7 Figure Counseling Practice Presentation ACA 2014

Building a 7-FigureCounseling Practice

Anthony Centore Ph.D.

Becoming an Entrepreneur

Someone willing to work 80 hours a week to Avoid

working 40

Hands on Entrepreneurship

We needed new rugs

Low Typical Moments

Can I be an Entrepreneur?

Cons PROS

ConsDifficult

PROS

ConsDifficult

Risk

PROS

ConsDifficult

RiskWork

PROS

ConsDifficult

RiskWork

PROSFlexible

ConsDifficult

RiskWork

PROSFlexibleCreative

ConsDifficult

RiskWork


Own Boss

ConsDifficult

RiskWork


Own BossFinancial?

A note on rugs

What it takes to succeed in Private practice

A tale of 2 counselors

Brian

Emma

Advantages

Advantages

Clinical Experience

Advantages

Clinical Experience

Business Acumen

Advantages

Clinical Experience

Community Reputation

Business Acumen

Advantages

Clinical Experience

Investment Capital


Business Acumen

Advantages

Clinical Experience

LuckInvestment

Capital


Business Acumen

Constant Forward Movement

un-catch 22s

Progress > efficiency

CFM

Who’s story sounds more like you?

Not a solo practice

Group v. Solo

Go solo

Simpler

6 Figures

Higher Profit Margin

More Time Counseling

Go Group

Sellable

Fly wheel

Freedom from the couch

less isolating

SHOW me the money

SHOW me the money

SHOW me the moneyA counselor will bill about $75 per session


36 sessions a week = $2,700


36 sessions a week = $2,70048 weeks a year = $129,600



A psychologist will bill about $95 per session



A psychologist will bill about $95 per session= $164,160

SHOW me the moneyJust therapy, without:

Psychological TestingMedication Management

Group CounselingCourt Appearances

Other Ancillary Services

SHOW me the money7.7 Counselors, or6.1 Psychologists

to earn$1,000,000 in Revenue!

$1,000,000 in revenue!

But Wait!

Revenue is not Profit

SHOW me the money

Therapist Compensation

55-70% of Total Revenue

SHOW me the moneyTherapist Compensation

55-70% of Total Revenue

~ $300,000 - $450,000 left

What can you buy with $450,000?

1.08 ct. platinum, fancy vivid blue diamond

775 sq foot apartment, with one bath, in Brookline, MA

Take That, Austin Powers

Not so fast

Operational Expenses

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%Unemployment, General & Professional Liability Insurance: 0-1%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%Unemployment, General & Professional Liability Insurance: 0-1%Recruiting: 0-1%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%Unemployment, General & Professional Liability Insurance: 0-1%Recruiting: 0-1%Computers & Equipment: 0-.5%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%Unemployment, General & Professional Liability Insurance: 0-1%Recruiting: 0-1%Computers & Equipment: 0-.5%Dues & Subscriptions: 0-.5%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%Unemployment, General & Professional Liability Insurance: 0-1%Recruiting: 0-1%Computers & Equipment: 0-.5%Dues & Subscriptions: 0-.5%Insurance Audits: 0-.5%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%Unemployment, General & Professional Liability Insurance: 0-1%Recruiting: 0-1%Computers & Equipment: 0-.5%Dues & Subscriptions: 0-.5%Insurance Audits: 0-.5%Meals, Entertainment & Gifts: 0-.5%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%Unemployment, General & Professional Liability Insurance: 0-1%Recruiting: 0-1%Computers & Equipment: 0-.5%Dues & Subscriptions: 0-.5%Insurance Audits: 0-.5%Meals, Entertainment & Gifts: 0-.5%Furniture: 0-.5%

