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The business model of NWPR caters to clinicians who want high levels of administrative support. Some clinicians prefer the "Do It Yourself" model of practice, using answering machines and doing their own scheduling, billing, and accounting. Some clinicians do some of this, and contract with outside sources for other services. We understand and respect this model.

NWPR was founded to service clinicians who wish to be able to come to their office, see clients for fees consistent with their level of professional training, and return home without being burdened with the practical aspects of office administration, billing, receiving, depositing, accounting, scheduling, reception, insurance verification, and accounts receivables. Our business model assumes that your revenue potential is diminished whenever you engage in activities that take away your ability to provide professional services, and when these activities could be assigned to support staff at a considerably lower hourly cost. Basically, when you are not seeing clients at your normal fee, you are leaving revenue on the table. The modern complexities of electronic billing, managing health insurance policies, and accounts receivables requires specific business training and experience most clinicians rarely receive in training. Fortunately, NWPR administration team members are experts in these issues. As much as possible, NWPR attempts to provide a “turn-key” practice experience for clinicians.

NWPR provides different overhead structures depending on your training level, licensure status, and type of professional practice. All contracts are reviewed on an annual basis. The various contracts are described below.

1. Partnership Structure

The NWPR executive team is comprised of two original corporate founders of NWPR, an Associate Partner Representative (APR) from the pool of full associates rotating every three months, and the Clinic and Office Managers. This 5-member Executive Team meets weekly, and is tasked with setting a budget for the July to June fiscal year based on projected clinic expenses. Executive Team members engage in many administrative activities each week, averaging between 1 and 4 hours per week outside their own clinical practices. While Executive Team members receive small monthly stipends for their work on behalf of all, profiteering is not part of NWPR. All clinicians are subject to the same base overhead costs to support their clinical practices, and thus share equally in the expenses of the clinic. Since expenses are shared, clinician overhead reaches its lowest potential when all suites are full.

With respect to any costs over and above the overhead fee, NWPR clinicians may elect by vote to fund certain activities and projects (i.e., marketing and advertising costs, specific amenities not already covered within the overhead fee, etc.). Individual licenses for our billing and scheduling software programs are also covered under this category. Known as "Shared Expenses," such costs are shared equally by clinicians, and are currently about $95 per month.

Finally, all current full associates contribute an additional $50 per month into a fund termed the Overhead Stabilization Assessment (OSA). The OSA constitutes a savings account that is accessed when an associate leaves the practice to help buffer remaining associates from any major increases in overhead by making up for the loss of revenue from the departing associate and to bridge the gap until a new associate is recruited and up and running.

2. Management of Referrals

A steady stream of referrals is the lifeblood of private practice.  It is critical to keep in mind that you are starting your own business, and will need to market yourself sufficiently to create awareness within the referring community of your presence, your expertise, and your availability.  There are many creative ways to do this. NWPR will help.  Quickly developing a lucrative practice is good for all of us, but final responsibility for making this possible rests with the new clinician.

Our observation is also that how fast your practice develops is largely contingent on how assertive and timely you are at getting on the various insurance panels serving our population.  Most new clinicians cast a wide net and get on as many panels as possible, and gradually become more selective once their practice is solidly established. 

Your clinical specialty area is also a major factor.  Rules of supply and demand apply in this business, like anywhere else.  Persons who only see adults for common mental health issues are the slowest to develop their practices. There are simply a lot of providers vying for these limited referrals.  On the other hand, having unique specialty areas and/or the ability to serve high demand areas (e.g., children and teens, psychological assessment, forensic work, etc.) allows for more rapid growth.

Referrals come to NWPR in two ways: 1) Direct referrals to a clinician from outside our office or an inter-office referral from another NWPR clinician, or 2) Referrals to any available clinician at NWPR.  The second type of referral is triaged by our intake staff.  There are many things to consider, including age, presenting problem, client preferences, who is paneled on the new client’s insurance, and the availability of clinicians to take on new clients. 

It is also worth noting that everyone practicing at NWPR is an independent contractor and in private practice.  This essentially places us in competition with each other for available referrals.  An analogy we often use is a food court at a shopping mall.  Shoppers are attracted to one spot to eat knowing they have a variety of options from which to choose. This model works well despite the competition involved, as it draws a large volume of customers to one place.  Shop owners who do well provide an attractive, superb, and well-marketed product with people standing in line, even if their neighboring clinician is selling hot dogs at a furious pace.

The intake staff expertly and sensitively provides the client options once the field is narrowed, and may specifically recommend a clinician who seems well-suited to the referral issue.  New clinicians work extensively with the intake staff to clarify appropriate referrals to their practice.  The clinician has the final word in accepting or rejecting any new referral.

