Episode 4: Telehealth Tips for Working Safely with Companies Who Funnel Clients to You
Subscribe and never miss an episode!
iTunes | Spotify | Stitcher | Google Podcasts Overcast | Castbox | Pandora | Amazon Music Podcast Addict | Podchaser | Pocket Casts Deezer | Listen Notes | PlayerFM | Podcast Index Castro | PodFriend
Welcome to the online income for therapists podcast!
what this episode is all about
Are you thinking about joining up with a company that "does all the marketing for you" and sets up all of your software as well? Listen in to hear some tips to ensure that your partnership is ethical, legal, and clinically sound.
Want to Follow Along…
Welcome: (00:12)
Hey, hey my friends. I am so glad that you're here. You're listening to the Online Income for Therapists Podcast where we talk about getting you more freedom, flexibility, and flow by taking the work that you love to do and turning that passion and those years of hard-earned expertise into businesses that work online. Because when your business is online, you can work from anywhere. You can work at any time. We talk about how you can build an online therapy practice, but also businesses like online coaching, whether it's business coaching or life coaching or online membership sites or perhaps online courses. We cover the gamut of the ways that you can take all of your expertise, all of your passion and turn it into a product or products that you offer online. We want to give you that freedom, that flexibility, and that flow so that you can continue to serve more while sacrificing less.
Telehealth tips for working for a company other than yourself: (01:24)
Today we're going to cover telehealth tips for working for a company other than yourself. So if you're working through a company that provides to you all of your video and email, all that good stuff and they provide a funnel of clients to you, those are the companies we're going to be talking about today and how you can work with them in ways that are clinically sound, ethically sound and legal. Sound good? Okay. Let's get to it.
Advocating for your own license working for an agency: (1:58)
I'm going to start by sharing a little anecdote with you. There was a time when I worked for an agency that I believed that the agency was going to know what was right and wrong and if I followed the policy and procedure the agency that I was working for, then surely I would be doing all the right things legally and ethically. Well, a situation came up where a client was asking for a copy of their records and the place that I worked at a policy against providing the full record. Which kind of made sense to me, right? It's all kind of written in like therapist language. It might not make sense to a client. It could easily be in like misinterpreted because we use our jargon in our notes. So that made sense to me and I shared that with the client and shared with them our policy of like we'll give you a summary, I'll write up a summary and we'll give that to you. And the client not satisfied with that. They wanted a copy of their records. And the more we talked about it, the more I kind of got it. Like with my own doctors, I want to be able to get a copy of my lab results and yeah, I might not be able to interpret them, but they're useful for me to bring to other physicians. They're useful for me if I get into Google Scholar and start diving deep, as I am known to do. So I really got this client's perspective and I started looking into the law myself because it started feeling kind of weird. And what I discovered was that the state that I was working in actually said that the clinical records belonged to the client. And so if they wanted them, they got them. Yeah. That was not what our policies said and it really turned things around for me. I became aware that just because something is written in the policy and procedure manual or a contract with whomever you're working for doesn't mean that it follows your state law or your professional ethics. So, from that point forward, I really became an advocate for my own license and I became a guardian for my own license. So the theme of today is that I want you to take that on as well. It really doesn't matter what organization or company you partner with, you are the only person responsible for behaving in a way that is clinically, ethically, and legally sound. And you have to take on that responsibility for yourself.
Structuring, Policies, and Procedures: (04:41)
So sometimes what I hear from folks is that the reason that they don't want to start their own line therapy practice as a private practice as their own company is because they feel intimidated by all of the structuring of the policies and procedures of their own company. But I want to share with you that you need to be doing that anyway because that's the only way to protect your license. I want you to think about the fact that many of these companies that therapists are partnering with that are, that are doing amazing things for clients in many cases, right? They're making therapy accessible, they have tons of money to market and let people know that online therapy is an option. There are a lot of really good things. However, keep in mind that these companies are going to be writing policies and procedures that protect themselves and it would be almost impossible for them to write up a policy and procedure that protected every clinician type in every state. I don't even know that that would be possible with the very best of intentions.
Steps to take while partnering with an organization: (5:52)
So here are the steps that I would recommend that you take if you're going to partner with an organization to get you to your telehealth equipment and get you to clients. Okay? So there's a way to do this and a way to do it ethically and safely.
