Episode #624: Good Enough Systems

Summary

Abundant Practice Podcast – Episode #624: Good Enough Systems

Release Date: February 26, 2025

Host: Allison Puryear
Guest: Mary

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Overview

In Episode #624 of the Abundant Practice Podcast, host Allison Puryear engages in a candid and insightful conversation with Mary, a therapist who recently transitioned from a group practice to establishing her own solo private practice. Titled "Good Enough Systems," the episode delves into the challenges Mary faces as a new solo practitioner, particularly around credentialing, billing, documentation, and managing the emotional toll of starting a private practice.

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Transitioning to Solo Practice

Mary shares her journey of leaving a group practice in June and launching her solo practice in August. Despite beginning to feel more comfortable in her new role, she encounters significant hurdles:

• Outsourcing Challenges: Mary initially decided to outsource credentialing and billing, believing it would allow her to focus solely on clinical work. However, her experience was less than ideal. “[05:00] Mary: 'The folks I hired to help me with the credentialing… it was just kind of a mess. I just came into this feeling frustrated…'”

• Ineffective Relationships: The outsourced team left her feeling unsupported and unclear about her practice’s status, leading to frustration and financial strain. “[05:26] Mary: 'It was really stressful and not very productive… I just feel like I'm bleeding money.'”

Allison advises Mary to reconsider the necessity of outsourcing certain tasks, especially those that can be managed efficiently with existing Electronic Health Record (EHR) systems like Simple Practice. “[08:19] Alison: 'It's so easy. Like, when you start doing the billing, you'll be like, oh, why was I paying for this?'”

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Embracing DIY Credentialing and Billing

Encouraging self-reliance, Allison emphasizes that many credentialing and billing tasks can be handled personally with minimal time investment:

• Efficiency of EHR Systems: “[08:50] Alison: 'It literally takes you seconds to build seconds… if she is doing a lot of the call and verifying benefits, it depends on the insurance company.'”

• Cost-Effectiveness: By taking over these tasks, Mary can reduce expenses significantly. “[09:20] Alison: 'She should be super cheap, and you shouldn't be talking to me about this.'”

Mary decides to take back control over credentialing, reflecting on Allison's podcast insights: “[05:55] Mary: 'I think I should have listened to Allison's podcast and just… set aside time to do it.'”

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Overcoming Perfectionism in Documentation

A significant portion of the episode focuses on Mary's struggle with perfectionism in her clinical documentation:

• Delayed Documentation: Mary admits to procrastinating transferring her handwritten notes into the system until she achieves the "perfect" template. “[07:42] Mary: 'I'm a little bit of a perfectionist, and I delayed actually transferring my handwritten notes to the system until I had the perfect template.'”

• Allison’s Reassurance: Allison reassures Mary that documentation does not need to be flawless to be compliant. “[12:01] Alison: 'Just like, here you go. Like, it's been behind two locks… so you're still abiding by HIPAA.'”

• Practical Solutions: Allison suggests practical strategies, such as scanning existing notes or hiring assistance for non-critical tasks. “[12:17] Alison: 'You could hire a college kid… just pay them an hourly rate… or you could do that while watching TV.'”

Mary grapples with letting go of perfectionism, recognizing it as a barrier to her practice’s sustainability. “[13:38] Mary: 'The perfectionism is going to slow you down and make your life a lot harder.'”

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Managing Loneliness and Building Community

Transitioning to solo practice often leads to feelings of isolation. Mary expresses concerns about the lack of regular interaction with colleagues:

• Decreased Social Interaction: “[18:02] Mary: 'I've moved from having 20 co-workers to zero over the last five years.'”

• Allison’s Advice: She recommends reaching out to local therapists to form support networks or virtual consultation groups. “[18:45] Alison: 'Consider reaching out to therapists that you respect in town and just saying… a Zoom clinical consultation meeting once a month.'”

• Focusing on Real-Life Relationships: Allison emphasizes the importance of enriching non-work relationships to combat loneliness. “[19:43] Alison: 'I would rather you make your real life, your non-work life, so rich with exactly the people you want instead of trying to fit some therapists that may be a great into like a round peg in a square hole.'”

