Transcript – Episode 414: An Interview with Maureen Werrbach on the Accountability Equation Part 2 of 2

Evan Dumas

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton and we are Person Centered Tech. This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and electronic health record system to support you in growing your thriving practice. therapy notes is a complete practice management system. With all the functionality you need to manage client records, meet with clients remotely, create rich documentation, schedule appointments, and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user, go to therapynotes.com and use promo code PCT.

 

Evan Dumas 

Welcome to Episode 414, An Interview with Maureen Werbach on the Accountability Equation, Part 2 of 2.

 

Liath Dalton 

You spoke to something that I know is top of mind for many practices here, which is the sort of challenging hire, as well as attrition from you know, folks thinking we’re all teletherapy, anyway, why don’t I hang my own shingle? And I know that’s something you’ve got good insights and just kind of framing around as well, so what would you say on that piece?

 

Maureen Werrbach 

Okay, where do I want to start? So, um, obviously, like, we’ve seen a lot of change since COVID. Right? That’s, that was kind of like this start of this most recent decade of, and that’s, I want to say decade because these issues minus the COVID piece, but like employment issues, the fact that there’s like a lot of too many clinicians, not enough practices, and then not, you know, too many practices, not enough clinicians, this has always happened, it circles through every, you know, 10, 15, 20 years or whatever. This is just the most recent one, and COVID precipitated it.

 

Maureen Werrbach 

I do want to say that, I think that in the coming couple of years that is going to change. And will probably swing back to, like a pendulum that swings back and forth, it’s going to swing back into a not into our favor, so to speak, to like into an easier to find people space, and it’s probably gonna swing back, you know, and forth, forever and always. So I guess I just want to say that caveat, because it feels scary when we’re in like an elongated period of time of being like, I can’t find anyone and everyone keeps leaving, and like, I can’t fill them as fast as they leave.

 

Maureen Werrbach 

Like, okay, I want to give empathy and awareness understanding for it. And it’s a great time to look at, like diversifying your services. I find that you know, there’s we see a lot and I’m sure you Liath know a lot about this too. But there’s stuff coming, we see stuff happening outside of like the immediate group practice world, like as small business owners. Like tech companies coming in, insurance companies buying group practices, how values based reimbursement and values based care play into it. And I think all of those things are going to impact hiring as well, because we see these tech companies being able to offer a crazy amount of pay that smaller practices can’t do, but that’s not sustainable. And so in my head, I can, as a visionary, more visionary person, like looking forward and can see that this is a temporary setback on us as small group practices, it will implode on their end.

 

Maureen Werrbach 

The reason they can do it is they have investors with millions and millions of dollars, but they’re they’re bleeding that out, that’s not sustainable. And it’s going, to, that ends, right? New ones might pop up, but it’s not a sustainable thing. And they also don’t offer things that small group practices, and I consider, and I’m calling myself small even though I’m large, but in comparison to tech companies like this, like small therapist owned practices can offer, might not be able to offer the pay, but they can offer the culture, the community, the upward movement of positions, leadership positions, diversified services that allow clinicians to not burn out on like 25 client facing hours a week. And these larger tech companies, it’s about profit. And so they’re not creating spaces for leadership growth or any of that other stuff that sets us apart.

 

Maureen Werrbach 

And so when you get scared and think that it’s not going to end, right, or that you’re never going to find people, I just think, remember that piece. And what we can do is diversify, like what we do, how can, and so how I look at it is, one, what services can I offer that are in alignment with my business, right? Because you don’t want to go off your values or away from the mission and like, the vision and future of your business, but like what things align with it?

 

Maureen Werrbach 

And so one example for me was, I was thinking about, people come in to see us, and it’s sort of reactive, right? Like they something is wrong, and now they’re contacting us, for the most part. And I was like, how can my therapists, how can our business still meet the needs of those people, but in a more proactive way, how can we reach them before a mental health crisis is happening or an issue is happening.