Operational ExpensesCredentialing, Billing & Credit Card Fees: 7-15%Rent & Parking: 3-7%Reception & Scheduling: 3-5%Office Expenses, Supplies & Postage: 1-3%Admin Salaries: 0-8%Marketing: 0-5% (once at capacity)Research & Development: 0-3%Clinical Supervision & Professional Development: 0-3%Software & Electronic Medical Records: 0-3%Accounting, Bookkeeping & Legal: .5-1%Travel: 0-1%Bank Fees: 0-1%Phone, Internet, Electric & Gas: 0-1%Unemployment, General & Professional Liability Insurance: 0-1%Recruiting: 0-1%Computers & Equipment: 0-.5%Dues & Subscriptions: 0-.5%Insurance Audits: 0-.5%Meals, Entertainment & Gifts: 0-.5%Furniture: 0-.5%Maintenance & Cleaning: 0-.5%

Net Profit

-25% to 25%

Results May Vary

Results May Vary1) Take home the same in solo practice


2) Only money they keep is what they produce


2) Only money they keep is what they produce3) Highly profitable, and self-sustaining


2) Only money they keep is what they produce3) Highly profitable, and self-sustaining4) A combination of self and team best

*Sellable & Real Estate

Getting to Black

Built to Sell

Starting with the End In Mind

Reasons to Sell Include...

Relocate

Career Change

to Liquidate!

Retirement

Think You’re Too Young?

QuickTime™ and aH.264 decompressor

are needed to see this picture.

An “unsellable Business”

Do you know what your Business is worth?

EBITDA, MULTIPLE OF REVENUE,

OWNER BENEFIT, Cost of Starting from

Scratch

Recoup investment in 3 years, and make a living

along the way

12 ways to build Value

Brand

Grow Far Beyond SOlo

Don’t leave potential unrealized

“Potential co-operative marketing with other health related professionals in same location. Potential to expand professional referral network, expand hours/days of operation or add complementary services. Huge potential to leverage social media marketing for targeted local advertising.”

Consider an Earn Out

Finance the buyer

Focus on New Clients

Which would you pay more for?...

A practice with four clinicians performing a total of120 sessions per week, and 8 new client inquiries per month. A practice with two clinicians, performing a total of 60 sessions per week, and 80 new client inquiries per month.

Credentialing

Committed Staff

A psychiatry practice is being purchased from an absentee owner/manager. A few weeks before the close of the sale, the new owner begins working in the practice and begins to implement some basic rules of operation for the administrative staff. They revolt! The staff destroys documents, cancels appointments, refuses to answer the phone, and creates a hostile work environment (they were also, as it was later discovered, stealing from the company). The new owner has no choice but to fire the entire staff, and hire a new administrative team.

A buyer of a counseling practice discovers that the previous owner has overpaid his clinicians by compensating them heavily for completing basic administrative tasks the previous owner did not want to do. The new owner realizes that the practice cannot survive without the clinicians forgoing their administrative duties (along with the extra cash-cow income). The counselors do not respond well to receiving what they perceive as “a cut in pay”, and several leave the practice. Revenues drop by over 40%, and the practice doesn’t recover for over a year.

Assets

A good lease

A BAD lease

The practice has a 5-year lease in a bad location. The buyer would prefer to move the office, but breaking the lease will be too expensive.

A BAD lease

The practice has a 5-year lease in a bad location. The buyer would prefer to move the office, but breaking the lease will be too expensive.

The lease is non-transferable, and the landlord wants a 20% rent increase from any new tenant/owner.

A BAD leaseThe practice has a 5-year lease in a bad location. The buyer

would prefer to move the office, but breaking the lease will be too expensive.


The lease terminates within a year, and the landlord plans to raise the rent more than 5%. Or, the landlord isn’t interested in committing to new lease terms at the present time, creating a big ol’ question mark for the buyer.

A BAD leaseThe practice has a 5-year lease in a bad location. The buyer would prefer to move the office, but breaking the lease will be too expensive.


The lease terminates within a year, and the landlord plans to raise the rent more than 5%. Or, the landlord isn’t interested in committing to new lease terms at the present time, creating a big ol’ question mark for the buyer.

The space is simple TOO BIG for the practice.

Honest & Open

Desirable Location

Finish Strong

...And letting go.

