module #8 q&a call · passive income for therapists – with casey truffo and joe bavonese –...

Passive Income For Therapists – with Casey Truffo and Joe Bavonese – Copyright 2013 /28

Module #8 Q&A Call Casey: Okay great. Okay, so this is our Q&A call. This is our final Q&A call for this class.

As I said, fewer and fewer questions have been coming in, so I’m hoping that means that you’ve been getting more and more of your questions answered and that there are fewer that are left out standing. If you have questions and I appreciate Joe has been putting a bunch in the Q&A box there. If you’re on the phone and you have questions, if you want to press star 2 we’d love to hear your questions. We’ve got some of them coming in on the webcast as well. I think I had one or two that were e-‐mailed to me. Joe, shall we get started?

Joe: Let’s do it.

Casey: Okay, great. Joe from Chico says, “I have a question about systems. If I increase my phone calls using AdWords and my incoming calls increase, how do I get phone coverage when I’m in a session or otherwise unavailable? Would it be wise to have my associates help?” I have some thoughts on that. Joe, did you have some thoughts on that?

Joe: Sure. Yeah, my experience with using associates answer the phone has been mixed on that part of the question. I did that early on before I had any office help and sometimes it seemed to be helpful and other times it seemed to cause problems because the associate basically hogged all the phone calls and gave themselves all the referrals which wasn’t the system that I had in place. I would say either using an answering service or again I’m going to advocate for the office assistant working like four hours a day for a minimal amount of money is also a good option to spend your money on to get somebody live in your office to answer the phone.

Casey: Okay. I have a good counterpoint to that. I think having somebody answer your phone, like Joe said, is a really good idea. Whether you want to have that as a person in your office for four hours, I know some offices can’t even do that because they’re in executive suites. The idea being that you want to make sure that somebody is answering the phone in as many good hours as possible. Yes, you can do it with an answering service and again, we talked about this early on,


but I really want to make sure that we hammer this home and that is, if you have an answering service answer it make sure that the people that answer it understand how to handle especially two questions, what are your fees and do you take insurance. We want to make sure that that’s handled.

Now, one of the gals that I mentor has associates answering the phone and the way she has it set up is she has some kind of internet phone system. We have RingCentral. She has Google Voice I think. When the phone call comes in it goes to five different numbers at once. The first person that answers it gets to handle the call. She set it up as sort of a challenge experiment with her associates so that whoever answered the phone call first could take the client so I thought that was interesting.

Another person that I worked with had associates doing it and they were allowed to take the client if it fit with their specialty, but they had to have a certain number of on call hours to be able to take the phone so rotate it through. Those are just two things. Have you heard of people doing either of those, Joe?

Joe: No, I haven’t. My other question about the first option, so the busier the therapist is the less likely they can get a referral?

Casey: Yeah, this was for people that were just not too busy.

Joe: Oh, okay, so it ended up evening up pretty much, okay.

Casey: Yeah, yeah, but that’s a very good point, yeah.

Joe: How does that work? Is it working out? Have they done it for a while? I’m just curious.

Casey: She’s done it for about two months and so far they’re loving it because people are much more receptive. They’re hopping on these phone calls because they know that it doesn’t just go to a voice mail, it goes to somebody. You have a good point. Somebody has to be handled. I think she does that when her office person isn’t in the office. When the office person is in the office person is in the office they can do it manually.


Joe: It strikes me that it could be the Peter principal in fact that the person who doesn’t do a good job of connecting with clients end up getting the most referrals over time anyway as it gets busier. Anyway, interesting option.

Casey: One of the things that I like to say is I use, and I know you do too Joe, I use my business as a Petri dish. I test everything. Try to minimize one variable at a time and test it from data see if it works.

Joe: Right, exactly. Let’s address what you said about the executive suite. If you have a situation where the space is not configured in any way where you could have a person answer the phone in your office, I’ve known some people that have had someone answer the phone in a different location. That’s worked out well too. Even if you can’t fit it in in your location, there may be a way to get someone who is essentially an office person of yours who is at their home or somewhere else.

Casey: Exactly. Yes.

Joe: There’s no doubt that anybody answering the phone live is better than voicemail. As Casey said, if you do use an answering service, you’ve got to be really careful about the money questions, because that could really lose a lot of referrals if it’s not handled correctly. I recommend doing role playing with either an office person or answering service until you’re really happy with the way they respond to those questions.

Casey: Exactly. Don’t forget to do the secret shopper stuff because maybe there’s one person who didn’t get the training.

Joe: Yep. I have my story. My first office assistant, that’s a true story Casey, that I converted a closet into an office. It was pretty pathetic but it worked. We put a little desk in there with a little two way door. It wasn’t the greatest thing or the most elegant, but at least it got us to experiment, exactly what you said, experiment with the idea of having an office person in our office. Then when we had the revenue to expand to a bigger office, they made sure it had an area for an administrative person to sit, no?


Casey: Yeah. This question came to me during the week and I don’t have it written so I’m going to say it to you, so feel free to ask any questions about it. The question was, it was in terms of hiring more people. This gal had one person that she was credentialing on an insurance company. The way that it would work, Joe, is that she would bring somebody on and then she would credential them and that would take 90 days. She had them not taking any clients until 90 days because she was filling her existing clients with the fee for service people. Then what happened was that after that there would be a lag there where there was nobody there to take insurance because she had somebody who didn’t come back from sick leave or would be full or something. Do you look at somebody and say, “Okay, when your extra sent full is when I start hiring the next person?”

Joe: Oh, in terms of when to expand your clinical staff?

Casey: Right, right.

