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Hey, everybody. Welcome back to the podcast. Today is a business [00:01:00] episode. We’re going to be diving into a trend that many private practice owners are noticing. The trend is that client inquiries are staying steady, but conversion rates are dropping, especially for private pay practices. If you have been feeling this shift in your practice, you are not alone.
I was talking with some individual consulting clients and my cohort from the 2024 Crafted Practice Retreat and this has come up a number of times among practice owners. So what is driving this downturn? And more importantly, what can we do about it?
In this episode, I’ll break down the possible reasons behind the trend from economic factors to pricing models, and share some strategies to help you boost conversions and communicate the value of testing more effectively. Whether you are an established practice owner or just getting started, this discussion will give you some practical tools to navigate [00:02:00] this potentially changing landscape and book those clients.
So speaking of this business discussion, if this is something you’re wrestling with and you want to talk in a little more detail about this or any other business management topics, you can check out thetestingpsychologist.com/consulting. I am doing strategy sessions now, which are one-off hours where we dive in and try to solve a problem or two, and send you on your way with some practical real solutions to move forward. If you’d like some help, you can go to thetestingpsychologist.com/consulting and book a strategy session right there.
But for now, let’s tackle this problem of decreased conversion rates.
[00:03:00] All right, everybody. Welcome back. We are here. We are talking about this problem or trend of what seems to be happening in different parts of the country, especially with private-pay practice owners. And the trend is that inquiries for services seem to be steady, but conversion or booking for these services seems to be declining. So I wanted to first dive into possible reasons for these declining conversion rates.Right off the bat, I think about economic factors that might be at play. So we are coming out of 2, 3-year period of inflation. So related to that, there’s been an increased cost of living, and financial uncertainty has certainly been at play among a lot of folks. Likely this makes [00:04:00] potential clients hesitant to commit to out-of-pocket expenses, especially big out-of-pocket expenses.
There is some data, the numbers are escaping me right at this moment but I remember listening to some podcasts, at least a year ago, talking about how the COVID relief money that all of us receives is running out. So for those folks who saved it or otherwise were able to bank some money during COVID for whatever reason, that money is running out for folks and has likely run out by this point. So that coupled with increased cost of living and uncertainty, an election year is historically very uncertain time financially, and folks are less likely to spend money on big purchases during election years.
We had that going on in the fall. All that leads to clients may be prioritizing [00:05:00] essential expenses over psychological testing, which is unfortunate to see testing as an unessential expense, especially for kids, but also for adults. I think the reality is that that’s how people are viewing it at this point.
Another factor is that given the economic pressure, uncertainty, and higher cost of living in a lot of parts of the country, the natural tendency is that a lot of clients are seeking services from in-network or lower-cost providers, or like I said, just putting it off entirely especially for kids potentially pursuing services at schools.
Another factor that’s operating in the background that may not be playing a huge role but is certainly floating around out there is the possibility that these quick diagnosis options that you’ve seen [00:06:00] online, especially for ADHD, but it’s growing in popularity for autism as well, these businesses may be stealing a little bit of the market share as well.
One thing, economic factors. Another thing though, is potentially increased competition. So this is related to that last point that I just made, but more private practices are possibly offering similar services, and that makes it a little tougher to stand out for those of us who’ve been around for a long time. The group that I am seeing the most struggle with are well-established private practices who “never had to market before,” and all of a sudden, the conversion ratios are declining.
And so part of that may be that there is just more competition and that more folks are going into private practice. They’re less willing to [00:07:00] take agency jobs, hospital jobs or whatever it may be, which may be related to another economic factor, that’s assessment is not the most lucrative service line in an agency, and it might be being eliminated from some of those agency or entity positions, which forces more people into private practice.
So that may be something to think about if you look around your area and see some newer practices or more folks going into private practice, we may just have higher competition. And that means you have to stand out, which ties into the third factor, which is weak differentiation.
Let me step back. We went through a rebranding process about 6 months ago. A big part of that is to make sure that we are standing out in an increasingly competitive market. So up to this point, many practices are not [00:08:00] necessarily effectively standing out either with their branding, with their messaging, or with their services.
I saw this firsthand when we were going through our rebrand, part of the process was my branding consultant did a lot of research into our competitors in the area; the local metropolitan area, our specific city that we’re in, but also the broader geographic area. There was one point in the branding process when he put all of the logos and practice names up on a slide for me to look at, and it was startling.
