Your Podcast Hosts
Kathleen Mills, LPC-S,
Phillip Crum, JP
This Week's Guest Mentor
Rob ReinhardtRob Reinhardt, LPCS, M.Ed., NCC
Column editor for Counseling Today
Regulatory Compliance For Counselors
Regulatory Compliance For Counselors
Phillip Crum: I’m still Phillip Crum, the podcast guy.
Kathleen Mills: Yeah, you are. You still are.
PC: The Content Marketing Coach. And you are still Kathleen Mills-
KM: As of today, yes.
PC: Proprietor and entrepreneur of Practice Mentors website, which can be found at http://practicementors.us, and its an ever-growing, ever-changing site. So fresh back from Colorado, there she is right there.
KM: Yep. There I am. Here I am.
PC: What did you learn in Colorado that you didn’t already know?
KM: I learned that I have new friends and we had to go to Colorado in order to meet them all. I had to meet them all and they were in Colorado. And one of which is on the other end of the line right now – Rob Reihnardt.
PC: One of the Dark Knights.
KM: One of the Dark Knights. How are you doing, Rob?
Rob Reignardt: I’m doing well, Kathleen. How are you?
KM: I’m doing great. I’m so glad to talk to you.
RR: You’re back in the- well, I don’t know maybe you’re having- I was going to say you’re back in the heat and the humidity after Colorado, but maybe you guys are having cool weather like you are.
KM: We are having cool weather and it’s rainy and I’m not saying a word because our days are numbered until it gets to be really warm.
KM: Well, for those of you who don’t know Rob Reignardt, you need to get to know this guy. He is an LPC supervisor. He has his own private practice in the great state of North Carolina, and he also is a consultant. And his consultant firm is called Tame Your Practice. Rob’s expertise is really focusing on three big, hot topics for private practice counselors who are just starting out.
[1:48] RR: I hope you guys are still there. Kathleen cut out and I can’t hear anything.
KM: Can you hear me now?
[2:01] KM: And I want to introduce you to Rob Reignardt. He is a consultant and an LPCS in the great state of North Carolina. He is in private practice and a consultant with his firm Tame Your Practice. And Rob, you focus in on three wonderful areas for our profession, and that is technology, marketing, and business. And I think those three are pretty crucial in today’s time. So if you could just tell us a little bit about you and what you like to do at Tame Your Practice for our audience, that would be awesome.
RR: Yeah, sure, Kathleen. Are you allowed to call other states, “great” when you’re from Texas?
KM: Yes, sir.
PC: It’s a small g, though.
KM: It’s a small g.
RR: Oh, okay.
KM: “Great” in Texas is all caps, buddy. (Laughs)
RR: Thanks for clearing that up.
KM: You’re welcome.
RR: The short version of how Tame Your Practice started was I started looking at cloud-based practice management systems, or EHR, several years ago. I wanted to make my practice more efficient and save some time and money, and researched them all. Then I realized, no, I’ve been in this business awhile and I’m noticing that people in our field didn’t get any business training. They didn’t get any technology training. They didn’t get any HIPAA training in their graduate program. They don’t have the technology and business background that I have. Maybe I should put these out there to talk about about. Here’s what important about the technology side of things. Here’s what important about the business side, how it can help your business. Here’s how you can use them all compliant with HIPAA. And Tame Your Practice was born, so a lot of people know me because of those reviews, but also I also help them with other aspects of their practice.
KM: Tell me about why you kind of honed in on the cloud-based practice systems and you thought it was a great idea?
PC: Why do you do what you do?
RR: I had actually already been using my homegrown system. I was a software developer before I went back to graduate school to do this. So I had built my own database program that does a lot of the things these systems do, like kept my progress notes and my schedule and so forth in there. And I was working in two offices, but still having to use a separate system for filing insurance claims. It’s quite a bear to build a system that’s going to handle that piece, and I wasn’t about to try to tackle that. So said, you know there’s all these cloud-based systems coming out. Prior to that, it had been mostly traditional software. You pay this big price up front, you install it on your computer, and then they charge you for upgrades every couple of years. I just wasn’t interested in investing in those programs because I knew things were moving to being internet-based where you pay a monthly subscription fee. So I was following that for a while and then a lot of them were out and they started having the features that I wanted so I started shopping around for one that could do everything in one place. Everything from the notes, the scheduling, and appointment reminders, filing the insurance claims, so I could have all that stuff integrated and be very efficient.