One of the major benefits of affiliation with NWPR is our strong positive reputation and breadth of services offered. This is combined with intensive assistance new clinicians receive before, during, and after getting their practices up and running. Few practices offer this level of support. This allows NWPR to enjoy a steady stream of referrals, and has historically placed few burdens on new clinicians for aggressive marketing.  Nonetheless, it remains worth reiterating that new clinicians need to keep the following things in mind:

1. Do not be passive and expect full caseloads when arriving.
2. Be prepared for some degree of financial stress during the initial start-up phase of your business.
3. Be prepared and trained to accept a broad range of referral issues, but also have a specialty niche that compliments and adds breadth to what other clinicians are offering, and meets a high-demand need within our community.
4. Work closely with the Clinic Manager to assertively complete and submit insurance panel applications.
5. Remember that it is your responsibility to market yourself sufficiently to produce the referral stream necessary to support your business and revenue goals.

3. Types of Overhead and Service Agreements at NWPR

Post-Licensure Contracts

Standard Associates Contract

Independent and licensed clinicians at NWPR enter into a yearly lease contract with NWPR. Overhead for each clinician is the same regardless of type of degree or total number of hours in practice each week. Essentially, all standard associates share equally in monthly clinic expenses, after revenue from all other sources is accounted for (e.g., trainee and psychometrist revenue, overheads from non-associate clinicians). The following scenario may help to clarify:

The clinic expenses for a month total $43,000. There are 13 standard associates and four persons on non-associate (training, psychometry, or practice builder) contracts. The income from non-associates totals $4,000, leaving a $39,000 balance. This balance is split equally among the associates, totaling $3,000 each. In this coming fiscal year, we expect associate overheads to average roughly $2900-3200 per month.

This model creates some degree of fluctuation in overhead each month, as expenses are rarely exactly the same.  Associate overhead is lowest when all suites are occupied, thus allowing more people to share in the expenses. The Executive Team’s effort on behalf of all to keep expenses low is the other side of this equation. Maintaining a strong trainee/intern program also helps bring in revenue to contribute to expenses.  We encourage all associates to obtain training necessary to serve as clinical supervisors for trainees within their respective disciplines.

Practice Builder Option

We understand that developing a client base from scratch is difficult and time consuming. In our experience, it often takes up to a year to develop a strong referral stream, often depending on the nature of your specialty and how aggressive you are a marketing yourself. New clinicians may be eligible for a "Practice Builder" option allowing for a temporary overhead reduction during the first six months of practice, after which you will move to a Standard Associates contract. This option entails a base overhead that is the greater of $250 or 40% of gross revenue the first month, $500 or 40% in months 2 and 3, and $1000 or 40% in months 4-6. In exchange, you receive all NWPR amenities and a private suite to furnish according to your unique tastes and needs.

Pre-Licensure Contracts

Non-Licensed and Residency Option

Many of our most productive clinicians began as post-graduate counseling and psychology residents with NWPR, choosing to stay as Associates after developing a thriving practice. For eligible clinicians, we offer a Training Option that entails the following:

Month 1: Overhead is waived
Month 2: $250 or 50% of gross revenue, whichever is greater
Months 3-12: $500 or 50% of gross revenue, whichever is greater

In exchange, the NWPR partnership offers all the amenities of the practice, plus a furnished suite and professional supervision to meet your training requirements. This contract usually lasts until you gain licensure and an independent clinician, but rarely exceeds more than 12 months. At the end of this period, you may elect to enter a Practice Builder or Standard Associates contract. Residents are expected to personally incur the costs of commuting, relocation, and housing.

4. Practicum and Internship Training Options

Based on availability of both office space and supervisors, we are occasionally able to serve as a practicum or internship site for students who are early in their training and require supervised activities in interviewing, counseling, test administration, and report preparation.

These are unpaid and time-limited positions tailored to meet the requirements of your training program. Advanced students may be assigned individual clients, while most students serve as co-therapists and observe senior clinicians performing diagnostic interviews, testing, and therapy. Any revenue generated by the student clinician is returned to the clinic to help cover administration costs.

Although NWPR is not an APA- or APPIC-accredited training site, pre-doctoral clinical psychology interns may be accepted. This training is generally full-time, 9-12 months in duration, and is tailored to meet the needs of your training program. Although structured very similarly to the Residency Option described above, interns typically do not pay overhead, but may negotiate to receive a monthly stipend, a fixed percentage of revenue they generate, or personally collect any revenues beyond a base overhead fee negotiated with NWPR. Interns are expected to personally incur the costs of commuting, relocation, and housing.

Certification Requirements for Pre- and Post-Graduate Trainees

In most cases, NWPR requires pre- and post-graduate trainees to apply for and obtain license certificates as either a Licensed Mental health Counselor Associate (LMHCA) or as a Certified Counselor (CC) within the State of Washington. Since this application may take some time, trainees should begin the application quickly and preferably complete it before beginning.

On a practical level, unlicensed students providing free or very low cost services are rarely able to generate sufficient revenue to offset the clinic and supervision expenses they generate, or to get adequate client contact hours to meet requirements. Having either of these licenses will allow the trainee to contract with a few insurance companies. This will greatly increase the range and number of clients they can see, and allow them to bill for services that produces adequate revenue. If you are considering a practicum, internship, or post-graduate position with NWPR, please perform the following two steps before contacting us:

Step 1: Review the Washington State Department of Health website to ensure that you are qualified for at least one of these certifications.

