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Referrals, or, Flossing the Gift Horse

October 9, 2010 by 14 Comments

Image Courtesy of Open Education

A lot of my colleagues complain about not being able to build up their practice. I don’t get it. I am usually as booked as I want to be, and the phone rings pretty much daily. But when I talk to colleagues, I often begin to glean why they might have a difficult time getting their practice full. They don’t want to do anything outside of the therapy appointment to bring in referrals, and worse, some of them are actually hard to refer to.

 

I will often try to offer some overflow referrals to these peers. It becomes like twenty questions: “Do they plan on using insurance?” “What kind of insurance do they have?” “How did they get your name?” “Did you tell them to call me?” “Did you tell them I’d be calling them?” “What kind of therapist are they looking for?” “Are they looking for Saturdays? I don’t do Saturdays.” The list goes on. These folks are sending very mixed messages: They want referrals but they don’t want to do any of the work for them. They are concerned about the vacancies in their practice but don’t seem to want to make a phone call and ask some questions.

Look, I know that your time is valuable. Mine is too. And when I give you a referral isn’t it worth your time to make the call even if it turns out not to be a fit? The narrower the opening you leave in your referral process, the fewer referrals can get in!

The reason I have so many referrals is because I worked long and hard to develop multiple referral streams. I join EAPs on the other side of the US so I could be their only provider in MA. I advertise in every free online venue I can. I have a presence online in Psychology Today, on Google and HelpPro. And in real life I am constantly talking with my colleagues, networking, sending out newsletters and giving workshops. This all occurred during those hours I had vacant in my practice to start with, and still occurs, sometimes at 2:00 AM! I’ve got my own hell to raise, so when I pass along a referral, don’t expect me to do your footwork for you.

We therapists need to cultivate our aggression when it comes to getting patients. No, I don’t mean going out and clubbing them on the head to drag them to our office. I mean that we need to be willing to spend hours marketing ourselves, refining our strategies; hours and dollars on consultants and coaches if we need to learn how to do this. We undervalue that part of the business, worse, we sometimes act as if we think it is below us.

Let me give you an example. If you are someone who provides private supervision, what do you do when someone walks up to you at a workshop or meeting and says, “so I have this difficult patient and I want your perspective.” And then they launch into the case presentation right there. Would you begin supervision on the spot? Of course not. You’d say something diplomatic like, “I’ll be happy to set up a time to talk and think about this with you.” Because you value the importance and the seriousness of clinical supervision. And you’d most likely never walk up to someone in a similar situation and presume to do the same in reverse. But I can’t tell you how many times people approach me and other practice consultants I know as if growing their practice is a 5 minute conversation topic. How devaluing!

Learning to build and market a private practice is a process, and those who have expertise in it have a skill set just like the other skill sets that go into running a therapy business. None of the successful psychotherapists I know are waiting in their office like film noir gumshoes for their phones to ring. We don’t have time for that. So bring your laptop to work, brush up that LinkedIn profile, ask that senior colleague out for a coffee and network, or plan that public workshop that can give potential patients a look-see at you. If you want your practice to grow be ready and willing to invest your own time, money, and energy into it. Consult experts and do the footwork. And if someone offers you a referral with just a name and a number take it, and assess the referral on your own time.

I know that this sounds like a tirade, and please don’t think I begrudge helping a colleague out. That is one reason I offer you these blogs and concrete suggestions. Just keep in mind that the reason you don’t work in an agency anymore is because you wanted to own your own business, and that means you have to do much much more outside the 45 or 50 minutes with patients. So this week, what are you planning to do outside the therapy hour to grow your practice?

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No Time To Lose

October 5, 2010 by 17 Comments

Photo by Matt Metts, on Makezine.com

In the past year we have seen the power of technology to impact human lives in sad and brutal ways. More cases of cyberbullying, live camera feeds in dorm rooms, Facebook page harassment. We have seen young people take their lives, go to jail, shun their peers. We have read about a grown woman setting up a MySpace account,  pretend to be a teen’s peer and persecute her. Every day people experience emotional assault, risk of job loss, conflict, infidelity, insult and cruelty online, ingame, via email and social media.