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Addressing Stress and Resource Management

The episode also explores the psychological aspects of starting and maintaining a private practice:

• Redefining Stress: Allison introduces a nuanced understanding of stress, suggesting that sometimes what is perceived as stress may stem from a dislike of certain tasks. “[20:11] Alison: 'The demand is not exceeding your resources. You have so many resources… somebody's got your answers.'”

• Utilizing Available Resources: Mary is encouraged to leverage the podcast’s community and other available resources to alleviate feelings of being overwhelmed. “[20:34] Alison: 'You've got access to every support and answer that I actually need.'”

• Mindset Shifts: Shifting from viewing tasks as stressful obligations to seeing them as manageable responsibilities can significantly reduce anxiety. “[21:25] Alison: 'Instead of labeling it stress… maybe I just simply don't like some of the things I feel responsible for right now.'”

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Recommended Resources

Allison mentions a book that could help Mary and other therapists dealing with similar documentation challenges:

• "Stress-Free Documentation for Mental Health Therapists" by Melissa McAffrey: This book offers templates and practical advice to streamline documentation processes. “[14:13] Alison: 'Melissa McCaffrey runs QA Prep… this might calm your perfectionist…'”

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Key Takeaways

1. Evaluate Outsourcing Needs: Only outsource tasks that are not easily manageable with available EHR systems to save costs and reduce dependency.

2. Combat Perfectionism: Aim for “good enough” in documentation to prevent delays and ensure compliance without unnecessary stress.

3. Build a Support Network: Establish connections with other therapists locally or virtually to mitigate feelings of isolation.

4. Reframe Stress: Identify whether challenges are genuinely stressful or simply tasks you dislike, and approach them accordingly.

5. Leverage Resources: Utilize community support, educational materials, and practical tools to build a sustainable and fulfilling private practice.

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Notable Quotes

• Mary on Outsourcing Challenges:
  "It was really stressful and not very productive… I just feel like I'm bleeding money." ([05:26])

• Allison on Billing Efficiency:
  "It's so easy. Like, when you start doing the billing, you'll be like, oh, why was I paying for this?" ([08:19])

• Mary on Perfectionism:
  "I'm a little bit of a perfectionist, and I delayed actually transferring my handwritten notes to the system until I had the perfect template." ([07:42])

• Allison on Redefining Stress:
  "Maybe I'm not stressed. Maybe I just simply don't like some of the things I feel responsible for right now." ([20:37])

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Conclusion

Episode #624 offers a compassionate exploration of the hurdles faced by new solo practitioners. Through Mary’s experiences and Allison’s expert guidance, listeners gain valuable insights into managing the business aspects of a private practice while maintaining clinical excellence. The emphasis on realistic systems, community building, and mindset shifts provides a roadmap for therapists seeking to create sustainable and joy-filled practices.

For more resources and support, visit Abundance Practice Building or Abundance Party.

Transcript

[Alison]

Foreign hi, welcome to the Abundant Practice Podcast. I'm Alison from Abundance Practice Building. I have a nearly diagnosable obsession with helping therapists build sustainable, joy filled private practices, just like I've done for tens of thousands of therapists across the world. I'm excited to help you too. If you want to fill your practice with ideal clients, we have loads of free resources and paid support. Go to abundance practice building.com Links all right, onto the show so I've talked about therapy notes on here for years. I could talk about the features and the benefits in my sleep. But there are a couple things I want you to know about Therapy notes that doesn't typically make it into an ad script. First is that they actually care if you like their platform. They don't only make themselves available on the phone to troubleshoot so you don't pull your hair out when you get stuck. They also take member suggestions and implement those that there's client demand for. Like Therapy Search, an included listing service that helps clients find you internal and external secure messaging Clinical outcome measures to keep an eye on how your clients are progressing A super smooth super bill process Real time eligibility to check on your client's insurance. In my conversations with the employees there at all levels, they all really believe in their product and they want you to love it too. Second, they are proudly independently owned. Why should you care about that? Because as soon as venture capital becomes involved, the focus shifts from making customers happy to making investors happy. Prices go way up. Innovation plateaus. Making more money with as little output as possible becomes the number one focus. With over 100,000 therapists using their platform, they've been able to stay incredibly successful and they don't have to sacrifice your experience to stay there. You can try two months [e-mail] with the coupon code Abundant Some of y'all aren't sending HIPAA compliant email and it's a problem. Even if you're paying for a business Google Workspace account and have a signed BAA, your emails still aren't 100% compliant. That's where Palbox comes in. You can connect Palbox to your Google Workspace or Microsoft 365 email one time and you're completely covered. No one has to sign into portals. It sends and it shows up like any other email. Behind the scenes. Pow box software checks the security settings of the recipient and ensures that the email is sent properly so you're not violating HIPAA and the ways accidentally be. Now I know HIPAA isn't sexy, but we don't avoid compliance. In an abundant practice, we check the boxes we need to check. And this is the easiest way to do that with email. Check out my [e-mail]. that's P A U B O X. Use code abundant to get $250 off your first year of powbox. That makes it less than a hundred dollars for your first year. Again, that's P A U B O x dot com. Use code abundant.

