module 2 transcript · copyright2015!–!beawealthytherapist.net! module 2 transcript...

Copyright 2015 – BeAWealthyTherapist.net

Module 2 Transcript

Casey Truffo: Hi, everyone. It's Casey Truffo and today Joe Bavonese and I are going to be

sharing with you about hiring your first clinician or your next clinician.

One of the things we wanted to say is that we know that many of you on this call both have existing. Some of you are thinking about whether this is a model that you want to do that whether or not this is the model that you want to try. I love it that you're investing the time and really thinking about it.

On the other hand, there's some of you who know you want to do it already and you're trying to get all your docs lined up. Then there's a third set of you and these are people who already have clinicians and are trying to decide whether or not you're doing it in a way that makes sense for you and how you're going to move forward and make it really a good business model and more profitable.

One of the things that Joe and I were talking about this morning was about Michael Gerber's book. I think Joe mentioned it to you last time The E-‐Myth Revisited. One of the things that Michael Gerber talks about in that book is that there are really 3 types of personalities within our sight as we therapists think there's probably more than that but there are at least 3.

The first is the one that we're all familiar with, which is the clinician, and he calls it the technician. It's the person who actually does the work and gets paid for it. Then we have the entrepreneur and then we have the manager. These are 3 different types of our personality and 3 different roles that we really need to have to have a business work.

One of the things he says in that book is that lots of times we're working for somebody else and we have what he calls the entrepreneurial seizure, which I love that term. We wake up one day we go, "Hey, wait a second. Why am I


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working for this other person? I could work for myself." We take our clinician hat or as he calls it the technician, the one who does the work. We take our clinician self and we go and we open up a business forgetting that we know nothing about business. We don’t know how to manage a business. We certainly don’t know how to necessarily project that business forward toward the future.

This is one of the things that we're trying to do. Joe and I are trying to do here in this class is really set you up because you could actually have run your existing therapy business with just your clinician hat on and not really thinking about the entrepreneurial role or the managerial role and still get by. Once you decide to start adding associates, it's no longer an option.

Hi, Joe. Welcome.

Joe Bavonese: Hi, Casey.

Casey Truffo: Any thought you wanted to say on that idea of the 3 parts to our personality and how our goal and part of this class is to really help them get that managerial role up?

Joe Bavonese: Just that I think it's so important to recognize that because as Michael Gerber goes through in that book so clearly, just because you're good at doing something doesn’t mean you know how to build the business around it that’s successful. We'll be talking about how you need to either sometimes learn from these skills or sometimes outsource some of the skills all the while maintaining a profitable business.

Casey Truffo: I was really shocked when he was talking about the people that have made the first … 80 percent fail within the first 5 years and then something like another 80


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percent of those who made it through the first 5 years don’t make it through the second 5 years and so that’s why we really want to help with you these skills.

One of the areas where people had the most questions and also make the most mistakes I think is on hiring people. Shall we just jump right in there, Joe, we'll get started?

Joe Bavonese: Sure. Let's do it.

Casey Truffo: We talked about this last time. We can bring people in in 1 of 2 ways. They can either be contractors or employees and you can talk with your accountants and your attorneys about which is the best for you and what level of risk you want to assume. We're not going to be able to tell you more than that on the answers to that question but we're going to talk about is hiring them, when to hire.

Let's talk about somebody, Joe, who is getting maybe 4, 5 calls a week that they can’t take. Is that the time to hire?

Joe Bavonese: I think absolutely. With that many that they can’t handle, it couldn't be less than that but certainly after getting that many they can’t handle that means they're either referring almost all those out or they're trying to create a waiting list. I think that’s definitely a good time to do it.

Casey Truffo: Excellent. Let's talk about what to look for. We talked a little bit about this last time but let's really get a little bit more clear. When you talk what to look for, what are your thoughts when you're looking?

Joe Bavonese: For me, my ideal client, Casey, would be someone who is an excellent clinician and a good team player and someone who is not too entrepreneurial. That’s my


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3 criteria as well as has integrity and trust and all those kinds of good qualities, but I focus on those 3 things. Like I usually say don’t hire anybody who's in this program because we would all probably be want to do our thing eventually sooner or later and we're too ambitious in entrepreneurial to want to work under somebody else's rules.

There's a lot of people out there who, as I said, they like to do therapy. They want to make some extra money. They don’t want to be bothered with the administrative part and the marketing part. They're a good team player and they understand part of your system. To me that’s the ideal person.

Casey Truffo: I think that’s really good. I think one of the mistakes that I know, I made one I first started, was hiring somebody that I liked, just the personality fit with mine. I thought they were fun to hang out with. I thought, "Wow, this would be a perfect match." What I didn’t look at were what were their goals short and long term. I didn’t look at what level of supervision might they need and I'm not talking about unlicensed person who needs supervision.