And still my colleagues often talk about how they can’t possibly learn to use Facebook. Or lack the skills to go on Second Life or WoW; or have never heard of blogging; or think “Tweeting is for the birds.”

I’ve said it to you before, and I’m saying it again: You cannot afford to remain ignorant of these things. I’ll say it more strongly: It is hurting your patients. It is driving referrals from your waiting room–People who need to talk with you desperately about how their life struggles and hurt play out in the virtual and digital environment. I’m not even talking about the business you are losing, I am telling you as clearly and as forcefully as I can, that you are practicing suboptimal treatment.

The days in which the laptop was the exception rather than the rule have ended. The majority of people now use technology on a daily basis. And they use it for psychological reasons, emotional reasons, personal reasons. In the above tragic stories, technology was not the problem; it was the arena the problem played out in, maybe even the weapon used. But the problem is the emotional distress and violence.  The people using technology as a weapon and expression of hatred are people. We are STILL talking about human relationships here.

It’s high time we stopped confusing technology with pathology and tools with abusers. And it’s high time we stop being complicit in the problem. Every therapist I know has a continuing education requirement each year, yet how many of us fulfill part of that requirement by taking a webinar on social networking, or a workshop on online therapy, or listen to podcasts on gaming? Very few, if the patients I have heard from over the past 10 years are to be believed. I’ve heard tales of colleagues judging their patients about how much time they spend on the computer, without having the least understanding about what their patients may be doing there. I’ve seen how people have been “trained” by prior therapies about what they are allowed to talk about, and Web 2.0 is not on the allowed list. This is what we call in the business an “empathic failure.”

You may think by the above tirade that I am exempting myself from this, but I am not. I still catch myself shying away from talking about online gaming because I worry we won’t talk about the “serious stuff.” I still struggle to refrain from interpreting that conversation about blogging as avoidance. I still send dozens of nonverbal cues that shape the expectations about what can and cannot be considered important in the therapy room. I do it too, and this is a work in progress.

You may also think that I’d be happy as a businessman to have found a niche that few of my colleagues are tapping into.

I’m not.

I used to be, but now my practice is mostly full, and when I have a request to take on a patient who wants a gamer-affirmative therapist, or a therapist who does not view blogging as social phobia, or a therapist who takes virtual affairs in Second Life seriously, I don’t know who to refer them to. I have many names to offer for EMDR, IFS, CBT, DBT, psychoanalysis.  I have many trusted colleagues who have years of dealing with mood disorders, anxiety, trauma and bereavement. But I have only a handful of peers who I can refer to and trust that technology talk will not be taboo or overlooked.

I need your help, and I need you to care enough to learn. People are dying, or living alone in pain, because not enough of us are staying in learning mode. People are flunking out of school, losing jobs, ending good relationships and beginning bad ones, and they don’t have time to explain to you and I what Twitter is on their dime. Please begin to push yourself. Download a new iPhone App for the DSM IV ($.99,) , or surf over to Technorati (free) and read a few blogs, or create a free character in Second Life.

This is continuing your professional education:  This is important.

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The Schematics of Neurosis

October 1, 2010 by Leave a Comment

Around the year 1880 John Venn created a tool that has been used throughout the fields of education, philosophy and mathematics.  I am of course referring to the elegant Venn Diagram which allows us to map sets of things in terms of their overlap, inclusivity and exclusivity.  The Venn diagram we are most frequently familiar with is usually comprised of two or three circles, like so:

I have always loved the clarity and beauty that can be illustrated with Venn diagrams (he came up with much more intricate ones, for much larger sets) and they are one of the things I remember from my high school career.

Another thing, or rather person, I remember learning about in high school was Karen Horney .  Not from classes exactly, but from buying her books at a used book store.  I read them during study hall, at first to cultivate a certain geek chic:  Who could resist reading something entitled “The Neurotic Personality of Our Time” to impress one’s friends?  Actually nobody was impressed, but as I actually delved into TNPOOT I was impressed by Horney’s thinking, and her courage to talk about things seldom heard about in our daily lives, neurosis, homosexuality, taboo, and aggression to name a few.

