided by 16 touchpoints. We’re talking like a minute and a half or a minute and a quarter per touchpoint. Sorry, I’m going to do some math here, so, 20 minutes a month times 20 patients that would be 400 minutes a month, or almost seven hours a month. So if we say seven hours a month, so 84 hours a year for that 72, sorry, divided by 84, so that’s $857 per hour if you’re at your most efficient [ALEX] Right, exactly. So the profitability for a therapist to adopt remote therapeutic monitoring is massive. I mean, I’m excited to throw this into my practice immediately starting in 2023 if for no other reason than the fiscal opportunity as a psychotherapist. But on top of that, the studies that have looked at client outcomes with remote patient monitoring, they’re seeing improved outcomes and more efficient outcomes at the upwards of like 44%. The clients that are on remote therapeutic monitoring are seeing outcomes faster than those that are not on remote therapeutic monitoring. [JOE] Go ahead, go ahead. No, no, no, you go. [ALEX] Okay, sorry. The last stat I’ll throw out there is for those clients who are severely ill, and they still have a care team, they still have a good care plan, those clients that are severely mentally ill are 40% less likely to be admitted to the hospital if they’re on a remote therapeutic monitoring system. [JOE] That’s a huge thing for insurance too. [ALEX] Massive, massive. So you think about your suicidal clients, your clients working with psychosis trying to overcome major psychiatric disorders. If I’m like, man, nearly 50%, I have a, if I can decrease their chances of being admitted to the hospital by 40%, man, I want to do that. It gives me more bang for buck in terms of my practice. I mean, I’m just pumped about it. [JOE] Yes. [RECEPTIONIST] When I had my group of practice, I was so sick of running to the lobby to see if my next appointment had arrived, or even more awkwardly to have a bunch of therapists run to the lobby when we heard the door open. Maybe you want a more discreet, stress-free way for your clients to check in. Take a deep breath. The Receptionist for iPad empowers your practice to create a zen-like check-in experience. This episode sponsored by The Receptionist for iPad, it’s the highest rated digital check-in software for therapy offices and behavioral health clinics used by thousands of practitioners across the country, including many who are just getting started. The Receptionist for iPad is super simple. It’s an inexpensive way to allow your clients to discreetly check in, to notify providers of a patient’s arrival and to ensure your front lobby is stress free. The software sends an immediate notification to the therapist when a client checks in and can even ask if a patient information has changed since their last visit. Start a 14-day free trial of The Receptionist for iPad by going to the Again, that’s the and when you do, you’ll also get your first month free when you sign up. [JOE SANOK] So the numbers we ran was based on 20 people that are opting in doing 20 minutes a month on each one. Now, what risks are there in regards to, I guess like, do clients have to do something in order for people to get paid? Is there some sort of opt-in they have to do is it actually likely that all 20 clients would want to do remote patient monitoring? What risks are there to just, listeners understand realistically, because it’s great to hear 72 grand extra. Who wouldn’t want that? Who wouldn’t want almost $900 an hour? But is that even, and I know that we’re talking 2023, so it’s mostly speculative at this point, but what’s your sense being in the industry? Would a 20 person caseload mean 20 people would really opt into this, or would we talk five or six and then we run the numbers a little differently? [ALEX] Yes, I think it’s hard for me to say honestly. What I can speak to is, in my own practice, I have clients that I know for sure would opt out and the signals that I’m looking at there are clients that have low-tech, like a low tech profile. Like they don’t wear mobile device, like a wearable on their mobile device. They’re just not interested in sharing data. They’re isolated and not interested in incorporating technology into their life generally. Then I have clients who, speaking about sharing data, I have clients that have significant fears about sharing their health data, even with their primary care providers. So there’s clients that have a general distrust of handing over sensitive information to someone in a position of power like a therapist or a healthcare provider. Those clients might be less likely to join an RTM and be part of that service. On the flip side those clients that are open to integrating technology into their healthcare I think, yes, those might be some of the early adopters. I should, maybe it might be helpful to zoom out a little bit and look at what’s happened with telehealth over the last two years. I would speculate, again, this is all speculative, that the same clients that were excited are open to doing telehealth might also be open to remote therapeutic monitoring. Now there might be some factors of that that are different, but — go ahead [JOE] Is there reporting to the insurance companies of those health things, because I could see how, like I’m type one diabetic, I have a history of cancer, my life insurance actually went significantly up after cancer and I understand why, but for those people that are worried about the data side, in the same way that maybe a insurance company might audit certain aspects of a case, can they audit all that data? [ALEX] Yes, so this could, I mean, if you were to demonstrate to your insurance’s providers that you are engaged in a service or treatment