I told the story last time that I brought in a client and I brought in a therapist as a clinician. She saw the client for 1 session and then a few days later saw that client again for the second session. During those maybe 4 days in between, she and I had 14 phone calls or emails on that 1 client in that situation. I knew pretty quickly this was not going to work with more people and more sessions. Luckily, she figured that out, too, so we decided to part ways.

Joe Bavonese: Wow, 14.

Casey Truffo: I think those are important things to look at is what is it that you want in a person. I actually have a list of qualities that are important to me. I told you guys


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last time to go look at your vision and value statement, the values from Steve Pavlina. There was a homework assignment in there.

The thing that I think is important is that when you can look at what your values are that you want for the center, then you can begin to pick people with those things in mind. For us in our center, what we want are people that are very, very loving. That’s just something that’s really important to us.

When I'm interviewing with people, I can see. We had a few interviews with people who tell me how angry and rude they were to clients. They actually told me the story in the interview and I knew right away these are not the right people for us.

Joe Bavonese: They said that in the interview, Casey, really?

Casey Truffo: Yes, a lady said that somebody she … I said, "How are you at collecting the money," because one of things you want to know is, are they people who feel comfortable collecting the money. She said, "I am so good at that that there was one time a guy who owed me money and so I started sending him texts, like 4 and 5 texts a day saying, 'When I'm going to get my money?'" Not a good address.

That’s another thing is that I look for is are they able to charge and are they able to collect the money, because a lot of people who come at community mental health either have never had to do that or they're not used to being able to keep clients on a regular basis. If somebody comes in to your community mental health and they come once a month, that might not bother you the same as when you're in a private practice. Talk a little bit about that, Joe.


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Joe Bavonese: I remember it reminds me of when I heard a really good clinician who'd been working in an agency his whole life and he was used to getting a salary. I remember I think he'd been working with us 3 or 4 weeks and he cancelled 3 appointments to get a haircut. I was like, "Are you kidding?" Really, in retrospect it was just his mindset from years of being … He was first in a hospital and an agency where he had a salary and he was like, "Just do you want to do you get paid." It was a little bit of a mindset shift there that we had to go over it.

Ever since that point, he was fine. He was one of our best therapists from that point so it wasn’t a big deal, but he just totally just didn’t realize that. It's a different mindset.

Casey Truffo: When you hire people, Joe, do you talk to them about their expectation of being able to keep the clients or how often you want those clients to come in?

Joe Bavonese: I don’t talk specifically… There's no … Some clients need more than others, obviously. I never want to give the impression to my therapists that everybody should be seen the longest you possibly can as if you're going to unethically string them long. I do tell them that we have averages based on our years of experience and we will be assessing whether you're in that average range for the clients we give you and that’s one of several factors we'll be using to evaluate your performance as we go through your probation period and beyond, so that’s all I'm saying.

Casey Truffo: One of the things I do is that I really talk about how we as a center need to remain open and that if we need to have the people come at a certain amount of time because it cost money to bring in those clients.


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One of the things that I talk about is what the expectation is and I think that that’s been very helpful. The thing that I will tell you is that it's so nice when I told them a number like, "The center doesn’t make money until they come in in X number of times." Some people seem to think that that’s the number that they shoot for and then they stop.

I'll say, "The person needs to come in at least 8 times in order for us to breakeven." They'll say, "I'm doing really good. My people were all coming at least 8 times or up to 8 times." That was exactly what I meant, so now I'm extending that. If you're going to stop at the finish line, that’s an issue for me.

Where do we find them? Where do we find our associates?

Joe Bavonese: Really good question. I think there's multiple places where you can find associates. I'll go over, Casey, some of the places I've used and maybe you can join in with some, you've used and what we've heard from other people.

Casey Truffo: Sure.

Joe Bavonese: I've used the state professional organizations, such as the psychological association, counseling, social work, and MFT. I found those to be good places to post a classified ad for inexpensive, just text. People who are looking for work will definitely be looking on those places.

I've also found people at universities. If you live in an area that have graduate school departments and social works psychology counseling or marriage or family therapy, you'll often find some of your best clinicians could be professor who enjoys teaching but doesn’t make enough money. They're happy to work 10


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or 20 hours with you. They are also great PR because they talk about your practice to their colleagues and their students at their graduate school program.

I recently heard someone told me there's a website. Casey, have you heard this called indeed.com?

Casey Truffo: I have not.

Joe Bavonese: I never did either and I thought neither of us had. This person told me they’ve gotten some really good people from that. I guess what it is, it's like an aggregate like a monster.com but they aggregate a bunch of different job sites. They said that quite a few therapists responded to it and they got some really good people out with, so that’s a new one to try out if you're still looking for somebody.

The one I have not gotten much luck from was craigslist. I tried that once and I basically got a whole bunch of really inappropriate responses, so whatever that word.

The other is professional mailing list, if you have colleagues that you either can send out an email or print mailing or just call them up and let them know you're looking. I got several people that way by asking people if they knew of anyone. I have a professional mailing list that I use for my therapy practice as well as my client list. Periodically, I'll send out something saying we're looking to hire somebody.