Reviewing their paperwork: (6:08)
Number one, I would ask any company I was thinking about partnering with to send me all of the paperwork that they send to my clients. And I would want some clarity on are these my clients or do they belong to you? Are they your clients? Now that doesn't change things with regard to your license and liability, but it is kind of a helpful thing to have in mind if somebody becomes in desperate need of emergency services, like who is the “clinician of record”? I would always just assume it's me because I know that I'm going to look after the person, but you really do have to check those things out. So I would first say, please send me all the paperwork that you send to these clients. Then I would read through that paperwork really carefully and make sure that it lined up perfectly with my own professional ethics code, my own professional guidance statements if those exist, and the state law where I'm practicing, where I'm licensed in. So I would read through that and make sure that it matched up. It will be hard for it to match up. So I'm specifically looking for two pieces. One, is there anything not in this paperwork that my state or profession requires my clients to have? And if so, I'm going to make my own paperwork that includes that. That's going to be an addendum to the company paperwork. And number two, are there things in this paperwork that directly contrast with what I have to do in my profession for my state or for my professional ethics? And if so, I need to have a conversation with the company about that. And is that contract editable or is it kind of written in stone? If it's written in stone, I can't confidently work for them because their policy is opposite of my professional ethics and the laws or regulations that regulate my practice. So there is some homework that you need to do. I'd also want clarity again about who is the provider of record. So by law, if something bad went down, who is the person that is on the hook here? Who is responsible for the client? Am I seen as a consultant? Am I their clinician? Like what am I here? And I would want to make sure that in my paperwork with the client that was super, super clear so that they understood, you know, if I leave this company, are they coming with me or do they belong to the company? Or if an emergency happened, do they contact me or do they contact the company? I want all that to be wickedly, wickedly clear in my paperwork. It would be very important to me that the company allowed me to have my own paperwork with the clients in addition to theirs. And again that their paperwork didn't say anything opposite of what mine would say. Okay? Again, your license is your responsibility, not anybody else's. So get a copy of the paperwork that they give to the clients, and then I would also very, very carefully read the paperwork that they give to me as somebody contracting with them. And I would make sure that that paperwork matched for, guess what I'm going to say here, my code of ethics and my state law. Okay. And if there's anything that doesn't, it is your responsibility to iron that out with them in writing and keep that documentation. Then I contacted my liability provider and I would outline everything that I learned and I would say, “tell me now, will you guys cover me if something goes down here?”. If they say “uh, no cause you're contracting with a company and they have their own liability provider and so it'd be on them”, that would make me a little bit nervous because their liability provider is going to back them up before they're going to back me up. So I would want to make sure that my liability provider would still stay with me and would back me up even if the company had their own. So that would be another piece that I would check.
Equipment: (10:35)
One of the other things that I've seen, is that as they are picking out your equipment so you sign up with them and they give you your video and your HIPAA compliant email, et cetera. I would want to make sure that they were using the HIPAA compliant versions of each of those products. And so just in case, you don't know, most of the companies that offer HIPAA compliant software also offer non-HIPPA compliant versions. So it's not enough for them to say, yeah, we're using Zoom for example because there are non-HIPPA compliant versions of Zoom. So I would want confirmation that each of the companies that they're using are in fact the HIPAA compliant versions of those. And one way that you can be sure of that is by asking for a copy of the BAA that they have with that company and then getting that copy in your own records so that you can be sure. Relatedly, if you are keeping records like electronic health records through the company, be really careful about that. So you guys know that I go through iTherapy. With iTherapy, they aren't a funnel for clients in the way that some other companies are. They advertise for clients, sure, but the clients belong to me and iTherapy doesn't have access to be able to see into my electronic health records despite the fact that my money to them each month covers my EHR. The EHR actually belongs to me. So the BAA that I have with my EHR, which is Theranest, doesn't go through iTherapy. It comes directly to me. So, iTherapy pays for it, it's in my name, and that prevents iTherapy and some company from having access to my clinical notes. That makes sense? So you just want to check on these things to make sure that you are completely, completely covered.
Billing: (12:38)
You might also think about the fact that, and I don't know how the billing works for each of these companies, right, but let's say that they're using a service like Stripe or SquareUp or whomever they're using to do any invoicing or billing. If they send an invoice via email or electronically in any way, that invoice is bound to contain some PHI, Protected Health Information. The person's name or their email address or their phone number. All of these are identifying pieces of information and so you're going to want to make sure that their paperwork, their informed consent includes them having signed off on that being okay for them because that's the only way that it is HIPAA compliant. We can't send stuff electronically that contains PHI without having had permission to do so. Now, if your electronic health records is the means by which you bill and invoice, you might already have a build-in workaround. Now, here's the funny thing to me about all of this. It's so much work to figure all of that out, that if you're going to be doing that amount of work, it's hard for me to understand like, well, why not just build your own practice? Because you're basically doing all of the work that you'd be doing to build your own practice anyway minus, let me give a true acknowledgment here, minus the fact that you're not going to have to market, right, because they're going to funnel clients to you. The tradeoff here is that they're going to be funneling clients to you so you're not having to market, but you're going to get a much lower income level. So you might need to see a lot more clients in order to hit the same amount of income that you might be able to hit in your own private practice. So there's a trade-off there and it might be a worthy one. You might just hate the idea of marketing and so like whatever, I'll make less money per session, do more sessions cause I'd rather do more sessions than do more marketing. That makes sense to me, I get that.
