The “Nuts and Bolts” of How to Build a Group Practice | PoP 253

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The nuts and bolts of building a group practice

In this episode, Alison Pidgeon speaks about the “nuts and bolts” of how to build a group practice.

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In This Podcast


In this episode, Alison Pidgeon speaks about the systems and processes required for running a group practice and how to make it more efficient and streamlined. This includes making use of an electronic health record system, hiring administrative help, and writing down your processes.

If you set up a process and a step in this process gets skipped, it can be very disruptive for the business. The same applies if there is a weak link in the process.

The administrative side of your practice is going to increase dramatically from a solo practice to a group practice. If you’re planning on growing to a group practice, strongly consider hiring an administrative person.


These may include the following:

  • How to schedule a new client
  • How to check insurance benefits
  • What paperwork needs to be completed for an intake
  • What happens regarding rescheduling / taking co-pay

Be sure to write all these different processes down in order to make it very clear to a new employee. Think about the standards you want your employees to abide by within your group practice.


Collect data around as many processes as possible, i.e.: referrals, reasons behind not rescheduling, etc. This will inform your decisions around possible changes to make to improve your practice.


An electronic health record system is a very beneficial and efficient addition to a group practice. TheraNest is a great example of this. Be sure to check out the 21-day free trial! TheraNest means you and your clinicians can do your own billing.


Figure out a clear, efficient way to manage schedules. Try to ensure that your office space is being used from 8am to 5pm every day of the week. You can also use TheraNest to do this.

Useful Links:

Meet Alison Pidgeon

unnamed-300x200Alison is a licensed professional counselor in the state of Pennsylvania. In 18 months she went from starting a solo private practice to building a insurance-based group practice. She now employs 3 clinicians and a virtual assistant. In her spare time she is often seen running after her two small children and her therapy is cooking.

Click here to consult with Alison.




Thanks For Listening!

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Podcast Transcription

File: POP-253 The nuts and bolts of how to build a group practice
Duration: 0:19:51

[START OF PODCAST 00:00:00.20]

Alison Pidgeon: If you have been thinking about starting a group practice, but have no idea how to structure the business, download our free e-book at


This is the Practice of the Practice Podcast takeover with Alison Pidgeon.


Welcome. I am so glad you are here. My name is Alison Pidgeon. I am your host for the Practice of the Practice Podcast takeover. You’re probably wondering why you are not hearing Joe’s voice. He has allowed me to take over the podcast for five episodes to talk to you all about starting and running a group practice. And I am so excited to share with you what I have learned over the past two and half years of running my own group practice. So today’s episode is going to be all about putting processes in place in your group practice and how that’s different from when you were running a solo practice and I realize this is kind of a boring topic. So I am hoping to make it somewhat interesting. But as I was thinking about a metaphor that I could use so that you could kind of relate to another example, I was thinking about cooking and baking. So those two things I really enjoy. And I think cooking and baking are really good example of having to follow a process. Obviously, you have a recipe. You have to gather certain ingredients. You have to put the ingredients in maybe in a certain order for things to turn out correctly. And I think we have all had the experience of messing up a recipe in it, not turning out exactly like we have planned or it gets totally ruined. And I think this happens usually for one of two reasons. One is, maybe we left out a key ingredient that we thought maybe was no big deal, but ended up kind of making or breaking the whole thing. Like, did you ever make a dish that had cilantro in it. If you didn’t have cilantro, you just left it out and then it’s just not the same, it’s just not as good as it would be if it had cilantro in it. Another example that I think about was I got into baking bread for a while and one I had some yeast in pantry that I thought seemed fine. And well, my bread never rose, and so I ended up with a hockey puck of a bread loaf that no one wanted to eat. So obviously having a subpar inadequate ingredient can really affect the result. So now, let’s translate this example to setting up a process in your business. So if you set up a process and somebody skips a step in the process, obviously that can greatly affect the outcome. Like, if you don’t check insurance benefits before the clients comes in and you think they owe one thing and they owe something completely different, that can really be upsetting for the client. Another thing is if you, you know, have a weak link in your process and so maybe some of the time it’s getting done and other times it’s not getting done, obviously that can affect the process as well.