Once you get known, the other thing that happens to me now is that I'll usually get between 3 and 6 emails a month asking if we have any openings, so when you get to a certain size and had been around a while that will happen also.


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Casey Truffo: That’s a really good thing. One of the things that you told me I think and that I've started doing is asking my existing clinician if they know someone and that seems to work well, too. Then did you just say this and I just was taking up so I was looking at questions, did you talk about going to the community mental health agencies?

Joe Bavonese: No, I did not.

Casey Truffo: You want to talk about that?

Joe Bavonese: I have a guy known in Seattle who's done extremely well by going to community mental health agencies where people are making very little money and usually pretty overly stressed-‐working conditions, feeling with multiple crises per minute. He built this whole practice staff almost exclusively from community mental health. He employed and I'll be talking a little bit about pay soon and he employed a flat-‐rate model where he pays people. He's done extremely well with that and found some good clinicians.

Casey Truffo: Nice. I tried craigslist and because I wanted licensed clinicians but the most of people who had applied for that were pre-‐licensed and then I tried LinkedIn. I spent a fortune on LinkedIn and that was not good. I didn’t get anybody from there, but my state associations that worked out really well. That’s where I've been getting mine.

Joe Bavonese: That probably seems the most solid thing.

Casey Truffo: Good, good.

Joe Bavonese: It's not something that money has to do.


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Casey Truffo: Exactly and that’s the other piece. Because Joe tends to run on the thrifty side, frugal side and I tend to run on the overspending side, I try to put every single thing you could possibly want in my ads. It's like 100 dollars when I could have just put in 4 lines so it would have been 20, you know what I mean.

We're going to talk about paying, I promised you that. I just want to talk about how to interview them. I have a whole process set up to interview them, but I think you do, too.

Joe Bavonese: Before we get to that, I just want to say a word about what you just said about what to put in an ad because I think it's important. Despite being on the cheap side, what I have found works is what are the benefits of working for you versus what other options they might have. If you're licensed therapist and you don’t know how to generate your own referrals or you just don’t want to bother trying to learn, where else might you work. Then you want your ad to show the benefits of your practice in contrasting to that.

For example, in my little 3 or 4-‐line ad, I said, "A minimal paperwork and meetings. Opportunity to create your own program." I wanted to stress the things that I thought I heard people complain about when they're at some of these agencies where there was a lot of managed care or they were told how to do their sessions where they just had endless meetings that were just a complete waste of time and that seemed to really appeal to people.

I just want to mention that because I think that’s another way to catch people's eye when they're looking for a work.

Casey Truffo: For those of you that have done your ideal client exercise for your therapy clients, you can actually sit down and do this for your clinicians, too, what is it


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that their chain point is, what is it that they're looking for help with and then do what Joe just said put that in your ad.

I have a client who runs a center that has I think 12 clinicians in it. She said that she was having trouble with her ads that she's putting in the professional association. She wasn’t getting anyone and then she sat down and did the ideal client profile exercise for the associate clinicians, changed her ad up and started getting more calls in.

When I hire somebody, I have actually from the ad I send them to a link that is a hidden page on my site that has a 7-‐minute video. In the video, I talked about the values of the center, the vision for the center, how it would work if the person came in. I actually talk about what the compensation is on the video and we will be talking about that in a minute.

Then I invite them to do 2 things. One is to send me their resume and the other is to call a phone line that I have set up that has a 3-‐minute-‐message machine on it and I invite them to answer 3 questions. One of them is I think what was something in the video that touched you or that resonated with you, tell me about experience working with couples and then there's a third question.

The reason I did that is because I want to hear how they sound. I want to hear their voice. I want to get that sense of what it might be like to be with them and then I get the resume. I match those 2 up and then those that … Also it gives me the idea if they're going to work with me. Some people just send me the resume and they don’t even read the rest about here's the video and all that. It tells me something upfront of how we're probably going to communicate later.


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I found that the people that I can really resonate with on the audio are people that I end up hiring. They’ve learned everything upfront. If they didn’t like that compensation, that was fine. We didn’t go further. They didn’t have to leave a message and they didn’t have to follow up with their resume.

When I interview them, I actually have a checklist of all of the things that were important to me and I go down and then check it off as we go through, so that’s my process. Do you want to share yours?

Joe Bavonese: Mine is not nearly as systematized. I think that’s really great. I have a more informal process.

As I said, Casey, in the last few years I've had so many people email me that I haven't had to really reach out to people. I'm finding those people usually pretty good candidates. I usually just tell them send me the resume and then if I like what I read there, I'll set up a time to meet with them in person.

What I'm looking for is a couple of things that they have experience with the clients that we any issues we work with that what is their reason that they want to join our practice. Is it that they have heard about us from somebody else? Is that they have been failing in private practice and they just want somewhere else to go? The motivation, the reason that they're interested is really important to me.

