Mental health professionals interested in practice opportunities with Northwest Psychological Resources
Our Business Model
First and foremost, it is critical to note that clinicians practicing with NWPR are neither hired by NWPR nor employees of an agency or corporation. NWPR is not a group practice, but rather a consortium of self-employed persons each operating as a sole proprietor of their own business. NWPR is an administrative services company with whom clinicians contract to operate various aspects of their businesses. NWPR serves as a billing and receiving agent for clinician revenue, distributing 100% of this revenue back to the clinician and reported as 1099-MISC income for tax purposes. As self-employed independent contractors, each clinician is responsible for their own retirement planning, health insurance coverage, taxes, and furnishing their office.
The NWPR business model caters to clinicians seeking strong 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. 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. When you are not seeing clients at your normal fee, you are leaving revenue on the table.
The complexities of electronic billing, managing health insurance policies, and accounts receivable 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 allowing you to come to your office, provide your best quality services, and go home knowing your income and accounts will be expertly managed.
The NWPR executive team is comprised of three NWPR clinician associates and the Clinic and Office Managers. This 5-member executive team meets weekly and is tasked with managing the business aspects of NWPR. Executive team members average 1 - 4 hours per week outside their own clinical practices to perform these duties. While executive team members receive small monthly stipends for their work on behalf of all, profiteering is not part of NWPR. All clinicians, including executive team members, 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 and everyone is busy.
Clinician Overhead Costs and Fees
NWPR provides different overhead structures depending on your licensure status and both type and location of your professional practice. All contracts are reviewed on an annual basis and most can be terminated with 90 day notice. The various contracts are described below. The fee structure for each is described.
Standard Associates Contract
Independent and licensed clinicians at NWPR maintain yearly lease and service contracts with NWPR. Overhead for each clinician is the same regardless of type of degree or total number of hours in practice each week. 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 15 standard associates and four persons on non-associate contracts. Overhead revenue to NWPR from non-associates totals $4000, leaving a $39,000 balance. This balance is split equally among associates, totaling $2,600 each. Each associate pays this amount to balance operating expenses and revenue for the month.
This model creates involves fluctuation in overhead as expenses are rarely the same each month. Associate overhead is lowest when all suites are occupied, thus allowing more people to share in the expenses. The executive team works to keep expenses as low as possible. 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
Developing a practice from scratch is difficult and time consuming. In our experience, it often takes 6-12 months to develop a solid referral stream, often depending on the nature of your specialty and how assertive 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. As commonly happens, a clinician under this contract may convert to a Standard Associate contract at any time within this 6 months when they believe they will save money by converting to the Standard Associate rate rather than continuing to pay 40%.
Part-Time and Off-Site Options
These contracts are individually negotiated. Clinicians wishing to shared office space within NWPR for less than three days per week may qualify for a contract based on percentage of revenue rate. NWPR may designate a suite for shared use, or you may independently contract with an existing associate to sublet their suite on days they are not here.
You may operate your practice outside of the NWPR building and pay for your own office space while still having NWPR do most or all your scheduling, billing, and accounting. In most such off-site cases, the overhead fee is a flat 25% of revenue collected on your behalf. A disadvantage is that you may not be able to be able to panel with some insurance companies who contract only with clinicians on-site at NWPR. Both part-time and off-site clinicians also incur monthly costs of maintaining their personal billing and scheduling software licensing fees (see Shared Expenses, below).
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 training options that offer amenities of the practice plus a furnished suite and professional supervision to meet your training requirements. These are based on availability of both office space and supervisors. This contract usually lasts until you gain licensure and an independent clinician, but rarely exceeds more than 12 months.
Other Costs and Fees
Shared Expenses: 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/scheduling software programs and expenses related to credit card payments are among items within this category. Known as "Shared Expenses," such costs are shared equally by associate clinicians which range from $80-120 per month. Off site and part-time associates typically pay roughly half of what on-site associates pay.
Overhead Stabilization Assessment: All full-time 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 and a suite becomes vacant. Having this fund helps 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. Once this account reaches a ceiling amount, no further contributions are assessed.
New Clinician Start-up: Persons just beginning private practice require extensive support to become paneled with the broad range of insurance companies used by our clients. Your income stream will be limited until you can become a provider on these panels. You may obtain and complete these applications on your own, hire an independent insurance paneling specialist, or independently contract with our Clinic Manager who is an expert at this task. We strongly recommend the latter, which will be money well spent. These fees range from $300 - $500, which is much less than hiring an outside consultant. This becomes part of your business start-up costs.
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 busy practice is good for all of us, but final responsibility for making this possible rests with the new clinician.
Getting Your Practice Up and Running
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, gradually becoming more selective once their practice is solidly established.
Once licensed to practice, your speed in paneling with insurance companies is dependent on several factors. These include your timelessness in completing applications and/or working with our Clinic Manager. 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 as there are many providers vying for these 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, etc.) allows for more rapid growth.
Referrals come to NWPR in three ways: 1) Direct referrals to a clinician from outside our office, 2) inter-office referrals from another NWPR clinician, and 3) referrals to any available clinician at NWPR. The last 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 again 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, high quality, and well-marketed product with people standing in line, even if their neighboring vendor is also doing very well.
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 marketing. Nonetheless, it remains worth reiterating that new clinicians need to keep the following things in mind:
Do not be passive and expect full caseloads when arriving.
Have your Washington license to practice and work closely with the Clinic Manager to assertively complete and submit insurance panel applications.
Be prepared for some degree of financial stress during the initial start-up phase of your business.
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.
Remember that it is your responsibility to market yourself sufficiently to produce the referral stream necessary to support your business and revenue goals.
National Health Services Corp
NWPR is an NHSC approved site for their student loan repayment program.
While we cannot guarantee you will be approved, NWPR will strongly support your candidacy and assist with your application.
Many of our clinicians have benefitted from some or all their student loans being paid off using this valuable and generous program.