Exploring the Difference Between Sliding Scale and a Range of Rates for Therapy

In growing your private practice, it’s not uncommon to have questions about how a sliding scale works. In fact, for many clinicians, the concept of sliding scale gets confused with offering a range of rates for client services. We tend to use sliding scale and a range of rates interchangeably when in reality, they are very different approaches to running your mental health practice.

Sliding scale describes an income-based calculation to determining what the client will pay for each session. The client must report to you their income in order for you to set a rate they can afford based on that income. This is a clear-cut option in having the transparency of a table of rates and the calculations used to determine them in your state of practice. It demonstrates that there is no discrimination against clients of diverse backgrounds in having set rates that are predetermined. Take a look at the Khalil Center which shares sliding scale rates for their therapy services in Illinois, New York, California, and Toronto, Canada.

Although the charts are easy to interpret and are uniform to use, sliding scale does put you as the therapist in a position of asking the client to report on their income, which can make some people uncomfortable. Not only that, but what if they report an income that is incongruent with their reports of their lifestyle in sessions? I have seen colleagues struggle with unspoken resentment wondering why the client is taking vacations every other month but reports an income level where they can only afford $90/hour therapy sessions.  How often would the therapist re-evaluate the rate based on income changes for the client? Is the therapist prepared to offer the lower rate when the client comes in stating a change of employment such as a loss of job or layoff? Would the therapist introduce a re-evaluation of income and session fees when a client discloses a promotion or new job?

You can see why it can feel like a sticky situation to navigate client income as the fee determinant for private pay rates in private practice. It takes a lot of attention to detail to maintain a sliding scale. A second option to consider is a range of rates in your business as another viable option. 

Range of rates means that the business owner, in this case the therapist, identifies a range of rates they are comfortable charging for their services. For example, perhaps the clinician identifies that $120-$150 is an appropriate range that 1) feels fair to them as a licensed professional accounting for expertise and their current location and 2) feels accessible to the population they are trying to serve. Once the range of rates is set, the therapist can share it openly on their website and in initial calls with potential clients for client consideration. The client is encouraged to pick a rate that they feel they can afford, allowing the client to demonstrate financial autonomy. The agreed upon rate is recorded in the client file and both clinician and client are comfortable to move forward with sessions at that rate.

Similar to sliding scale, the range of rates may need to be revisited if the client experiences a loss of employment or other financial hardship. Recently, some of our colleagues have reduced rates to help individuals impacted by COVID-19. Others have had conversations with existing clients to adjust their rate as they look for new jobs or wait for news from their employer after being furloughed. Although these decisions can occur on a case by case basis, the biggest question that arises in private practice is what to do when you are ready to increase your rates.

Rate increases for private pay therapy are commonplace in January as the start of a new year. Will you raise your rates for existing clients? For new clients only? How will you notify existing clients of the change if the rate change applies to them? 

Some important elements to consider include:

1)    When and how current clients are notified of a rate increase. In writing is the ideal method.

2)    Documentation of the client decision including agreement to the new rate effective January 1st and beyond.

3)    Documentation of referrals provided within the client’s price range if the client is unable to continue with you at the increased rate.

As a business owner, you get to decide if sliding scale or a range of rates works better for you. As you move forward with your decision, clients will be deciding to either move forward with you in sessions at the higher rate or may require a transfer with referrals. Therefore notifying clients of the upcoming change 2-3 months ahead of time can be helpful to both the therapist and client in support of a seamless transition. My hope is that this blog will support therapists in exploring their options while encouraging them to navigate rate changes in ways that feel empowering and authentic. 

Pivoting in Practice: How to Embrace Business Change within a Pandemic

We’ve been riding the rollercoaster of this pandemic for months. It’s almost hard to believe. We can’t even begin to fathom the full results of this event and the impact on our businesses. As therapists, we know we must fortify ourselves for the mental health crisis that comes with COVID-19. As a colleague, I’m hearing that we are burning out, stretched too thin by grief, anxiety, and tragic loss. In the grand scheme of things, this means we will need more mental health professionals to carry the load. It also means therapists are maintaining smaller caseloads to allow for self-care in the face of overwhelm. As business owners, we are clenching our muscles and leaning in. As entrepreneurs, we are rallying. Now is the time for pivoting and planning. Months into COVID-19, we are looking for ways to pivot to allow our practices and businesses to not only survive, but thrive.

Planning to Pivot?

Pivoting is a term in business for shifting gears, changing direction, and/or finding new focus. As private practice owners, we get the opportunity to pivot in order to address life’s changes and challenges in ways we feel are a good fit for our business. For some of you, pivoting means:

·      Offering telehealth

·      Providing webinars

·      Speaking online

·      Developing online coursework

·      Writing blogs or a book

·      Identifying a secondary income stream

It can be exciting to start new endeavors, and it can also be challenging. Let’s recognize that creativity can feel limited when other responsibilities require your attention and stress levels are so high that they may hurt your ability to focus. You don’t have to do this all in one shot. You don’t even have to do this alone. Here are some ideas to help you move deeper into a creative mindset to better your business.