One of the big red flags for me is the degree to which I consider them to see themselves as too entrepreneurial or too special or too much pre-‐Madonna and I don’t think they would fit in with the team. I've learned that one the hard way by hiring people who were really good clinicians but they were very demanding in


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terms of special treatment and so to me that’s really a problem in terms of the overall mix of the team and my time, so I'm looking for that as well.

The last thing is … I know they'll talk about money until the end until I think they're good a fit only when talk about that. Then I make a clear to them that this would be a trial thing if we want to give it a try. It may or may not work on either side but I'd like to give it a try. If I want to give it a try, I hire them for 90-‐day probation.

Casey Truffo: Awesome, awesome.

Joe Bavonese: I just want to emphasize to everybody, Casey, that that’s a good example of how we do things very differently. There really is no one-‐size-‐fits-‐all for this any clinician's idea. There's a lot of different ways to do it and not of them are necessarily better worse than any other. In this program, we're going to share a wide range of ways to do things. You can craft something that really works for you with your practice, your situation that may not be exactly what we're doing.

Casey Truffo: Exactly. Some people are asking here in the webcast that what happens if we are rehired people and we didn’t do some of the things that we're talking about here and one of the things that we will share a little bit about that with you later on. The bottom line is let's learn now what you want to do going forward and then we will see how we can clean up whatever we need to clean up for.

Joe Bavonese: My experience is almost everybody makes some mistakes in the beginning and hiring I still think it's a lot like dating that some people look good on paper and until you go out with them a few times you don’t know who you're really with. Sometimes you need to go out with them a while before you know who you're really with and that’s just part of the uncertainty of it.


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What we're going to pass on on this program is even if you've made some mistakes in hiring or how much you pay people, there are ways to make course corrections. Some of those course corrections are absolutely essential if you're going to be profitable and not be one of those statistics that doesn’t make it to the tenure mark.

Casey Truffo: Exactly, exactly. Let's talk now about paying them. We'll talk a little bit about the fee structure that we use, which is I think identical. Then we'll talk about some other options you could do and then we'll also … I just do want to mention that there's going to be a difference between employees and contractors. This is where when you're paying an employee remember, you're paying part of the payroll taxes there where your contractors pay their own taxes. I don’t want you to think that you can give the same amount to both percentage-‐wise because you have to add on to the idea that you're paying payroll taxes for employees.

Let's talk about the numbers for contractors and then you guys if you do have employees, you're probably going to want to lower them somewhat. Joe, let's talk about are we splitting here if we're giving like somebody pays me 175 dollars per session and I give 96 dollars to one of my clinicians, are we fee splitting?

Joe Bavonese: No, we're not fee splitting because that’s not the only aspect of our relationship with them. In other words if I had an office 10 miles from you and I paid you 100 buck per referral and we had no other business relationship other than that, that’s would be fee splitting. Because we're offering a wide range of business services as part of our relationship, it's appropriate, you're also offering an office and you may be offering a voicemail system and a billing service and a website, marketing services, et cetera, so you're offering all those other things and that’s why it's not fee splitting.


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Casey Truffo: Because what's happening is they are … The way the attorneys presented to me where he said, "They are actually paying you for space, admin support, marketing support, supply, whatever it is that you do there," billing support, all that. Excellent, excellent.

Joe Bavonese: I'll just be clear about that because you'll hear people say that but obviously, it would be inappropriate on us to call for any healthcare professional to simply have a referral relationship with someone else where you just paid them for their referral. We're not talking about that at all.

Casey Truffo: Good. There's a question. What sort of things do you have to do to hire someone as a contractor in terms of legalities?

The best thing to do with that question is to listen to the hour-‐long audio you have in your bonus section from Steve Frankel and/or talk to your own attorney because since we're not attorneys, we can’t really say. We did talk about sample agreements. We actually have some in your resource center so you should be able to see some sample agreements that we've done up for you. Again, you want to run everything by your own attorney to do that.

Let's see. We do have 1 question here. Let me just pick it up. Is that Jessica?

Jessica: Hi, yes. Can you hear me?

Casey Truffo: Yes.

Jessica: Could you tell me the difference then between an independent contractor and an employee with regards to what you're providing them? Because an employee I would imagine would also be getting the access to the office, the space, the


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admin support, et cetera that you were just explaining with the independent contractors. What would differentiate the 2 besides the tax bit between the 2?

Casey Truffo: There's some legal sayings in terms of for what you give them. It may not be different from all of that. From an employee versus a contractor, again, these are legal definitions and financial definitions that we're going to have difficulties answering for you, but what we will say is that you can tell an employee how to work at your business but you can’t really tell a contractor how to do therapy at your business. Would you agree with that, Joe?

Joe Bavonese: Yes. You have more permission and control over telling them their hours, their fees, even how they do their therapy, things like that. Some of the other things, as you said, might be identical.

Casey Truffo: Exactly.

Jessica: Thank you.

Casey Truffo: Good. Does that answer it, Jessica? Beyond what we can do, that’s about it.