What’s this got to do with Venn diagrams?

The way I first understood neurosis was through Horney’s explanation of it, which sketched in my mind a classic Venn diagram.  There are, Horney asserted, two forms of the self at play in neurosis.  The first is our ideal self, that way we wish to see our self, the way we finish the sentence “I’m the type of person who…,” and perhaps what Lincoln was referring to when he referred to “the better angels of our nature in his inaugural address.  The second is our real self, the self which, like Walgreens isn’t anywhere near perfect.  The real self is how we really are rather than how we wish to be.  Having explained this, Horney goes on to explain that the self as a whole looks something like this:

See that spot in the middle where the two overlap?  Well that is the measure of your neurosis.  The larger the overlap between your ideal self and your actual self, the less neurotic conflict you have and the less troubled by neurosis you’ll be.  It will be the rare event that who you wish to be doesn’t dovetail with who you really are.  Sound like anyone you know?

Yeah, me neither.

For most of us, the overlap is more like the one in the above picture.  We have clear ideas of how we want to see ourselves and be seen, but they don’t always match up with who we really are at the moment.  That makes us feel conflicted and guilty and we try to repress knowledge of it as much as possible.  Psychotherapy, in this light, helps us come to understand where our ideal and real selves disconnect, to find the middle of the Venn diagram.  Having done that, maybe we rethink our ideal self, or maybe we see our real self in the here and now with more acceptance as we try to get the circles to overlap more.

Ok, so one more diagram for you:

How Neurotic is your practice?  How far apart is the private practice you want from the one you have?  As you think about the last few months, has the overlap been getting bigger and the circles closer?  Or have the circles been drifting farther apart, so that what you do and what you wish to do are a thinning sliver?  Meditate on this image this week, maybe print it out.  Because you know when you’re feeling more conflicted about your business and when you’re feeling in synch.  A Venn diagram is worth a thousand words:  What does this one tell you about your practice?

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Pet Therapy

September 27, 2010 by 4 Comments

This is my sidekick, assistant, pet co-therapist Boo. She has been a part of my practice for over a year now. How she came to practice with me is worth mentioning. I had started my practice with the goal of working 4 days a week in the office, and having an extra day to stay home with my family. Over the past two years my practice had been steadily growing, and I was starting to fill up on four days. I found myself turning away patients because I did not want to give up “my Friday.” And this became problematic, because life, and its expenses, change over time.

I realized that I need to change my business plan, be more flexible, if I was going to have a vibrant positive practice experience. But I also did not want to set myself or my patients up for resentment. Nobody wants a resentful therapist. So I decided to take a look at what made me not want to work Fridays, and I realized that part of it was about work/life balance. Boo is an important part of my work/life balance, and unlike the fellow in the blog banner (more about him some other blog) Boo likes to have a job. In fact she used to come to an alternative school program I worked at, and the kids loved her.

So I made a deal with myself:  I would start working on Fridays, and Boo would come with me. I made it a point to check with new or current patients whether they were allergic or not dog-friendly before offering a Friday appointment to them. Now it is a year later, and I have a wait-list for Fridays! Boo greets each patient in the waiting room and escorts them in, and then after a minute or two she usually lays down on the floor or the couch until the end of the session. On several occasions she has been able to comfort a distraught patient in ways I can’t, and I am forced to admit that she sometimes picks up on a change in feeling before I do. Between appointments, I am able to scratch her ears, pet her, and take her for a walk, all of which can help me work through a difficult appointment. Best of all, although sometimes the extra 15 minutes it takes to get her ready and in the car are more work, I always feel like Fridays are a “casual day” at work.

Owning a business requires being flexible, and seeing opportunities. Are there things you have been finding yourself getting rigid about lately in yours? Can you see any opportunities to change that?

