Dr. Jeremy Sharp (00:01)
Hey everyone, welcome back. This is the final episode in Pillar 2, the business sprint of March. So today we’re talking about the holy grail for many clinicians and that is making the private pay pivot. How many of you have thought about doing this and backed off because it was too scary? Well, I’m not going to sugar coat it. If you think you can just stop taking insurance and raise your rates to $3,500 or $4,000 and then
your current lifestyle without changing your model at all. I don’t think that is very possible. In many markets, people expect to use their copay of $40 to $60 and asking them to pay the equivalent of honestly a used car out of pocket is probably going to be an uphill battle. But it’s a battle you can win if you can understand one thing. When you move to private pay, you are no longer in the
medical billing business or the services business. You move to a place where you’re in the expert access business. So today we’re going to talk about some field tested strategies to make the transition work and pull some lessons from the world of concierge medicine to help you decide if you are ready to pull the plug on insurance and move to private pain.
Now, as you know, I am recruiting heavily for Crafted Practice and that’s because I believe in it so much and the past year’s attendees have said such good things about the event. So this is, I think, the only all-inclusive business retreat for testing psychologists. Maybe the only business retreat period for testing folks. So all-inclusive, you just get yourself to Northern Colorado. It’s four days. We hammer the business stuff hard. We do small group coaching, a lot of connection with other people who really get
you and your life and your practice. You have downtime if you want to relax and we just spend the time diving into our businesses and taking space and enjoying all of that. So come hang out with us. You can go to the testing psychologists.com slash crafted practice and get more info and do the registration. But for now, let’s talk about this private pay pivot.
Dr. Jeremy Sharp (02:21)
All right, folks, we’re back here and we are talking about making this private pay pivot. I want to start with a little bit of a talk about mindset. That is why would anyone pay three to $4,000 for something that they can get for quote unquote for free at the local hospital or another private practice? So the answer lies in something called consumer psychology.
I’ve talked about this on the podcast before in different ⁓ contexts, but essentially in the world of, you know, high stakes assessment, which is what we deal with quite a bit. There’s something called the quality price inference. What this means is that if a parent is terrified that their child has some kind of neurodevelopmental delay or concern, ⁓ a $50 copay evaluation can actually feel
⁓ kind of cheap or rushed or any number of other sort of negatively connotated terms. So research into the concierge medicine world, which is fascinating by the way, this is a field that’s kind of already mastered this pivot into private pay, shows that people typically don’t pay for the exam, you know, they’re paying for the relationship and the depth of the experience. So
I think this calls back to, there was a great book called The Experience Economy that came out, I don’t know, it probably 10 or 15 years ago at this point. And it was very, very relevant and kind of ahead of its time. So that’s a great supplementary reading material for this discussion. But the idea is they pay for relationship and depth. So if you want to charge private pay rates, your product, so to speak, has to be different than
just a turn and burn insurance practice. Insurance tends to pay for the minimum necessary to get a diagnosis, right? And we’ve had some discussion in the past couple episodes just about CPT codes and billing and ⁓ psychometrists and so forth, which is fine, right? Like this is a model that we run in our practice to a certain degree. I wouldn’t call us a turn and burn by any means, but we do take insurance. So on the flip side though, private pay tends to
pay for the maximum possible to get a life roadmap. right. So I’ll say that one more time. Insurance tends to pay for the minimum necessary to get a diagnosis, whereas private pay will pay for the maximum possible to get a life roadmap. Okay. Just even conceptualizing that, that feels very different. Right. So this means just for an example, ⁓ longer feedback sessions, ⁓ school observations for kids.
Dr. Jeremy Sharp (05:13)
and doing more of that integrated narrative that we talked about back in Pillar 1 last week. So what this comes down to is you essentially have to sell the depth that insurance refuses to fund.
So how do we actually do this? Well, one lever that you can pull, I think, when you are private pay is maybe an overlooked one. OK, so I might go so far as to say the strongest tool in your ⁓ marketing shed, so to speak, is one of the least expected. And this is your calendar. What does that mean? Well, I think a lot of you probably know that ⁓ the wait time for evaluations right now is
pretty high in insurance based practices. I children’s hospitals, at least in our area, are booking out anywhere from 12 to 24 months. And I talk with a lot of practices around the country, including our own, where the wait time is six to 12 months when insurance is involved. And y’all know this probably, for a family or an individual in crisis, ⁓ that can feel like an eternity. So this is where you can leverage your calendar and more specifically leverage speed.
So the marketing could lead with don’t wait a year for answers. We provide a comprehensive assessment and a finished roadmap with a clear plan within 21 days. Now obviously you don’t want to make a claim that you can’t back up. If you can’t get people in within a few weeks and then finish the eval within two to three weeks, then obviously don’t say that. But I think it is very much worth it trying to rearrange your practice model so that you can.
get people in quickly and use that as leverage in your marketing. There’s a lot of research out there that people will pay for speed, certainly. And for many families, especially those who are kind of maxed out in that sandwich generation where they’re caring for aging parents and they’re also managing their kids, time is a lot more valuable than money. And I think that it even goes deeper just across our culture right now. ⁓ Instant access is kind of a thing.
You know, you can get prime shipping and have stuff ⁓ at your door overnight. You can ⁓ do, you know, streaming where you can access anything that you want to watch within like nanoseconds. Music is the same way. So this is just like in the zeitgeist right now. So people are used to things happening very, very quickly. And so ⁓ if you can leverage that and get people in quickly, I think the price of the service.
kind of becomes secondary to the relief of having a plan and just knowing that they’re going to know how to move forward. leverage your calendar if you can. That is step number one. Now, if you are scared to make this leap, that totally makes sense. And that’s where you could do something. I’m going to throw y’all a bone. Like, if you don’t want to do the private pay leap, that’s totally fine. That is understandable.