Jessica: I appreciate that. Thank you.

Casey Truffo: Great, sure. Now the question is, what percentages are you going to pay them?

There's 2 models. One is a flat fee that going to pay them a flat-‐fee amount per session. Another model is you pay them on percentage of the fee. We're going to talk about … Let's talk about percentage first and the plusses and minuses of that. Joe, you want to do that?


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Joe Bavonese: Sure. The first model is to say whatever money they bring in during a pay period, like I pay my associates twice a month, whatever they bring in in a 2-‐week period they get a percentage of that and the business keeps the rest. That percentage can vary from 50 percent. In my practice in can vary from 50 all the way up to 70 for some very high-‐achieving experienced people who've been with me a long time, depending on their experience, their volume of clients and things like that, which we'll talk about in a minute. That’s basically how the model works.

The 1 caveat I would say is if you have a percentage model like this and if you bill insurances, you do not want to pay people for the session until the money has come in. I've seen a lot of people try to do that and be losing money every month even though insurances are lot better now in terms of paying on time given electronic billing just looking to have some claims that get delayed. If you're paying the money out before the money comes in, it's a lot riskier for you as you don’t know the business.

Casey Truffo: What's happening is that Joe are paying on collected. As the money comes in, I pay my people at somewhere around the fifth of the month for everything that came in during the previous calendar month that was collected and then I pay them up percentage of that.

The dangerous part is if you have insurance and it hasn’t been collected and you're paying them, what's going to happen later if it was denied for some reason and you've already paid the clinician for that now you got a messy bookkeeping situation. Just really claim if you can pay them uncollected.

Joe Bavonese: Casey, you only pay once a month?

Casey Truffo: I only pay once a month.


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Joe Bavonese: Does anybody complain about that? Are they okay with that?

Casey Truffo: Nobody is complaining because it's been from the beginning. They know when they start we pay once a month.

Joe Bavonese: Okay.

Casey Truffo: How often do you pay? Did you say twice?

Joe Bavonese: Yes, I did twice a month. We did the first of the month and the 16th of the month unless it falls on a weekend and then we do it on the Monday after that.

Casey Truffo: Just really easy because I have it all set up in my practice management softwares so I just run 1 report that tells me how much they did and then I just multiply it by 55 percent, write them a check.

Joe Bavonese: The reason I ask because I've heard some people who did it once a month and the therapist complained that it was too long to budget their money for the whole month.

Casey Truffo: Most of the people that I have from other jobs … What?

Joe Bavonese: I was going to say on some level it's not your problem as the owner that they can’t budget their money for a month.

Casey Truffo: My husband has thoughts about that. It's like, "That is not my problem that you can’t budget your money." Deposit half of it now then the other half.


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Somebody asked me can I share my interview checklist. I actually have shared my interview questions in the Module 2, so it is right there. Before we get more into that, there's 2 models again. I just want to answer a couple of questions on here. How do you handle it with the clients you've given them if they choose not to keep them after probation?

Joe Bavonese: You mean if the therapist who she decides not to keep them. We'll talk about this later in more detail, but the client always has the option of going wherever they want. You don’t own the client. If the person is leaving at the end of 3 months or after 3 years or any time for that matter, what I do is I sit down with the therapist and say, "Let's go over your caseload. Are you going to be working somewhere else?" Usually, there's a yes, sometimes it's a no. If it's a no or there's people they don’t want to take, then I'll go over and say, "Who would be the most appropriate to refer to?" That’s how I handle it.

Casey Truffo: Because the bottom line guys is that non-‐compete clauses are unenforceable legally. You can’t write in your contract you can’t take the clients with you. What my attorney has suggested is putting in the contract that says and we talked about this before is that everyone expects to stay at least 2 years. We just put that in there so that I can look them in the eyeball to eyeball when we start out and it looks like we're on the same page.

The idea is that you can’t enforce a no-‐compete plus if you were the client and your therapist left, you would want to go wherever your therapist goes. That’s another reason that’s … Go ahead.

Joe Bavonese: I will just say that’s not always the case. One thing, I'm a big believer in branding and one of the reasons I am is because one of the things that’s going to happen if you're having clinicians to practice over time, people are going to come to


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therapy for 6 months or 2 years and then they're going to finish and then they might come back in 3 more years.

What I've seen happen numerous times in our practice, we've been around for a long time, is somebody will say, "Can I see Jill?" I'll say, "Jill is retired. She's no longer seeing clients," or, "She no longer works here." What we're finding happening about 2 out of 3 times is instead of saying, "Where can I find her," they'll say, "Is there somebody else here I can see?"

Sometimes that will happen as well if the allegiance and the alliance is to your brand of the company rather than to individual therapist, which sometimes happen. I just want to mention that for people that are thinking about creating a stronger brand of the group than they may have had as an individual. You might have only had your name.