KM: So your relief is telling people how to make this a lot easier on themselves through everything that you learned?
RR: Right. And a lot of that is an educational piece, because again, people in our field generally don’t have that business background. They aren’t trained to analyze what is return on investment? Why does it make sense to invest in certain things? How is this going to affect your work flow? How is it going to affect the bottom line of your business? In a lot of cases, people are, “Well, it’s going to cost me x amount of dollars, and I don’t want to spend x amount of dollars now.” So a lot of what I do is helping them work through, “Okay, you’re going to spend x amount of dollars, but what’s your return you’re going to get?” A lot of people find that their system is paid for just through the appointment reminders. If you have one person not cancel at the last minute, one person show up who was otherwise going to forget about their appointment, you’ve probably already paid for the system because the ones that aren’t free are somewhere in the $40-80 range.
KM: So your point is that the price can take care of itself and be more cost effective. What do I need to be looking for in a great electronic health records system? I mean, honestly Rob, aren’t they all the same? I kind of want to get the cheapest thing I can get.
RR: They’re not. I tell people all the time that there’s currently no Facebook or Amazon of Practice Management Systems or EHRs. Facebook and Amazon are good examples of things that have cornered out a market and everybody knows they do this thing and they do it well and everybody uses it. There’s great variety in both the feature set and the quality of the different Practice Management Systems. And it really depends on the practice’s individual needs and the priority of their features. So in other words, one of the things I do is help people – I have a couple of different services I use to help them identify which of these systems is a good fit for them. One practice may decide that I really want that client portal. I really want clients to be able to come online, fill out my intake paperwork, do scheduling, all that stuff. I want to go completely paperless. Other people are, “I don’t care about the client portal. I still want people to fill out my paperwork. What’s important to me is being able to customize my progress notes.” And so all of these systems have their strengths and weaknesses. The ones that might have a really good client portal with lots of features, and they have very rudimentary progress notes. Another one might have no client portal but really robust progress notes. So there’s ones that are just awful, although there are some I probably wouldn’t recommend. It’s that you have to match it up with what your practice needs.
KM: But what if I don’t know what to look for? Can you list a couple of priorities that, in your mind, you’ve got to at least have this?
RR: Sure. Yeah, there’s a couple things you certainly want to look for. There’s the big picture things, like you want to make sure the vendor is HIPAA compliant. Some people out there may not be technically HIPAA covered entities, but even if you aren’t, I would encourage you to go with a vendor that is complying with HIPAA because you know they’re doing the extra stuff they’ve got to do to keep the data secure.
PC: That doesn’t always mean they’re doing what you need to be doing for yourself. They’re doing what they need to do to cover their backside, right?
RR: Right, and that certainly takes responsibilities from stress off of your shoulders, if you’re trying to comply with HIPAA, that they’re doing some of that work. But it does not at all relieve you of all the work of complying with HIPAA.
KM: I think your point, Rob, is the counselor is doing their diligence by finding HIPAA compliant vendors to be compliant with their own policies and procedures of HIPAA.
RR: Exactly. The example I typically use is: It doesn’t matter how secure that vendor and their system is, if you’re using “password” as your password, you’re defeating the whole purpose. You still have responsibilities on your end that you got to take care of to comply with HIPAA.
KM: Got it. So that’s the first- yeah, keep going.
RR: Yeah, so making sure they’re handling that on their end is an important piece. And that covers a lot of ground. There’s a lot of things they have to be doing like redundant pack notes from encryption and so forth. So that covers a lot of ground on the security side of things. You want to make sure that they’ve got good customer service. And that can be one of the harder things to gauge up front so that’s an area where I do encourage people to ask some colleagues, check out the reviews on my website, look around online for different reviews and see what the general feeling is. If you do one of the free trials that a lot of these software vendors offer, ask them lots of questions, even if you kind of already know the answer. Ask them some questions to see how quickly they respond. What kind of response do you get? Do you get a personal, helpful response, or do you feel like you’re kind of getting a cranky, why-are-you-bothering-me kind of response?
PC: Rob, are most of these different products out-of-the-box and easy to use? I’ve done free trials with various software before that you get 30 days free and it took about 45 just to figure out how to turn it on and set it up.