that’s decreasing your risk for their costs, that might be a fiscal opportunity for the client to demonstrate, just like, I imagine, and again, I’m not an insurance expert, so I can’t speak exactly to what their policies are or not. But I know that when I opted into a safe driving application for my auto insurance, my insurance premiums have gone down as I’ve demonstrated that, hey, my driving behavior is what’s within this certain threshold of safety where you don’t have to, I don’t have to pay as much every month. Now, I’m not sure exactly what happens with chronic health issues or what the actuarial science is around what this would do for someone’s premiums but the anticipation is that their quality of healthcare will improve and the quality, essentially the issues that come from these chronic illnesses will be mitigated to a significant degree. They’ll have to pay less for a variety of different services. Whether that’s an ER visit or even up to various medications or the amount of psychotherapy they’ll need. I think you start to see improvements for the client in terms of their efficiency and for the psychotherapist to have this near subscription model where now it’s recurring revenue. It’s like, I’m not afraid of losing a client or not seeing them once a month because I can, I’m still getting cash from that. I still have cashflow from taking care of this client in a more efficient way. So there’s a lot of different fiscal benefits as well for the client that they may consider that, might push them towards adopting this. [JOE] Yes, I think it’s great to start to test it maybe with a small group that would enjoy it. When I started implementing Muse, the biofeedback headband that’s used for meditation I started with the teens that I was working with and they would do it in the session. They’d do a five-minute meditation and they’d be like, I got two birds, or I got five birds, or whatever, because the muse gamifies it and then the kids went home and they’re like, mom, I want to muse for Christmas, they’re like, you want a meditation headband? That’s amazing. So that’s awesome to just like try it with some people that can be those early adopters and learn your practice’s best practice and then to start to roll it out and to work with the insurance companies to make sure that I’m sure maybe priority Health versus Blue Cross versus Aetna, they may have different ways that they view privacy or they view that data and what they request and being sure that the CPT codes and what you think that that insurance is going to use the data for I is accurate and all of that. That’s the due diligence that the therapist needs to do. But also I think that’s what points to working with a company that’s also helping with that data monitoring and with that IT side and the business associates agreement and all that. [ALEX] That’s right. Yes, that’s exactly right. I will say for those, maybe there’s therapists that are listening in right now that might be shut off to billing insurances because they’re cash pay or they don’t accept insurances or not on a panel yet or whatever your situation is. To those therapists, I’d say look at Air RTM not as an insurance exclusive experience. You can bill at market rate and have clients pay you a type of subscription service for this remote therapeutic monitoring. If you have cash paying clients, it actually increases their cash efficiency as well in terms of bang for buck and you start pulling in recurring revenue. So yes, while the CPT codes are reimbursable, I wouldn’t throw it out as insurance exclusive intervention. It can be adopted or, sorry, excuse me, adapted into a private care or a private practice that doesn’t leverage insurance as one of their sources of income. [JOE] Well, and anytime that you can have someone, like give someone something of value that increases efficiency if you’re a private pay practice, if there’s a perceived value, that changes the way they view your practice. So even just for me, I had this refrigerator in the lobby that had a clear front. We always had fancy beverages in there like frappuccinos and LaCroixs and coconut water, that cost me maybe a hundred bucks a month, but it creates an environment that feels more like a spa than a therapy practice. So then the perceived value is, oh wow, I don’t mind paying almost twice the cash rate of other therapy places because I feel like this place is special, this place is very zen, very however they would articulate it. I think that even if you’re just eating the cost of doing some of this it could have the potential to then raise the quality of outcomes to make it worth it because you can just charge even more for the private pay because it’s just, you include it. So it could be something that it’s like the drinks in the office that you just eat the cost and a bit of the time for. I have just a couple more questions, and I know we’re pretty close to our time, is there an opportunity to, and again, I know a lot of this is new, but to have say an intern do the remote patient monitoring and then report out to like the fully licensed therapist or a provisional therapist like co-partner with the main therapist so that it’s not on say, the owner to do the remote patient monitoring for all of their clients or is it best practice at this point that the actual therapist is always the one doing the remote patient monitoring also? [ALEX] No, you’re spot on, the power of delegation is massive here, and depending on how your practice is set up, at least in the language of CMS and the CPT codes is that medical staff or clinical staff can support the provider in administering remote patient monitoring in psychotherapies world remote therapeutic monitoring. What that looks like