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Secret Formula PB+5

September 22, 2010 by 12 Comments

I have frequent consults with beginning or seasoned practitioners looking to get on Medicaid as private practitioners.  Their logic on the surface makes a lot of sense coming from their agency backgrounds.  A majority of their patients in agency are on Medicaid, and they may want to keep them as they transition to private practice.  And many of us went into this work because we want to help a range of people, including the most impoverished or differently abled.  These are laudable goals, and I want to assert that they are not incompatible with private practice.  But I do think that Medicaid is, at least in terms of building one.

What happens when your patient misses their appointment?  With Medicaid you cannot charge them for a missed appointment.  And after they miss two or three, you may have the conversation about “are you really interested in treatment?”  They say yes, miss again, and you fire them, or don’t call them back and feel guilty and frustrated; or they drop out of treatment feeling like they’ve failed yet again.  And in Massachusetts, the newest vendor of Medicaid, Beacon Health Strategies, is trying to change the provider contract to say that you are not allowed to fire them for no-shows!  Outrageous, but hey, you signed the contract, so until NASW or APA fights this statewide that is your agreement.

This is such a lose-lose!  Private practitioners are not able to make a living, low-income patients are not able to get consistent treatment, and everyone feels like a failure, except the insurance company which pays nothing.  But there is a way to build social justice and healthy treatment into your practice right at the beginning, I call it my Pro Bono + 5 session.

Imagine this, you decide that you want to start out in private practice, and while you are building it you want to be able to take referrals from your old agency, which usually has mostly Medicaid patients.  So you call them and let them know that you have 2 immediate openings for your pro bono plus 5$ sessions.

Your what?

You explain that while you don’t take Medicaid, you are offering two sessions in your practice where you contract with the patient that as long as they are on Medicaid you will never charge them more or less than $5.  You don’t participate in Medicaid, but you won’t bill Medicaid either.  You’ll only ask them for a nominal $5 fee payable each week as part of your committment to building a socially just practice.  When you meet the patient, you explain this to them, and explain your no-show policy.  They keep their appointment, they pay the $5.  They miss the appointment, they pay the $5.  If they’re sick or unable to make the session, you’ll gladly offer them a phone session, because they’ll still be paying the $5.  This is made clear the first appointment, with whatever your normal policy is.  You see, you can’t do phone therapy on Medicaid, but on your PB+5 plan you can.  For the patient, they are getting a great discount and affordable treatment.   For the beginning private practitioner you are getting great clinical experience, including talking about the fee and your therapeutic contract, and feeling like you are doing some diverse work, which hopefully helps you feel more confident in being circumspect when filling the rest of your week.  The referring agency gets to win in that they can refer someone immediately.   Win-win.

This is not a new concept.  Freud created the Vienna Ambulatorium to provide free psychoanalysis almost 90 years ago.  We all know that Freud saw many upperclass patients, but he also allotted some time for low-cost or free treatment.  You can do the same.  And I suggest that you set a fixed number of sessions right at the start of your practice, which will help you later keep the number of full-pay or insurance appointments fixed as well.  So what do you think?

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Psychotherapy and Web 2.0

September 14, 2010 by 10 Comments

Recently, I had two referrals to offer to colleagues.  Although I like to make personal referrals, these patients had already had problems finding in-network providers.  So I mailed a general query to a listserv I am in.  Within an hour I received 5 emails back from therapists saying they had availability and providing phone numbers and their emails.  Only one had a website however.  I cut and pasted all five into a note to my patients, and I can guarantee you they will only call the therapist with the website initially.  This event provides us with a perfect example of the difference between Web 1.0 and Web 2.0

Web 1.0 refers to websites and internet technologies that were historically non-interactive, sites that we can read but not actually actively interact with.  Remember those?  Nowadays it is hard to find any examples of them.  Email and listservs, while still VERY valuable, and not at all disposable, would probably be considered Web 0.5.0 .  They are not going anywhere soon according to the recent tech experts I’ve read, but they are more limited in their nimbleness.  They also tend to give people burnout more quickly, as many experience them as intrusive emails from strangers who lob their opinions into the group, then someone lobs back an equally long rebuttal, and so on.  The majority of folks on listservs quickly become passive and resentful, and soon create that sort rule which sends all of the information into the infamous “folder” many of us have.