Joe: Yeah, what I like to do, as we talked about it, it does take time to find someone. You can’t assume you’re going to have somebody in place in two weeks. I basically like to look and say, “Is the whole staff about 80 or 90% of where they want to be?” I also check with my office staff and I said, “Are you having trouble getting new intakes in within one week?” That’s the other question I ask. If they say yes, then I know we’re going to lose people if we can’t get them in. Those are the two criteria that I use.

Casey: Joe, what was the first question again?

Joe: The first one is I informally ask the therapist, I say, “How is your case load? Do you have any openings? How many more do you want?” If I’m hearing consistently, “I’m full. I’m full. I’m full.” Or “I have two openings.” Then I know that we’re really going to have a hard time handling the number of intakes we’re going to get in the next month. That’s what I said, if I hear that everybody I talk to is 80% to 90% or 100% of where they want to be then I’m going to proactively start looking.

Casey: Great. The second question was when you ask your office staff, “Do you have trouble getting people in within the week?”


Joe: Yes. Ideally, we’ve never talked about this as a metric, but it would be a good one to track is how many days from the call is the first session scheduled. I do used to track that at another job as a director of a clinic. It was an interesting step. I think if you can keep that number certainly under seven and ideally under five or four, you’re going to do a lot better on conversion, because a lot of people call and they’re motivated right now. If a week or two goes by they lose their interest.

Casey: Right, yeah perfect. I know one of the things that you have always mentioned, Joe, is making sure that you’re focusing on when is the quickest part I can get them in, when is the soonest I can get them in.

Joe: Right. Because the hardest and most expensive and time consuming thing is get person in your office the first time. It’s a lot easier from there, but that’s the thing you’ve got to put all your attention on optimizing and minimizing any kind of resistance or anything gets in the way of that.

Casey: Perfect. Okay, good. Again, if you’re on the phone and you have a question you can press star 2 and we’ll take your question. If you’re on the webcast you can type it in that little box here, we’ve got several. One thing I want to mention is at the top of the hour we will be having Steve Frankel, our attorney. If you have legal questions related to adding clinicians, if you could put that in the Q&A box so that we’ll make sure that we have questions for Steve. I know some of you are asking questions about things that aren’t related to adding clinicians, so we won’t be covering that in this session with Steve. He is specifically here to talk about issues with adding clinicians and that. I know some of you are asking about Telehealth, not part of this curriculum though, so we won’t be able to talk about that.

Okay, let’s see. There are no handouts, it’s just a conversation with Steve, so if you have questions you want to make sure you get those into our Q&A box. We’re getting some specific questions about scheduling. What do you call it? Software. Wanting to know pros and cons of the software, is that something that you want to talk about or you think it’s best left to the people then?

Joe: I think if we have some time, if we have time I think we can talk about it.


Casey: Okay, all right, I put there in your chat what the question was here. All right. “You mentioned something about agencies or companies that help clinicians get credentials. Would you say more about that? I’m in a saturated area and I’m frequently told that the panel is closed.” I mentioned that there is a company called Thrive Works and they charge $239 per insurance panel to get you credentialed in. When I say get you credentials what I’m mean to say is they fill out the paperwork. They help you make sure that the paper work is getting in and then they call up and they try to follow through on stuff. They do not guarantee and they will tell you when they talk to you, “Hey, that panel in your area is probably full. It’s probably not a good one.”

Thrive Works is the one that I talked to. Again, I have not used them and there may be lots of others. I know that Susan Frager, F-‐R-‐A-‐G-‐E-‐R used to have a business doing that. I think if you Google her you might find out more about that. Do you have any feedback on that, Joe?

Joe: No. I’ve never used anything like that, so I don’t know.

Casey: Okay, good. Let’s see, we have more questions here. “I work in a rural county in which the largest city has a population of 100,000. Is it reasonable to expect that I could add two to three associates and keep them busy?”

Joe: You said about 100,000?

Casey: Correct.

Joe: Yeah, I think so. Obviously, it depends on the amount of competition in the area, but I think that’s reasonable with 100,000. I mean it also depends on, I guess the other part of it has to do with the sort of how therapy is viewed in your community. I’ve worked with some people coaching them who are in a college town with 100,000 people and there was a lot of therapists and a lot of interest in therapy. Then I’ve worked with some people in a more rural 100,000 population where therapy was frowned upon as something that was more for serious disturbances. That was obviously a harder thing to fill. It depends on all those factors really.


Casey: Again, if you go back, Joe who asked the question in Chico, if you go back and start looking at the number of calls that you’re getting in and how many over time you think you would want to give to somebody else, that will give you your best estimate on what you could do. It’s about collecting the data. It’s not that we could give you the, “Oh yes magically you could do it.” The second part of that is once you know what the data is then you say -‐ is it data is, or data are? Anyway, once you know the data, you can then go through and say, “Okay, I want to ramp up my marketing.” Then you can do the AdWords or you can do the speaking in the community or you could do any of those things.

The final thing I wanted to say about that is I know lots of people that work in rural areas that actually pull from the cities that are a little bit further out. One of the parts of the branding is anonymity because you’re not going to somebody in your local area. They’ll get on these panels for insurance. It’s not an insurance panel, it’s a list of providers that handle physicians who have gotten in trouble or attorneys who have gotten in trouble and then will reach out to the attorneys or physicians in those cities and then those people will be happy to come to a more rural area sometimes so they’re not there seen coming out of the office with their colleagues in the waiting room.

Joe: That’s a good point.

Casey: Just some other ideas thought.

Joe: The other thing I want to mention about marketing to smaller populations or rural areas is the internet may not work very well if you’re dealing with under 100,000 within 30 miles of your office. Unless it’s a very high tech like a college town or something area that you may need to really focus more on all the marketing options that Casey talked about, all that excellent material that’s available. Is that module 4 or 5? I can’t remember.