 

Maureen Werrbach 

And so we built a Well Being in the Workplace arm of our business, where we have therapists who are in charge of literally going into the corporate world, training leaders on how to be more mental health focused with their employees, and also working with actual employees of like hospitals. We we work with whole hospitals we work with, like, corporate Ulta, the makeup place, Lurie Children’s Hospital, like lots of bigger companies, where the impact of not focusing on the mental health of their employees makes a big, has a drastic effect. And we’re going into those workplaces and being more proactive. So we’re, we’re going to them and meeting them where they’re at, before they’ve gotten to a point maybe where they’re so burnt out, but they come into our practice.

 

Maureen Werrbach 

And so those are ways that we can sort of set ourselves apart from those other types of places, which helps with recruiting. Because a therapist with, if there’s one thing I learned is that a therapist loves to be able to flex their skills, not in just one way, you know? If you have opportunities for leadership growth, if you have opportunities for them to be able to work with their ideal clients, in a different sort of setting from just one on one work, that is all going to be very valuable. And something that is going to bring clinicians your way, instead of to the maybe slightly higher paying corporate place where they’re going to be like a cog in the wheel or whatever it is, and just like seeing client, client, client.

 

Liath Dalton 

Well, and I think, in addition, those outfits aren’t nurturing providers in their clinical development, either, right?

 

Maureen Werrbach 

Because that costs money.

 

Liath Dalton 

And in fact, often, what they are requiring in terms of sort of the parameters for how client care is delivered hampers that.

 

Maureen Werrbach 

Yep.

 

Liath Dalton 

And so I mean, I, I’m with you on, feeling very strongly that this is cyclical, that it’s not sustainable, and is going to run its due course before very long, but that in the meantime, that doesn’t mean just rest on your laurels. There are still ways to be the action oriented, that are supportive of your team and the community. And like I love the way you’re addressing it, of going into corporate spaces who yes, the incentive for them is like productivity and monetary oriented. But you’re able to leverage that goal for them in a way that is serving the overall well being of their teams, which makes it good for the community.

 

Maureen Werrbach 

Yeah, and as I say, that’s like the unfortunate part of that specific program is when we go in to pitch it. We have to obviously, the CEOs and all that, CFOs of those businesses have to agree to it. And mental health is not a priority, the way it needs to be at, where they’re willing to spend money. And so we have to, we have all this data on employee retention and how mental health support is all very numbers based and beneficial, like how it’s beneficial to the business, and is a crappy sort of place to have to communicate it from that point. But we know like if your can get you to say yes, we go in and we flip it around, like we are working with leaders who are very resistant.

 

Liath Dalton 

Absolutely. 100%. I mean, that’s a way of effecting systemic change.

 

Maureen Werrbach 

Like some who like literally refused to not have all their staff come back in person. And we’re like, let’s look at the staff satisfaction rates of your teams. Because you’re an old white dude who thinks that the only thing that works is like, that people are just not working when they’re at home. And you’re going to require everyone to come back at 100% How that affects their mental health and how in turn that’s going to affect one your attrition rate, for clinician or your your teams, and you’re their happiness level, which impacts the bottom line. So like if that’s important to you, let’s work on your like view of mental health and like, and that’s the fun place to be. I’d rather challenge every leader than, you know, then, like, work with the employees on learning how to deal with a bad workplace, if that makes sense.

 

Maureen Werrbach 

Yeah.

 

Liath Dalton 

And you know, to do that you have to be able to speak the in in terminology that’s going to resonate and make it possible. Ooh, here, we’ve got a question that just came in, related to the configuration of your practice, how many what percentage of your clinicians are doing teletherapy, currently?

 

Maureen Werrbach 

Um, like, 100%, teletherapy? I don’t know.

 

Liath Dalton 

I’ll ask her to clarify, because I think you’re you have a hybrid model of in person, and teletherapy, and in and out of office.

 

Maureen Werrbach 

Yeah. So we, when we stayed longer, fully telehealth, and most practices did, I think maybe like, a year ago, we like said people could come back in office, or a year and a half ago, somewhere around there. But it was a lot, we were very late in the game to coming back. We initially offered a full telehealth arm, and then a hybrid arm and nobody took the telehealth. And so because I work from a like, I want to make sure that if we offer something that we have everything supports wise is needed, in place. And so that included having someone who lead and supervised that, and since there was no one there for that I then was like, then we don’t need to put a, I’m not gonna put a person leading it and paying for it when there’s no one there.

