Fall 1999 - IP; Psychologists and Dentists: Mutual Practice Opportunities

Insurance Free

Psychologists and Dentists: Mutual Practice Opportunities/Sondra Goldstein

You Thought It Was Private?/Dana C. Ackley

The Suffolk County Psychological Association Managed Care Free Support Group/Joseph Czekala

Building a Coaching or Consulting Practice: Writing a Reader-Friendly E-mail Newsletter/Ben Dean

Opening New Markets: Paying Close Attention to the Company You Keep/Lou Perrot

CPG Behavioral Health Resources: An Ongoing Transition/Jeffrey Zimmerman and Elizabeth Thayer

The Therapist as Personal Coach: Reclaiming Your Soul!/Patrick Williams

The Managed-Care-Free Private Practice Kit: From Fear and Trepidation to Joy and Prosperity/Ofer Zur

The Underutilization of Psychologists as Expert Consultants/Witnesses/John Fleer

The Business of Practice Network (BOPN)/Kal Heller

**Insurance Free**
	Psychologists and Dentists: Mutual Practice Opportunities/Sondra Goldstein
	You Thought It Was Private?/Dana C. Ackley
	The Suffolk County Psychological Association Managed Care Free Support Group/Joseph Czekala
	Building a Coaching or Consulting Practice: Writing a Reader-Friendly E-mail Newsletter/Ben Dean
	Opening New Markets: Paying Close Attention to the Company You Keep/Lou Perrot
	CPG Behavioral Health Resources: An Ongoing Transition/Jeffrey Zimmerman and Elizabeth Thayer
	The Therapist as Personal Coach: Reclaiming Your Soul!/Patrick Williams
	The Managed-Care-Free Private Practice Kit: From Fear and Trepidation to Joy and Prosperity/Ofer Zur
	The Underutilization of Psychologists as Expert Consultants/Witnesses/John Fleer
	The Business of Practice Network (BOPN)/Kal Heller

The Managed-Care-Free Private Practice Kit: From Fear and Trepidation to Joy and Prosperity
We psychologists in independent practice have been repeatedly told that either we join panels and form groups or perish. We have been led to believe that there is not enough money out there to support out of pocket practices and that people will not pay $500.00 – $600.00 a month for therapy even if they have it. We have been assured that managed care is here to stay. We have been frightened into low paying provider panels by the Nicolas Cummings’ of the world and books on the “Demise of Private practice.” We have become convinced that we are no longer psychologists but are “providers” and some, supposedly, lucky ones amongst us are even “preferred providers.” We became very anxious when we were informed that psychologists’ private practices were obsolete and that we were soon to be replaced by MA level therapists who will take over the market by offering similar but cheaper service.

In reality, the reason most psychologists are hurting is not for any of the above reasons. It is because we have not taken a systematic, strategic and effective look at how to fight managed care and regain control over our beloved and honorable vocation.

As a matter of fact, reality does not support any of the above catastrophic predictions. In 1997 alone, people spent 1.7 billion (yes, billion) dollars on psychic hotlines (this does not include seeing psychics face to face). More than twenty times that amount is spent on out-of-pocket consultations with non-traditional health care practitioners each year in the U.S. The money is there and people spend plenty of it on health clubs, dieticians, herbalists, personal coaches, personal trainers, and vacations.

As a greater number of members of congress and their families have first hand experience with managed care, they realize that their health insurance is more about insuring profits than insuring health. The daily exposés by the Media are starting to show results. In a country that places extremely high values on privacy, freedom of choice and getting what one pays for, Managed Care with all its wealth, greed, and lobbying power will likely prove to be a fleeting phenomenon.

For almost a decade I have been in a 100% out-of-pocket-pay practice and 100% outside of managed care. I have trained thousands of therapists in my seminars, I have a waiting list for full paying clients, and I communicate with many like minded psychologists around the country. This is all clear evidence that not only can we survive in a solo private practice outside of managed care we, in fact, can thrive and prosper with joy and dignity.