So let’s dive into the content today about talking about really the nut and bolts of laying the foundation of a group practice and how that’s different from a solo practice. And I know you might be thinking what is the difference. You are going to hire therapists. They are going to come in and they are going to provide their bit, just like you do, right? But here is one big difference. Think about all the things you do in your business when you provide treatment and increase it by the number of therapists you plan to hire. So for example, let’s say you only want to hire one more clinician and right you see 20 clients a week, but when that new person comes, all the sudden you have 40 clients a week. And you may only get 3 phone calls a week when you were in solo private practice, but now you are going to get six. So on and on. So the administrative piece of what happens in your practice it’s going to increase and it may increase dramatically depending on how many people you are going to hire. So as a solo provider it may feel very manageable right now, but it’s going to become unmanageable potentially very soon into the process. So that’s why I recommend if you’re thinking about starting a group practice, definitely consider one of the first steps to be hiring an administrative person whether that’s a virtual assistant, whether that’s a billing company, whether that’s a receptionist who will come to your office and work there. I have two assistants. One is a virtual assistant and one is a assistant that comes in to the office and I find them to be totally invaluable, and I will tell you little bit more about how I came to hire them in the next episode all about the hiring process, but the one thing that you should think about is definitely getting some administrative help if you are going to start a group practice. And that may very well be the first step that you want to take.

So now I want to talk about the processes that you need to establish in your group practice, and by process I mean anything that happens that your staff does, a process that a client goes through. Some examples might be for your admin person that answers the phone, may need to need the know the process for how to schedule a new client. That might be a multi-step process. They might need to know how to check insurance benefits. They need to know what website to go to, then how to communicate that to the client. Again, that’s probably a multi-step process. For a clinician, a process might be like what paperwork needs to be completed for an intake the first time a client comes in, what happens with rescheduling or collecting copays? Is that their responsibility? If so, what are all the steps to that kind of process? What I found is that most people in solo private practice have these processes down, but they have not necessarily written them down. So you know, oh yeah, I got a complete XYZ paperwork when a client comes in and that’s all well and good. But when you hire somebody you are going to need to communicate all those processes and so if they are not written down that’s really going to be one of the first steps that you need to take. Get all of that down on paper. So then it’s very clear to your new staff person what they are expected to do and it’s in wrting so then you don’t have to reinvent the wheel every time you hire a new person. It’s all right there. And if they have questions they can always refer back to the paper as well. One really helpful way of thinking about all the different processes you need to map out that happen in your business is imagine the client going through the entire process of therapy from the initial phone call to the day of their last session. What are all the things that happen and that will probably cover most if not all of the different processes that you’re going to need to map out. Something else that goes hand in hand when you’re starting to write down these processes is thinking about the standards that want to have your employees abide by or the standards that you want to have met. So for example, you might want progress notes to be done within 24 hours of the appointment or you might want your administrative person to return phone calls within 2 hours or whatever it might be. But the more specific you can be from the beginning, the better. Because then you are going to have laid out the expectations and there’s not going to be a… you know, your employee was thinking one thing, you were thinking another thing and so mistakes were happening or the standard by which you want to run your business isn’t necessarily being followed and then there is a conflict and all that kind of stuff. So the best thing you can do is make it really clear from the get go what some of those standards are.

The next topic I wanted to cover that kind of flows right into this whole discussion on processes and standards is talking about collecting data on these various things that are happening in your business. So for example, I could collect data on our phone calls really being returned within two hours or our progress notes actually being done within 24 hours, I could collect that data and see how often that’s actually happening. I have a way of collecting data in my electronic health record, actually lots of different points of data, that we will talk about a little bit more in the next section, but a piece of data that I collected that I found to be really invaluable is we keep a regular old google spreadsheet on the number of referrals that we get each day. What day of the week it is, where the referral came from? We also collect information on if we didn’t schedule the reason why. And so my virtual assistant who makes the phone, she keep all the data for me and that tells me so many things. One of them mean which one of the slow times of the year, one of the busy times of the year. If there is a particularly busy time that we got a lot ot phone calls, why was that. And actually I found that when I run Facebook ads for the practice, we tend on get a lot more calls. So it is nice to see, oh, my return on investment there is good. I also take note of why we are turning people away because that may inform me of changes I want to make in the practice like maybe I should find a therapist who does couples counseling or maybe we should consider getting on a certain insurance panel or something like that. So there is so many different things that I can learn from looking at the data. So if you are not collecting data on where your referrals are coming from and when and why certain people aren’t scheduling, I would definitely recommend that you start doing that, and there is actually an example of the spreadsheet in the e-book, so you can see how it is all laid out.

