Today is the day Blue Cross Blue Shield cuts my reimbursement rates by 11%. Yesterday I got another “FYI” (yes, that is the official name *smirk*) from Blue Cross telling me that they will no longer reimburse out of network providers directly and “are working to encourage our members to use in-network providers to contain costs.”

This is not-so-subtle code for, “Screw all of you who signed off the panel in protest of our cuts last month, now we’re making it even harder for you to get paid.”

I stayed on the panel, but my colleagues who resigned as of 9/1 are miserable right now. They are angry, frustrated and worst of all going to feel the hurt financially very soon.

If you are a regular reader here, you know I offer ideas and solutions for these kinds of business issues.  Most of the information is free, or super low cost. People acknowledge how helpful this information is. Which is nice to hear.

But then they say (actual quotes)………

“I don’t have the time to do your marketing program.”

“I’ve been writing a book for 2 years and just can’t seem to finish it.”

“I’m in your Marketing Your Private Practice program, but never listen to the audio or watch the video, please unsubscribe me.”

“I know I need to add another income stream, but just can’t seem to motivate myself to get started.”

Hm. When your income is set to be cut for years to come, it is so hard for me to accept that no one has the time or energy to DO SOMETHING to change that reality.

The irony here is that Blue Cross (and the other managed care companies) seem to have plenty of time to change their policies every 30 days.

More irony, they are people, just like you, and they have the same 24/7 that you do. No one gives anyone an extra hour or two in the day to do more, create opportunities and change their future. (And dream up ways to move their business forward at the expense of yours).

I don’t buy that no one but me and a few other biz savvy therapists has the time to innovate, market and escape the downward spiral of their main income stream.

What Does Time Have to Do With It?

When someone claims “I have no time,” or “I’ll get to it later,” it either means:

• They don’t want change bad enough (and aren’t in enough pain to get up and do something)
• They are afraid (Legitimate. However, Do you know what I’m afraid of? Getting paid 11% less every hour. Starting today.)

or

• They’re lazy and want someone else to rescue them.

I hope most of my colleagues are suffering from the first two bullet points and not the third (though if you were to ask me, many are looking for a rescue, though they would never define themselves as lazy.)

So how do you find the time and the motivation? Here are some ideas you can use today.

Motivation

Imagine that the managed care companies will cut your rates and allowed authorized hours for your services every year for the next 10 years. (Wait! I don’t need to imagine that. It’s happening TODAY!)

Picture a weak economy for the foreseeable future with more and more people needing your services, but no means to pay your full fee.

Believe the reality that costs will continue to rise and your income decreases.

Motivated yet? And don’t be the frog in the pot of water slowly heating up to boiling. You know, being slightly aware that change is happening, but not feeling it badly enough yet to do anything about it. That approach will only burn thought the resources you have now, leaving you with no equity to invest in new ways of growing, healing  and making a living.

Time Sources

Look at your daily schedule. Where are you productive and where are you frittering away time? Examine the time you watch TV, surf the internet, waste time being anxious about things you can’t control (like an 11% salary decrease!). You waste time.  We all do. Find an hour of this unproductive time and dedicate it to developing a new program or marketing. [And TV is the worst, worst time waster. Pick the few shows you really love and watch them, but don't stare at the tube when the content on there is not worth your time.]

Get up earlier. Many entrepreneurs I know work early in the morning. It’s quiet and they are alert. If you feel you really need that extra hour in the morning, work later in the evening. Or go to bed earlier to wake up earlier — you get the idea. I’m writing this post a 6:30 AM.

Stop using your time fighting to hold on to the old ways of doing thing. I see so many of my colleagues in a frenzy about these cuts in managed care. OK, I get it. It’s discouraging and shocking and hurts the bottom line. But you aren’t going to change a damn thing with your complaints and surveys and meetings with your senators. Health care reform is about CUTTING COSTS. Hello…that means providers make less money. The President of the United States wants costs cut. Your survey does not trump the power of the POTUS. [Sorry for the rant, I just get so frustrated when I see time invested in "solutions" when there is no realistic hope that all those efforts will change anything back to the way things used to be. ]

Take the energy that you would use to try to regain the ground you lost and shift it to create something new.