In order to achieve that freedom from managed care we must move away from a frightened and worried victim mode to a place where we take control over our destiny and our chosen vocation. There is a lot we can do to regain control over our practices and provide better care for our clients.

As a result of my outrage over the immorality of Managed Care, and my deep disappointment with the training I received, I have learned to market myself with pride, to manage my practice effectively and most importantly to consult with my clients in a different way from the way I was taught in graduate school.

What I am about to propose is as appealing as it is difficult. The appeal is apparent as most therapists in private practice seek not only to help their clients but also to have independence, freedom, joy, and a decent income. The difficulty lies in the requirement that we shift our thinking about our roles as clinicians, our actual clinical work and our relationship to the community.

The Blessing (in disguise) of Managed Care:

Before I outline the steps towards freedom and independence from managed care I would like to share how managed care like any evil or malignant event also brings blessings in disguise. I believe that the following blessings may even have, unintentionally, saved the soul of our profession and secured the future.

Managed care demands of psychotherapists to be accountable and to show tangible results of their work (The “resistance” excuse that we have used for so long to justify our own ineffectiveness is finally relegated to the past and hopefully for good.)
Unlike most of our graduate school professors and supervisors, managed care does not buy into the sacred worship of theoretical orientations and will accept only empirically based and not ideologically based treatment plans. A cartoon that captures the problem states, The wonderful part of psychoanalysis is that even if the client does not get better, you know you did the right things..
Managed care requires therapists to grapple with whether what they are treating is indeed “medical necessity” and “mental and nervous disorders” or problems in living and other existential and spiritual questions of our era.
Managed care forces therapists to re-evaluate their beliefs about the nature of psychotherapy and decide whether they belong with traditional western medicine or elsewhere. It brings to the table questions, such as, is therapy an art or a science? Do therapists belong with western health practitioners or with the mentors, coaches, shamans, and others who Arthur Kovacs calls “secular priests.”
Managed care evokes second thoughts amongst therapists about their worship of DSM and the need to label and pathologize clients in order to get reimbursed.

Eight tips to build and sustain a managed-care-free practice

The ability to develop a managed-care-free practice is tied directly to our ability to explain to clients how it is more beneficial for them to pay us $125 per session instead of paying only a $5 co-payment to someone on their managed care provider panel. This $120difference is significant. In order to bridge this difference psychologists who are interested in developing a fee-for service private practice must be liberated from old dogmas about the nature of therapy and marketing. The following is a brief summary of what is involved in breaking free of managed care.

1. Rethink your role – Get out of bed with medicine: Become a mentor, guide, or coach.

In order to get out of the grip of managed care, we must first learn how to be consultants, coaches, guides, mentors, or wise men and women rather than doctors who treat mental and nervous disorders. Most of the people who seek psychotherapy are neither broken nor mentally ill. They are people who are struggling with the complexities of living in the modern era. The fact that we can give them a DSM diagnosis is mostly a reflection on the medicalization of our profession and our wish to be reimbursed, rather than a reflection of our clients’ condition. We can practice outside managed care if we learn to help people through the difficulties of normal developmental crises, (divorce, retirement, grief), love, health, parenting, or vocation and be skilled in helping people deal with these everyday life issues intermittently throughout their lives. Arthur Kovacs well termed well this role, the “Secular priest.”

2. Educate your client about managed care’s threat to their privacy:

Very few clients will choose the managed care option, regardless of how cheap it is, if they fully understand its far reaching implications for their privacy and confidentiality. During the first telephone conversation I explain to clients the incredible risk they take when they seek mental health services from most managed care companies. I warn them that not only the fact that they have a “mental disorder” but also the most intimate details of their lives, may be sold, accessed, broken into, exchanged, or shared without their knowledge, permission or control. I educate them that with a fee-for-service or out-of-pocket arrangement they have full control over such private and intimate information. It should not come as a surprise to anyone that in a culture that worships privacy, most informed people will not choose the managed care option. I have produced my own informational brochure (“Beware of your managed care”) and have a ready made package of articles detailing the problems with confidentiality, that I regularly mail or give to prospective clients, businesses and people in my community. If one is well prepared, it takes very little to convince people that the $120 difference is well worth it.