Certified Counselor http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/

Licensed Mental Health Counselor Associate http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/

Step 2: If you are still enrolled in classes, contact your training institution to make sure they do not have prohibitions about you seeking either of these licensure levels for the purposes of this training experiences during the course of your study.

Undergraduate students in psychology who are simply wishing to job shadow or gain class credit for activities within a mental health setting do not need to apply for these credentials.

5. Part-Time Options

NWPR may have shared office space available for use by persons wishing to practice 1-3 days per week with NWPR.  There are two basic options offered under this plan:
Option 1: NWPR associates may, by majority vote, designate a suite as reserved for use by part-time clinicians.  The shared space is available 7 days per week. Scheduling is negotiated by the clinicians using that suite, typically based on seniority (“First come, first schedule”). If NWPR provides this suite, 35% of the part-time clinician’s monthly revenue is assessed to cover both office space and full administrative support.  Our goal would be to place enough part-time individuals in that suite to provide income to the clinic roughly equal to what a full-time associate would offer.

Option 2: Part-time clinicians may also sublease the suite of an existing NWPR Associate.  The cost for subleasing this space is entirely at the discretion of the Associate and subleasing part-time clinician.  At that point, the part-time clinician essentially becomes “off-site,” meaning they are funding their own space and contracting with NWPR only to provide administrative support, similar to the Off-Site option described below.  Their overhead is 25% of monthly revenue.  

In either case, the clinician must also go through the same interview and vetting process as would any NWPR clinician.  A part-time clinician would also be responsible for the full costs of their billing and scheduling software licensing fees, which are about $50 per month, combined.  These costs are fixed regardless of revenue generated.

6. Off-Site Options

Administrative support services provided by NWPR can be extended to persons not physically located within the Keystone Professional Building. Licensed and independent clinicians developing a practice or who are already practicing in their own community may elect to contract with NWPR to provide for the administrative aspects of their practices.  This contract would also apply to someone wishing to sublease space from an existing NWPR Associate.

Services include phone answering, 24-hour answering service, scheduling, insurance benefits checking, electronic and paper billing, revenue collection and accounting, accounts receivable, affiliation with the outstanding reputation of NWPR, access to insurances panel contracts we have secured (unless prohibited by your location), and assistance with panel applications in your community.  These amenities allow you to enjoy your own private office with relative freedom from many of the administrative burdens taking you away from doing what you do best – providing revenue-generating client services. Contracting with NWPR to perform these activities on your behalf can be an excellent way to free yourself up from administrative burdens, spend more time seeing clients, and improve the image and accessibility of your practice to both your clients and referral sources.

Clinicians practicing outside of the NWPR facility are expected to lease and furnish their own office space. Monthly overhead for an off-site clinician would be 25% of revenue collected by NWPR on their behalf. 

Off-site clinicians would need to incur some technology-specific costs normally included in starting your business with NWPR. For example, the clinician would need to purchase user licenses for both our billing and Web-based computerized scheduling programs. These each run about $50 per month. Clinicians would also need to purchase an Aastra model 6731i VOIP telephone (approximately $115), and have access to high-speed Internet connection within their office. You will also need your own fax or PDF scanning device to exchange documents with NWPR.   These services allow for billing and account management, real-time and coordinated scheduling of clients, and access to our telephone and voicemail systems.

If you are a licensed clinician practicing in another community or state and would like to discuss off-site affiliation with NWPR, please contact Dr. Steve Meharg at 360-414-8600 x130, or smeharg@cfmal.com.

7. Business Launch Fee

Getting you up to speed and paneled on our major insurance companies is a time-intensive task, even before you see your first client.  Fortunately, our staff is expert at this process.  A Business Launch Fee of $750 is paid at the time a clinician agrees to affiliate with NWPR and designed to defray the costs of 20+ clinic manager hours devoted solely to their credentialing and insurance paneling needs before assuming occupancy or paying overhead. Clinicians already licensed and paneled on two or more insurance companies may be eligible for a reduced of $500.  These costs are fixed regardless of how many days worked per week. This fee is non-refundable.

8. A Special Note to Psychiatric Providers

Prescribing psychiatrists and nurse practitioners often have higher-volume and more complex practices then do counselors, social workers, and psychologists. In addition, our experience in multi-discipline partnerships suggests that psychiatrists often expect and require a higher level of staff support than do other clinicians providing mostly hourly-based psychotherapy services. Although basic overhead rate is the same regardless of professional degree, a psychiatrist may be responsible for hiring a personal assistant (part- or full-time) to accommodate his/her needs, assist in managing his/her accounts, and provide other patient needs (i.e., contacting pharmacies, labs, etc.). This assistant will co-report to both the psychiatrist and the NWPR Office Manager.