Trust me, you will feel so much better. Letting go is the first step to moving forward. The old models are dying. Really. I know it’s sad and scary. But what are your options? Make time to change.

When you do carve out an hour to do creative work, turn off all distractions and focus. Often when we have a “free” hour we find all sorts of ways to fritter it away. We reply to old emails, make a cup of coffee and check out the newspaper or pick up a book, plan a vacation. It’s very easy to do anything but the thing we are a bit nervous about doing. Try to stop that.

Take little steps. Many people who I meet through Biz Savvy Therapist admit that all of this innovation is “intimidating.” That’s normal. It’s new and you have no idea how it all works. In so many ways, I’m right there with you. Want to know how I handle that fear of doing it wrong or being a failure? I set a goal I think I can reach and do one thing a day to get me there. Then I”m not overwhelmed and scared because writing one blog post or recording one audio is no big deal, right?

Group like tasks in time blocks. Clump together your client hours on several days and your creative/innovative work on others. I see clients 3 days a week and do my creating the other days. It’s much easier to focus when I have a stretch of 4-6 hours to do this work, rather than try to fit it in here and there between other time demands.

Use the weekends. There are 48 hours on the weekend that are available to you! Even if you used 2 of those, you’d be well on your way to completing that book, writing blog posts or figuring out Twitter.

Avoid the excuse of “no time.” When you hear yourself saying there’s “no time,” stop and think about what you can do to make time. There IS time. There’s always time.

How I Do It

You know I work the way I do so I can be home with my child as much as possible. Since his birth I have worked after he goes to bed, early mornings and several hours every weekend.  (I get 7-8 hours a sleep a night, too). Anytime my son has been in daycare or had other caregivers has been the time I see clients and I’ve never been to my office more than 3 days a week in the last 7 years. Now I”m dialing down to 2 days a week, but my income will increase this year.

I watch minimal TV (never before 9 PM), never go to the mall, my house could be better organized and I could always do more laundry. I choose to prioritize time with my family and creating an innovative practice that helps lots of people through multiple services.

Honestly, I’m not special and am certainly not super organized. I just want to make it happen. Does that make sense? How about you?

Photo credit: Alexkerhead via Flikr

Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the way we practice from now on.

Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, I suppose. But is that what you want for your career? Do you want to work for someone else for a Relative Value Unit (whatever those are)?

How about your patients and clients? Do you think they would prefer to receive care in a small practice where they are known by the staff and cared for with dignity?

Despite the commoditization of health care, small private practices can still thrive, but you’ll need to be willing to move into what I call a “next generation practice.” The old ways of doing things sucks doesn’t work any more. Here are four steps to you new, profitable practice.

1. Develop a well-defined specialty.  Yes, even a primary care practice can specialize (families, elder care, fitness freaks, people with weight issues, families with autistic kids, etc.). If you want to be a generalist, join a group practice. If you want your own small business to thrive, niche up. Why? People will find that very unique and attractive. When they find the practice that speaks to their needs, they’ll be more likely to be loyal to the practice and pay for extra services.

2. Offer services specifically tailored to your target patient. This can include typical therapy appointments and assessments with added support groups, coaching services, information nights with professionals who also serve your population.

For example, a practice focused on helping people with weight loss could have a support group that meets once a week and a monthly info night for new and continuing patients where a nutritionist, massage therapist, fitness expert and yoga instructor come to talk about how their services can support weight loss. This would be great for networking, PR and patient satisfaction.

3. Embrace technology. And I mean give it a big hug. There are lots of HIPAA compliant scheduling programs, electronic medical records platforms and email encryption services. Set up systems so you can answer patient queries by email a few times a day (or have an assistant do it for you), do as much scheduling as possible online, start referring your patients to relevant smart phone apps and encourage them to stay connected with your practice via social media.

Why get all plugged in? First, it’s cool and many patients will be excited to work with a networked health care provider (those that are intimidated by technology will be able to get care with a more traditional practice). Second, it sets you a part from your colleagues and is good marketing, third, it will be much easier to be profitable when you leverage technology to make your practice more efficient and streamlined.