Casey Truffo: One of the calls before you got on, one of the questions before we started the recording we're talking about was in terms of that branding. If you're going to be naming your center, yourself and associates, it gets a little harder for you to give the associates to anybody else because they want to see you, the principal. Really, begin to think about what you want to call your center so that you can brand it so that people can do exactly what you just did.

This is amazing. There's a lot of great questions coming in. We're going to keep talking about the finances part and then I'm going to go back and talk about the number of calls per week. Sally has a question on that. We're going to talk about that and a couple of other questions that are coming in here. Let's just … There's so many questions coming in so let me just try to do this.


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Joe and I pay our people on average or contractors because we both have contractors and we pay them 55 percent of what is collected. That’s what we do. That’s what I do. Is that what you do?

Joe Bavonese: That's what I do starting until they have a higher volume and then I give them incentive.

Casey Truffo: If you have employees, you're probably going to want to make that a little bit lower amount. We'll talk about the incentive in a minute. The other thing was a flat fee rate. This is where … Depending on what number you pick as your flat fee, you could make money or lose money. If you say, "We're going to pay everybody a flat fee that really is like 80 percent of the amount that comes in," that’s not going to be good for you.

Talk about flat fee, Joe.

Joe Bavonese: First of all, with the flat fee, you have to know your average fee that you actually get. Not the average fee that you say your fee is which for many people is actually higher than what they actually get. If you average all of your sessions by the money that came in in 2014, that’s your average fee.

If your average fee is 120 or 150, you can then use the contractor rate that we're suggesting. Somewhere around 55, 60 percent could be a reasonable flat fee if you have contractors. If you have employees, again, you might want to lower that by 7 to 10 percent to make up for the extra taxes, et cetera that you have to pay. That’s how I think about it.

Then, again, if you're doing insurance billing, you can opt to either pay for the sessions that they did or wait until the money comes in for that session.


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Casey Truffo: I said I give them 55, 5,5 percent to start. We'll talk about what happens after they’ve been there for a while in a minute. That’s what they get and then the center gets 45 percent of the fees that come in.

If they do a certain amount of volume, certain number of sessions per month, you can incentivize them by increasing that percentage by 5 percent. If they do, say, more than … They do 40 sessions, 40 to 60 or so sessions a month, you can say, "Instead of the 55 percent, we'll give you 60 percent." That incentivized them for them to want to do more sessions for those that are incentivized by money. It gives them the opportunity to increase their income because now they get 60 percent on the whole number of sessions they did that month. That doesn’t mean that the following month if they only did 15 sessions that they still get to keep with that 60. It's only within the month that they get the extra now.

Anything you wanted to change or add to that?

Joe Bavonese: That’s the same way. I have a 5 percent and a 10 percent that I give bonuses. If they average 80 or more, I'll give them 10 percent bonus if they’ve seen an average 20 people a week. I do 5 percent if it's between 10 and 20 a week for the whole month.

Casey Truffo: Got you. Nicely done. This is where Joe says in all of the years that he's been doing this that nobody has ever asked him for a raise because when they ask you for a higher percentage, you can show them that they could increase their rates if they wanted to.

Joe Bavonese: I also say 2 other things. You can increase your fee for your private-‐pay clients and make more money and you can start a group or a workshop and make more money. You want to give people more options to make more money and


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basically put it back on them and say, "In my case, you're independent contractors, you can create something else. You can raise your fee and that’s your way to make more money."

In 15 years, I've never had anybody asked for raise. I hear this all the time that what do I do, everybody wants a raise after 1 year. I just think if you give them options for making more money, that issue will be greatly minimized.

Casey Truffo: If somebody who asked me for a raise and said, "I've been there for a year and I'd like raise," my comment was, "You can raise your fees and if you raise the number of sessions, you get the bonus that month." The response was, "I don’t want to raise my fees right now. I don’t feel comfortable doing that, but I'm really excited about working toward that bonus." Very cool. Very cool.

Joe Bavonese: The bonus, Casey, I find this really motivating even though as the owner. It's not a huge difference in how much more money you pay out, but I think it appears to the clinician a big deal especially if they didn’t get 10 percent.

Casey Truffo: Let's go back for a second. Joe says for you the owner that extra 5 or 10 percent doesn’t seem a lot for a bonus because then my head goes, "Why don’t I just offer them 5 to 10 percent from the beginning since it's not a lot?"

Here's the thing. When you're just starting out guys, you've been paying all the bills by the therapy that you're doing. You bring somebody else on it and it's easy to look whatever else they're bringing in is just extra in gravy. The bottom line is you're providing those services, the admin, the space, the support, all of that for them.


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In the beginning you really don’t have if we do profit and loss and we'll be talking more about this in our next sessions. If you do your profit and loss statement, if you start noticing how much money you have coming in and what your expenses are going out, you'll see pretty quickly that if you're paying them more than 55 or even 60 percent, you potentially going to have trouble making a good profit.

That changes as you get volume. Once you have 3 associates or 5 associates or 10 associates that are doing a fair number of hours, now you can afford to give in the same way Joe is just talking about those bonuses and it does an impact to you on the same way.