First let’s look at what all five therapists did that was marketable, in terms of 1.0  They are on listservs, they respond rapidly and include email as a way to be in touch with them.  These are great things, they position these 5 therapists ahead of the pack.   They are responsive and accessible in the manner needed for growing or maintaining a practice.  Anyone who responds after two hours is too late.  When I told my patients I would gladly forward other names if they came in, they basically said, don’t bother.  So that is the power of Web 1.0, that is what these clinicians are doing right, and that is the barest minimum, the barely bare minimum of where you should be with technology if you want to have a private practice in the next 2 years.

If you are reading this, you are at least at Web 1.0, so now let’s look at the therapist above who has begun to make the jump to Web 2.0.  But first, what is Web 2.0?

Web 2.0 basically refers to web-based social media and social networking websites, like Facebook, and LinkedIn.  What makes it 2.0 is the interaction.  We don’t just read what someone somewhere put up on a site, we participate.  We respond to information; comment on videos; share links with friends and colleagues; post blogs; make podcasts for websites or continuing education that others can download; host webinars; IM with friends while we share news or music.  In particular to LinkedIn, which is designed for our work world, we can sign up for discussion groups (and there are hundreds) but also create an online profile which can be as specific or vague as one likes.  The profile can include publications, and links to them, and a professional version of Twitter called your status.  Mine sometimes says “Michael Langlois is accepting new patients.” Folks looking at my profile can see that I have experience in gamer-affirmative therapy and learning disabilities, which makes it easier for people to refer to me or ask me different questions.

The therapist above has much of that.  He has a website, it has an interactive copy of his book, a picture of him, links to other sites and information.  He even has links for professionals and I joined a email list as a result of his site.  If I were providing consultation to this guy, we would be able to devote a lot of time right from the start on webinars and podcasts, because he has a lot of Web 2.0 down pat!  He gets that the rules of engagement for therapist and patients have changed significantly.  Patients want to see your face, hear your voice, think about what you have written, read recommendations from colleagues about you.  And they want to do all that before they meet you.  Remember the saying that therapy begins when you say “hello” to a potential patient on the phone?  Well, in a Web 2.0 world therapy begins before you even get the phone call.

So you need to become familiar with Web 2.0 ASAP.  And not knowing how yet is not an excuse, because as one of my colleagues said “people don’t go around nowadays saying, ‘the telephone, I don’t know how to use that.’”   The telephone has become much more a part of our daily world and Web 2.0 has become much more part of our patients’ world.  Technology is constantly evolving, in some ways like psychoanalytic theory.  Even 100 years ago we might have heard ourselves saying, “free association, what’s that?  I don’t know how to use that.”

So please, because I really do want you to succeed, please start gearing up for Web 2.0 and beyond.

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Too Cool for School?

September 10, 2010 by 2 Comments

This week many of our patients, children, partners and friends went back to school.  Maybe you went back to school too, to take a course or teach one.

I teach at a local graduate school, one I have been teaching for several years now.  And before that I worked in public schools, so I have had the opportunity to be mindful of how commencing a new academic year feels for me, and how it can differ from year to year.  Some years the summer has seemed so short and the prospect of work so alarming I dreaded it.  But this year I am pleasantly aware of how psyched I am to be going back to school.  I teach a class on diversity this semester, and this years class is wonderfully diverse across race, age and many other categories visible and invisible.  I have brushed up on a few things here with the course, tweaked a few there, and I am ready to go!  I hope it lasts, because when I remember how cool it is to be educating future therapists I am very grateful for the opportunity and the pay.

On other occasions, I can feel very differently. It can feel like a drag getting out to campus by car.  The weather gets colder.  The students haven’t read for the discussion or are angsting about grades.  Those days I am more grumpy, less creative, and they, the students, can notice it.