4. Stay flexible. Change is going to be the norm, not the exception during this generation of health care. New technologies will be coming out at an increasingly fast pace. Health insurance will be adapting and adjusting to new laws affecting reimbursement rates over and over and over again.  Plan for change. Stay flexible. Don’t invest in anything that will take 10 years to pay off.  Keep alert to new trends, regulations and service possibilties. When you see trends or changes, be ready to adjust and take action. Practices that can turn on a dime will be consistently profitable. Those that can’t adjust without months of evaluation and debate will be burdened with lag time between what used to generate income and what works now.

The next generation health care practice will be innovative, cutting edge and meaningful to patients and clients. It will appeal to a generation of people who are plugged in, educated and informed. A practice that wisely integrates technology, specializes and is ready to adapt to change will be positioned to help more people and be exceptionally profitable.

The new opportunities the future will bring us are exciting to me. How do you feel about the concept of “next generation” practices?

A few weeks ago I did a webinar with Corey Quinn of MyTheraistMatch.com called,

I just went over to the health care blog, KevinMD.com and am now in a bad mood.

Why? Because when I read the comments over there I get slimed by negative comments and cynicism.  Check out the comments on this post (written by yours truly).

Quick summary, I wrote a piece about my bad experience with the administrative staff at my primary care doctor’s office.  It was a frustrating experience and I wanted to share with other doctors the business lessons inherent in this customer service experience.

However, some of the comments I received on the post were  just weird (or “off topic” as we say in social skills group).  Some docs are telling me that I shouldn’t have received the medicine I needed, others felt Obamacare had something to do with my issue that the support staff was rude.  Another person said I got good care because I’m a PhD. And then there was the debate about whether I was “critically ill.”   Huh?  I was trying to make a point about customer service.

There’s a lot of venting and whining about how patients don’t understand them, managed care is screwing them.  I hope none of these folks ever treat me for an illness because they don’t seem too compassionate.

Bad attitude.

What this all says to me is the people who commented on this blog (not a representative sample, I am aware) don’t get it and are in a collective bad mood.

First, I don’t see them viewing people as “people.” You know, with feelings and needs and CHOICES.

Secondly, they are stuck in the mentality that “good enough” should be appreciated. What I heard (between the lines) was, “Hey, you got an appointment and the drugs you wanted, what more do you want from us? Eye contact?!”

Third, they accept things as they are and don’t see any way to make them better.

“I’ve Fallen and I Can’t Get Up!”

I’ve said this before and will again, in the health care field we are victims to a vicious cycle of “learned helplessness.”  Like that woman in that MedAlert (or whatever help device was being advertised) we feel we are knocked down and have no power or self agency to get up.

We look at our profession and career and say,

“This managed care mess is HOPELESS and we have NO OPTIONS! Patients don’t understand my plight and are demanding and clueless.”

And with that mindset, we use our energy to complain, condescend, debate moot points and be ineffective in making any real change.

And we wonder why people prefer to see nurse practitioners, or pay out of pocket for reiki or accupunture or a naturopath or an unlicensed life coach.

Whether you’re a doctor, psychologist, LMHC, MSW, chiropractor,

people want you to CARE, see them as a PERSON and treat them with RESPECT.

Busy professionals may think, “Well, I’m busy and I’m talented and skilled and people should respect me for that. If I’m brusque or my staff is rude, so what? That is little price to pay for access to my services.”

OR

“I’m stressed out and work hard. This managed care stuff is a drag and patients demand too much.  What more can I do?”

Well, there are many things you can do. Here are a few.

How to break the bad attitude cycle

Be cognizant that we ALL have choices. As a patient I choose my doctors and if I want to pay them with my insurance or out of pocket.

As a physician or clinician you  also have choices. You can choose what insurance you accept, which patients you see, how you treat the people who trust their health to you, and how stressed you allow yourself to become.

Blaming everyone else is unproductive.  In my post about the rude staff, not one of those physicians indicated they would consider training their staff to be more professional (which was my point).