3. Educate people about other hazards of managed care:

I routinely describe to people how in most cases the managed care option shifts the control of the treatment from the client and therapist to the company’s CEO and stockholders. I explain that the length, type, quality, privacy, and follow up treatment are often compromised under most managed care plans. I mail, FAX, or present to people stories from the printed media (i.e. Newsweek, N.Y. Times) about how managed care can be dangerous to one’s health or even deadly. My brochure also outlines the concerns about conflict of interest, explains capitation, and informs them how providers are being selected or dropped from panels. I have found this educational approach to be extremely effective and successful in helping people make informed and educated choices. If some convincing is in order, I send supportive documentation to potential clients showing how selecting the managed care option for mental health may compromise their future employment and ability to get health and life insurance.

4. Market Yourself Effectively, Become an Expert-Educator:

Marketing is usually a bad word to most therapists. I have found out that marketing, while at times hard work, can also be fun and respectable. I suggest that we abandon the Yellow Pages or ‘Ego Brochure’ approaches. Intelligent consumers are aware that these approaches are just a reflection of how much money you can spend on advertisement and how much you can toot your own horn. I suggest that you concentrate on three aspects in your marketing efforts: education, education, and education. People will come and see you if they perceive you as an expert-educator who can help them. Then the real question about marketing is how to present oneself as this helpful expert-educator. There are endless ways of going about it. One can give (free) lectures or print simple educational brochures on one’s topic of expertise. Make sure that the brochures are not about you but are truly informative and helpful and not just a tease to get them in the door. A lot has been written about how to identify and penetrate a certain niche in the market. Visibility in the community is an effective way of getting referrals, as people like to refer to people whom they know and, of course, appreciate. Working as a psychologist with the media, schools, boards of directors, community centers, PTA’s, etc. are all ways of positioning oneself as an expert.

5. Change your own and clients’ expectations of reimbursements:

If we learn how to stop trying to fix or cure diseases, mental disorders, or any of hundreds of ‘name calling’ categories of DSM we can also educate our clients that there is no reason for managed care or any other insurance company to reimburse us for our services. I tell my clients that no insurance company reimburses my herbalist, accountant, attorney, Rabbi, mechanic, personal trainer or gardener. Once we disassociate ourselves from the medical model we are also free of the constraints of DSM and third party payment policies.

6. Learn to work effectively in accordance with client’s problem not your supervisor’s dogma:

There is a saying: “If the only tool that you have is a hammer everything else looks like a nail.” Our field is dominated by competing dogmas and theoretical orientations vowing to prove their superiority over all other orientations. It is time for us to pledge our alliance to our clients rather than to our graduate school professor or our beloved orientation. For this we must be skilled in a wide variety of approaches and learn to implement them flexibly. We must choose our interventions according to how effective they are with certain clients and certain problems. The bottom line is embarrassingly painful, however very simple: If you are highly effective your clients’ family and friends will notice and will want similar results for themselves. As all seasoned clinicians know, most and ultimately the best referrals come from former and present clients.

7. Identify the managed-care-free markets:

Forensics, mediation, custody evaluation, weight/smoking, chronic illness/health, step-families, parenting, family business consultations, and organizational development, are just a few examples of markets which are generally 100% managed care free. Create a vision for yourself, identify the market you want to penetrate, develop a detailed niche marketing plan, and spend the time and money necessary to execute your plan.