Is there a way you can say that that’s more articulate than what I just said?

Joe Bavonese: The point is if somebody goes from 12 to 20 sessions a week because they're motivated to get that bonus, you're giving up 5 percent more but they're making a ton more money for you. It's exponentially in your favor. You know what I mean? That’s why I think it works. The volume thing works because it keeps people motivated to keep their numbers up and it makes more money for you, so that’s why to me I think it's a no brainer.

I just think you have to have some way to incentivize more volume because otherwise it's human nature to ask for raise. In this business, you can’t give a raise every year. You can give your admin person a raise every year but you can’t give your therapist a raise because where you're going to end up. If you're starting at 55, you're going to end up at 90? You just can’t do it. There's no room for the profit.


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Casey Truffo: I did want to clarify that that extra incentive percentage is a bonus. It's done once a month and it is on the full amount just not on the extra clients they’ve seen. I have that same question. That was a great question.

Let's see. When you pay that 55 percent of the money collected, is that after the credit card fees or before?

If it's a 100-‐dollar fee, I give the client 55 dollars and I eat the credit card expenses. That’s part of the expenses to the business.

Joe Bavonese: I think it would come off as incredibly cheap if you deducted the 2 percent or whatever you pay the credit card company. That’s just the cost of doing business. You got to just need that. You can’t pass that on.

Casey Truffo: This is probably none of your doing this because you're very entrepreneurial, but occasional I've been seeing if Facebook recently where people are trying to add on the credit card fees if somebody pays by credit card to the client. I'm just going to ask you guys just set a fee and then know that credit card fees are part of doing this.

Do you have any say in setting the fee with the contractors? That’s an interesting question. Do you want to take that?

Joe Bavonese: Sure. I absolutely do. In other words, I hired somebody recently and I said, "What do you want your fee to be?" She goes, "Oh, I didn’t think I would have any part in that." I go, "Yes." Then she said, "What does everybody else charge?" I said, "It's a range. From 125 to 175 is our range." I said, "It really depends on what you're comfortable with because you're going to be discussing this. If you feel uncomfortable saying 175 or 150, that’s going to be conveyed. We also have


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office staffs that are going to be using that number and talking about you as a clinician."

In general, I find that the newer people are in the field the more uncomfortable they are with the higher fee and so it's just important that they feel comfortable. You can always nudge them up. I always tell people, "Hey, you're in low side. Why don’t you go up 10 bucks this year or something?" They're usually happy to do that.

I really feel it's got to be something and that they feel comfortable with otherwise when they talk about it with the client it's going to come across as very tentative and uncomfortable.

Casey Truffo: Then the other thing is for me I say, "Can you charge that," knowing that we're asking people to come on a weekly basis because some people say, "I can charge that then I'll let them come every other week." Now I have a scheduling problem because I can’t schedule you with somebody if you're going to take people only every other week.

Joe Bavonese: I probably have 50 percent every other week, 50 percent every week. I'll let the clinician decide what's the best based on the clinical needs because I don’t think everybody needs to come every week. I don’t think it's appropriate for contractors, for me to mandate that in any way, so I just don’t even talk about it.

Casey Truffo: Very well said.

Joe Bavonese: That’s what I said. There's a lot of ways to do this that’s fine and we have differences.


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Casey Truffo: One of the things I want to do is back up because we're getting some questions that we've lost people a little bit. If you're ahead, this is your time to sip some coffee. If you're struggling, just listen to this for a second.

When your clients come in, they're going to pay the center a check or credit card or cash. If they give the cash or the check to your clinician, the clinician is going to do whatever process you have to collect that money and we'll be talking about that in the future sessions. The bottom line is all the money is going to come in … all your cash-‐paying money is going to come in and go through the center. Then at the end of whatever your pay period is for your contractors, you're going to figure out what it is that you want to pay them based on how much money has come in and based on your agreements with them.

The answer to the question was when money is coming in, do I charge it through my system? Yes, you're going to charge it through your system. It does get a little complex if you have clinicians who are taking insurance who are independently not through your center but through their own NPI credential with an insurance company and they're taking in money. Then if they're taking in money because it's coming under their name, you and your office staff have to come up with a process to do that.

You guys can ask questions in the Q&A if you want. Joe can explain how he does that. The bottom line is I want you guys understand the money is coming into the center and then you are paying the bills of your center, including your contractors or employees.

Somebody says, "In regard to the bonus when you do a 5-‐week month then they frequently go over on those months but they may not have really seen more people but they may have done more sessions."


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Again, you still incentivize them, right?

Joe Bavonese: Of course. One of the things that we've learned from Michael Gerber about systematizing is keep it simple. In other words, don’t … If you had a different system for a 5-‐week month than a 4-‐week month or February only has 28 days and March has 31, you'll drive yourself nuts. Just keep it simple. Everything you do has to be duplicatable, systematized and as simple as possible to make your life as simple as possible. It doesn’t matter to me how many days there in a month.