RR: That’s why when you say, “What are the most important things you want to look for,” it’s hard for me to say. For me? I’m a big usability guy. When I was doing software development, my focus was the interface. I want to make this as user-friendly and efficient as possible. But that’s not always what everybody wants, so if it was me talking I would say another thing you want to look for is this usability factor. You want it to be nice and easy to use, and I think most people would generally agree with that, but I’ve had many cases where I’m helping somebody identify a system and they would say, “If I have to pick between a really friendly interface with a small learning curve, and this other one that has all the features I want, I want all the features. I don’t mind if it takes me a little longer to learn how to use it. I want to make sure I have x, y and z features involved.” So I can’t say it’s a universal that people should look for that friendly interface, because that might not be their priority.
PC: Tell me you have a spreadsheet or a chart on your website that compares a lot of this, because that’s the kind of thing – if I had to do it all over again, I’d probably marry a comparison spreadsheet. I just love the-
RR: I don’t have a spreadsheet that’s openly available on the website. I certainly have my own database which, it would be a bear to even try to put it on a website because there’s so much information in it. There’s well over a dozen opens out there and I track probably about 100 different feature points for each one. And I keep that database to help me make the recommendations for people. So when they contact me, I have a form they can fill out where they say, “Hey, client portal is a high priority for me. And progress notes are a medium priority for me.” And they go through a list of features and that enables me to say, “Okay, which of these systems is a best fit for their priorities?”
KM: Got it. What are some of the other- yeah, go ahead, Rob.
RR: I was going to say, I’m thinking that even if I put all of that information on the website, it would still be overwhelming for people look at the 15 entities and 100 different features they might be looking at for them, it would still be pretty overwhelming.
PC: I think you just addressed my next question, which was, “How many of these things are there out there? How many different EHR programs are there?” Is there 15 as you just mentioned, or was that a number you pulled from something?
RR: I’ve lost count. When I’m saying 12 and 15, I’m guesstimating because I’ve lost count at this point. So first of all, I’m talking mostly about ones that are targeting at mental health professionals. When you look at the broad bucket of EHR, including everything that medical professionals use, there’s too many to count. So I primarily focus on the ones that are focused on mental health professionals, and I’ve probably reviewed at least 20 of them and some of them are ruled out because they’re too expensive unless you’re a very large organization where they’re very specialized where you’ll probably only use it if you’re a very large, multi-office agency that’s doing primarily Medicaid work. I’m aware of those and I can certainly help people identify those, but when you talk about thd ones that I do in-depth reviews on, they’re typically for mental health professionals in small to medium sized group practices, private practice. So there’s probably about 15 to 18 of those and there’s new ones coming out. There’s a couple that are in my queue to review and I just haven’t fully evaluated yet.
PC: Is there a system out there that has a feature that will, you know, if somebody no-shows for an appointment, they system will hunt them down like the dog they are and stomp on them like a dirty bird? Because that what Kathleen says she wants.
RR: I think if you ask the vendors, I think that’s something they’ll say they’re considering. I don’t know if any of them that have implement them, although they’ll certainly let you track those no-shows and even implement your no-show policy. For example, if you charge a fee for late cancellations or no-shows, you can certainly track that and note that in the system. But I’m not aware of any that employ animals or other third parties to go after-
PC: The Guido feature.
KM: Phil is making me look horribly bad.
PC: No, no.
KM: Yeah, you are.
PC: No, no. What else do you do, Rob? You compare EHRs. That’s a full-time job right there. And you help people select which one is appropriate for their practice. What else is involved in your world, in addition to that?
RR: Well, if we’re sticking to just the Tame Your Practice world, I also help people with other software selection. They often have questions about accounting software. Most of the EHRs aren’t full-fledged accounting packages. They’ll do your billing and invoicing, but they won’t track your expenses and allow you to do everything you need to do for your taxes. So people have questions about which accounting software you use and what the HIPAA implications are there. They also have questions about business structure. Hey, I’m just starting out – should I be a full proprietor and LC or an SCorp? And all the other questions that come with starting out. Should I take insurance or not take insurance? I help out a number of people starting out their practice. I help in other phases. Hey, I’ve been in practice for a while. I’m full. It seems like the next step is to form a group. How do I do that? What are the ins and outs? Do I hire contractors or employees? Does this change my business structure? So lots of the business side of things that people don’t have the extensive training in when they go through their graduate program, I help with.