 

Maureen Werrbach 

So what we have had, is we have a hybrid model, everyone, I don’t think I have anyone who’s fully in office, only. Everyone to some capacity, has like one or two days that they work from home doing telehealth, and a couple of days in the office. So we have kind of a line in the sand for it. That’s 50/50. So I don’t remember now, if we do it by day, or by I think we do it by hours, because some people work less hours, but across more days, people like do two long days, and in the same amount of hours as someone working shorter and four days. So I think we do like if if they have 1200 hours, they’re supposed to work in a year, whatever 50% of that is, has to be in the office. And then the other half could be at home.

 

Liath Dalton 

And so when they are in office are the sessions that they’re doing split between in person and telehealth as well?

 

Maureen Werrbach 

Yep. Yeah. I would, I’d have to look at current like this, since this month, the data but I want to say that we probably have maybe 30% of people still choosing to do telehealth. Even me, I see my therapist, I’ve never actually met my therapist in person. I love not having to I mean, I love in person too. I just love not having to spend extra time driving. So, we probably are around 30% that continued to want telehealth or who are new, who choose telehealth and maybe 70 ish, it probably toggles between 60 and 75%. on any given month, that are in person.

 

Liath Dalton 

Now, has that hybrid model allowed you to sort of leverage your physical spaces to bring on more clinicians then if you, and the way you’re managing it too is key, for that have been having the split defined, right?

 

Maureen Werrbach 

Yeah. I will admit that I am, I like things are organized in a way. Like I get a overwhelmed when you know we have 67 people. So like if everyone’s kind of doing something different I feel like I don’t know how to like, do that. And so as a neurodivergent person myself, I’m always like checking myself that like don’t be too rigid about this and also being like, I want everyone to be able to have as much autonomy as possible. So one of the things that when I really wanted people back because I’m like a big workplace culture and community person, and I do feel like the more telehealth they are, at least in how we had set up our my organization, it is like very community, in person sharing, like someone bringing pizza in, and you know, going to, a group of people going to get drinks maybe after work at the end of the day. Like it’s very much like that which is hard to do through telehealth. So I initially wanted everyone just to come back so I could see that culture again. In that same way, I just had to revise what culture looks like for us. And then good can mean other things like a blending of sorts. And obviously, that makes the culture of our business looks a little bit different.

 

Maureen Werrbach 

But one of the positives to your point was that there’s so much need in my community client wise, that the building of business, the building of locations, is something that comes easy to me, I actually don’t mind it. The people management is way harder to me then, which is why I have a whole leadership team helping me with that part. But the building is like fun. But it’s overwhelming. And it’s a lot of work, like physical work building furniture, shipping things, all that. And so it’s been nice to be able to keep building without having to physically build like, and that’s what having this blended program allows is that we can have a lot more clinicians across our four locations than we would if everyone was back in the office full time.

 

Liath Dalton 

Awesome. Yeah. How?

 

Liath Dalton 

How are you, because you already alluded to the fact that the marketing landscape has changed dramatically, in the 12 years, since you launched and started marketing, your practice? What are you seeing as the most effective ways for practices to bring in new potential clients?

 

Maureen Werrbach 

This might be, you’ll get very varying opinions. My opinion is, and this is based off of a practice who’s brick and mortar. So even though we do a lot of telehealth, I’m brick and mortar, if you’re a full telehealth practice, it’s gonna it’s gonna be a little different. But I find that community based marketing, because I think of marketing in two prongs, you know, digital marketing and community based, that community based marketing, I do the digital, we have a Google Ads person, we do all all of the digital stuff, our SEO is great. And we get a lot of referrals that way. But it’s nothing in comparison to like, the relationship building in the community with other therapists practices, with other wellness related like our chiropractors offices, and doctor’s offices nearby, being a part of the Chamber of Commerce, those things just our know, like, and trust factor increases so quickly, with community based marketing than with our digital marketing. So I believe that we should be engaging a little bit in both, but I focus mainly on community based, and I find that it yields the most, and I to this point, because it can feel overwhelming, like, are you supposed to meet every therapist in your community, every doctor’s office? No, I find that quality over quantity.

