How to Step Successfully Into Private Practice Expert Jena Castro-Casbon answered questions about starting a private practice in a recent ASHA online chat. The Leader listened in. Overheard
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Overheard  |   November 01, 2016
How to Step Successfully Into Private Practice
Author Notes
  • Jena Castro-Casbon, MS, CCC-SLP, is a private-practice consultant who helps SLPs, occupational therapists and physical therapists start their own private practices (www.independentclinician.com). She is the author of two books: “The Guide to Private Patients” and “The Guide to Creating a Web Presence for Your Private Practice.” IndependentClinician@gmail.com
    Jena Castro-Casbon, MS, CCC-SLP, is a private-practice consultant who helps SLPs, occupational therapists and physical therapists start their own private practices (www.independentclinician.com). She is the author of two books: “The Guide to Private Patients” and “The Guide to Creating a Web Presence for Your Private Practice.” IndependentClinician@gmail.com×
Article Information
Practice Management / Professional Issues & Training / ASHA News & Member Stories / Overheard
Overheard   |   November 01, 2016
How to Step Successfully Into Private Practice
The ASHA Leader, November 2016, Vol. 21, online only. doi:10.1044/leader.OV.21112016.np
The ASHA Leader, November 2016, Vol. 21, online only. doi:10.1044/leader.OV.21112016.np
Participant: How do you approach possible referral sources, and what materials do you suggest providing to them?
Jena Castro-Casbon: When approaching new possible referral sources, you need to be clear about several things: what types of clients you work best with, what the benefits are to working with you, and your best contact info. New referral sources are gold, but developing those relationships can take time. You might get referrals right away or it may take a while to actually get the referrals—that’s why follow-up is important, too.
Participant: My practice took off great with new clients, but now I feel like it has slowed down. Any thoughts/advice?
Castro-Casbon: That’s great that you were able to take off—now we just gotta keep the ball rolling. When it comes to growing your private practice, you need to focus on three things: 1) increasing findability (your ability to find and be found by ideal clients), 2) awareness of your services and 3) relationships with referral sources. By concentrating on all three areas (and not just say, your website, which would be considered “findability”) your practice will start to grow.
Participant: What steps would you suggest to a speech-language pathologist just starting out in her own private practice who wants to hire other SLPs?
Castro-Casbon: Hiring other SLPs is a big step—but necessary if you’re ready to grow. There are several things that you want to consider: You want to make sure that you have enough steady referrals to support them building their own caseload. You also need to make sure that you have space for them to work (if you have a brick-and-mortar practice) or other arrangements. You also need to make sure that you have enough liability insurance to cover them (they should have their own, too), and you should meet with a lawyer and an accountant to see if you should hire them as true employees or as contract workers (easier in the beginning).
Participant: How much time does it typically take to go from ground zero (no clients) to having a sustainable income, and how much time does it often take to start seeing profits from the business?
Castro-Casbon: The time is really variable and depends on quite a few factors. One big factor is how much time, energy and money you have to get started—as well as what type of private practice you’re interested in having. If you’re interested in having a small private practice and treating private clients “on the side” and you have minimal overhead (i.e., treating clients in their homes), you’ll be profitable much faster than if you, say, quit your job, rent clinic space, buy tons of materials, hire employees, etc. I always recommend that people get started with small private practices “on the side” of their regular jobs. This will help you make sure this is really what you want to do and help you get organized from the beginning—before things ramp up too much.

I always recommend that people get started with small private practices “on the side” of their regular jobs. This will help you make sure this is really what you want to do and help you get organized from the beginning—before things ramp up too much.

Participant: As a new grad, my question is about timing. You want to start when you know what you are doing, but you also do not want to put things off for a long time because you feel insecure. How long should a new grad minimally wait?
Castro-Casbon: When you start is really up to you. I always tell people to wait until their services are truly valuable. New grads don’t always get enough credit for their fresh information and big drive, but you lack experience. I don’t have a timeline that says, “You have to wait X years” (but you must have your CCCs!), but you need to make sure you’re valuable. You might want to get an advanced certification in something like PROMPT, LSVT, etc., as parents are seeking out those specific trainings. I started a year after completing my CF—other people wait 30 years! It’s up to you—just be valuable before you do anything.
Participant: I am interested to hear about your clients—I believe I read that you work with adults? That is my interest as well. What Dx [diagnosis] do you typically see? I am getting LSVT certified in a few weeks. I am also very competent in treating adult-onset cognitive dysfunction, dysphagia, etc. Do you find that there are enough adults who want to pay privately in order to have a thriving private practice?
Castro-Casbon: Yes, I primarily work with adults. I love kids (I have one little boy and another on the way), but I prefer to do therapy with adults. LSVT is a fantastic training program/certification to get and then market yourself to neurologists, Parkinson’s support groups, rehab centers that don’t offer it, etc. As you’ll learn, following their program is pretty intense for clients and lends itself well to private therapy (you need to see clients four times a week for four weeks). Many clinicians create packages around this. My current caseload is mostly adults with aphasia and cognitive deficits secondary to traumatic brain injury. I want to give a shout out to Tiffany Taylor of Swallowing and Neurological Rehabilitation. She has a fantastic adult-focused private practice.”
Participant: I have not started seeing private clients yet, but I hope to start building up to going full time. At what point do I need to find an accountant? At what point do I need to consider some sort of business license?
Castro-Casbon: Business licenses are quick and easy to get! Just go on your town/city website to see if you need one. If so, fill out the form, pay a small fee and get a license at city hall. Easy, easy. Accountants are worth their weight in gold. The very first year I treated privately, I was very do-it-yourself (DIY). I didn’t want to spend any money on my business (although I should have! I didn’t have enough tax deductions!). In year two, when I felt like I could afford an accountant, I hired one. I think he was $250—I ended up deducting over $1,000 in mileage alone, which I never would have done without him opening me up to the world of tax deductions. They pay for themselves, and they keep you organized. What I wouldn’t spring for right away is a billing person. Don’t hire a biller till you need one, which probably isn’t for a while if you’re just getting started.
Participant: What did you do or what would you suggest in regard to funding the business?
Castro-Casbon: If you mean buying materials, tests, etc., I personally did a lot of DIY stuff until I had income. I also was lucky to be able to borrow tests from fellow private practitioners until I could afford my own. I’m not a big fan of credit cards but have certainly used them from time to time (make sure to get one with points/rewards). Also, keep in mind that business expenses are tax deductions—save your receipts and deduct those expenses!
Participant: My concern is leaving my job in the future and having the ability to purchase good health insurance for my family. I’m not sure what options are out there for self-employed people. What did you do?
Castro-Casbon: Yes, you need to be financially stable before leaping into private practice. Many state speech-language-hearing organizations offer health insurance for private practitioners. Otherwise, look into high-deductible health plans or Obamacare. But don’t leave your job until you can swing it!
Participant: Can an apartment be used as a home private practice?
Castro-Casbon: Most likely. You need to check with your town. Some towns/cities allow you to use a home office as a place where customers come. Some have rules about separate entrances, parking, etc., and others don’t. If you treat clients in your home, you’ll need general liability insurance and business insurance, too (in addition to professional liability insurance). Start off by seeing clients in their homes.