Even though I knew in the back of my mind, it was startling to see it all in one place how many practices have some variation on a brain logo. They’re usually blue or green. The practice name is something [00:09:00] assessment services, or neurodevelopmental something, or brain something. It’s very hard to differentiate and stand out in this market. I think that’s starting to hurt some of us.
The other part of that in differentiating your services is that clients may not understand the benefits of private-pay versus insurance-based services. And so we’ll talk more in a little bit about how to emphasize those benefits.
The fourth factor, though, is perhaps lying in your website. We’re going to talk about this, but your website may not be optimized for conversions. So are there clear calls to action? Is it loading quickly? Is there too much friction in the booking process? There’s also a copy factor; what does your messaging say [00:10:00] on your website? Does it align with your client’s pain points?
And then another factor here is the lack of compelling content, honestly, demonstrating expertise and value in testing. So the website is a part of this. That’s a factor to even get people to call in the first place but also, people are going to do a lot of research before they call you. And if your website is not working for you, then that can be a detriment.
Another factor though, is perhaps sales and pricing issues. What does this mean? There is the basic sense that pricing might be perceived as too high without the accompanying value for that service. It could also be that we are not doing a good job in selling our product. And this feels weird, especially for practices like my own, where you haven’t had to do much marketing and the clients just come to you, to [00:11:00] view booking clients as a traditional sales process can feel very foreign.
We’re going to talk about some strategies to combat that and develop a little bit of a different script, but what I mean by sales concerns is that there may be, for instance, a lack of urgency in following up when potential clients inquire. You may not be checking back in with them immediately after the call if they don’t say yes right away, for example, or nurturing the client through the booking process or the sales process.
Another factor is that clients just might, going back to price, experience a sticker shock if your fees are not framed properly. We’ll discuss what that means. And then lastly, just another factor I was thinking about with all this is that clients are just feeling hesitant right now. They may be uncertain about the financial commitment. They may not totally understand how an [00:12:00] assessment can help with their specific issues.
It’s a big commitment, especially for those of you in metropolitan areas charging $3,000, $4000, $5000, $8000, $9,000 for your evaluations. This is a big investment for folks and they have to have some sense of trust and comfort during that booking stage to take the leap.
So lots of different factors that might be contributing to these declining conversion rates. You can think about your specific geographic area in your practice and see which one of those resonate with you. My guess is you were listening and two or three of those probably hit you a little harder than the others. And that’s probably a good indicator of the factors that make the most difference and that you might want to pay the most attention to.
All right, so what do we do? You know that I like concrete strategies and making things practical. So what are some things [00:13:00] that you could do to improve the conversions for your testing?
Let’s start with the website. A big part of this might include optimizing your website for conversions. What does that mean? There are a lot of factors. First one, make sure that the scheduling process is completely seamless. I really like this word friction or this concept of friction in the client experience, and any friction that we have introduced into the booking process is something that needs to go away.
So if you think about when Amazon introduced that buy now button on the product page, conversions went way up. It’s the same process for us. You don’t want clients to have to take a bunch of steps, click a bunch of buttons, do a ton of information before they’re able to book a call, even if it’s just a consult call. [00:14:00] So whatever you can do to make that as seamless as possible is great.
Personally, I am a fan of just having them submit a form rather than making a phone call to you. I think for a lot of people, phone calls are very friction-filled, and there are any number of reasons not to make a phone call. So if you could do an online form or even a text inquiry using a bot or something like Wendy, that could be super helpful.
What else can go on your website? I’m a big fan of video. So if you can record a video and put it on one of your booking pages or your service pages to build some rapport before that first call, I think that makes a lot of sense. You could even do two videos or a combined video where it’s you as the practice owner with your intake coordinator or whoever’s answering the phone, you’re making those calls. Video [00:15:00] goes a long way.
What else can you do? You can have clear pricing transparency with an explanation of value. I’ll talk more about how to do that in just a second, but pricing transparency. I’ve done podcast episodes on this in the past and how people value transparency in pricing. So whatever you can do, just put your prices on the website. And then you’ll have to do a little bit of work to frame the pricing appropriately, but it can be done. I think it goes a long way.
Another factor with the website is using client-centered language. So instead of saying something like our services, it’s how we can help you. It’s just a slight tweak to your language to speak directly to the client and take the focus off of you as a practitioner or the practice and make it actionable and oriented toward the client.
Let’s move on to talk about [00:16:00] messaging a little bit. I’ve talked about this in a lot of my consulting sessions. We need to adjust our messaging as much as we can to emphasize value and outcomes instead of process. One of the components here is that you want to clearly communicate the unique benefits of private pay, if you’re a private-pay practice.