 

Maureen Werrbach 

And so we just have about five really good connections in the community that we nurture throughout the year. And that’s it. We don’t, try to get to know every school and every, you know, chiropractor’s office, and every pediatricians office by for each location, so I have locations kind of far from each other. But each location, the person that leads it, is in charge of, you know, really securing five, three to five really good relationships with businesses in the community that serve the same kind of clients. And we’re spending a lot of time like throughout the year being like, what are you working on over there? Like, is there something new going on, you know, really focusing on our attention on their business, because psychology 101 is when you give attention to them and not just have the sole purpose of I’m going to call someone and let them know about our openings, all of our new therapists, that’s not going to give us as much as when I go and say, like, hey, we just saw that you moved, can I come and see what it looks like? Is there anything we can do to help you?

 

Maureen Werrbach 

You know, that yields that kind of closeness that brings us so many more clients. And then the second really quick thing is, we do community trainings. So I put that in line with community marketing, but we’ll go to like our local YMCA every quarter and we do like a training for the community. It gets, the YMCA has a huge list of people right, an email list and audience, and then we let ours know. And then we will go and do free training in the community. We do one a month somewhere for free. But we noticed that usually the day or two days post any training we ever give, we have an influx of new clients that call because they saw one of my therapists do that training. So it’s a something free and obviously you can you can charge for it too. We just for our anti oppression work, community based work we that’s our free thing that we do. But I can’t kind of count that in with community marketing.

 

Liath Dalton 

And for those that is there like psychoeducational workshops, primarily, correct?

 

Maureen Werrbach 

Yes. Yeah. And we even have them I mean, you can go on my website and sort of see it, too, but we even do them just digitally. Obviously, that started during COVID time when we couldn’t go in, in person. And we’ve kind of kept that up as sometimes our in person stuff, we’ll record and put it up digitally. But sometimes we do psychoed stuff just through webinars, and we do a Pay What You Can option so that it’s accessible to everyone, and those that can’t pay can still have access and those that can can pay what they want. So we do that as well.

 

Liath Dalton 

I love that. And it also seems to serve well, the ability to be nurturing different areas of interest and skill sets for team members.

 

Maureen Werrbach 

So one of the ways that they can, you know, because there’s only so many leadership positions you can have in a business, and so like, not every person in your practice can be in a leadership position, it just doesn’t work. But one of the ways that they can diversify their workload is those that have an area of strength in presenting or feel like they have a topic of expertise that they like to train and teach on, they get to reduce their clinical hours. So that they can do that in lieu of seeing clients.

 

Liath Dalton 

How, how do you measure those kind of metrics of success in terms of allocating reallocating client contact hours to those community marketing and training hours?

 

Maureen Werrbach 

Yeah, so for the training, for any clinicians that are doing any sort of community based training, we don’t ask them to market, we have dedicated people for that. But for every hour of training, we give three, I want to, I want to say three, and not four, but we get three, we allow them to reduce three clinical hours for every  one hour of training, so it allows them you know, two hours of prep for and then an additional hour of the actual training. I don’t think it’s four, I want to say it’s three. Yep. And so that’s how we do it.

 

Maureen Werrbach 

So if they want to give if they want to do, and so we have a little bit of a screening process, because obviously, if they are not good at presenting, right, because it’s similar to the assessing for leadership, not every great clinician is a great leader, not every great clinician is great at training people on their area of expertise, like they might be really good at doing with their clients. We have like a short little screening thing, because we don’t want them recording trainings that we’re like, oh my god, we can’t use this. So we have, we have a really quick, they have to send us like a one sheet. And if anyone were a CE NBCC, continuing education provider, they have like a one sheet, you can Google it and find it.

 

Maureen Werrbach 

And it essentially is like, what is your topic? What’s the objective of that topic? What are three core things that you’re going to, that your audience is going to learn? We have them fill that out, if they if they are an expert, it’s gonna take them one minute to be like, I want to talk about this, this is what the objective is going to be on it. And these are the three main things that the clients that come are going to learn. They fill that out and bring it to our clinical director. And then they have to do a one minute video that they can do from their phone, we’re very laid back in my practice, where they just have to explain in one minute, what they’re going to talk about.