[Mary]

Hi, Allison. Mary.

[Alison]

How you doing?

[Mary]

I'm good. I was so excited about today. I've been trying for, like, three months to get on your schedule, and I was really into my note, which never happens. Just something I wanted to talk to you about, and I lost track of time. I'm so glad I got that email. How are you?

[Alison]

I'm doing well. Yeah. What about you? Good.

[Mary]

Yeah. I'm happy to see you. And I just wanted to say, I know you're in. Are you in Asheville? Yeah. Yeah. I just. I wanted you to know you've been in my thoughts, and my sister's in the area, and I've been there recently to see her and just been thinking about y'all.

[Alison]

Yeah. Well, thank you. I appreciate it. Yeah. Well, what would be most helpful today?

[Mary]

Yeah. So I was thinking about. I'm new in private, in solo practice. I left a group practice in July, actually June, and started this practice in August. So it hasn't been that long, and I'm starting to feel like I'm getting the hang of it. But there are some things I'm wondering if I should outsource or things that I'm outsourcing that I should do. So that's where I got really, I think, thrown off at the beginning, and I wanted to talk to you about that. Yes.

[Alison]

Let me get my pen. Okay. Tell me all about it.

[Mary]

So I was under the. Just knowing my personality type and my work style, just felt like I wouldn't be so great at the credentialing process, at the billing. I really wanted to just focus on welcoming my clients into my practice and the clinical work. Obviously, there's like, a whole very important business side of things, but I thought, you know, it's worth my money to pay someone to help me with this. What ended up happening was the folks I hired to help me with the credentialing. It was a really stressful and not very productive relationship, and I was left in the dark a lot. It wasn't clear on if I was paneled. I got paneled with the wrong folks. Like, it was just kind of A mess. And I just. I went into this, like, spiral the first month or two. Just being really angry at them.

[Alison]

Yeah.

[Mary]

But just also feeling stuck. Like, I don't know what. What they're working on, what I'm working on. And so it just kind of set me off on this bad note. Like, I just came into this just feeling frustrated and. And I'm still working out kinks in insurance and all of that. So I'm not really making the money that I. I mean, I think the money's out there and their claims unpaid. I just. It's all kind of a mess right now.

[Alison]

Yeah.

[Mary]

I do have someone that's helping me with billing. Oh. So coming back to the credentialing piece, I fired them and I said, I'm going to just take over. Just send me, like, the status of everything. And that was helpful and just got me thinking, like, what it. Like, I should have listened to Allison's podcast and just. I could have done this myself if I just believed in myself more and been like, set aside time to do it. Because it's not like the credentialing piece doesn't sound that complicated when it comes down to it.

[Alison]

Yeah.

[Mary]

So I think I'm okay on that front for the most part. And I know, like, I need to go in and check the chq. Is it chqh.

[Alison]

Yeah.

[Mary]

And just maintain those contracts and everything. But I don't think I'm going to have anybody help me with that piece anymore because I think I'm. I've got my foot on the ground when it comes to that billing. There's someone that I've never met in person. She's local and was recommended by a couple other therapists, and she's been helping me with submitting claims through a simple practice. And she's also helped me. She kind of stepped in and helped with insurance, like, to help me get those EFTs set up and so that I could get paid. But she's kind of the only person I go to now when I have any questions about insurance and billing. Although I think I'm getting stuck with, like, at what point should I just see what I can do myself? I mean, what are some of the simpler things that I can do to save money? I'm just, like, bleeding. I feel like I'm bleeding money.