Casey Truffo: There's another interesting question here. It says, "Does incentivizing volume have any ethical considerations that we need to manage. I'd be worried that my associates will be pulling for clients to come in more often and stay longer than it's ethically appropriate."

Which is interesting because that is the same dilemma that we all as business owners or all as clinicians go through. It's like I need to pay the rent. Here's the client, is it ethically appropriate for them to continue to come in or we really done and that is the decision … Those are hats that we always have to manage and go back and forth between.

I've never had anybody worry about that myself. Have you, Joe?

Joe Bavonese: No, I haven't. Your point is well taken. We've all dealt with that and in fact I think it's worse when you're on your own. I think there's more because every client means so much to your income but I think it's even harder. I remember struggling with that and I think I always erred on the side of not seeing people enough because I'm always worried about going in the other direction but I think it's the same issue.


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Everybody is incentivized to make money. Usually, that’s one of the biggest incentives people have as well as doing good work. That’s just part of being in this field.

Casey Truffo: Then if your clinicians are doing the workshop in the community, the people are still paying the checks to the or paying the center for that workshop that’s happening.

Joe Bavonese: Or they may be doing it in your own space if you have the space. Even if they're off site at another center, another facility, true they pay their checks. Everything goes through the business name.

Casey Truffo: Then Carol asked, "How do you then tell clients that there are different phase for different clinicians rather than having one set pay for the center?"

It's one sentence. Tell her what your sentence is when you do it.

Joe Bavonese: My sentence is just that all of our clinicians set their own fees based on their experience and expertise, that’s what I say.

Casey Truffo: I usually say just same thing and they range from this amount to this amount and they set their own fees so you just get to choose. Again, we're talking the range for cash pays. It's not like it's 20 bucks to 200 dollars. There's not that level of range. It's 20 or 30 dollars. Is that the same case in yours?

Joe Bavonese: No. Like I said, ours is 125 to 175 and then I always have an intern who has sliding fee scale usually down to 40 or 50 just so I can accommodate people with varying socioeconomic levels. It just depends and it's interesting. Sometimes


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people say, "I want to see the person who is the most expensive because they must be the best one."

Casey Truffo: Good. We're going to get into the Q&A in just a couple more minutes. I just want to make sure that we've covered everything. What we wanted to cover was and if you guys have any questions on hiring, so when to hire, what the expectations are, how to find them, how to interview them.

We talked about this in the first one but making sure you know whether you want new clinicians, whether you want to provide supervision for them or whether you want experience, so that’s all going to be part of when you're hiring.

Then we talked about paying them. We talked about we're not fee splitting and they're paying for marketing, admin space, whatever all those things are. We talked about determining the fee structure and how much and when are you going to pay. We talked about that.

You may have at times associates set different fees because you may change. You may decide right now that you're paying too high and the next people that you bring in you might want to bring in at a lower percentage. You get to make that choice. I wouldn't go announcing that to anyone. There may be people that you pay at a different percentage.

Then we talked about if they set their own fees, how you say that on the phone. I use my 4-‐part script, which is our office is located near John Wayne Airport. Our sessions are 45 minutes in length, that’s 45 minutes in length. Our fees for each session range from 160 to 175 dollars. We have afternoon or evening appointments available, which would you prefer? I also say we have male or


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female therapist and afternoon or evening appointments, which do you think you'd prefer? It's pretty simple.

We are right now 160 to 175. We'll probably be increasing that because we are quite low for our area. Joe, for your intern, do you also offer a percentage? How do you pay them?

Joe Bavonese: Same way, same percentage. Again, remember what I said, I keep everything simple. Everybody has the same exact system for everybody. Whether they’ve been with me for 3 weeks or 30 years, they're all going to have the same system so the intern gets 55 percent of their fees and then for volume incentive, too.

Casey Truffo: A lot of that depends on what they here in. In California, we can’t have an intern as a contractor. Again, you just want to talk with your attorney.

Joe Bavonese: Exactly.

Casey Truffo: Then we talked about …

Joe Bavonese: Again, just to emphasize about hiring. Again, check the ego at the door. I can’t emphasize this enough that one person who wants to be the star of your group will cause you more problems than everybody else put together. Just really keep your eyes open for that issue.

Casey Truffo: Awesome. What I'm going to do now is if you need to leave, you can do so. We're going to pause. I'm going to stop this recording and then we'll get the other recording going and we'll add in all of the additional questions that you guys have. There's more coming in on the webcast. If you want to ask some on the phone, you can press star 2. If you need to leave us, we understand that.


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Our next class will be coming up and we'll be talking about how to measure your results, your efforts, and your successes. We're going to be talking about what your metrics are, income, profit. We're going to talk about how to evaluate your associates to see if they're helping you to make money and how to stay true to your values. That will be on our next class.

Then in the meantime, we're going to be taking our Q&A for this module on your hires. Let me just stop the recording quickly.

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