However, most of them had someone else to blame: Me for asking for an appointment or antibiotics, health care reform, managed care, patients for not understanding them.

The solution:  Start with you.

You can’t change me or health care, or insurance companies.

But…..

Can you change your mindset that your patients are clueless or that you must accept managed  care blindly?

Can you train your staff?

Can you find other ways to improve the administrative side of your practice?

Choose differently

I don’t understand why health care professionals just accept all the garbage managed care throws at us. I really don’t get it.  If an insurer is hard to work with , don’t work with them. If they pay low rates, don’t accept them.

I know your worries are these:

• My patients will not have quality care.

• I won’t have any patients.

I get it.  But if you free yourself from blindly accepting what a third party tells you to do, you can use the energy you now dedicate to being frustrated to designing new models of care and payment.  Shift your way of thinking from one of stuck frustration to one of innovation.  Figure out payment models that work for you and your patients, partner with other like minded professionals to cut costs.

And you WILL have patients because lots of folks are going without care because they won’t deal with annoying business practices, or paying loads of money to go to alternative practitioners because they give them a different healing experience based on something other than the billable hour or procedure.

The thing we need to keep in mind is this: the crappy attitude is self imposed. No one forces us to run our businesses this way.  No one.  You do it because the generation before you did, right?  But is “everyone else is doing it” a reason to continue to do it the same way?

We live in a new time.  We need to step up and lead a new way to treat people who need health care.  We need to be open and compassionate and respectful to the whole person, not just the part of them that pays our overhead.

Where do we go from here?

My three part plan

1. I vow to never work with a health care professional or team who treats me or any family member with disrespect. We deserve better. I will travel a longer distance and pay more money if I have to.

2.  As a clinician I will always treat my clients and their families with respect. It’s the right thing to do as a person and it is very good for my business.

3.  I will not tolerate the whining and bad attitude of my colleagues who are invested in their victimhood and learned helplessness. I won’t be rude, but I will stand up and say, “If you don’t like the way things are, what will you do to make them better?”

Remember, change is possible. It starts with you as an individual.

And no, it’s not easy, so please don’t leave me a comment saying this isn’t easy. And please no comments about typos. I spell check. It isn’t perfect. I’m OK with that.

Just remember, you chose how you use your energy.  You can use it to spin your tires in helpless anxiety or use it to make change–your choice.

This is not a warm and fuzzy post and that is intentional. I feel our professions are important to our communities, but we don’t take care of our selves or our businesses.  An empowered health care profession is better for everyone.

When you let go of unproductive business models, everything becomes easier–treatment, income, professional satisfaction.  What do you think?  Can you empower yourself, shift your mindset?  What is YOUR 3 part plan to move forward, make change and improve your practice?

Oh, and if this type of rant is your thing, you may want to sign up for my email updates, so you can get these articles in your mailbox…..

This is a question I ponder daily:

Can mental health treatment be  moved online or into a virtual space (via phone, video chat, second life) effectively and ethically?

Then the questions really start rushing in.  I ask:

What does virtual mental health treatment look like?

How does it work?

How do people benefit?

What pieces absolutely CANNOT happen in an online space?

What parts of treatment are better in a virtual space?

The Evolving Definition of “Relationship”

No one can deny our culture  is changing, as is our definitions of “relationship.”  In the world of Facebook, Twitter and LinkedIn who do your clients consider a “friend?”  Psychotherapy is a relationship-based art. But now that many people experience true relationships online, how do we adapt the approaches we use?

If we believe that the relationship is  a driver of healing and people can form real, meaningful relationships online, how does that change our work?