[Alison]

Yeah. Yeah.

[Mary]

So I'm paying for an hourly rate.

[Alison]

Yeah. I mean, if you're using simple practice, like any of the major ehrs, it literally takes you seconds to build seconds. So I think I don't Know how she would charge an hourly rate unless she's actively on the phone with the insurance companies a lot, trying to track down those claims that you haven't gotten. So I might hold on to her to get that part done. But after that, I mean, it's so easy. It's so easy. Like, when you start doing the billing, you'll be like, oh, why was I paying for this?

[Mary]

Okay.

[Alison]

But if she is doing a lot of the call and, like, verifying benefits and things like that, it depends on the insurance company. A lot of them are, like, portaled through the major EHR system. So you can look and see, like, what are their benefits while you're in your system? Some of them you have to sign into the insurance company, but it literally is just, like a quick check that you could do, you know, while you're on the phone onboarding somebody or before their first appointment, so that everybody's real clear.

[Mary]

Yeah.

[Alison]

And what I've done in the past is just said, like, I want you to check with your insurance. Like, I've put the onus of responsibility on them because I. I didn't want to be messing with insurance all the time.

[Mary]

Yeah. I'm paying her to do the verification of benefits for every client.

[Alison]

Mm. And so I. I would look into what that process actually is, because if it is a sign into a portal or sign into simple practice and just look, and it takes you less than a minute, I would so much rather you do that, because if that's the case, she should be super cheap, and you shouldn't be talking to me about this. It's just charging you per hour.

[Mary]

Okay.

[Alison]

Yeah. Unless she is the one waiting on hold saying, we still have not gotten these.

[Mary]

She is doing some of. Some of that. Yeah. And this simple practice is still not showing correctly, like, which claims have been paid. So I think that's on the simple practice side of end of things to the eft.

[Alison]

Yeah.

[Mary]

Yeah.

[Alison]

It just.

[Mary]

It was a lot because I. I started with a full practice because I was able to take my clients with me, which is awesome. Yeah. But I just. I just underestimated the amount of time that I needed to get everything in place. And so now I just feel like I'm backpedaling a lot and going back to learn. I mean, I need to. So going into simple practice, too, and looking at the billing, how billing works and through there, and. And then with all my panels, kind of learning that process on my own.

[Alison]

Yeah.

[Mary]

Okay, that's good. So. So you're saying, like, it really shouldn't be taking that long to submit claims. It's just.

[Alison]

No, no, it's literally less than a minute. Every claim. Maybe. I mean, some of it's probably even automated.

[Mary]

Okay.

[Alison]

So. Okay. Yeah, okay. She should be super cheap except for her time talking to them.

[Mary]

Okay. Okay. Thank you. And the other thing I mentioned, the notes. I get really stuck in figuring out I'm a little bit of a perfectionist, and I delayed actually transferring my handwritten notes to the system until I had the perfect template. I don't have the perfect template. In my old job, we have one that I liked. I didn't love it, but I used it and I was familiar with it. And now I'm like, putting together my own based on what I'm seeing in Simple Practice. And I just. I'm behind. I'm very behind. I know you probably hear this a lot because it's the bane of a lot of our existences, but maybe it just needs some motivation or like, clarity from you on the documentation not being as big of a deal as I'm making in my head or like letting go of some of that.

[Alison]

Yeah. I mean, you have it documented. You have everything documented. It's just on paper. So, like, worst case scenario, you got audited right now.

[Mary]

Yeah.

[Alison]

Just like, here you go. Like, it's been behind two locks. Like, I'm not leaving it on my desk in my unlocked office.

[Mary]

Right.

[Alison]

Yeah. So you're still abiding by hipaa, so I want you to know that you're not in control.

[Mary]

Considered that. I didn't even think about that. Thank you.

[Alison]

Yeah. And so honestly, what I do. I believe Simple Practice has a feature where you can just scan things in.

[Mary]

Huh.

[Alison]

You could. You could hire a college kid, have them sign a BAA Business associate agreement which basically says, like, I will abide by hipaa. And you could just pay them an hourly rate just to scan and pop them into the right folders, or you could do that while watching tv.

[Mary]

Okay, so just to get caught up on.

[Alison]

Yeah. Instead of like hand typing out everything that's already written, I would just get to a place of caught up and then take it from there. With your good enough template.