Those of us who do it know this means there are no insurance restrictions, it’s more personalized care, perhaps higher confidentiality because you’re not sharing any information with insurance panels. So communicating those benefits very clearly can be super helpful.
You can also use case studies or testimonials. I just did an episode two weeks ago around reviews and testimonials, and how to solicit them ethically. If you didn’t check that out, definitely go listen to it. You can use those case studies or testimonials and put them on your website to highlight transformation stories essentially and how the [00:17:00] testing process can help clients.
Then the last component is maybe shifting the focus from the cost of the evaluation to “return on investment.” What do I mean by that? I’m sure you’re saying, okay, this sounds like one of those cheesy sales tactics or whatever, but it’s a cheesy tactic because it works. It’s rooted in psychology.
What does this mean? This would mean framing it in something like, “Investing in an assessment now can save you years of struggle down the road.” So framing it as an investment versus just an outlay of cost.
Let’s talk about cost in a little bit more detail on how we might adjust our pricing presentation to reduce the sticker shock. Cost is often a main objection of folks. [00:18:00] So the way that pricing is presented can make a big difference.
Here are a few things to consider. You could frame the pricing in terms of long term value. So instead of saying, our testing costs $2,500, you could say, for less than what you’d spend on a year of tutoring or therapy, you’ll get a roadmap that can shape your child’s life over the next several years. Something like that. So then you’re emphasizing that a comprehensive evaluation saves money in the long run and avoids wasted time on ineffective treatment or running around trying to find what works.
That’s one way that you can adjust the pricing presentation, and frame it in terms of long-term value. Another component is that you can break down what’s included. I think this is a fine line. Honestly, if any of you have done consulting with me, you know I’m a big fan more of selling the outcome versus the process, but at this stage of the game, I [00:19:00] think there are a lot of clients who are balking at a large price tag without realizing what they get.
So I think it is worthwhile at some point, not front and center, but on your website, you can break this down and say, okay, this is the testing we do. This is what you get, the feedback session, the school observation, customized recommendations, the follow-up afterward, if you do that.
I think that is worthwhile because sometimes people just hear these numbers and they equate it to going to a primary care physician and doing a 15-minute appointment and walking out with medication. So this is a huge leap from that. I think we do need to spell it out for folks, especially now when we’re trying to convince customers of the value of our services.
And then the last strategy that you could do in terms of reframing the pricing is think [00:20:00] about or communicate the cost over time. So $2,500, you could say something like, that’s about $200 per month if you spread it out over the year. So that’s about the cost of a single therapy session. If that’s something that resonates with them, that’s great. You might need to find a different example if it’s not therapy, but maybe it’s like, that’s a tutoring session or that’s a gym membership at a really nice gym or whatever it may be to spread the cost out over time.
That was a lot of website stuff. Let’s talk about payment and pricing flexibility. A lot of you are already doing this, but it’s worth emphasizing that instead of changing your pricing or charging your pricing all at once, you can do a lot of things to make the payments easier in order to improve conversions.
One of those is offering payment plans. So this would [00:21:00] be what a lot of people probably do. You could do it like, a deposit is due to book the appointment. Then another payment is due at the intake, and then a payment is due at testing, and a payment is due at feedback. So you could break it into three or four payments that occur over the course of a month, let’s say.
You could also go more formal and do something like breaking everything into a 3-month installment plan. So deposit for booking the intake, then the next payment is due a month later, and the next payment is due a month later. Of course, this runs into solving the problem of having a reliable payment method. That’s where credit cards come in handy. And making sure that the card is valid. So you can work that many different ways, but offering a monthly installment can help.
Another option is to split the assessment into phases. [00:22:00] You can start with a very affordable initial screening that people attend before committing to the entire evaluation. Maybe someone comes for the intake, and the intake is $300. If they continue with the assessment, then it goes toward their balance for the assessment, but if they stop after the intake, then they only pay the $300.
It helps build trust and rapport and increases the likelihood that they would continue once they meet you, but it also reduces the psychological barrier of a large upfront cost. So if you let them know, hey, you can just pay $300 to get started and then we’ll decide at that point, it’s just a little more psychologically appealing.
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Let’s get back to the podcast.
And then the last option is, and this is controversial, you would have to build into your pricing model to account for this, but you can do a discount. So if you’re a private-pay practice, you could offer a slight discount for paying in full upfront. So when they come in for the intake if they want to pay in full upfront, maybe you do a 5% discount to reward that behavior, so to speak.