8. Exploit managed care to your own advantage:

The managed care era provides us with enormous opportunities to operate independently. I have discovered that many physicians refer people to me because I am not on any managed care providers list. These physicians are under capitation contract and know that referring to me will get their ‘chronic’ clients off their backs and out of their offices, without being penalized by their managed care company. For this to happen, we must be effective in dealing with chronic illnesses and diseases and have good rapport with the physicians.

In summary, as we continue our legislative, legal efforts, and the media exposes more and more, we can simultaneously take charge of our practices today. Not only it is possible, but it can be fulfilling and rewarding to be faithful to our vocation. We do not need to bow to the managed care gods. If you market yourself well, conduct therapy effectively, not dogmatically, and strategically position yourself outside managed care you can thrive in a private practice which is free of managed care.

Ofer Zur, Ph.D., is a psychologist in private practice in Sonoma, CA. His catalog and seminar information on managed-care-free private practice is available from: (707) 935-0655, E-mail drzur@drzur.com, FAX (707) 936-3918, or web site www.drzur.com.

Ofer Zur, Ph.D.

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		The Managed-Care-Free Private Practice Kit: From Fear and Trepidation to Joy and Prosperity We psychologists in independent practice have been repeatedly told that either we join panels and form groups or perish. We have been led to believe that there is not enough money out there to support out of pocket practices and that people will not pay $500.00 – $600.00 a month for therapy even if they have it. We have been assured that managed care is here to stay. We have been frightened into low paying provider panels by the Nicolas Cummings’ of the world and books on the “Demise of Private practice.” We have become convinced that we are no longer psychologists but are “providers” and some, supposedly, lucky ones amongst us are even “preferred providers.” We became very anxious when we were informed that psychologists’ private practices were obsolete and that we were soon to be replaced by MA level therapists who will take over the market by offering similar but cheaper service. In reality, the reason most psychologists are hurting is not for any of the above reasons. It is because we have not taken a systematic, strategic and effective look at how to fight managed care and regain control over our beloved and honorable vocation. As a matter of fact, reality does not support any of the above catastrophic predictions. In 1997 alone, people spent 1.7 billion (yes, billion) dollars on psychic hotlines (this does not include seeing psychics face to face). More than twenty times that amount is spent on out-of-pocket consultations with non-traditional health care practitioners each year in the U.S. The money is there and people spend plenty of it on health clubs, dieticians, herbalists, personal coaches, personal trainers, and vacations. As a greater number of members of congress and their families have first hand experience with managed care, they realize that their health insurance is more about insuring profits than insuring health. The daily exposés by the Media are starting to show results. In a country that places extremely high values on privacy, freedom of choice and getting what one pays for, Managed Care with all its wealth, greed, and lobbying power will likely prove to be a fleeting phenomenon. For almost a decade I have been in a 100% out-of-pocket-pay practice and 100% outside of managed care. I have trained thousands of therapists in my seminars, I have a waiting list for full paying clients, and I communicate with many like minded psychologists around the country. This is all clear evidence that not only can we survive in a solo private practice outside of managed care we, in fact, can thrive and prosper with joy and dignity. In order to achieve that freedom from managed care we must move away from a frightened and worried victim mode to a place where we take control over our destiny and our chosen vocation. There is a lot we can do to regain control over our practices and provide better care for our clients. As a result of my outrage over the immorality of Managed Care, and my deep disappointment with the training I received, I have learned to market myself with pride, to manage my practice effectively and most importantly to consult with my clients in a different way from the way I was taught in graduate school. What I am about to propose is as appealing as it is difficult. The appeal is apparent as most therapists in private practice seek not only to help their clients but also to have independence, freedom, joy, and a decent income. The difficulty lies in the requirement that we shift our thinking about our roles as clinicians, our actual clinical work and our relationship to the community. The Blessing (in disguise) of Managed Care: Before I outline the steps towards freedom and independence from managed care I would like to share how