New Ideas

Here are a few ideas I have about the future of mental health treatment:

• I see intensive work happens face-to-face, but when people begin to integrate coping skills and adopt healthier habits and patterns, we can begin to work with them via phone, email, text to follow, up, support and check in.
• Issues that are less intensive, such as parent skills, stress management, behavior change can be initiated and treated in a virtual space.  We can utilize individual phone/video work along with live telegroups and online forums.
• National networks of psychotherapists and psychiatrists will need to emerge.  We will need to collaborate with one another to support those in our communities and online. For instance, if I am doing parent coaching will a mother in California, but realize she will better benefit from individual therapy, I will need to be able to network with colleagues in her geographical area to provide an appropriate referral.
• More of our work will be virtual.  We’ll need to grapple with the concepts of confidentiality, how to protect information, defining our professional boundaries.
• Turf wars will need to cease. Psychologists, social workers and masters level therapists will need to work together in an online/virtual space.  We will need to be able to practice over state lines.
• Niches and specialties will be absolute necessities as we all become available to a much larger pool of potential clients.
• The role of managed care reimbursement will change. I”m not sure how, but it will need to evolve, too.  What do you think?

I’m excited for this evolution! How about you?  What are your ideas about the future of mental health treatment?

Just a quick follow up to my Different Doesn’t Mean Wrong post…..

I just realized that if the Pew Foundation is right and 62% of Americans are searching for health care information online…..those of us who are online building websites/blogs and communicating with clients via online technology are, in fact, part of the majority of the population using the internet to get health care information and services.

However, many of you have said to me that your colleagues or supervisors aren’t supporting your online endeavors.  Some people have been discouraging you from doing anything new or innovative.

But if my math is correct, about 2/3rds of the country is using the internet for health care purposes, leaving only 1/3 still using traditional methods.

If you’re reading this blog, you’re with the majority of the population!  Your nay saying colleagues are the outliers.

I just got off the phone with a client who tells me some of  her colleagues are vehemently against her becoming innovative in how she structures her private practice business.  Their reasoning, “It’s not the way we do things.”

Hm….if Freud stuck with the established way of doing things, he would have continued working in  neurology, dissecting eels (no kidding) and not founded psychoanalysis which changed the practice of psychology forever.

It’s All Different Now

The emerging business of health care is different than what was done before.   But I would argue our whole economy and culture is evolving. Do you agree?

When things change, it is those who adapt who are successful and those who stay put, refuse to bend and stick with what “should” work who are soon out of business.  Need proof? Just look at the music industry that tried to hold the line fighting online downloads and losing all their market share to iTunes and Amazon.com.  Adapting to a new way of distributing music would have been much better than just closing the doors and shutting off the lights on their dying industry.  The thing is, people still buy music, just not the way to big record labels wanted them to.

If you want your private practice to succeed, you must adapt to a new economy and new technology.  The “old ways” are just that “old.”  The next generation of clients communicate via text message, Facebook and AIM.  They don’t pick up a phone, and are accustomed to getting access to exactly what they want and need at the touch of a button.

You can’t change the cultural shift. You can’t change the new economy or health care reform.  You CAN change how you structure your business so you are successful.

Adapting to the new is a choice.  Some of you will chose change and often your colleagues will not support you.  That’s ok.  Just keep moving forward and speak to your clients’ needs. You aren’t wrong. You’re just ahead of the curve.  And for some perspective, back in the day Bill Gates and Steve Jobs were considered crazy mavericks and look where they are now…….

Thinking of trying new ways of structuring your practice? Sign up for my RSS feed to get updates sent directly to you! Or register for my free e-course: The Way of the Biz Savvy Therapist: 8 Ways To Help More People, Make More Money and Enjoy Your Life.

I am in the middle of reading Seth Godin’s Linchpin and it is rocking my world.  [As an aside I will be talking about the book and how to apply it to small businesses in my new Small Business Book Club. You may want to check it out. It's free.]

Linchpin is the “it” book now in small business and marketing circles.  It’s an easy read and Seth’s ideas are new, powerful and accessible.  He talks at length about “emotional work” in business. Essentially he is addressing the necessity of our putting ourselves into our work, being human, sharing with others. He suggests that businesses that do this emotional work will be much more successful than those that simply follow a formula or go through the motions.

Sonia Simone, over at Copyblogger, has this to say about Seth’s idea of emotional work:

“Make a stronger connection. Care more. About your readers, about your customers, and about your own business. I don’t care if you have a four-hour work week or a hundred-hour one. I care about how much love you bring to the work when you get there”.