Get paid on the day of service or in advance—at least until you have a solid relationship with the client and know they are trustworthy.

Participant: Did you take out a small business loan to purchase materials and assessments?
Castro-Casbon: Yes, I did. I was able to pay it off fairly quickly, though.
Participant: With children, what have you found to be the best way to schedule clients?
Castro-Casbon: It depends on the age of the kids. Young ones can often be seen during the day, while school-age kids need to be seen after school and in the early evening, and sometimes on weekends. Telepractice is a great way to work with middle-school-age kids, by the way. Also, think about your frequency and duration. Thirty minutes twice a week might be better than one hour.
Participant: Would you be open to sharing with us your biggest mistake in private practice and what it taught you?
Castro-Casbon: Probably my biggest mistake was not checking coverage for a client before 1) accepting them and 2) billing their insurance. When I first got started, cognitive rehabilitation wasn’t always covered by insurance (still isn’t), and I did a ton of cognitive testing and rehab before submitting to insurance and lost out on a ton of money (at least it felt like a ton at the time!). The lesson: Call the insurance company first and make sure the client is covered for whatever diagnostic/CPT codes you intend to use!
Participant: If you are working a full-time job and a person has asked you to work with their child with private pay, what security measures do you need to have in place?
Castro-Casbon: First, you need to check with your employer to see what their rules are [see the Leader article “Doing the Right Thing After School”]. Most don’t allow you to treat that same client in both capacities. The client is allowed to stop seeing you with your employer and start working with you privately (if they are going the private pay route, they are consumers), but most clients don’t want to do that because they are seeing you for free at your work, and employers see this as a conflict of interest. It’s better to pass on these situations and see other clients. Some people have made this work, but it’s a gray area that I suggest avoiding.
Participant: When marketing in a physician’s office, who is the best person to speak to? Physician, physician assistant (PA), referral coordinator?
Castro-Casbon: The best person to make initial contact with is the referral coordinator/referral nurse. Eventually, yes, you want to meet the doctor and PA, but you usually don’t get to start there. Oh, and always bring treats/goodies in addition to info packets, cards, brochures, etc. You need to find a way to be remembered.
Participant: Any suggestions for starting a practice with other SLPs? I know conflicts can happen with more than one.
Castro-Casbon: Yes, conflicts can happen. I usually recommend starting by sharing office space and nothing more. When you incorporate and form partnerships, things can get a bit crazy and relationships can change. Lots of private practitioners are co-owners or have partners, but it can go sour, too. Start with sharing office space and some general expenses (like Wi-Fi, etc.) before committing. It’s like marriage!
Participant: How do you suggest getting your name out to school district directors? An introductory letter, an email, both? Do you include your rate card or other information up front? Any insight on making that first connection would be wonderful.
Castro-Casbon: When it comes to school district directors/special education directors, I would recommend meeting with them. They are busy (but not as busy as physicians) and making a personal connection is key. Create an info packet with things like an intro letter, list of diagnoses treated, hours, etc. Make sure they know what kinds of kids should be referred to you. In these situations, it’s better to be a specialist (e.g., AAC, fluency, feeding) than a generalist.
Participant: If I am about to start working with my first private-pay client in their home, what type of paperwork do I need to provide them, if any? Besides liability insurance, do I need any other safeguards in place such as HIPAA paperwork or confidentiality paperwork?
Castro-Casbon: You need your own professional liability insurance and a way to document your services. You also need a HIPAA form, consent to treat form, informed consent form and plan of care agreement.
Participant: For someone on the verge of jumping in and starting with their first client, what advice do you have for them in that first six months?
Castro-Casbon: Start fast but build slow/at your own pace. Stay organized! Treat as many clients as you can. Make connections with colleagues, old clients, etc., who might be able to refer to you. Keep track of your income and your expenses and have a good picture of your financial health before reducing your hours or quitting your job. Make connections with other private practitioners! This can be a lonely road but it doesn’t have to be.
Editor’s note: Private-practice clinicians who provide services to Medicare beneficiaries must comply with all Medicare regulations, including the requirement to enroll as a Medicare provider and submit claims for covered services. See “The Facts About Treating Medicare Beneficiaries.”
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November 2016
Volume 21, Issue 11