Casey: Module 4, yeah.

Joe: Four, about how to do presentation and network with other professionals in the community. That’s another thing I just want to mention.


Casey: I think I might have misspoken. I’m looking at it right now. I thought it was 4, but 4 might have been systems so …

Joe: Okay, maybe it’s 5. I think it was 5 actually now that I think about it, yeah.

Casey: Yeah, and that’s actually coming up with the next question too. Module 5 was Marketing Online and Intercommunity and we do know, you’re 100% right Joe, the studies I’ve done is that when people have done more community marketing in rural areas it really makes a difference. Getting in with the lawyer, the pastors, the physicians, all of those people, I think that makes a huge difference.

Okay, great. Let’s see. We have another question here. This is an interesting question. We talked a minute ago about if you’re going to hire somebody and then you’re going to get them credential, there’s a lag there in terms of it can take anywhere from 90 days to six months to get them credentials. What do you do with them in the meantime if it’s primarily an insurance based practice? Joe, did you have thoughts on that?

Joe: Yeah. I guess my response to that would be you probably do have some fee for service. What I’ve even done, I remember I had two people in the situation, while they were waiting to get credentialed, they offered a lower sliding fee scale than some of the other staff just to get busy and get their case load filled up. I think there’s usually at least some fee for service coming in even if you’re an insurance based practice because I think you’re going to lose someone if they have to wait three months to make any money. I would just do whatever I could to give them some business and get them integrated into your system and get them to feel a part of something.

Casey: That is such an important point if you guys just heard the jewel that just got dropped there. That is a lot of people when trying to get somebody credentialed they actually end up losing the person or the person doesn’t have love for the practice in the way that you would want them too, because they don’t feel connected. If they maybe have one client here or there because somehow something slipped through, it just doesn’t feel like it’s a great new beginning. That’s what you want them to feel is excited and on fire about coming to work there. How can you get them their first five clients? What can you do? I love


the idea about doing a sliding scale because if they’re going to get 50% of what insurance pays, might as well offer a sliding scale for those people to come in, so.

Joe: Yeah. Anything you can do to get them built up to five to seven people I think is a good thing.

Casey: It’s kind of funny that you said that because when I went back and started seeing clients in my center because we were just starting out, when I hit the number seven, I really felt like I was being a therapist again. Do you know what I mean? When I was seeing one or two, I didn’t quite feel that way. Interesting.

Joe: That’s interesting, yeah.

Casey: Okay. Let’s see. Again, if you have the questions and you’re on the phone, you could just press star 2. If they’re legal questions feel free to put them in the Q&A box and if they’re not go ahead because we still have some time here for our final Q&A. Remember guys this is our final Q&A here for this class. I want you to get your questions answered. Okay good, we got two or three questions coming in, legal questions. Let’s see. Now, we’ll go back to the question about their online schedulers. All the online schedulers have pluses for somebody and there are minuses for people. This is where you really want to do your due diligence and get all the free trials, test them all yourself and find one that works the way that you do. The question was, “You said Appointments Plus is an online scheduler that allows multi office scheduling but you suggested that it might be a little clunky? Can you speak more about that highlighting the pros and cons?”

Joe: I think I had used Appointment Plus a couple of years ago and I do know they have updated their interface I think quite substantially since then. It was the best pure schedule that I found for the multi office, multi room kind of scheduling that had the best layout. It’s especially difficult if you have more than one location. A lot of the schedules are fine if you have one location, but when you add a second location or more, then it gets a lot trickier. I thought Appointment Plus had the best layout and format. I would probably say again, I know they offer a free demo and they base their pricing on how many appointments that you schedule per month.


With all of these it’s such a personal thing. I just think, again, try to do the free demo on all of them and I think you’ll find out whether it works for you or not. You can have the same features in two different programs and end up really loving one and really hating the other one just because of the way they’re laid out or the way the interface works. For a lot of people, just using Google Calendar or something free like that is adequate. It just really depends on your situation and what features you need or don’t need.

Casey: What you may need when you start out may be different later. You may have one location and one of yours will work very nicely, one of the things that we put in there. As soon as you add locations it may turn out to be different. That’s what you want to check and make sure that you test it. Don’t just listen to the sales people stuff. I will say the sales pages, meaning the page that give you all the benefits, for those that do multi office, multi-‐location they’re usually pretty strong about telling you that. It’s a benefit because they know that that makes them standout. The reason I’m a little reluctant to talk too much about the pros and cons, number one because everybody works differently, but number two, Joe and I might have used the free trial six months ago or two years ago and something has changed and been updated. We would not want to badmouth a particular and say something wasn’t there when indeed it was.

Joe: Yeah, but one that I would be glad to badmouth is Office Ally which has the great benefit of doing free intern spilling. They have an integrated calendar and I think it’s very hard to use. I have not seen those been updated but it’s free. Again, if free is one of your high features you’re looking for it meets that purpose, but the interface is pretty much like those of you who know what MS DOS is that makes you cringe then you know what I mean.

Casey: See, the thing with Office Ally you want to look at it is what are you using it for. If you’re using it solely for billing that’s one thing, but if you’re using it as your customer records management, practice management system with scheduling and all that, it’s very different. Beware of what’s the purpose of what you’re using. That’s why I really want you, before you start looking at all these things, is to really sit down and say, “Okay, what are the systems? How is it that I work?” Then you can look at them and see if they make sense for you. Because if you don’t know how you work, you’re going to pull these in and you’re going to be


trying to push that square peg into that round hole day after day after day and nobody is going to like it.