is the client’s data comes in at one of those 16 time points throughout a month and the staff looks at that. If the data is presented if they’re presenting something critical, like, man, they had a panic attack this last week that would be elevated to the provider where the provider could then make a decision of do I have this staff member, whether it’s a provisional licensed therapist or maybe an intake coordinator of sorts. You leverage those individuals within your wheelhouse and within your staff to follow up with the client, “Hey, we noticed some of the symptoms you were reporting last Wednesday, we just want to check in and see how you’re doing.” That also provides, as close as we can get to real time opportunities to present, prevent or present the interventions that would be most helpful. One of the offerings that Noble does is as clients, as this client’s data comes in, we can automate a variety of different interventions that are, at least research indicates are effective at decreasing anxiety, improving depressive symptoms. Whether it’s a mindfulness practice or some type of CBT, EFT, IFS, there’s a variety of different interventions we could use to help someone check in and improve in that moment. One of the greatest issues that I see in my own clients is they often report like, oh man, I had this moment, I forgot what I was supposed to do. I forgot the intervention we practiced on Tuesday, or I forgot what I was, what the right thing or the helpful thing would’ve been to do. I don’t take a stance that there’s one right way to cope with any of these issues but it would be helpful for them to create this library of interventions they know work for them and to have that on hand where if they’re experiencing some intense symptom to press as SOS type button and have that readily available. It just would significantly improve client adherence to protocol. I think it would improve their recovery in terms of being able to really stick some of these new ways of living in new ways of experiencing these symptoms such that their symptoms begin to decrease and even to the point where they’re able to prevent relapse of these symptoms. Again, I could probably talk at length. I know we’re coming up on time, but I’m just, I’m really pumped about the opportunities that both for our clients and for therapists, how we can benefit and improve our discipline through integrating this type of an approach to treatment. [JOE] Yes. Well, Alex, the last question I always ask is, if every private practitioner in the world were listening right now, what would you want them to know? [ALEX] The first thing I’d want them to know is that your expertise as a provider is valuable. I think, I see a lot of therapists downplay their expertise and they don’t see themselves on par with a primary care provider or others that have been trained in medicine and are maybe unfamiliar with some of the “objective” data points. But you’re a healthcare expert and you can, you’re intelligent, you’re capable, and if you can step into this role of leveraging the objective data with the subjective data I think you’ll significantly be able to improve your practice as well as improve the quality of care you provide your clients and I think you’ll be able to see your clients, especially maybe those that you’ve been hitting a wall with, I think you’ll start to break down some walls and begin to see some progress. So I just would love for each therapist to step into their ability and their confidence as a healthcare provider and really lean into this new opportunity that’s before all of us. [JOE] So awesome. I know that Eric, your CEO, is offering time to talk deeper with people that want to implement this to learn more about CPT codes. How can they sign up for that 30 minutes with Eric to talk more about remote patient monitoring? [ALEX] Yes, if you’re interested in that, you can go to and schedule a time with Eric. He’s currently talking to a lot of psychotherapists and I think we’re in the stage of psycho-educating and talking through what questions they have, and he’s excited and open to talk to any psychotherapist that’s interested in this. He’s awesome. I’ve worked with him for a while now, and he’s a visionary leader and I’m excited to be part of his team and he is yes, he’d be able to help any of you learn more or see how this might be able to fit within your practice. [JOE] So awesome. Thank you so much, Alex, for being on the Practice of the Practice Podcast. [ALEX] No, thank you for having me. It’s been a pleasure. [JOE] Well, 2023 is right around the corner. If you are listening to this the day it comes out so many things that you could vision for your practice, remote patient monitoring, maybe you’re going to amp up your SEO game, maybe you’re going to connect with one of our communities so that you can go deeper. Well, we couldn’t do this show without our amazing sponsors, and honestly, The Receptionist is one of those sponsors. The Receptionist for iPad is a simple, inexpensive way to allow your clients to discreetly check in and notify the providers when they arrive. The software sends an immediate notification to the therapist and even asks if there’s patient information that needs to be updated. You can start your 14-day trial for The Receptionist for iPad by going to When you do, you’re also going to get a month for free. So check that out over at Thank you so much for letting me into your ears and into your brain. Have an amazing day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for your intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the producers, the publishers, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.

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