Another area that I wanted to address is how to use technology in your group practice to make things run more efficiently. So when I started and I was in solo private practice, I was using paper charts and I was using a free billing service call office ally to do my billing and I was using a different sort of piece of software to send text message reminders. So lots of things that I needed to run my business and they were all kind of happening in a piecemeal kind of way. And I really felt like it wasn’t as efficient as it needed to be. So when I started the group practice, I figured I should invest in electronic health record. So the surveyed the options and I hear there is a lot of really good options out there and I am not going to spend the time now, sort of going over each one and talking about the pros and cons. But I just kind of wanted to speak to you about my experience using TheraNest because that I what I ended up choosing. And I love the software and it has made my life so much easier and it makes everything run so much more efficiently. And if you are interested in a free 21-day trial of TheraNest, we have a link at, and to be totally transparent. That’s an affiliate link, but I would not recommend that I didn’t use and love myself. So I definitely recommended to everybody I talk to. But what’s nice about the electronic health record is everything in there is connected in patient’s record. It takes literally a couple of clicks of a button and it sends the claim to the insurance company. It takes text message reminders to our clients the day before the appointment. So our not sure rate is extremely low. It’s only one percent. And I know that because TheraNest keeps all kinds of data and reports, like I was mentioning in the last segment about collecting data in your practice as you are obviously putting in client records. It’s aggregating data for you and it’s really helpful to go in there and see the reports and see what data you can pull out of there. So I really like that aspect of it as well. And for me, since I had figured out how to do the insurance billing, I actually have my clinicians do their own billing. Like I said, TheraNest makes it super simple. So I don’t have a biller and that saves me a lot of money as well. So I just feel like if you are going to start a group practice, definitely look into getting electronic health record. It’s going to make your life so much easier. If you are a self-pay only practice, and you are not planning [Inaudible 00:13:24.14] insurance, it might be okay to keep paper charts. But definitely if you are going to bill insurance, I would recommend getting electronic health record.

Something else you need to think about when you are starting a group practice is figuring out a really clear efficient way of managing the schedule. So what I found makes the most financial sense is if you have two to three people sharing one office, because if you think about it the office could be being used from 8 a.m. to 8 p.m. five to six days a week and so even if you have a full time person, they may only be in the office 25 hours week. So you would have time for a whole another full-time person in there and potential another part-time person to be in there as well. So you know I always recommend if you haven’t packed out your schedule or you are not utilizing all your space, definitely see if you can set up a really clear way of managing the schedule. What’s nice with TheraNest is that we can separate out the schedule by location and we can also separate it out by staff. And the staff names are color coded. So then it’s really easy to see when you are looking at the calendar who is where, when, and all that fun stuff. So this is a really great way of making sure you are having good communication among staff in that you aren’t double booking because that would be terrible. So if you are currently in an office, and you are thinking about starting a group practice, I would consider, you know, hiring one person to use the space when you are not in the office and kind of see how it goes before you jump in to renting a whole office suite or you want to go through the hassle of moving and expanding and all that kind of stuff. A really nice way of doing it economically would be just having somebody use the space that you are already in when you are not there.

So to recap it what we talked about today in relationship to really establishing the foundation and “nuts and bolts” of running a group practice, you need to strongly consider hiring administrative help, you need to make sure your processes are written down and you also have standards attached to those processes. And you also need to have some way of having a calendar to make office sharing manageable as well as consider getting electronic health record to make all the processes in your business run more efficiently.

If the content in this podcast series so far has peaked your interest, please consider checking out the free e-book that I wrote all about how to start and run a group practice. I started writing it and I just couldn’t stop. It is now over 8000 words. I think it’s about 34 pages. I probably could have kept going for a while. It probably could be at least double of what it actually is. But I had to stop somewhere. So I really enjoyed writing it and sharing everything that I have learned. And I hope you will check it out.

So I was thinking about how I wanted to end the podcast because Joe has this little catch phrase where he says thanks for letting me into your ears and into your brain. And so I came up with a quote. Quotes are really important to me. It’s something I love and I found a quote that says the distance between your dreams and reality is called action. And I love this because I have big dreams and I love to put them into action. And I know for some people that really scares them, but I love to see kind of the end result of the action that I took, especially when it comes to building a business. So think about all the things I mentioned in the podcast today. You know, maybe you could start out mapping your processes even though you may not be ready to hire a clinician for a while. That’s something you can work on ahead of time and then you would be all set to go when you are ready to hire someone.

Coming up in Episode three, we are going to talk all about the hiring process, both therapist and administrative help. And keep up rate of work. See you next time.


This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guest are rendering any legal, accounting, clinical or other information. If you need a professional, you should find one.


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