 

Maureen Werrbach 

And that just does like a very minor screening of do they know how to talk, like through, you know, through recording and anything like that. So those are the two things we do. And if they can do that, they only have to do it once. And then we trust forever, and always that they know how to do their speaking engagement. And they just have to fill that objective, and three, three things that the audience is going to learn. But if they do one a month, then obviously they get you know, like about four, they get one less client hour per week that they could do. Now, obviously that that’s just one thing. There’s a lot of different things that they can do that can reduce their hours.

 

Liath Dalton 

That’s awesome. Let’s see we’ve got a nother question on your how you pay, whether it’s salary or hourly. I know the answer to this.

 

Maureen Werrbach 

Yeah, I’m salaried. I used to be commission, like my team was paid by commission. It was 55% to the clinician. And when that was the case, we had a flat $200 that we would pay for every training that they did. The 55% kind of translated to about $60 an hour. So then, clinically. So if they did a training, and we paid for an hour, we paid $200, It had the assumption of the prep time it would take them in there if you took the $60 times three, it was kind of right around there. So we paid a flat rate of 200 per hour of a training. But we also made sure to approve it because we didn’t want someone to be doing like 15 trainings a month and us paying out a bajillion dollars. So we had sort of our limit of like, how many trainings per month would we approve across the practice, and it was kind of first come first serve. But now we’re salaried. So their salarie is their salary, and for clinician, non leadership positions, if they’re diversifying their workload in any other way, their salary stays the same. But it comes at a reduction in their clinical caseload so that they can be doing other things. And then obviously, salaried positions for leadership have a higher salary. And we break down their clinical caseload.

 

Liath Dalton 

What sort of led you to shifting from the hourly and commission percentage basis to, to salary? And were there, do you feel like there’s some sort of point,  natural point in the lifecycle of a practice or like some key indicators of hey, maybe it’s time to to make that move?

 

Maureen Werrbach 

I’ll say, I mean, I don’t know, I did it, I did it because of COVID. It was a great tool for getting more people to shift to salary. So we’ve been doing salary, literally, since almost just like the beginning of COVID, which was very scary. Not like the first month when everything went to shit. But like, when people started coming back, and everyone’s still working from home, we shifted our admin or our leadership team first. Because I wanted to, my leaders I like trust the most like, I think shifting to salary is really scary, because they have to have intrinsic motivation to keep seeing clients.

 

Maureen Werrbach 

Because if they are making the same whether they see one or 20, they’re gonna, it’s just there’s a lot of accountability, which is another reason why this book was written with like, because I feel like we’ve really figured out how to hold people accountable and be able to have salaries and all this stuff. We have unlimited paid time off, they can take off as much time as they want in a year, you want to go four months, go ahead. Like we have a whole system in place to make that work. But like it came with, you know, really setting up accountabilities.

 

Maureen Werrbach 

But we started it first with my leadership team, because I knew they were going to, they’re just like, so invested in the business that I wasn’t scared. So I did it with them. And I wanted to make sure that what I visualized to be correct in terms of the salary change, like how do you turn a percentage into a salary and all that. And then, like, I wanted to make sure that it matched up. So we did that for about six months. So I could see like, what did that feel like? Was what I thought happening, actually happening? And then I shifted and added my administrative team.

 

Maureen Werrbach 

So I did it in a lot of steps, because I was very scared, and a big practice already. Then I shifted my admin salary, waited another six months, made sure that the numbers I did made sense and didn’t mess me up too much and accountabilities worked, then I did it for new clinical hires. A new model of, they could only accept a position at salary, like we didn’t even offer commission. And then we were able to see what those first couple of hires, it wasn’t like putting 45 people on salary all at once. And then we were like, this looks okay. And then we opened it up to all the clinicians in my practice, and allowed, you know, a lot of them to choose. And now, that’s all we are, is salary.

 

Maureen Werrbach 

But it’s definitely scarier. I, part of me loves the commission model. Because I, I did it in a, I always am advocating for rate increases with insurance. And so my team was always getting, you know, making more every year. And it felt like, there was a lot less risk on me as a business owner. That’s what commission based pay is. So I liked that for the fact that if, like, they didn’t ask for raises all the time, because they knew well, I’m getting it sort of naturally when Maureen’s getting rate increases, and I also know she can’t do more if she’s not getting more.