Joe: You want to try to avoid duplication of effort wherever possible. I was just consulting with somebody recently Casey where they had I think it was five different programs managing their practice with associates. One was for scheduling, one was for money, one was for client information. I can’t remember what they all were. There was a tremendous amount of duplication and they had to enter the same thing often, three times. It’s tremendous inefficient waste of your time. As we said, time becomes your most precious resource when you add clinicians. So you have to optimize everything to work as seamlessly as possible and to reduce the duplication, because that’s really going to help maintain your sanity as time goes on and you get bigger.

Casey: Totally. I will say at the same time we are duplicating our scheduling because the practice management software that we loved has a wonky scheduler.

Joe: Yeah, I’m doing the same thing. That’s the one thing that I haven’t found that I like everything, but that’s okay. If you have to do that you have to do that.

Casey: Right, but when you start having too many of them it’s a nightmare. I love that you said that. The other thing I want to mention too is that I’ve been talking with some of you that are coming on as mentorship clients. One of the things I want to make sure you do is you don’t over analyze. Somebody the other day said, “So should I look at all these numbers every single week?” It’s like you need to have enough data to stand back. Joe, you do it monthly, right?

Joe: Yes.

Casey: Okay. there may be some things when you’re starting out, for example the number of calls coming in and how you’re converting those calls that a weekly check in and look at it is not a bad idea to make sure that everybody is doing what you want them to do, but your profit and loss statement do that on a monthly basis. You start doing that on a daily or weekly basis, it’s like weighing yourself when you’re trying to lose weight.


Joe: Yeah, that’s the best analogy. Casey, I do monthly, quarterly and annual because sometimes I find three months of data is more revealing of a trend than even one month based on what’s going on in the world or the season or the weather, whatever it is.

Casey: When you compare, I don’t know about you Joe but I compared this season to last season either month or quarter.

Joe: I did last quarter as well as a year ago quarter -‐

Casey: Perfect, perfect, yeah.

Joe: This reminds me, I remember during 9/11 our therapists were freaking out about what happened but also that our whole practice was going to go down the tubes.

Casey: Really?

Joe: It was very reassuring to them, because people are afraid to leave their homes for a couple of weeks. It was very reassuring to them when I could show them the number of intakes that we had in August and the number we had in September. It was a huge reassurance and relief to everybody. It was really striking though. It was one of the few meetings I’ve ever had where I tried to get everybody together because I realized everybody was panicking. It was really helpful to show them those numbers. They were like, “Wow, I guess we’re going to be okay” in addition to what they were dealing with individually.

Casey: Nice. Yeah, this is where maintain the culture I think is so important. You were nimble there in terms of we’re not going to be a place that has meetings, but yet at this point we need to have a meeting and communicate some information. That wouldn’t have been nearly as effective in an e-‐mail.

Joe: No, no and back then nobody had an e-‐mail.

Casey: Yeah, that’s a good point. I was telling somebody the other day, I remember when my newsletter list was 100 people. That was a lot. Okay, great. Again, if


you have more questions, if you want to put them in that Q&A box we’re happy to have it especially if you’ve got questions for Steve coming up.

Joe: Yeah, also Casey, I’d also like to hear from people if it would really be helpful to other people for them to share what’s been the most important or useful thing they’ve gotten out of this program. Because I find that everybody focuses on something different and it’s really good at the end of a program like this to review. If you have any feedback that we could share with everyone about it’s really helpful for me to focus on this or that or to hear that information or do something. We’ve gotten a lot of individual e-‐mails from a lot of you saying how helpful the program has been, but it’s always good to share that as well.

Casey: We have a question from Deb on the phone. Debra go ahead. Wait. Okay, there you are. There you are.

Debra: Yes, can you hear me?

Casey: Yes.

Debra: Okay. First off, I do want to say it’s been a wonderful program and I think that overall just getting a sense of all the stuff involved in doing this, because I haven’t done it before, I’m a newbie is just so valuable. All your details as well has been great. Sorry.

Casey: Go ahead, go ahead.

Debra: So I do have a question which is that I have now filed for a fictitious business name. I’ve put an ad out to hire and sort of synchronisticly the building that I’m in, I actually have three office buildings but I have three interns and in each building I have one office. I should be clear. In my main building in Sacramento there are synchronisticly two more offices that are going to soon be available to rent. I feel like I need to jump on getting both of them because I know they won’t likely stay available. They would sell quickly. Because of that I’m thinking as I start out and I interview, I should hire more people. In the beginning I thought two and how I’m thinking four associates. I’m wondering what you think about that and then sort of like trying to figure out what to do first, second, third. I’ve been working on a contract for the associates. I’ve decided to help


them be independent contractors. I’m starting to see the pieces fall together in terms of what I want to do.

One of my questions is also related to this is that I’m going to be putting out obviously a lot more money for rent every month and then I’m going to beef up my marketing quite a bit. I get a certain number of calls and my traffic is full, but I want to get as many clients in as I can for the new associates as quickly as I can. One of my questions is, I’m concerned about hiring an office assistant right off the bat because of the -‐

Casey: Okay, Debra? Debra, hold on, because you’ve already asked two questions.

Debra: I know, I’m sorry.

Casey: That’s okay, hold on. Let us answer them okay.

Debra: Yes, yes, absolutely. Sorry.

Casey: Okay, all right. Joe, what about the idea -‐ okay, Debra, I’m going to mute you because we’re getting an echo there. I’ll come back in a minute. Joe, what about the idea of she’s got these one office places and two more have opened up and she’d like to jump on them, thoughts on that?