Building the team...is tomorrow

Building the team...is tomorrowFinding


Recruiting


RecruitingInterviews



Contractors v. Employees



Contractors v. EmployeesAvoiding

Nightmare Counselors





Why Practices Lose Their Best

Clinicians






CliniciansOffer Letter /

Contract







ContractOn-boarding and

Training







ContractOn-boarding and

TrainingCreating a

Pipeline

Creating Culture

Zappos

Counseling practices Struggle

Contractors

ContractorsRogue Clinicians


Psychiatrist


PsychiatristOwner-clinician

Not a luxury

Tina Fey

“Don’t hire anyone you wouldn’t want to run into in the hallway at three in the morning.”

Starts with hiringBut doesn’t end there...

Things that worked

Things that worked

Things that worked

Things that worked

Things that worked

1) Respect and gestures of caring

“Thriveworks, at its core, is its team of people…We work to engender great loyalty in the team members of Thriveworks and hope that we are successful in developing and maintaining their loyalty to the point that they elect to stay employed with us for life.”

2) Community

3) Mission

4) Progress

Thriveworks Rank System

Level 1) Assistant Clinician

Level 2) Fellow Clinician

Level 3) Senior Fellow Clinician

Level 4) Associate Clinician

Level 5) Senior Associate Clinician

Level 6) Senior Clinician

Level 7) Distinguished Candidate Clinician

Level 8) Distinguished Clinician

Level 9) Magna Candidate Clinician

Level 10) Magna Clinician

Level 11) Summa Candidate Clinician

Level 12) Summa Clinician

Managing Clinician

Clinician Emeritus / Emerita

your practice, your culture

Spend Money to Make Money

We got Nickels Holding up a Dollar!

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are needed to see this picture.

We got Nickels Holding up a Dollar!

1) Your office building

2) client experience

3) Medical Billing

4) your clinical staff

5) Giving back

5) GIVING BACK

5) giving back

5) Giving back

6) Advertising

10 Biggest Marketing Mistakes

big blind swing

No Tracking

“Only half of my advertising is working.”

“The problem is I don’t know which half!”

Awful social media

bad headshot

technical bio

Spamming

guest blogging

bad website

bad website“Counseling for individuels, couples, and Families”

dingy office

dingy office“You can tell whether a business cares about its customers by how nice the

bathrooms are.”

dingy office“You can tell whether a business cares about its customers by how nice the

bathrooms are.” How are your bathrooms?

How are your waiting rooms?

no advertising at all

i’m about to blow your mind

everything is marketing

The Final 10%

How’s it possible?

The Last 10% is the HARDEST

Odysseus

What’s your 10%?

Are you quitting at 90%?

Are you quitting at 90%?“Clients don’t need wi-fi in the waiting room”

Are you quitting at 90%?“Clients don’t need wi-fi in the waiting room”“We don’t answer the phone, but most

clients will leave a message”


clients will leave a message”“My notes are for me. My records don’t need to

be great.”



be great.”“I don’t want to accept credit cards. Clients

can write a check”



be great.”“I don’t want to accept credit cards. Clients

can write a check”“That old armchair was my great aunts. I don’t

have time to refurbish it”

Are you quitting at 90%?“Clients don’t need wi-fi in the waiting room”

“We don’t answer the phone, but most clients will leave a message”

“My notes are for me. My records don’t need to be great.”

“I don’t want to accept credit cards. Clients can write a check”

“That old armchair was my great aunts. I don’t have time to refurbish it”

“I haven’t dug into new research in years. The most important thing is the relationships with

my clients”

obsession

Be 10% obsessed

Space

SpaceWhite glove clean and

organized

SpaceWhite glove clean and

organizedNo more Poland Spring

SpaceWhite glove clean and organized

No more Poland SpringHallway should smell better



SCHEDULING



SCHEDULINGIntake process simpler



SCHEDULINGIntake process simplerSessions in 24 hours



SCHEDULINGIntake process simplerSessions in 24 hoursNever double book




CLINICAL




CLINICALMore positive psychology

training





trainingProfessional development

program






programMeasure treatment

outcomes







outcomes

VALUE







outcomes

VALUEMore value to clients







outcomes


1st/10th appointment gifts







outcomes


1st/10th appointment giftsMost desirable place

10% is 100%

THE end

Education

7 Figure Counseling Practice Presentation ACA 2014