 

Maureen Werrbach 

With salary, it is just different. That’s how the our world mainly works. And so like people naturally want to ask for raises a lot. And you have to sort of explain, you know, if you’re at, we’re paying the max we can so we have to explain, like, unless we’re getting a raise, there’s nowhere to give more. So there’s definitely more conversations around it. I think it’s way easier to do. But it definitely every pay, pay style, I feel like comes with its pros and cons.

 

Maureen Werrbach 

You know, where I loved commission for the fact that it was, it felt very equitable in some ways, like there’s no way that I could make more profits without them naturally seeing it too, it was still a ton of work administratively to do payroll. And now, there’s no work administratively, but there’s a lot on leadership to hold people accountable, which is just the other end of the spectrum.

 

Liath Dalton 

So, like the it being feasible in practice would not have been made possible without having the pieces of the accountability equation?

 

Maureen Werrbach 

No. Don’t do it, if you don’t know, I mean, whether it’s the accountability equation or just being good at holding people accountable, you can’t you can’t do it. You can’t do it if if you don’t know how to truly hold people accountable. Not just have conversations, but like, feel comfortable making decisions to PIP someone or terminate someone, if chronically they’re not meeting that need.

 

Maureen Werrbach 

One simple example of a scary position is which I’m sure most of the practices listening with the Change Healthcare. Right, okay? If you’re salaried, do you know? I pay like 400 something thousand dollars a month in payroll, just to pay my staff a month. 400 something thousand. When we weren’t getting anything, they still get paid. When you’re commission, I’m gonna caveat and say that there are timely pay laws, and so when you do commission, you have to make sure you’re paying attention to that stuff. But the way commission works is if you have $0 coming in, there’s zero to pay out. So there was more flexibility in that.

 

Maureen Werrbach 

And so things to think about is like, do you have a cushion? You know, I opened up a line of credit to make sure that if, which we didn’t end up having to use but just to make sure, there’s no way to save, you know, a million dollars for like two months of shaky pay because of Change Healthcare. And so those are things to think about, definitely.

 

Liath Dalton 

So you kind of oh, wait, wait, do we have one more? Ah, this one is great. When we attempt to hold people accountable, we always fear they will leave. Has that been an issue for you?

 

Maureen Werrbach 

There have been a few people who have left because of accountability, but not in a way that I would call it an issue. The right people left, is what, is how I saw it. Like the people who we, when we were when we started this, who we were holding – the hardest people that this will be for, is existing clinicians who weren’t previously being held accountable.

 

Maureen Werrbach 

It is it shakes up their world to be like, no, we actually need you to do this thing. It is not difficult for new hires when you have an accountability set in place that you’re like having those conversations from the moment they’re in, in the practice, every one of our staff that have been hired in the past, like four years, I would like, I’d say, three, four years. They literally email their clinic, their supervisor, immediately if at the end of the week, they have like three notes left. They’re like, I just want to let you know, I didn’t finish my last three notes. And like our old ones that have been with us for like 10 years, I have people who like my first ever hire is still with us from 13 years ago, they’re like, they’re the ones that were like, hey, we need accountability, man.

 

Maureen Werrbach 

So like, I will say that the hardest people will be the ones that are used to not being held accountable. But those that really love where they’re working and understand that the accountabilities make sense, you just might have to really coach a little bit more. But the ones that have left were the ones that weren’t a good fit, like they would not want to do those things. And it, one is bad for culture because other people see it and then think well, then why do I need to? And two, from a financial perspective, as some, a practice that pays a salary, it’s not workable, if everyone doesn’t do their part. You know, the only way I can pay someone salary is because they’re actually seeing the clients.

 

Maureen Werrbach 

So I won’t say that it was hard. Or I won’t say that what was the word used? Like, issue? Yeah, it was not an issue. It was almost like a self selection of people leaving that needed to leave, because they, that it was just wasn’t good fit for them. Accountability wasn’t what they wanted, you know, being solo, where no one tells you what to do, and they can choose to be successful or not, like maybe it was a better spot for them.