Marketing: (14:39)
I would add, and I know this is a bias of mine, my bias is just that the marketing is not as hard as we make it out to be and you don't have to market forever. So yeah, you're going to have to kind of go pretty hard in the beginning. I would say the first three months or so. But then once you build up your caseload, in many ways it sustains itself because you're going to be getting word of mouth referrals, both from the people who have referred to you and have seen that you've had great results, and from your clients who are going to tell their family and friends and all sorts of other people about the great work that you're doing. So to me, the marketing is annoying sometimes. It's really not as hard as we make it. And yeah, you do need to go heavy with it in the beginning. It doesn't have to cost you a lot of money, but it does cause some effort. But then once you've done it, you’re pretty much done. I mean, there's a little bit of maintenance of like, yeah, let's call your referral source every now and then and say hello or Happy New Year or collaborate on clinical care with a client. But that's not all that hard. So to me, the kind of extra output that you have to do in the beginning to get clients in the door sort of pays off. I've seen a lot of people start with a company like the ones we're talking about here just to get their feet wet and to get a feel of how it goes, and then they transition into their own private practice. That also makes a lot of sense to me. Many times they're able to take some of the clients with them and slowly escalate their rate to their full rate, and so they kind of start with a base and then they're able to use the course or whatever to start building up more private pay or insurance-based clients where they're able to get more money for their hour. That makes good sense. If you're going to choose to use a company like this to transition into your private practice that you run yourself, then again, I just want to encourage you to go through the steps that we're talking about here to cover your behind. Yeah, and the cool thing is that once you've gone through these, you'll know how to do them for your own practice.
Video Software: (16:50)
Okay. One other piece that you might not know is that most of these companies aren't just creating their own videos software themselves. They're usually partnering with an established company, and it's totally fine for you to ask, “Hey, what company are you using?” You're going to see it on the BAA’s anyway, but I think it's helpful for you to know because if you love it, then you might use that company when you go into your own private practice or if you're like, Hm, it's never really worked great, then you're going to know that that's not a company you want to pick up when you move into your own private practice.
Emergencies and Crisis: (17:21)
Okay, so let's talk a little bit about emergencies and crises. I would want to be super-duper clear on what happens when there’s an emergency and clear in a couple of ways. One, I'm going to want to know from the company, what do you tell clients to do if there's an emergency or a crisis and what are the resources you give them to make use of that plan? Number two, I'm going to want to know what I can do to help that client in an emergency. So just like you would have in your own private practice, you need to have a risk prevention and risk management plan in place. So for example, you're gonna need to know where the client is. So if they go into crisis, you know how to get them help. You're gonna want to know what is the involuntary hospitalization procedure where they live. I like to get a couple of phone numbers of people that they're willing to let me call in a crisis to support them through that, so I get a couple of emergency contacts. So you still need to think out your own emergency and crisis response plan. You need to be clear about what the company's plan is. But remember, this client is yours and you are likely to be carrying liability for this client and your license is always gonna be the one that's on the line when you're doing clinical work with a client. Right? Like that's, that's just how it goes. You might also want to make sure that if the company doesn't clarify for you that they're only going to send you clients who are in the state where you are licensed, that you get clear about that yourself when you're talking with them. Because as we know, most states require you to be licensed in the place that the client is. So you still are responsible for checking that stuff out as well.