KM: Because sometimes the business piece, that’s the nature of- that’s why you probably named it Tame Your Practice – it can be pretty crazy and wild and unruly.
RR: That’s the impetus from the whole name Tame Your Practice. It’s all about the business and technology side. Those who are in this business are doing it to help people and I’ve heard more times, and I’m sure you have, too, “Hey, I just want to do the counseling thing. I just want to help people out. I don’t want to have to deal with insurance.” So Tame Your Practice your practice is all about how do we tame that side of your practice? How do we make that as clean and efficient as possible so it’s taking up no more time than it has to?
KM: Go back to the cloud-based practice systems. I’m hearing a lot of people just would rather do as on the free side with cloud-based systems as possible, and then they run into problems, like they can’t get their clients’ information if they switch to another cloud-base. There are some perils with the free part of cloud-based practice systems that get you hooked in because they don’t cost very much, but it’s costly at the back end if you want to get your client information out. Can you talk about that a little bit?
RR: Getting the client information out – that can be a challenge. What’s even more of a challenge with just about any system these days is moving it because they tend to all use different database structures. But in the realm on the EHR, the old maxim, “You get what you pay for,” certainly applies. The free ones are making their money somehow, so there’s been some issues. I’ve written in my blog, for example, with Practice Fusion had a big kerfuffle, if you will, a couple years ago where one of the things they decided to do was, “Hey, let’s open up some reviews and let’s get patients” – we call them clients, but they call them patients – “to review their doctors.” And they implemented the feature without telling anybody. And so here they are sending all these messages to their patients who are seeing their doctors saying, “Hey, review your doctor!” And these reviews ended up published online openly.
KM: Oh gosh.
RR: So that was a huge privacy issue, which was eventually addressed, but you got to consider those kinds of things when you get into free and those kinds of things. Hey, how is this company paying its bills? Are they doing something that would be an ethic or legal issue for me? And again, how are they paying their employees who are providing the technical support? Are they able to provide the quality of support? Are they innovative? What money are they using to innovate and add some new features that you may want to keep up with the other vendors? So there’s definitely a lot of concern. That’s not to say there aren’t some free ones out there that worked for people, but you’ve got to do that cost benefit analysis and say, “Am I going to get what I need out of this without any caveats?” Or are they better off paying $50/month to have everything I want plus really good tech support and innovation?
KM: Yeah, one of the thing about the EHRs – and I don’t know what your sense is, but – at Life Tree we do a lot of insurance claims, if you will, and we have to pay so much per claim with our EHR and electronic billing. And there’s a disconnect with counselors who are trying to purchase something like that that the claim send should be free. And if you were doing it on your own, you’d be spending hours putting it in the computer, printing out the claim, postage, mailing kind of thing. And so you have to kind of look at the time that you save with an electronic insurance claim send.
PC: Cost benefit analysis.
KM: The cost to send a claim, period.
RR: Right. Exactly, and that gets us back to the conversation that I opened with about return on investment, and understanding there’s more to it than just, “Oh, it’s going to cost $6. I’d rather have free.” Okay, even if you don’t use postage, a lot of people are very fond of Office Ally. And Office Ally is a clearinghouse. A lot of the EHRs actually use Office Ally in the back end as their clearinghouse. And it works really well as a clearinghouse, but if you want those extra features like integrated ERA – that’s where the insurance payment comes back into your practice management system and it automatically applies to the client record. So if you just think about how much time your billing person spends each month just manually entering payments, and you add up that time, imagine how much time and money that’s going to save you if that’s all happening automatically. It’s going to save you more than $50/month.
KM: Yeah, I totally agree.
RR: So you’re exactly right. It’s really important that people go through that full analysis of okay, not just how much is this going to cost, but what will I get for that? What will be my return? What time and money will I save with the features they provide?
KM: And that’s one of the reasons why I really like what you do, Rob, because I really do like you really staying with comparing these cloud-based practice systems and I don’t know of any other person that’s doing that. And so if you want to read his articles about that, this is the guy to go to, because you do have to compare apples to apples, your return on investment, and how much time you may ultimately save if you spend just a few more dollars on a really comprehensive package. So you can do other things.