 

Maureen Werrbach 

So yeah, but there is when you start to hold accountability, especially if you’re mid-business ownership. There, I don’t think there’s anyone that will say that they had like, no staff loss. Because usually most of us will have one or two people that really weren’t a good fit. And we just didn’t want to let them go or have that conversation because the income they brought in felt like that would be a loss for them. And that’s a scary spot to be in, to be like, but I need to keep this person because if I don’t have if they’re not if those clients leave with them, we’re going to be financially in trouble. Like it’s a horrible reason to keep people, just caveat thougt. I hear that a lot.

 

Liath Dalton 

If you are thinking about it in terms of like the health of your practice as a as an organism, right? That they’re bringing in the accountability piece, just like bringing in security, compliance and risk management requirements, those are things that are necessary for the health and integrity of the organization. And so if there is attrition when you are, like naming the needs and holding people accountable for meeting them. That’s a little bit like natural selection, right?

 

Maureen Werrbach 

Yep. It’s exactly how I see it.

 

Liath Dalton 

Last question, I want to ask you before we’ll, we’ll let you leave us and tackle the, like, regular techie questions that got submitted. But, you know, I know insurances increasingly been a pain in the hiney to to deal with for so many practices. And that there can be a lot of reticence about negotiating rates. And I know that’s something that you’re really good at. And so if there are any pieces of wisdom, or a just like, this is why it pays to do it and how to do it effectively that you could impart to folks, that would be lovely.

 

Maureen Werrbach 

Yeah this is actually, one of the most fun things I do that I haven’t given away. And it’s like an administrative thing, that probably any leader in my business at this point could do, but I love doing it, is requesting rate increases. I’ve been keeping a spreadsheet since I think 2014 of like my, each insurance that I was in, what the rates for the different CPT codes were, what amount of that goes to the clinician, and what amount of a session is for the practice, obviously, going to operating expenses and taxes and all the other things but like, what’s left.

 

Maureen Werrbach 

And then I every year request an increase with every insurance, I split it up across the four quarters. So I have a like a thing on my calendar each quarter to do like quarter one. So like this quarter, I just did, er, January through March, I’m still in communications right now, I did Aetna and Cigna and then quarter two, I have like Blue Cross and then quarter three, I have another and quarter four, I have another. So that then once a year, each one of them is getting paid attention to. I don’t always get it with every insurance. But I, every year, get rate increases with at least a couple of the, I think I’m in like four or five insurances. And I always get increases with a couple of them.

 

Maureen Werrbach 

It pays. I, since I started doing it in 2014 to now, like I went from like sub $60 per session average, to like 150s 160s average reimbursement from insurance companies. And I know practices in my area, who say what their rates are for certain insurances where I’m like, Oh, we’re a lot higher than that. And they’re a good practice. And it you know, I just play like the long game with it, is like my thought. I remember saying in 2014, like, this is crappy pay, but like I’m in it for the long, if I can get like $10 and $10, eventually, I’m going to be like – I actually had to increase my out of pocket rate this last year, to accommodate the fact that I was kept getting a rate increase with a specific insurance that like was above, you know?

 

Liath Dalton 

Right.

 

Maureen Werrbach 

So okay, I also I feel like you need to do it every year. Insurance companies don’t, are not emotion based businesses. And so they don’t care about how many people like love you or all that, they’re like very metrics oriented. And so if you’re asking for an increase, the things that I’ve found to be most helpful, and this, you can kind of manipulate it if you’re a smaller practice versus large. So like, one of the things is, I will start by saying either the percentage of our client of our, all of our clients that are use that insurance, or how many actual clients have that insurance, and it depends on like, what number sounds bigger, they’re both accurate. But like, if you’re a smaller practice, if you say like 80% of our clients use Blue Cross, but you only see like across three of you, you know, 60 clients with Blue Cross, saying 80% of our practice’s clients use Blue Cross is going to be a much higher number, whereas even if, 80% of ours did, 80% of ours is going to be like 10,000 something clients. So I might say 10,000 something of our clients take Blue Cross. Because it’s a number, it’s just, it needs to like speak to their their language.

 

Maureen Werrbach 

So that’s one thing I’ll do is either say the percentage of your practices clients that are with an insurance or the actual number of it which you can get in your EHR, whichever number sounds higher. Tells the same story, but one sounds usually, like more exciting than the other depending on how big or small you are.