Dr. Jeremy Sharp (08:21)
There’s something called like a hybrid strategy where you can offer a little bit like a bridge service where, you keep your insurance contracts for the base units of the practice. So this is like the core, you know, ADHD testing or cognitive testing, ⁓ even autism assessment, whatever it may be. But you can create like a premium evaluation tier or
package that is private pay only and made up of services that insurance does not cover. So here are a few things that you might include in that if you’re ⁓ working with kids. It could be 60 to 90 minute school observation. It could be a two hour ⁓ results strategy session with the parents and with someone on the educational team. ⁓ It could be an extended feedback session where you do
like a little bit of implementation, not therapy necessarily, but you’re really helping the individual or the parents implement some of those recommendations or getting them connected to resources and recommendations. You could do a quote unquote care coordination package where you personally talk to their ⁓ primary care provider or their psychiatrist or their therapist or all three to hand off the findings and really bridge that gap between the eval and their treatment. So these are just a few examples and
By bundling these like non-covered services, that’s trick. You have to make sure these are non-covered services within your insurance contracts. It’s not that you are charging more for testing, you’re just charging for a specialized consultation package that happens to include testing and builds on the ⁓ core testing that you are gonna build through insurance. And I think if you track the conversion rate for these services or this package for a few months, you should get like a decent proxy of
how many folks would pay for a full, like, private pay premium eval. I want to backtrack just a little bit. You know, we talked about the calendar as a lever to pull, you know, and really leveraging that speed. But I don’t want to lose track of something I said at the beginning, which is you also need to ⁓ enhance the experience, you know? ⁓ So again, longer feedback sessions, school observations.
Writing better reports where you’re not just regurgitating scores. You’re really spending time integrating that narrative. So this really is kind of a model shift ⁓ if you’re used to kind of that turn and burn insurance model where you’re, you know, just doing like highly templated reports and batteries and that kind of thing. There’s an element of personalization here I think that goes a long way. And I would argue too that if you’re making the pivot to private pay, you also need to
Dr. Jeremy Sharp (11:13)
think about how your office and your website represent your practice because if people are paying for a premium service, they expect the entire experience to be premium. So this means that your website needs to look really good. It can’t be clunky. can’t be a DIY website unless you just happen to be really skilled at that. The entire process should feel smooth. They should be able to reach you immediately or nearly immediately to schedule the appointment.
Hopefully there’s online booking available, that kind of thing. And then once they get to the office, you also need to upgrade your space, okay? ⁓ You need the office space to look premium. So this might mean, you know, a nice like fancy coffee maker or coffee bar or tea area or water station or, you know, ⁓ drinks provided in a beverage cooler that actually looks nice and sophisticated. It means new furniture, means paint, it means art on the walls, that kind of thing. So.
This shift to a premium model requires ⁓ consistency across the product, so to speak. All right. Let’s start to close with a discussion about a super bill. So many of you have heard about super bills, right? If you’re thinking of going private pay, I highly recommend developing a great super bill or out of network ⁓ support process for your clients.
Many clinicians, I think, view this as a chore. And truth be told, it does add more to the administrative side of things. But I want to shift that and hopefully help you view it as a really cool marketing asset. So in this case, you’re not just saying, I’m out of network, right? And you’re responsible. You can maybe get reimbursed for some of the services if you submit your claims. ⁓ You’re shifting to saying something like, we are a premium access practice.
While we don’t bill insurance directly, we will provide a concierge super bill package. And this includes a step by step script to show you how to submit your claims for out of network reimbursement, as well as get a quote of out of network coverage before we even get started. So this requires, of course, that you create this document. ⁓ And I think that goes a long way, right?
People want to be walked through the process. Submitting a super bill can be time consuming and difficult. So this might require, you you research your top like three, four or five panels in the area and actually look at what it takes to submit a super bill. And then you put that in this super bill concierge document and give it to people. And this just, it helps solve problems for them. Okay. It helps communicate, Hey, I’ve got this or you’ve got this for them and they’re going to feel supported.
Dr. Jeremy Sharp (14:02)
If you want to go the extra mile, you could utilize an out of network reimbursement service like Thrizer or reimbursify, something like that. And these are services that do almost like a white glove. Like they kind of fully handle the out of network submission process for your clients. Sometimes there’s a small fee involved, which you could cover. You could roll that into the cost of the eval, but I think it goes a long way to help people submit for out of network reimbursement. So when you help the client get their money back, you are lowering
the real cost of the evaluation for them without lowering your own fee, which is great. So we’re wrapping up our assessment business portion, the business portion of this ⁓ sprint. ⁓ Making a pivot to private pay is tough, right? Like we have not fully done it. And like I said, we’ve increased our private pay percentage of clients by, I don’t know, 5x, probably 500 % over the last couple of years, very deliberately.
So it requires you to be better at marketing, better at report writing, and honestly better at the client experience than pretty much everybody else in your zip code unless you live in one of those places where it’s just the norm to be out of network. But the reward is, of course, a practice where you have the time to do the work that you want to do without an insurance auditor or the threat of audit hanging over your shoulder all the time. So.
Thanks for tuning in. Next, we’re going to move into pillar three, which is all about technology and special cases ⁓ for assessment. We’re going to kick things off with, let’s see, an episode on digital versus analog testing. So we’re diving back into this discussion of Q-interactive or other electronic means of administration versus paper and whether that makes an appreciable difference in the work.
Tune back in. Those episodes should be coming out on Tuesday of next week. So we’d love to see you there.
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