Running a private practice is like this.  When I have had some good self-care and am relaxed, I am reminded about how interesting my patients are, and what a profound privilege it is to do this work and get paid for it.  I’ll read more articles, think more deeply about things and be more energized to provide treatment.

Think of your practice as Back to School Day today:  Are you feeling excited to go to work?  Are you dreading it?  Did you do something just for you this morning or roll right out of bed into “The Chair”?  Are you feeling interested, grateful and energized; or are you feeling put upon?  You better check in on yourself, because don’t think for a second that some if not most of your patients don’t notice where you’re at.

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Catholic School Secrets for Success

September 8, 2010 by 2 Comments

Networking your practice is not an activity as much as it is a steady stream of activities.  When therapists ask me what I do on a regular basis I tell them I post on LinkedIn, blog, send out newsletters via Constant Contact, and use my LinkedIn Outlook Toolbar daily.  When colleagues email me they soon find that they are getting emails from me on a regular basis.  Some of them are articles that made me think of them, others are more general polls and rss feeds.  All of this information can be as overwhelming as it is abundant, but I send it.  And yes, even though LinkedIn discourages this I send network requests to people I don’t know personally.  Why am I such a scofflaw and busybody?  Let me tell you.

When I was growing up and going to Catholic school, there were lots of rules.  Rules for when to get to school, when to go inside from recess, when and where to sit, how to address the teacher, what to wear, what NOT to wear, the list goes on.  You’d think that I’d have learned by now to follow all the rules, whether it be with managed care or networking or marketing, but I continue to march to my own beat even if the tomtomtom annoys others at times.  And the reason for this is the most important maxim I ever learned in Catholic School:  It is better to ask for forgiveness than to ask for permission.

Have you ever noticed how timid we therapists can be sometimes with our colleagues?  We can talk with our patients about sexuality, abuse, feelings of deepest rage and envy; but when it comes to telling a colleague about our work, we choke up.  When we are at conferences we are reluctant to give people our cards or bump iPhones, because we are afraid to seem pushy.  So we don’t, and we go home and suddenly we’re complaining to our spouse or anyone who’ll listen about how “lonely” our profession is.  Another maxim from Catholic School comes to mind here, “get off the cross, we need the wood.”  Introduce yourselves to each other.  If you are reading this, introduce yourself to me!  Comment away, send me an invite on LinkedIn, I won’t bite.  What is the worst thing that could happen?

How about this for a worst case scenario, it actually happened to me:  Five years ago I would often go to open clinical grand rounds in the community I practice in.  I was new to the area, and it was not easy to meet people.  But I had printed up my new cards, put on my best game face, and started trying to introduce myself.  After one grand rounds, the woman I was sitting next to was chatting with me about another workshop and she seemed friendly.  So I got up the nerve to pull out a card and ask her, “could I give you my card?”

She looked at me blankly for a second than she said, “you can, but I can’t imagine what I would ever need it for.”  She took it and walked away without saying another word.  Was I embarrassed?  You bet, and fortunately I had had some positive experiences with other people that day, so I lived.  And you will too, even if you run into a few curmudgeons.  Don’t wait and ask for permission, put yourself out there.  And if you get a cold look, or a curt response to your email, or a “Unsubscribe” to your blog, be polite and apologize for any inconvenience you may have caused (if you feel it is merited.)  And then shake it off and move on.

But do not, I repeat do NOT, forget how small or awkward you feel in that moment.  It stinks doesn’t it?  You shouldn’t have to feel that way, no one should.  Which brings us to the last CSSFS:  “Do unto others as you would have them do unto you.”

When someone offers you a card, take it and say thank you.  Ask them a question about their practice.  Accept that LinkedIn invitation, check out their website link, and send them a brief note saying, “nice job.”  You don’t want to feel small or awkward, so stretch yourself a little when someone takes the risk of trying to network with you.  We all know how hard it is to start and grow a practice, and we all know how to be encouraging.  So pay it forward a little, and you may end up with a treasured colleague or business connection as a result.