[Mary]

Yeah. Okay.

[Alison]

Like, as long as you've got medical necessity in there, you're like hitting the primary points. Then you'll be solid.

[Mary]

Yeah, Yeah. I mean, I have. I have that. I have a proof of like, the codes reflecting the service provided so that that frees me up. But I don't. I'm like, future self is going to want A template that's perfect.

[Alison]

Yeah. So here's my question. You're a business owner now. The perfectionism is going to slow you down and make your life a lot harder. As a business owner, I want it to be the same kind of good enough attitude you might have had as an employee or contractor, because it doesn't have to be perfect. That's just like business owner anxiety getting in the way.

[Mary]

Yeah. I don't know why I'm expecting more of myself now, but it's true. It is like. Like it's a mind game a little bit or mindset.

[Alison]

Yeah.

[Mary]

So what about treatment plans? And what is your view on using, like, the soap notes and the full biopsychosocial first visit, Having that all completed, that takes me almost an hour. Her client.

[Alison]

One thing you may want to consider. Oh, and hold on. I have a book right here. Hold on one sec. Okay, so I just got this book, Stress free documentation.

[Mary]

Ah.

[Alison]

Melissa McCaffrey runs QA Prep and is like one of the documentation gurus, but she keeps it light and fun. And this is cool because it has templates. Let's see. I've just thumbed through it. I haven't really looked at it, but this is treatment plan components, intake, assessment forms. So this might calm your perfectionist if you were to get. I don't know if it's out yet. They just sent it to me.

[Mary]

Okay. I think I saw. Heard a podcast with her maybe, or training. What's her name again?

[Alison]

Fantastic. Melissa McAffrey. It's M A, E L, I, S A.

[Mary]

Okay.

[Alison]

And then McCafrey. And it's stress free documentation for mental health therapists.

[Mary]

Okay.

[Alison]

So that might be something like, not a fun read necessarily. No offense to Melissa, but like something that could at least help you feel like, okay, I'm doing this the right way. I don't have to reinvent any wheels. I'm making sure that all my I's are dotted and my T's are crossed so that that part of you that's like. But what if.

[Mary]

Yeah, it's calmed. Yeah. Okay. I'll get it when it's out. Awesome.

[Alison]

Yeah. And I think probably when you've been an employee or a contractor throughout your career, you've just kind of like gotten your notes done. It wasn't like, how do I do this? Exactly. Right. And. And I love that there's this part of you that's like, okay, like, I am the one responsible. I'm the one in charge. I have to make sure this is done properly. I Love that that's coming up. But the fact that it's freezing you, that's the problem.

[Mary]

Yeah, yeah.

[Alison]

Not the desire to do it. Right. But the freeze response is the. Is the tough part.

[Mary]

Yeah.

[Alison]

So if it'll.

[Mary]

It's heavy. It's really icky. And then I just feel worse talking about it because it's so silly to be obsessed about it.

[Alison]

It's so, like, I want to normalize that. We all have that thing. For some people, it's notes. For some people, it's, I have to have the right headshots. For some people, it's, I can't get the right template for my stupid website. Everybody has this one thing that feels really important, but it isn't really about the thing. We think it's when you're getting your practice where you want it.

[Mary]

Yeah.

[Alison]

So this is just yours. It's a very, like, legal, ethical one. It's nice.

[Mary]

Yeah. Thank you for that, I think. And maybe it was the training with Melissa, what one of the speakers said, it's usually about a confidence issue, like when we get stuck. Or maybe it was you in one of your sessions.

[Alison]

But it sounds like me, but.

[Mary]

Yeah, yeah, No, I can hear that right now. And what you're saying, it's just something they get stuck on. And. Yeah, I think what's. What's helpful is that question of, like, why make it so much harder on myself when I was fine as an employee doing this and I was okay with my work there? Why is this expectation, because now I'm on my own, that it has to be bigger and better. I want this to feel sustainable. It just. It has been stressful.

[Alison]

Well, starting private practice is already really stressful. I know a lot of people are like, if only I had all the clients, then it would feel better. But it's a different stress because now you're trying to, like, build the plane while you're in it.

[Mary]

Right.

[Alison]

And that's tough.

[Mary]

Yeah.