Joe: Yeah, my thought is it totally depends on the referrals that are coming in. If you can afford the rent on the other offices at your current cash flow level or is it a I hope I can fill it up. Really to me it depends on the marketing and the flow of referral that are coming in. Because again, you don’t want to get in a situation where you’re not meeting your monthly expenses and you don’t have a solid plan to meet them other than maybe I hope this pans out or that pans out. I’m always concerned about that. At the same time, if there’s a phenomenal deal and you have enough resources either you get personally through either your own finances or even through a small business loan or something like that, it may make sense to do. It really to me says how many extra referrals am I getting?

Part B of that was should I hire four instead of two, again, this harkens back to what we just talked about 20 minutes ago which is if you can get all those people


up to five or seven a week within a month or two that’s fine. If they’re all going to have two or three clients nobody is going to be very invested in your practice and you may end up losing some good therapists. That’s my feedback.

Casey: The thing that’s cool and I was thinking about this earlier is that you can then, if your goal is when I bring on a new person I would like to get them to five to seven as soon as possible, so what’s my conversion rate now? How many calls are coming in now and what’s my conversion rate? If right now I have a month coming in, 70 calls coming in. My conversion rate is let’s say 70%, that means of those you should be able to get 49 new clients for that month. Yeah, you could fill up several people with that. If you’re getting seven calls a month, and you have a 70% conversion rate, that means that month -‐ am I doing this right Joe? Then that means you’re getting five clients a month. Then you have enough for one person.

I don’t know that I would want to hire four or five people which is the second part of her question, three or more people just because you have the space if you don’t have the numbers coming in. This is why the tracking part is so important because then what you can do, like you said Debra, is then you can say, “Okay, I want to increase the marketing.” I increase the marketing and I notice what’s happening to my calls and what’s happening to my conversion. That gives you the other piece to that.

Joe: Casey, my question though would be, what if I don’t know my conversion rate because I haven’t been tracking it for very long or at all?

Casey: Yeah. Do you have an answer to that?

Joe: No, that’s why I’m asking you.

Casey: Yeah, what I would do is start tracking instantly and if you can go back, like some people actually take notes in their book with this stuff and they don’t realize that they have the information. That would be what I would do and then I would go back to what Joe just said, what you just said Joe. If you’re going to jump on … I’m torn on this because on one hand I totally get it when there’s space there and you want that space. I want that space. I totally get that. On the flip side, I believe that stuff may come available later. It’s not that this is the only time ever


that this space is going to be available. If you can get it now and perhaps not furnish it and just pay the rent on it, if you can handle that with your existing cash flow that’s one thing, but recognize that that is going to be a drain on you and it might be four, five or six months before you get that starting to turn a profit. If you can handle that then I would do it.

Debra: Thank you.

Casey: Go ahead.

Debra: Thank you, that’s very helpful. Yes, I haven’t tracked my conversion rate closely, so Casey you’re right on saying that and I’m going to start doing that. I do have money saved that I can put into it. I’m figuring that I can keep two more offices afloat for maybe three, four, five months without having much income coming in or having lack of profit and whatever. The other question then related to hiring an office assistant, it feels like to add that into the mix would definitely be too much money going out right off the bat. I was thinking of doing that a little down the road once things are going along a little better. I’m not having second thoughts about getting the two offices right off the bat. Anyway, but I’m wondering your thoughts about waiting a little to hire an office assistant.

Joe: Yeah, I like that idea of waiting because it’s helpful for you to do everything yourself first so you know exactly all the steps. Even though you’ve been doing it yourself for your own practice, when you first start with a new associate it somewhat changes. It always reminds me of McDonalds always has people. Before they become a manager they have to do all the stations. I think it’s the same thing. You want to know all the office work, all the additional work that’s going to come on now as a result of adding clinicians so that when you are ready to hire somebody you can train them well and you know exactly what their stressors are.

Casey: I think that’s important and I think that you be careful on how long you wait. I’m still looking at my numbers. My conversion I think would be so much higher if I had somebody answering the phone more than I do now. I was in Chicago teaching over the weekend and I think I missed seven calls. You look at that and you go “Ugh.”


Joe: Wow.

Casey: Then I had another one that came in today literally five minutes before. I had a coaching client calling in. I’m trying to take this call and my attention is torn, right, because I don’t want to be late for my coaching call, but I want to deal with this on the center. I don’t have that single minded focus of how can I be of service to this person. It’s a problem. It’s a problem. Debra, I wouldn’t wait too long for that. I would at least wait a couple of months and then do it in whatever way. My answering service costs me $300 a month for just under nine hours of actual phone time which I think is a pretty good deal.

Debra: What answering service? Is it okay to ask?

Casey: Yeah. I’m not recommending them. I’m just telling you what I do. The one that I’m working with is Thrive Works.

Debra: Oh that is Thrive Works, okay.

Casey: Yeah, but I will tell you that there are lots of good ones out there, but when you do your due diligence, make sure that they are willing to be trained because some of them just want to take messages.

Debra: Yeah, makes sense.

Casey: Okay.

Debra: Thank you so much. I really appreciate it.

Casey: Sure, great. Yay. Okay. All right. So going back to again, if you’re on the phone and you have a question, you can press star 2. We’ll go back to the webcast ones that are coming in. Let’s see. “The idea about tracking metrics has been really helpful for me. I tend to go on my feeling about how things are going and as Joe said, often I find myself either on cloud 9 or in the seventh level of despair. I started tracking incoming calls now and it’s already given me a sense of control.” Awesome Maggie. I’ll tell you, that’s been the single most important thing for me too was doing the tracking because sometimes we’re


hungry for income and it’s not coming in and so we seek stuff, people aren’t calling but they are.