managed care like any evil or malignant event also brings blessings in disguise. I believe that the following blessings may even have, unintentionally, saved the soul of our profession and secured the future. Managed care demands of psychotherapists to be accountable and to show tangible results of their work (The “resistance” excuse that we have used for so long to justify our own ineffectiveness is finally relegated to the past and hopefully for good.) Unlike most of our graduate school professors and supervisors, managed care does not buy into the sacred worship of theoretical orientations and will accept only empirically based and not ideologically based treatment plans. A cartoon that captures the problem states, The wonderful part of psychoanalysis is that even if the client does not get better, you know you did the right things.. Managed care requires therapists to grapple with whether what they are treating is indeed “medical necessity” and “mental and nervous disorders” or problems in living and other existential and spiritual questions of our era. Managed care forces therapists to re-evaluate their beliefs about the nature of psychotherapy and decide whether they belong with traditional western medicine or elsewhere. It brings to the table questions, such as, is therapy an art or a science? Do therapists belong with western health practitioners or with the mentors, coaches, shamans, and others who Arthur Kovacs calls “secular priests.” Managed care evokes second thoughts amongst therapists about their worship of DSM and the need to label and pathologize clients in order to get reimbursed. Eight tips to build and sustain a managed-care-free practice The ability to develop a managed-care-free practice is tied directly to our ability to explain to clients how it is more beneficial for them to pay us $125 per session instead of paying only a $5 co-payment to someone on their managed care provider panel. This $120difference is significant. In order to bridge this difference psychologists who are interested in developing a fee-for service private practice must be liberated from old dogmas about the nature of therapy and marketing. The following is a brief summary of what is involved in breaking free of managed care. 1. Rethink your role – Get out of bed with medicine: Become a mentor, guide, or coach. In order to get out of the grip of managed care, we must first learn how to be consultants, coaches, guides, mentors, or wise men and women rather than doctors who treat mental and nervous disorders. Most of the people who seek psychotherapy are neither broken nor mentally ill. They are people who are struggling with the complexities of living in the modern era. The fact that we can give them a DSM diagnosis is mostly a reflection on the medicalization of our profession and our wish to be reimbursed, rather than a reflection of our clients’ condition. We can practice outside managed care if we learn to help people through the difficulties of normal developmental crises, (divorce, retirement, grief), love, health, parenting, or vocation and be skilled in helping people deal with these everyday life issues intermittently throughout their lives. Arthur Kovacs well termed well this role, the “Secular priest.” 2. Educate your client about managed care’s threat to their privacy: Very few clients will choose the managed care option, regardless of how cheap it is, if they fully understand its far reaching implications for their privacy and confidentiality. During the first telephone conversation I explain to clients the incredible risk they take when they seek mental health services from most managed care companies. I warn them that not only the fact that they have a “mental disorder” but also the most intimate details of their lives, may be sold, accessed, broken into, exchanged, or shared without their knowledge, permission or control. I educate them that with a fee-for-service or out-of-pocket arrangement they have full control over such private and intimate information. It should not come as a surprise to anyone that in a culture that worships privacy, most informed people will not choose the managed care option. I have produced my own informational brochure (“Beware of your managed care”) and have a ready made package of articles detailing the problems with confidentiality, that I regularly mail or give to prospective clients, businesses and people in my community. If one is well prepared, it takes very little to convince people that the $120 difference is well worth it. 3. Educate people about other hazards of managed care: I routinely describe to people how in most cases the managed care option shifts the control of the treatment from the client and therapist to the company’s CEO and stockholders. I explain that the length, type, quality, privacy, and follow up treatment are often compromised under most managed care plans. I mail, FAX, or present to people stories from the printed media (i.e. Newsweek, N.Y. Times) about how managed care can be dangerous to one’s health or even deadly. My brochure also outlines the concerns about conflict of interest, explains capitation, and informs them how providers are being selected or dropped from panels. I have found this educational approach to be extremely effective and successful in helping people make informed and educated choices. If some convincing is in order, I send supportive documentation to potential clients showing how selecting the managed care option for mental health may compromise their future employment and ability to get health and life insurance. 