[Alison]

Because you're. You're doing a lot of clinical care while you're trying to build it.

[Mary]

Yeah. And I took time off, but I had my kit, you know, it was the summer I had my kids.

[Alison]

Yeah.

[Mary]

This is not time off what I envisioned for my hiatus, so. Okay. Yeah. Any other, like, any advice that. I mean, you have a lot that you've shared with your. Through your recordings and everything. But what about when you start to feel lonely? Like, there's no one in my building that I see on a regular basis. I. I went from having, like, 20 co workers to then five to zero over the last five years.

[Alison]

Are there therapists in your building?

[Mary]

There's one who I sometimes will see, like, on a Tuesday afternoon. Oh, okay. Okay. And not my person.

[Alison]

Yeah. Yeah. So I wonder about reaching out to therapists that you respect in town and just saying, like, hey, how would y'all feel about, like a Zoom clinical consultation meeting once a month? Or. And this is like my. This is. So I used to feel very similar. I'm extroverted and I'm outgoing. Right. So, like, my need for people is like this deep. Well, the kind of things that introverts hate. I'm like, thank God. So I recognized that for me, I started with a lot of, like, I need to spend. I need to find colleagues. I need to, like, create a way to see them regularly. But what I ultimately found was I needed people in my real life more so than I needed in my clinical life. Because in your clinical life, you've got a person every hour. You know, like, you do have people. They're clients. It's a different boundary. But I would rather you make your. Your real life, your non work life, so rich with exactly the people you want instead of trying to fit some therapists that. That may be friends and maybe great into like a round peg in a square hole. You know what I mean? Like, if you need more interaction, I. I vote in your real life.

[Mary]

Okay. I love. I like that.

[Alison]

Yeah. We all need to be having a lot more fun than we're having. And we have lots of reasons why we're not.

[Mary]

Yes. It's very serious. And around here.

[Alison]

Yeah. Yeah. Yes.

[Mary]

And stress.

[Alison]

Stress will do it. Yeah, Stress will do that. So I was reminded yesterday of the definition of stress and how it is when the demand exceeds your resources. And the truth is, the demand is not exceeding your resources. You have so many resources. You've got me, you've got the Facebook group. Like, you've got all these people. You can. Somebody's got your answers.

[Mary]

Yeah.

[Alison]

And not everything has to be implemented right this second.

[Mary]

Yeah.

[Alison]

So I think what I've been doing since I was reminded of that. I heard that and I was feeling super stressed and I was like, wait a minute. I have access to every support and answer that I actually need. Maybe I'm not stressed. Maybe I just don't like. Maybe I just simply don't like some of the things I feel responsible for right now. Because they're not fun.

[Mary]

Yeah.

[Alison]

Or they're not fulfilling. It's just like annoying tax, you know? Just like, maybe I just don't like that, and that's okay. But instead of labeling it stress and putting it in my basket, of all the times in my life I've been terribly stressed and all the baggage that comes with that, if I can just like, oh, yeah, I hate having to get back to my accountant and this health insurance guy is annoying me. And like, that's just my. These are not my favorite moments.

[Mary]

Right.

[Alison]

And it actually made me feel a lot less stressed.

[Mary]

Yeah, I'm letting that sink in. This is recorded, right?

[Alison]

Yeah, it is.

[Mary]

Like, I'm gonna play this back when I need it.

[Alison]

Okay.

[Mary]

Awesome. Thank you. Sorry I was late, too. That's a bummer on my. For both. I mean, sorry for that time you got here.

[Alison]

I'm glad you did.

[Mary]

It is not because I didn't want to be here. So thank you for your time and everything that you offer.

[Alison]

Absolutely. Yeah.

[Mary]

Yeah.

[Alison]

Take care.

[Mary]

All right, you too. Bye.

[Alison]

Bye. If you're ready for a much easier practice, Therapy Notes is the way to go. Go to therapynotes.com and use the promo code abundant for two months free. Make sure your email is actually hipaa compliant with PowBox. Use code ABUNDANT to get PalBox for less than $100 your first year at paubox.com if you're listening, you probably need some support building your practice. If you're a super newbie, grab our free checklist using the link in the show Notes. I'd love for you to follow rate and review, but I really want you to share this episode with a therapist friend. Let's help all our colleagues build what they want.