Like I said, this is a little bit controversial and it does affect what a super bill might look like and so forth, but I think there are ways to do this and have it make sense. [00:26:00] So you might consider a prepaid discount to get the full payment upfront. And that’s just psychological. 5%, it could be a substantial amount but people just like getting a discount.
Okay, so that’s a pricing discussion. Let’s move to more of a discussion about the selling process and how you can improve your conversion ratio during the phone consults. I’m assuming at this point that you can get people on the phone. If you are not getting people on the phone, I would work to do that.
So the initial inquiry or call to action to me needs to be an online form or some digital means of letting them book, but then you want to get on the phone or in person with them to speak directly to them because this is how you’re going to convert into full evaluations. So [00:27:00] whether you are training your intake staff or you are doing this yourself, these points are applicable.
Scripting is important to address cost concerns. One of those things, just a simple example is, I totally understand that this is an investment. A lot of families worry about the cost, but what we hear time and time again is that getting that clarity now prevents years of unnecessary frustration and expense from running around trying treatments that don’t work. So you can train your intake staff to script a little bit. And this is a little more salesy, but it’s also true. You don’t want to say anything that’s untrue.
Another component is you can train your intake staff to normalize the cost hesitation. So this would be something like, hey, we know this is a big decision. A lot of families are in the same boat or a lot of people are in the [00:28:00] same boat. And that’s why we offer a payment plan, free consult, whatever it may be to help get them in the door.
Another factor or strategy that you can use to improve conversion rates is to use some scarcity to create urgency, if it is true, of course. You could say something like, we’re currently booking, for us, it’s 4 to 6 months out. So if you’re considering an evaluation, I recommend reserving a spot now. You can always cancel it later. Don’t say that if it’s not true, but you can always cancel later, but I just recommend booking a spot now to reserve your appointment.
And then to add on to that, if you know that it’s true is, you’re likely going to call around and find similar wait times at other places. I could save you some time and be happy to just get you on the schedule now, and then you can give me a call back if you need to change it. So creating a little bit of [00:29:00] scarcity can work wonders.
One last strategy when you’re on the phone is to make it easy to say yes. This sounds very salesy. Just get them to yes. I think there’s something to that. If people are feeling hesitant or you get to the end of your phone script and it’s time to do the booking, instead of asking if they want to book or waiting for them to tell you they want to book, you could ask, would it be helpful if I just walked you through the next steps, or would it be helpful if we just look at the calendar? Could I help you get this next appointment booked? Something like that versus leaving it at that.
I’m a big fan of transparency when you’re on the phone with people. And so I think it’s important to address this whole thing of why not use insurance and just talk about that head on. You [00:30:00] can do that in your website copy, like I mentioned earlier, but when you’re on the phone with people, you can always say, yes, we know we don’t take insurance but a lot of insurance-based assessments are brief and they lack the depth that you need for truly tailored recommendations.
Our evaluations go beyond the diagnosis. We’re going to give you a roadmap for the next 1 to 2 years to make sure that you have the highest chance of being successful, something like that. You just address it. You acknowledge you don’t take insurance and then you tell them why and you play up the advantages of that.
You can also offer some insurance reimbursement help. You could create a one-page pdf that walks people through not using insurance. If you use a service like Mentaya, Thrizer or any of those out-of-network assistance services, you [00:31:00] can talk them through that and what that would be like.
You can provide a prefilled super bill template, or show them what a super bill looks like and how to submit it with a little step-by-step guide. You can put together some materials to help people navigate using out-of-network services. And that can also help too, if you tell them on the phone, hey, we’ve done this a million times. We will hold your hand and make sure you get this submitted so that we can increase the likelihood of getting reimbursed.
Alright, what else? Let’s talk a little bit more about the pricing. I should have thrown this in earlier, but I’m thinking about lots of different things here and bouncing around. So one of the things that you can do, we’ve talked a lot about pricing on this podcast. You can create tiered services if you’d like.
You all know, I am not a [00:32:00] huge fan of tiered services, but if you did, here are some options that would help people have a little more buy-in and a little more willingness to consider your different options. For example, you could have a basic evaluation where you do the testing and write a short letter to summarize the results; a one-page report, so to speak.
So that could be your basic. You could do the comprehensive where you do all the testing and a full report, for example, and then that is more money. You could also add even a premium tier, where you do the full testing, full report, plus three months of follow-up, where you meet with the family once a month to [00:33:00] help strategize and support them if you can fit that into your scope of practice.
So this is a good, better, best pricing model to give people choices. Don’t give people choices that you don’t want to fulfill or that you don’t feel are helpful, but we’re thinking outside the box here to try to increase the perceived value and give people choices as to what they book into. And we want to increase the conversion ratio.