4. Market Yourself Effectively, Become an Expert-Educator: Marketing is usually a bad word to most therapists. I have found out that marketing, while at times hard work, can also be fun and respectable. I suggest that we abandon the Yellow Pages or ‘Ego Brochure’ approaches. Intelligent consumers are aware that these approaches are just a reflection of how much money you can spend on advertisement and how much you can toot your own horn. I suggest that you concentrate on three aspects in your marketing efforts: education, education, and education. People will come and see you if they perceive you as an expert-educator who can help them. Then the real question about marketing is how to present oneself as this helpful expert-educator. There are endless ways of going about it. One can give (free) lectures or print simple educational brochures on one’s topic of expertise. Make sure that the brochures are not about you but are truly informative and helpful and not just a tease to get them in the door. A lot has been written about how to identify and penetrate a certain niche in the market. Visibility in the community is an effective way of getting referrals, as people like to refer to people whom they know and, of course, appreciate. Working as a psychologist with the media, schools, boards of directors, community centers, PTA’s, etc. are all ways of positioning oneself as an expert. 5. Change your own and clients’ expectations of reimbursements: If we learn how to stop trying to fix or cure diseases, mental disorders, or any of hundreds of ‘name calling’ categories of DSM we can also educate our clients that there is no reason for managed care or any other insurance company to reimburse us for our services. I tell my clients that no insurance company reimburses my herbalist, accountant, attorney, Rabbi, mechanic, personal trainer or gardener. Once we disassociate ourselves from the medical model we are also free of the constraints of DSM and third party payment policies. 6. Learn to work effectively in accordance with client’s problem not your supervisor’s dogma: There is a saying: “If the only tool that you have is a hammer everything else looks like a nail.” Our field is dominated by competing dogmas and theoretical orientations vowing to prove their superiority over all other orientations. It is time for us to pledge our alliance to our clients rather than to our graduate school professor or our beloved orientation. For this we must be skilled in a wide variety of approaches and learn to implement them flexibly. We must choose our interventions according to how effective they are with certain clients and certain problems. The bottom line is embarrassingly painful, however very simple: If you are highly effective your clients’ family and friends will notice and will want similar results for themselves. As all seasoned clinicians know, most and ultimately the best referrals come from former and present clients. 7. Identify the managed-care-free markets: Forensics, mediation, custody evaluation, weight/smoking, chronic illness/health, step-families, parenting, family business consultations, and organizational development, are just a few examples of markets which are generally 100% managed care free. Create a vision for yourself, identify the market you want to penetrate, develop a detailed niche marketing plan, and spend the time and money necessary to execute your plan. 8. Exploit managed care to your own advantage: The managed care era provides us with enormous opportunities to operate independently. I have discovered that many physicians refer people to me because I am not on any managed care providers list. These physicians are under capitation contract and know that referring to me will get their ‘chronic’ clients off their backs and out of their offices, without being penalized by their managed care company. For this to happen, we must be effective in dealing with chronic illnesses and diseases and have good rapport with the physicians. In summary, as we continue our legislative, legal efforts, and the media exposes more and more, we can simultaneously take charge of our practices today. Not only it is possible, but it can be fulfilling and rewarding to be faithful to our vocation. We do not need to bow to the managed care gods. If you market yourself well, conduct therapy effectively, not dogmatically, and strategically position yourself outside managed care you can thrive in a private practice which is free of managed care. Ofer Zur, Ph.D., is a psychologist in private practice in Sonoma, CA. His catalog and seminar information on managed-care-free private practice is available from: (707) 935-0655, E-mail drzur@drzur.com, FAX (707) 936-3918, or web site www.drzur.com.
Ofer Zur, Ph.D.
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