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Self-Promotion, No One is Gonna Do It For You..

September 4, 2010 by 12 Comments

When I am doing workshops with colleagues or consultations on building a practice, I am often struck by how mortified they become at the thought of self-promotion.  And yet, I know too well what they are up against.  I have been marketing myself for a while now, in a dozen different venues in multimedia, and it is only recently that I have begun to do so without the negative self-talk or twinges of guilt.

What was I worrying about?  Well, in the past I worried that people would say to themselves, “I am so sick of Mike tooting his own horn” or think of me as a narcissist or superficially greedy, etc.  Boy did I have to get over that, and if you want to be a successful business owner, you will too!

Back when I worked in a large institution it was fine to hide out, do good work with my patients and bring home a paycheck week after week.  But when you decide to start a private practice, you are basically committing to becoming a business.  And businesses need marketing.

One of the great things about being a solo practitioner is that your research and development department and your marketing department is the same person, you!  Self-promotion is much easier when you have a product or services that you believe in.  So I look for opportunities to do the things I enjoy, and then show my colleagues and clients how this adds to my value.  When a recent insurance company began stepping up its efforts to bully clinicians, I had no trouble rising to the occasion.  I like reading up on parity, researching and educating myself about the business climate, and thinking about how language can be used by HMOs to disempower therapists.  And after a few conversations with colleagues, who were clearly looking for a fresh approach to that problem in their practice, I realized that I had something of value to offer.  So now I’m doing workshops on the subject and loving it.

It is very tempting to trade the structure of an institution for the imposed structure of managed care.  Don’t do it!  If you do you have only yourself to blame.  As I tell my consultancy clients, you need to remember that the most important difference between you and the insurance company reviewer is that you have better things to do with your time.  The reviewer is a salaried employee who is paid to call you and conduct these clinical reviews.  Whether you are on the phone 5 minutes or 50 minutes, they get paid.  You don’t.  In your time you could be:

  • Seeing another patient.
  • Devising a workshop strategy
  • Networking with a colleague
  • Being the first to call a potential referral back
  • Writing your newsletter or blog
  • Designing your website
  • Writing your google ad
  • Writing an article for your professional magazine
  • Depositing checks in your bank
  • And more!

The way the intimidation tactics work is that HMOs are banking on your need to buy into a system, even a system of oppression, rather than your own.  Yes, they may say they are not going to pay for any more sessions, that’s their mission.  So make the call brief, and use the time to self-promote some other part of your business.

Self-promotion scares many of us even more than HMO reviews, but self-promotion ultimately pays better and gives you more freedom, motivates you to stay current and innovative, and puts you back in the driver’s seat rather than the victim seat.  I want to know:  What can you do to toot your own horn today?

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Remember the Alamo, er TOPS!

September 1, 2010 by Leave a Comment

I was just reminded by Liz Z. on a poll comment (there’s still time to weigh-in on the one-question poll btw, and read the interesting comments) about BCBS alliance with BHL consulting group and the TOPS.  I think this was a timely reminder for myself and any who are feeling discouraged at our work.

When BCBS first rolled the TOPS out, we were all flooded with propaganda about it, how it was going to revolutionize things.  And there were the subtle incentives (a higher rate for those who filled out the form) and the not so subtle disincentives (those who did not fill out these forms would be required to do more onerous authorizations ultimately.)  I remember the time I got back the results with one of my higher functioning patients, recently unemployed, who had endorsed “had unwanted thoughts or images,” and was considered at high risk for psychosis.  I remember trying to embrace the TOP process and then I remember feeling alternately angry and insulted.

It seemed like the TOP was here to stay, and then it wasn’t.

The TOP failed to stick because we refused to do them.  We objected on legal grounds, questioned its validity, and most importantly took action by refusing to do them.  Websites like this one sprung up:

And now a year later, the TOP is rapidly becoming a distant memory.  I think the moral to the story is that we can effect change.  I hope that we can galvanize ourselves in the coming months and not take the “you can’t fight city hall approach.”

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