RR: Just to underline it – imagine you have a technical issue with it, and you’ve got Company A that’s free but it takes you three hours of back and forth calls and emails to finally get an answer to your technical question. And then you’ve got Company B that costs you $50/month, but within 20 minutes you’re able to get a response. There’s so many different factors that can make those systems pay for themselves when you decide okay I’m going to invest.
KM: And it goes back to you really need to be vigilant about asking that question, that customer service question: How long is it going to take to resolve my situation? I know for mine, it’s like five minutes for crying out loud, and that’s just amazing to me.
PC: Let’s not be naïve enough to think that a company is going to open its doors and fund everything that a company has to do in order to build a product that they then give away for free. They have to make a living somehow, and they don’t do that by jumping on-
KM: They don’t give me everything I want just because I’m a good [?? 24:36] who’s saving the planet?
PC: No, dear.
RR: Right. They’re just like Facebook. They’re totally free because they just are wonderful people that want everybody to have a free way of talking to each other and sharing, right? They don’t collect all that information people are posting and use it to sell advertising and target advertising at you at all.
KM: Right. The only person who needs to be making money is the counselor. Everybody else doesn’t need to make any money. (Laughs.) Very good point. Okay, Rob, let’s wrap it up. Give me three solutions to help keep new clinicians, old clinicians, all of us safe as we look at our cloud-based practice system and what you know that you would like to pass along.
RR: Sure. So three things to keep them safe: One is certainly making sure the vendor is complying with HIPAA. Two would be: Even if you’re not a HIPAA covered entity, you’re not filing electronic insurance claims so you don’t feel like you have to do the HIPAA thing, I still encourage you to do most of the stuff that you have to do to comply with HIPAA just because your clients deserve that.
KM: Well, you’re in health care.
RR: Your clients deserve that level of security and privacy. And the third thing is take the time to do due diligence. The other point I want to bring up is I feel a lot of people ask their colleagues and go on Facebook and ask, “Hey, what HER are you guys all using?” And because a bunch of people will mention the same one, well lots of people are mentioning that one so that one might be good for me. That’s like me asking you, “Hey, Kathleen, what do you like on your pizza?” And you say, “I like sausage, tomato and anchovies,” and me saying, “I’m surely going to like sausage, tomato and anchovies if Kathleen likes it.” That’s not how it works.
KM: That’s not how it works, you’re right.
RR: My taste buds are different. My private practice might work differently. So do the due diligence – still ask people because that’s a pretty good gauge of whose getting good customer service. People aren’t going to recommend one if they haven’t had a good experience. But go further than that and look at, “What are going to be my priorities? What’s going to be a good fit for me?”
KM: Yeah, being in business requires you to really research.
PC: So you had HIPAA compliant, do your due diligence, and what was the third one?
RR: Well, the first two were both kind of HIPAA. Make sure the vendor is compliant, then the second one is to do your thing towards compliance to make sure you are keeping things secure.
PC: Slid a two-parter in there.
KM: He sure did.
PC: Yeah, lots of folks will try and slide a two-part answer in there like that just to get out of that third. I like the way you did it.
RR: Do I lose points for kind of doing a combo answer?
PC: Slid it right past me, you did.
RR: Ten points from Gryffindor.
PC: We’ll edit that out. Rob, if somebody wants to find you, do you have a website?
RR: Yes. It’s www.tameyourpractice.com.
PC: Just like it sounds, or some weird-?
RR: And one of the menu items is blog and under there the EHR reviews are highlighted so they’re pretty easy to find.
KM: Your articles are really wonderfully written, very well prepared and it’s very helpful.
RR: Well, thank you.
KM: You’re welcome. I really encourage you to go to www.tameyourpractice.com, check out what Rob’s got to offer you. You don’t have to do this business thing alone. You need to have great mentors to help you get your business up and running.
PC: And Rob are one.
KM: Yep. Rob are one.
PC: And I’m Phillip Crum, the Content Marketing Coach, at www.contentmarketingcoach.us, and you would be, and where would we find you?
PC: Thanks, Rob. We’re going to do it again.
RR: Yeah, thank you. I appreciate y’all having me on today.
PC: Alright, see you later.
KM: Thank you, Rob.
PC: Bye bye.