I know Joe, I was taking to a gal that I was mentoring this morning and she said that only one of her calls last week, the first session turned into the second session. There were only two new clients. So 50% of them turned into a second session which we would want that percentage as a rule to be much higher, but on a sample of two it’s hard to do. The session that didn’t make it to a second session, the person arrived drunk and was belligerent. Anyway, it was a perfect one too. That’s when you say, “You’re not going for 100% conversion.”

Joe: Yeah, not exactly a typical session, yeah.

Casey: Right, right. Okay. We do not have a list of attorneys we recommend in different states. What we do suggest is that you or what I suggest anyway is that you go through your association publication and they will often have malpractice attorneys in there and those malpractice attorneys in my opinion often know a lot about the laws in your state. You can also ask your colleagues. They will often have other attorneys. Do you have any answer to that Joe?

Joe: Yeah, or just post it on the list serve on your state professional organization. I think that’s another. A, I think it’s good to get feedback from people you don’t know as well as people you know because they may have a wider range of experiences than just the people you know.

Casey: Right. Very good. Do you suggest renting or buying your large office equipment such as standup fax scanner shredder? How does the therapist apply their own technical equipment? Okay, let’s do them one at a time. Do you suggest renting or buying a standup fax scanner shredder?

Joe: I say buy.

Casey: I say buy.

Joe: It’s not that expensive and these days, technology is pretty reliable. I have found Brother to be an inexpensive very, very durable company for technology like that.


Casey: You can get a Brother Laser Printer which will save you on ink. You can get them for 300 some dollars.

Joe: Yeah, they have a series called the MFC. I don’t know if it’s still in the 7000s or the 8000s now, but it has a scanner, a fax and a laser printer all built in. It’s a couple hundred dollars.

Casey: Yeah, I’ve got my MFC 7860. It’s several years old. The thing is that they will break. I used to buy thousand dollar printers and they break as often as the Brother $200, $300 printers. Yeah, you want to buy all that stuff and you don’t need a big thing. You can get a little thing in terms of a fax. Then, “Does the therapist supply their own technical equipment or the clinic?” I’m assuming we’re talking about laptops and computers when you say technical equipment. In my center, everybody does their own. What about you?

Joe: I don’t understand. I mean I don’t buy computers for everybody, but I also don’t have them inputting anything.

Casey: In mine we do, but when they’re hired they’re asked, do you have access to a laptop or an iPad.

Joe: Oh, okay. So you require that they have that on their own?

Casey: Well, I won’t require it. I have an extra iPad and I have an extra computer if I needed to give it to somebody, but they score points if they do.

Joe: Okay, does anybody resent having to use their own?

Casey: No.

Joe: No, okay. Yeah, there has been this whole movement in the technology world of bring your own. I would assume people would expect that. I would rather use my own if I was working somewhere rather than having to use somebody else’s.

Casey: Right. That’s actually what happened. I gave my computer to one of my clinicians. It’s an older Mac but it’s not a bad Mac. I mean it’s two years old.


She said, “I’m a PC gal. I don’t get this.” Then she wanted to use her own and it worked fine.

Joe: Okay.

Casey: Okay. Let’s see.

Joe: You haven’t converted her yet?

Casey: Well, that’s funny because that goes back to the Office Ally thing because Office Ally told her that it wouldn’t work on a PC which I think is crazy but …

Joe: It wouldn’t work on a PC or on a Mac?

Casey: Excuse me, it wouldn’t work on a Mac. It’s web based so of course it works …

Joe: Yes, we used it, yeah, okay.

Casey: I understand. I understand. “I’m trying to figure out the profitability of AdWords. If I understand your numbers I will need to budget $10 a day, $300 a month to get one new client.” Again, those numbers may be different whether you’re insurance or cash. I just want to say that.

Joe: Well, what I said, yeah, let me just interrupt. What I said in that module what $5 a day for one client if you’re insurance based, $10 a day if you’re not.

Casey: Okay, perfect. Thank you for clarifying that.

Joe: Yeah, so I had said that. Okay, so go on.

Casey: We’re assuming that this is cash practice because you said that. We’ll just go in that assumption for a moment. “If I can expect 12 sessions my associate’s average, then can I expect to net $480 from that client?”

Joe: Wait, say that again. I’m sorry.

Casey: Okay, I’m going to put this in your instant message so it will go over it, so you can see it there. So, what they’re saying is, if I understand the numbers, if I budget,


so I spend $300 to get one client. If the client stays for 12 sessions and it’s an average of $40 a session then they make $480 for that client, right? 12 sessions at $40 profit. Does that mean they’re only getting $180 per client?

Joe: Oh, I see, I see now, okay. Let me say a couple of things. First of all, this is based on your -‐ the $10 day thing and the $300 a month is based on an average number assuming your landing page is in good shape and you’re converting, your area of specialty, I mean there’s a lot of factors that go into it. You may be a little better, a little worse than that. Let’s assume that’s the number and you make $40 after you pay the therapist, that’s your profit. Yeah, those numbers are correct.

Casey: Okay. Now, when people start freaking out, I’ve got this whole associate thing and it’s only $180 per client. Well, if you get 100 clients that’s now $18,000, right?

Joe: Yeah, or you may find, if those numbers are not very appealing, then you may want to do some other forms of marketing like all the ones Casey talked about that require more time and less money. That may work better in your situation.

Casey: Right, a very good point.

Joe: I mean there’s so much great information that Casey put in Module 5 that I hope everyone has a chance to download and read about how to do that, but if you have more time than money and you want to hire profit margin on each referral, then community networking or presentations is going to be a lot better than AdWords.

Casey: Yeah, this is where Joe and I felt that we both learned a lot from each other on the marketing stuff even though we’ve been doing it forever individually. That Module 5 I really encourage you to spend some time there. If you’re not getting the numbers that you want, spend some time there. One of the things that I think was important out of that module too is we have in there both the videos that Joe has given you, the online stuff. Again, if you’re wanting him to help you with AdWords you can go to uncommonpractices.com and click on services. It’s a bargain. I will tell you, I have done it. I paid the full price for it and I’m totally making that money back, so very happy to do that.