Another facet of improved or added value is if you present things as being free, for example. So even though you’re going to bill the cost of these services into the evaluation, you can present them as free add-ons. This would be something like, we include a meeting with school staff for no additional cost to help transition from [00:34:00] our evaluation to school intervention, or we include no cost workplace consultation to figure out how to talk to your employer about your diagnoses and needs at work, something like that.
People love the perceived or their perception of getting something for free. And you can bill that into your evaluations as well. Use psychology to improve the perceived value.
Getting back to having people book into a low-investment option, if you’re not doing free or low-cost consultations, I think it is worth a consideration. Even if you have an admin person who is booking the intakes, if you offer the option for a 15-minute consultation just to let people talk to “the doctor” [00:35:00] and hear from you, hear about your approach, I think that can be a really nice move. The conversion rates for clients once they actually meet with a clinician are usually pretty high. So it could be a brief phone consult. I probably wouldn’t do an in-person appointment for 15 minutes.
And if you absolutely cannot do it for free, then charge something nominal like $50 to do a “free consult”. Obviously, you wouldn’t call it free, but $50 consult just to have them meet you. And then you can apply that toward the full assessment if they continue.
Another option that you could do as a low-commitment entry point is to give them a checklist or a screening tool before the full assessment. So this will be something that happens on the website unless you’re doing an in-person [00:36:00] consult. You do a very brief free or low-cost screener that they can fill out on the website.
Of course, we’d want to do a research-supported screener that they could fill out. It’d be open source and get the results and then you bill that into the workflow or the sales flow where if the results indicate a potential diagnosis, then they can give you a call to schedule their evaluation.
The last thing that I’m going to talk about in this whole process is what I will call strengthening the follow-up after the calls. We have this happen a lot in our practice where people will get off the phone with our intake staff and they give some version of, I need to think about it or I’m going to call around and see what else is out there, or I need to talk to [00:37:00] my partner or spouse about this; some version of that. Basically they are delaying, and it’s usually because of the cost and the investment. And so I think it goes a long way to immediately follow up and not just trust that that person will call back.
What we have started doing is booking that person into another screening call the following week so that they have an appointment to talk with us again about the evaluation process. Some other things that you can do are send an email immediately after that call with the following items. You can do a recap of your conversation. You include an FAQ on pricing and payment options, and testimonials from families who hesitated, but saw the value. And then a booking link that has a little bit of urgency built in that says something like, like I mentioned, we’re booking 4 months out, so you can schedule your appointment right here [00:38:00] and reserve your spot.
I’m a huge fan of creating a template of this. So you create a template where you can put the person’s name in really easily, but these other components that I mentioned are just built in and it’s built into the template. So you are not recreating this email every single time.
And then if you can automate this process, great, if not, you do it manually, but then you follow up again in a week if they haven’t booked. So this is where something like a CRM could come in really handy, but you can also do it manually. You can use a spreadsheet. So follow up again, if they haven’t booked and send another email with similar information. The hope is that they will feel compelled to book that appointment.
There is some data out there around people need to be contacted or given the opportunity to buy something several times before [00:39:00] they commit to it. You’ve maybe experienced this if you’ve looked at something online and then come back to it two, three, four, maybe even five times. And so we’re not going to pester people and send them five emails after they have a screening call but it does go a long way to send two emails. You send one right after and then one after a week if they still haven’t booked.
Pulling this all together, one, you’re not alone. If you saw the episode title and started to weep, you’re not alone. This is happening around the country. I’ve talked to several people who are having this experience, but there are also some strategies that I think you can do. It will require some more effort and some work, especially for those of you who’ve been around for a long time and are used to not having to market. I get some of that, we had to start doing some marketing about a year ago for the first time ever.
So what can you do? You can experiment with different payment options, [00:40:00] installments or splitting things up, train your intake staff on how to, it’s called objection handling; reducing the sticker shock, reframing the cost as value, things like that. You can think about doing free consults or a low-cost screener to get people in the door. You can make sure to communicate the case for private-pay versus insurance-based testing. Make sure that’s clear everywhere. And then improve the post-call follow-up from your intake staff to nurture any clients who might be hesitant to take the leap.
So lots of options out there. You don’t have to do all of them. You can pick the ones that make the most sense for you. Just know you’re not alone and there are definitely some strategies to help you with this dilemma.
All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take [00:41:00] away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.
If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.
If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
[00:42:00] The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your [00:43:00] area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.