Schedule Time for Creativity

That’s right. Put it in your calendar. Where can you find time to work ON your business rather than in it? Can you map out time for brainstorming? Writing? Course creation? Conversations with other inspiring entrepreneurs? I too have learned that if I don’t schedule it, it doesn’t happen!

Move your Body

Have you ever noticed that some of the most brilliant minds are depicted as pacing in movies when trying to figure something out? There is a reason for that! Movement allows deeper processing, especially when it’s a repetitive, low-energy motion like walking or pacing. So get outside and take a walk, allowing your mind to mull over the possibilities at an easy pace.

Remember your ‘Why’

No matter where you decide to take your business, be sure to slow down enough to check in on your ‘why.’ Does this new endeavor support your values and brand? Does it support your mission as a person and as a professional? Carry a notebook and write down ideas as they come to you. Run new ideas by a trusted colleague or friend to see what they think. 

Invigorating Investments

For many entrepreneurs, if the pivot aligns with their business, it can feel both exciting and invigorating to have a direction to go and plan of action to take.  You see, entrepreneurs enjoy building and creating and they feel much more emotionally invested when creating something new or worthwhile. I hope that you too can experience the excitement (dare I say giddiness?) of pivoting in your practice to support your mission, vision and brand. Check out my book Perfectioneur: From Workaholic to Well-Balanced launching June 1st for other ideas on how to thrive as a driven entrepreneur. I can’t wait to see what you create!

Streamlining Your Business Process: 7 Tips for Private Practice

A new year has begun! For many mental health professionals, we are resuming our schedules after holiday travel and hoping to start the year off right! What are your goals for the year? Perhaps you want to streamline your paperwork process to maximize time with clients? Or maybe you want to explore a billing support business to stay on top of your insurance claims and expenses? Perhaps you want to transition to only taking private-pay clients so you aren’t required to identify a diagnosis and can work with clients from a different lens? So how do we stay on top of our thriving practice addressing client needs and interventions while still remaining compliant with the more mundane and time-consuming processes of paperwork and billing?  Below are some tips and tricks to consider in maintaining a balance of both organization and time management!

Tip #1: Go Paperless

In today’s day and age, technology continues to enhance our processes of organization and time management. Consider going paperless with your client note system to complete paperwork in less time. Companies like SimplePractice, TherapyPartner, and TherapyNotes offer encrypted, protected and thus confidential note systems that can support your client files electronically as well as connect clients to appointment reminder texts and emails and offer billing services to streamline claims submissions and payment.

Tip #2: Set a Schedule

When trying to balance your time with clients and stay on top of paperwork demands, it can help to set a schedule.  Setting aside some time daily or weekly to submit your billing not only helps you complete it when the content is fresh in your mind and getting paid in a timely manner, but can assist you with leaving work truly at work, representing a transition ritual from work to home.

Tip #3: Use a List

This may seem strange when we’ve just discussed the benefit of going paperless bur having a to-do list where items can be crossed off when completed can be very satisfying. Consider using a planner or notebook that’s with you at all times. For others, consider using your to-do list in your phone where you can set reminders and due dates for completion. In our busy world, it can be hard to keep track of everything so a list that’s accessible from anywhere at any time can help record thoughts and ideas that come up in our daily living.

Tip #4: Creating Connections

Staying on top of trainings, webinars, books and other materials can help you streamline your niche and business practices. There any many great materials out there but we especially love Simon Sinek’s Start with Why in discovering what drives us as helping professionals and business owners. Joining an online community for mental health professionals can also be helpful in asking in-the-moment questions about business practices.  We suggest checking out The Private Practice Startup and Building Brilliance as two online communities that offer tips, tricks, and offer access to a community of like-minded individuals.

Tip #5: Have a Business Plan

Working as hard as you do, it helps to have a business plan to create a sense of direction. Is your goal to have 20 clients per week consistently? Do you want to expand to include other insurance panels to serve more clients? Perhaps you want to identify a stream of secondary income? By creating and reviewing your business plan on a regular basis, you can check in on both short and long-term goals of being your own business. Templates for creating a business plan can be found online.

Tip #6: Have an Accountability Buddy

Even with a business plan, life can sometimes get in the way of tracking where we are headed. Combine that with how private practice can feel isolating at times and we can find ourselves procrastinating or drowning in the details. Connecting with a colleague and identifying one another as our accountability buddy can help hold us to our goals as well as remain connected within our community. Engaging your accountability buddy can help inspire your process, define your goals, brainstorm strategies to achieve those goals, and celebrate your successes along the way.

Tip #7: Take Time Off

Being a business owner can take a lot of our time and energy. Don’t forget to take time off to prevent burnout and allow creativity to flow from s different headspace in another environment. We know that being our own business means we can potentially work 24/7 not only in serving clients but the behind-the-scenes responsibilities. Time off can support us in being grounded, compassionate clinicians as well as focused, driven business owners who can enjoy the results of our hard work and remain inspired to continue to serve the populations we value most.