Now, I will tell you though that I just get so excited about this. I’m sorry. You guys, there’s stuff in that module about how to get clients from the community if you have more time than money and you don’t want to spend money on AdWords. You do not have to spend money on AdWords to get it. In that module, Joe and I who have been doing this, we’re probably together between 40 and 50 years were able to pick up stuff from each other. What I don’t want you to do is to go do the shiny thing. If somebody calls you up and says, “Hey, do you want to put a sign up at the gym?” You think, “Well the gym, that’s my ideal client.” Don’t do those things until you’ve gone through our materials because what we’re trying to give you is the quickest way to clients and the most …

Joe: Let me give you a more blunt version of that which is don’t do social media until and unless you’ve gone through search engine optimization and community networking because social media is the shiny new object. I’ve seen more people waste more time on social media than just anything else for the least return.

Casey: Totally agree, totally agree. I talked to a gal over the weekend who said she was so excited because she had a thousand followers or friends or whatever. I said, “Where do you get them?” She goes, “Well, I travel all over and I just post pictures of where I am.” That’s wonderful that you’re having this social thing, but these are not potential clients for you.

Joe: Right.

Casey: Thank you for saying that. In my self-‐study course I say, “In a year or two or five I might be totally saying something different and …

Joe: Yeah, but right now, the one thing I would say that we really didn’t talk too much about is Google Plus because the whole thing about social media is people are there to socialize. Google Plus is sort of a social network, but it’s also an information network. If you can get people to plus one your Google Plus profile of your practice or have a colleague write a review for it that will impact your Google search results. That’s something that’s sort of social that’s worth doing I think much more than Facebook or Twitter is.

Casey: Agreed, agreed. For those of you, Joe and I are again thinking about running this ongoing continuity program to help you continue to learn and continue to ask


your questions as you grow and mature into this new expanded practice. That is one of the things we will be talking about is Google Plus and some things cool that can be done there. It’s beyond this class, but something we want to cover there if you’re okay with that Joe?

Joe: Sure, absolutely.

Casey: Okay. When does the clinic pay for training versus the therapist? If I need a DBT therapist and one of my office is interested, who would pay for the training?

Joe: If one of the staff was interested?

Casey: Right.

Joe: Well, the first thing I would do is I’d hire somebody who has a training first, but if the situation arose, I think you have to handle them case to case basis. I have done three things. One, I’ve had them pay for their own training since they’re going to make the money from it. I’ve paid a percentage of the training which is equal to the percentage that I normally pay them. I pay for 60%. In a few cases I’ve paid for the whole training if I felt it was going to really substantially add to our brand by having something like DBT or EFT or something that was a hot topic that really filled the niche in our lineup.

Casey: Yeah, I was working with one of my coaching clients and she has a training that cost between $10 and $20,000 per employee.

Joe: Whoa!

Casey: Yeah.

Joe: That’s just a lot.

Casey: Her solution was to create a contract that said they would work there for three years and it was pro-‐rated by a year. I had some concerns about that because we know it’s not legally enforceable and I’m concerned about how it impacts the culture.


Joe: Yeah, how do you make that much money back? I mean I guess if they’re seeing 30 people a week maybe you would, but …

Casey: She actually had the numbers and it was a three-‐year thing, yeah. It was a special kind of autism or something, I’m not sure.

Joe: At that point the person can just leave and take all the clients with them.

Casey: Exactly.

Joe: Yeah, that’s risky.

Casey: Yeah. Again, agreed. Yes, we will be letting you guys know about the upcoming continuity program we’re calling it, the upcoming connected way that you guys can stay together. We’re working out the details about this, but we’ll probably be teaching one class like this a month and then we will provide an amazing forum where you guys can share resources and connect with one another, and really exponentiate your success. We’re in the process of coming up with it and you will be notified. For those of you that are interested we’ll be telling you a lot more about it. That’s sort of on our books today, but we wanted to make sure that everything was okay. Joe, are you hearing the audio cutting in and out?

Joe: No, I’m not.

Casey: I am not either. There are some people saying that it is. If you’re having trouble, my recommendation is that you make sure that if you’re listening on the webcast, you might want to make sure that you have not too many other programs open because that will impact your quality of the audio. If you’re on the phone, I would hang up and call back in because sometimes the bridge line does have a little bunch of boo boos on it. I would recommend that.

Okay great, let me just see if we have some more. You guys, I just would really like to echo you putting in the Q&A. We didn’t really get a lot in there, but we would really love for you to put into the Q&A what you’re taking away from this program. Was this helpful? Where was it helpful? What was helpful? If you guys could just put that in there, it would really help me to check into that. Okay. All right, is anybody on the phone? If you could just press star 2, tell me if


you’re having trouble hearing us, press star 2 please on your phone. Okay, pressing star 2. Let me just see how many coming up. For those of you that have the webcast available, if you could just put in there what you’re taking away from this.

I’ll tell you, for me, I think the most important parts were … well, let me just back up here. We really tried to set it up that we set you up for success. We really helped work with the mind set and all that in the beginning. We talked about hiring your first or your next associate. We gave you all kinds of opportunities and ways that you could potentially do that. We then talked about how to measure your efforts, results and success. This is where we’re talking about creating a business plan and not a business plan that you put on the shelf that’s in some binder, but it’s really your profit and loss statement, what are your objectives? What are you trying to hit each month? What’s happening with your call volume and turning those into clients? What’s happening with your staff and how that’s going? Those are the kinds of things that we were measuring each month.