As helping professionals we bring ourselves into our work every day. But do we use it in our marketing?  Do we let people know how much we care, love and  emotional work goes into our every day jobs?  If anyone knows about emotional work, we do!  It seems that now the business world is catching up to US!

So, keep doing what you are so good at: giving, caring, showing empathy, compassion. Don’t be afraid to show the world your emotional work. Grow a remarkable practice  by bringing that attention and care to every facet of your business, not just the treatment. Sharing the love will build your business and you don’t have to just take my word for it.

[photo by Whipped Bakeshop via Flikr]

Who wants you to be successful?  At first, this seems like a silly question with an obvious answer. You may think, “Of course *I* want to be successful. And my spouse/partner, my Mom/Dad want me to be successful, too.”

Then, the smarty pants among you are going to say, “What do you mean, ‘successful’? How do you define it?”

For me success means using your gifts to make a decent living helping others lead better lives.

Do you want to know who really needs you to be successful? Your clients, your community, and people you have never met who can benefit from your genius and gifts.    They need you to be good at what you do and available to help them solve their problems.

But the question remains do YOU have what it takes to be successful? Do you want to share your gifts to make a decent living helping people live better lives?  Do you want to do the work it takes to be successful? Do you want to work the hours, do the thinking, take the risks, give away some genius for the greater good?

Or do you want to sit on the sidelines, be “good enough,” do what you are told, wait for permission, settle for less, make excuses about a poor economy, the evil of managed care, your lack of money and resources?

Success is a choice. For all of us.  However, success is not easy and the path not always clear of bumps.  The information and resources you need to achieve success are available to you if you are willing to take advantage of them.

The greater community needs you to be successful.  They need you to use your gifts to help them live better lives. Do you have what it takes to succeed?

Hey, have you seen the most recent Newsweek article by Sharon Begley?  It seems antidepressants don’t work. Apparently, 82% of the improvement people feel is placebo effect.  If you are a mental health professional, you know this, whether or not we want to admit it.

Let’s face facts, folks. When it comes to curing mental illness, we are in the dark ages.  We have NO IDEA what we are doing. It’s not our fault. The brain is just so stinking complex!  But we have this need to say we know stuff that we don’t.  I know we get pressure from our clients/patients, other professionals for an easy answer, a quick fix, the little sad blue pill that turns yellow and happy after taking Prozac (remember those commercials?).  It seems good marketing trumped good science but we all wanted to believe it was that simple.  And yet, in the face of the evidence,people treat the researchers like criminals and they are labeled as anti-science.

Again I ask: How does this help people? How does it improve lives?  If we KNOW something is not working, why hold on to the fallacy that we are “doing good” by perpetuating a non-effective intervention?  I’m sure money is a motivator, so is laziness and fear. But I don’t want to talk about that, because looking for a scapegoat or a cause of the issue doesn’t solve the problem we have in front of us.

How do we help people with depression?

Let’s start thinking about  collaborating vs. going solo. If psychiatrists, therapists, and researchers all got together and worked together on how to address the complexities of depression we could come to a better answer.  But now, we have therapists saying therapy is the answer (and they seem to be right, but can’t agree on what approach is most effective-CBT or psychodyanamic), psychiatrists saying medication is the answer (and this is a weaker argument by the day), and researchers saying they don’t have an answer, but know what doesn’t work (but will tell the public it does because  a placebo effect, is better than just doing nothing.)

What a mess.

And the truth is, we are failing people who need our support. The more the evidence surfaces that we are at a loss on how the brain works and how to improve people’s mental health, the more the public sees us like the man behind the curtain in the Wizard of Oz. Because we claim to have answers we don’t have.

We are failing alone, publicly.

What if someone put a grant together to pull researchers, physicians and psychotherapists to tackle these issues? What if part of the grant was to bring in a good PR person (who understands social media) and opened the doors to the progress being made? And what if participants in the studies were recruited via social media, doctors’ and therapsits’ offices?  Do you think we’d be able to find enough volunteers to help solve this really big problem?  Do you think we could get an article in Newsweek talking about the collaboration and the progress? Do you think working together we’d learn more and generate knowledge faster than we are working alone and in isolation?

What do you think?