 

Maureen Werrbach 

The second thing is like what insurance companies and you can Google, most insurance companies, if you do enough Googling, and now you could probably use chat GPT to get these answers, but insurance companies will say, like in the clinical world, what they value most. So the Blue Advantage, so for Blue Cross Blue Advantage, I think is the name like what they call their little newsletter they send out in Illinois, and a couple of years ago, they highlighted specific things that they that they valued most in clinicians, which usually had to do with like a lack of that type of therapist. So Polish speaking, Spanish speaking, those were coming up, a CADC, so drug and alcohol counselors was at that time, you got to look it up every year because it, you know, can change. But if we have that, that will input in there, and I change it depending on the insurance, and what they say is like what they’re looking for, or what they value.

 

Maureen Werrbach 

So like for Blue Cross EMDR, drug and alcohol counselors CADCs, those were two big ones. And then we have Polish speaking therapist and several Spanish speaking like at work, and our intake paperwork is in those languages, all that. And so we’ll highlight that as well. So that’s something to look into. So the number of the percentage, or the actual number of people that utilize that insurance, Googling and looking up what it is that each insurance is valuing at that moment in clinicians. And if you have it, to state that.

 

Maureen Werrbach 

And then I put a comparison of what our out of pocket rate, and what the average rates for different insurances are, compared to them. And I’ll obviously only list the ones that are above theirs, you know? Yeah, I don’t, I’m not, I don’t have to list that I accepted an insurance that maybe pays $2 less than them, it’s not that helpful.

 

Liath Dalton 

Right.

 

Maureen Werrbach 

And so I’ll look and say, you can’t list which insurance it is, obviously, but I will say like our out of pocket rate for these CPT codes, are this, this, and this, your rate for those CPT codes are this this and this. It’s just a little spreadsheet, very easy to see. And then I’ll say our average rates, with insurance, the other insurance companies that we accept are that, that and that. And it gives an idea of like, where they stand in comparison to our out of pocket and other insurance companies that we accept. And that’s mainly what we do.

 

Liath Dalton 

And that’s your, your pitch for the increase.

 

Maureen Werrbach 

Oh, and lastly, they’re gonna say no, immediately, and don’t accept the no. You can say like, I would like to, I’d like to renegotiate that, or is there someone else like a supervisor, I know it sounds weird. I’m not like that kind of person in normal life. But they don’t care. It’s all scripted, they don’t take it personally. And just to say, like it when they say no, because that’s how it is, they’re not going to just hand you it.

 

Maureen Werrbach 

Oh. And when you ask for an increase, I either say $20 or 20%, whichever number is lower. The only reason for that, is if you ask for like a $50 increase, it’s just insulting to, they’re literally not going to do it. So I always do 20 or 20% $20, or 20%, whichever number is lower, which lately is just usually 20%. For me, I asked for a 20% increase, slow and steady. No one’s going to give you a 50% rate increase. Then yeah, when they say no, say that you would like to renegotiate those terms. And if they aren’t able to be that person, because a lot of times they’re the front, first person, they don’t actually have the negotiating power, asked to speak to the person who does have that. And they will gladly move you up the pipeline. Right.

 

Liath Dalton 

So there’s a degree of it that just performative like you have to go through the right motions in order to get it escalated to the person who does have the authority to make a decision there. So you don’t want to stop and give up at the at the outset after the first no. That is incredibly helpful. And I’m sure will be really supportive to a lot of our folks, so. As is all of the other wonderful insight that you you’ve shared with us. So thank you so much, Maureen. And we’ll actually before you leave, let everybody know when when your book is coming out. And if they want to learn more about the accountability equation or connect with it for their their practices.

 

Maureen Werrbach 

Yeah. So my book comes out on May 6. So just in a few weeks on Amazon, digitally, physical book, audible version, whatever way you want to absorb. And then also if you go to the grouppracticeexchange.com We have the accountability equation like programs where you work with me in a small group cohort, or in person we do once a year. And that right now I know, our digital cohort enrollment is open right now through April 29. Because I think the first meeting starts April 30. So if you wanted to actually jump in and work in a group with me and on it, you can go to the grouppractice exchange.com and you’ll see it there.

 

Liath Dalton 

Thank you, Maureen. This has been Group Practice Tech, you can find us at PersonCenteredTech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast or click podcast on the menu bar.