We talked about that in terms of relating to systems. Joe, I think you did a really awesome job when you just said let’s not hire a staff person before we develop some of those systems because they do take some iteration as you’re really taking out what’s in your head and putting that down. We then talked about marketing online and in your community, Module 5, which is the secret sauce. You can go back there. You will have access to this for a few more months. Go in there and download and really pay attention to that.

We then talked about how to manage your future growth in terms of your time and your energy. We answered a lot of questions on pulling this all together. For those of you that are just starting out, some of you said they want to know what the first steps are, well, I will tell you that the first steps are you can go back to the first couple of modules here and make sure that you look at that initial steps checklist, because that will really give you the first steps.

All right, so I just want to go back and Joe, what do you think was powerful for you in this course?


Joe: Well, I just love the fact that I think it was very step by step and systematic. I think hopefully we broke down a lot of complex things into a systematic process. I know when I started doing this I was very naïve about all the different parts of it. I think I’m happy that I think we’ve really elucidated the complexity of it, that it’s not a simple undertaking. There’s a lot of parts to it and there’s a lot of resources. It’s something that’s developmental in the sense that you go through different stages where it works for a while and then you hit a growth stage which is exciting and also creates some more challenges. That’s why I do think having ongoing support is really important for this kind of process.

Casey: What do you think the ongoing support would do in terms of … we say support, but what does that mean?

Joe: Meaning like let’s say, yeah, I just got to a certain point of growth or I just got to a certain issue with a therapist that I’ve never thought would happen an I’m freaking out and I don’t know how to deal with it. I’ve got eight clients today. My office managers suddenly got pregnant. Those kinds of situations happen and it’s very hard to stay rationale and calm and it really helps to have other people who are in the same exact situation giving you objective feedback from a caring place. I just think that kind of support is really invaluable because these things happen. You’re going to hit some bumps. You’re going to have staff problems. You’re going to have infrastructure problems. You're going to have software problems and at times you’re going to have more than one at a time. It really helps to have other people that understand.

Casey: The thing that I like about having this, especially because we’re going to have this form where people can connect with each other. What I’ve discovered is that many people will have had the problem that I have or that you have.

Joe: Yeah, exactly.

Casey: The idea is that they may have a different problem than I have, but they give me feedback. Then you’ll have the opportunity to get the feedback from multiple people.

Joe: Right.


Casey: Okay, excellent. Just want to check in. We had some really good comments coming in here on what people are taking away from today. Some are saying the marketing and the step by step breakdown was most helpful. Somebody else says, “I feel confident in the direction I’m headed …” Joe, I’m hearing feedback on your line.

Joe: Sorry, that should stop.

Casey: Okay. “I’m feeling confident in the direction I’m headed and I’m motivated to hire my first associate.” Woohoo. “The most important parts were the materials, the metrics and the case examples shared of the lessons learned. Also, please answer questions that were previously submitted.” We have answered all questions that are not legal. If you have a question that was not submitted, I need you to resubmit it please.

Those are the things that I see here. We’re just waiting a few minutes to get Steve on the line because I think he had an issue with work today. It might be a moment or two. Joe, I just had to tell you whatever that is settled down there? Okay. All right. A couple of the things that are coming up and again, we’re waiting for Steve, he had an issue with court and so we’re hoping we’ve got to call into him and we’re expecting him. He confirmed as of this morning. He’s probably just delayed a couple of moments.

People ask about if we could post some pictures of our offices. I did want to say that. I just had a video done. Now, several of you have asked about is video powerful and I’m just curious Joe on your thoughts about video as a marketing tool?

Joe: Yeah, I think video is extremely powerful for a couple of reasons. One reason is that it’s much more engaging medium on more senses certainly than text is. People are more likely to stay on your site longer. There’s also a search engine benefit to video because if you upload a video to YouTube and then embed it on your site, it can also show up on a search. The best part of all, video is free these days pretty much compared to a couple of years ago when we had to pay hundreds or thousands of dollars for what we can do now for free.


Casey: Yeah. I decided to experiment and will be able to tell you the results later with getting an office video done and it cost me $375 to have a professional videographer come in and do it. If you go to ocrelationshipcenter.com and click on Couples Counseling you can see the video there. Basically just kind of talks about the center, talks about us. Gives some pictures of the office which is why I wanted to bring that up for you.

Joe: If you think Casey, we know from tracking studies that a lot of people will spend 20 to 40 seconds on a site before leaving. If you have a 2 minute video, there’s a great chance that they’ll watch the whole video if it’s short and they’ll get a sense of you as a person. They’ll get a sense of whether they feel you can be of help to them and they’ll stay in your site a lot longer. There are so many advantages to doing it. I would say this, if your camera shy, which I know a lot of therapists are [crosstalk 1:06:20] do an audio. Oh, there’s Steve. Do you want to …

Casey: Yeah, Steve, hi welcome. We’re just finishing up a question. Go ahead. Go ahead, Joe.

Joe: Yeah, okay, yeah I was just saying, if you’re camera shy you can even make a little slide presentation and PowerPoint or keynote that you just narrate the audio if you’re absolutely uncomfortable being on camera which a lot of therapists are. Any way you do a video it’s a good thing.

Casey: Yes. I recommend Animoto which is just something you could get also. You can just Google Animoto and on OC Relationship Center our homepage it has Animoto video on it so you can check that out too. Okay, great. Well, I’m delighted that Steve Frankel has joined us. Welcome Steve.

Steve: Hi Casey. Glad to be here.

Casey: Okay, great. Let me just stop the recording for a quick sec.

module #8 q&a call · passive income for therapists – with casey truffo and joe bavonese –...

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