Testimonials: (19:15)
Okay. I think this might be the last piece that I talk about here and that is about testimonials. So one of the pieces that I've been hearing a lot about recently is that some companies are soliciting testimonials from therapy clients and putting them on their website. There are a few things to think about here. So first you want to, and let me be clear, there is a difference between a satisfaction survey that goes to you and maybe to the company but isn't seen publicly and a testimonial which is a public statement of the quality of your work written by a client. So the first piece is that you need to check your own professional ethics and your state regulations about testimonials. The write-ups by our professional ethics are very different across professions. And some of them they say this is a no-go. You cannot do this. In others they say, “you know, testimonials aren't necessarily a terrible thing, but you'd need to not solicit them from vulnerable populations”. So you need to check with yours because it's going to be different everywhere. And then you need to check with the policy of the company that you're working with. And then I would talk to my liability provider because if they are soliciting testimonials on your behalf, you need to check with your liability provider and likely the board in your state and likely your professional body who puts out your ethics statements to see if that's okay. And then you need to check in with yourself and see if that's okay. See if that sits well with you. If the other parties say that it's cool and legit, you know, if they say like, “Hey, you didn't solicit it, this company solicited it”, you need to check in with yourself and see how that feels and you also need to think about that particular client and are they somebody who would feel maybe coerced is too strong of a word, but maybe that they didn't really have a choice about it if they wanted to maintain a good relationship with you. Just really think this stuff through. Nobody can make these decisions for you, but you. You might also if you decide that you're not comfortable with it, ask the company if they just won't do it for your peeps. Maybe that's a compromise that you can make. The last piece here is that I have heard, and this is like, you know, through multiple parties, so I don't, I have not checked on this myself that, some companies are not just requesting testimonials from your clients, but and they might consider them their clients, but also saying, “Hey, if you give us this testimonial, we'll give you X”, like a certain number of sessions free or something like that. And that to me would feel coercive and I would not want someone doing that to my client. So really check the policies and procedures of the company that you're working with. Make sure that they align with your clinical judgment, with your personal values, with your state regulations or your country regulations with your professional ethics code and guidance statements and your liability provider. Okay. As I listen and I just keep, I know it's my bias, I know it's my bias. I know it's my bias, but it just feels like a crap ton of work that you're going to have to do anyway for your own practice, so why not just do it for your own practice? That's my bias. I would love to hear some pushback about that. Maybe in the Online Therapist Group so I can challenge that bias a little bit. I do know some people who have really just loved it as an adjunct to their primary income, which is pretty cool. And we do have members of the group who do messaging based therapy or email-based therapy without even using one of these companies as an intermediary, which is also kind of interesting.
Wrap- up: (23:23)
So there are so many ways to go about your business. I never want you to feel trapped into any particular one or shamed into any particular one. If you're feeling trapped with a company because you don't know how to work out these details, lean on us in the Online Therapist Group, we will help you. If you want to step by step of how to do it, join me in the course. It starts live in November, there is instant access to it right now. I don't know how long that's going to continue, but if you're like, I need to get started now, Amber then go ahead and check the show notes and there will be a link to learn more. Or if you're in the Online Therapist Group right now, you can skip the show notes and you can just click the banner at the top of the page and you will see a link there to learn more. I just want you to be successful in whatever way that lines up for you. I don't want you to feel trapped into doing something that doesn't give you the biggest, boldest, best life, but I also don't want you to feel shamed out of doing something that's working well for you. Okay. So I hope these tips were really helpful for you. I hope that you have a fantastic day. Please make sure that you do join us in the Online Therapist Group if you're not already part of our crew. Today's podcast is brought to you by Step-by-Step. It's an all the things course to building your online private practice. The next live version runs November 2019 but we're taking signups right now. So if you're interested in having someone walk you through every piece that you need to build your online therapy practice, including how to get clients, please do join us. You can check a link out in the show notes, or if you're in the online therapist group, you can just click on the banner, that big picture at the top of the page, and you'll get some texts that shows up on your right-hand side with links to learn more about the course.
access to all the things
★ Be the first to know about “Marketing that Works: Full Fee, Private Pay, Online or In-Office,” a guided experience and course just for therapists by jumping on the waitlist!
→ https://www.onlinetherapistgroup.com/marketingguidedexperience
★ Checkout my YouTube Channel for Additional Support!
→ https://www.youtube.com/channel/UCJ6SueI3KMQIkJ7UctIRvjg/
★ Learn more about the different ways we can connect and I can help support you in building your online therapy practice (and additional income outside of therapy)! Just hop on over here and…
Grab some freebies
Get on waitlists for upcoming offers
Gain support
Book a session with me
Download my informed consent
Learn more about coaching
And so much more…I got you!
→ https://www.onlinetherapistgroup.com/connectwithamber
★ Grab your FREE “Get It Going Checklist” to start building your online therapy practice!
→ https://www.onlinetherapistgroup.com/checklist
AND...don’t forget to join us in our FREE Private Facebook Group!
→ https://www.facebook.com/groups/138663903332494
To learn more about iTherapy, CLICK HERE! If you join, use coupon code OMHO and receive 50% off your first month!
