Mental health professionals interested in practice opportunities with Northwest Psychological Resources
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Our Business Model
First and foremost, clinicians practicing with NWPR are neither employed by NWPR nor by any agency or corporation. NWPR is not a group practice but rather a consortium of self-employed individuals, each operating as a sole proprietor. NWPR is an administrative services company that contracts with clinicians to manage various aspects of their practices. NWPR serves as a billing and receiving agent for clinician revenue, distributing 100% of this revenue back to the clinician and reporting it as 1099-NEC (non-employee compensation) for tax purposes. As self-employed independent contractors, each clinician is responsible for their own retirement planning, health insurance coverage, taxes, office setup, and practice equipment and supplies.
The NWPR business model caters to clinicians seeking robust 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 serve clinicians who wish to come to their in-person or virtual office and see clients for fees consistent with their level of professional training without being burdened by the practical aspects of office administration, billing, receiving, depositing, accounting, scheduling, reception, insurance verification, and accounts receivable.
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 require specific business training and experience that 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 provide your best quality services while knowing your income stream and client accounts will be expertly managed.
Partnership Structure
The NWPR executive team comprises three NWPR clinician associates and the Clinic and Office Managers. This 5-member team meets weekly and manages the business aspects of NWPR. Executive team members spend an average of 1 - 4 hours per week outside their 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, incur the same base overhead costs to support their clinical practices and thus share equally in the clinic's expenses. Because expenses are shared, clinician overhead is at its lowest when all suites are full and everyone is busy.
Clinician Overhead Costs and Fees
NWPR offers different overhead structures based on your licensure status and the type and location of your professional practice. All contracts are reviewed annually, and most can be terminated with 90 days' 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 revenue, overheads from non-associate clinicians).
The following scenario may help to clarify:
The clinic expenses for a month total $43,000. There are 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 fluctuation in overhead as expenses are rarely the same each month.
Associate overhead is lowest when all suites are occupied, allowing more people to share expenses. The executive team works to keep expenses as low as possible. Maintaining a strong trainee/intern program also helps generate revenue to offset expenses. We encourage all associates to complete the training required to serve as clinical supervisors for trainees in 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 build a solid referral stream, depending on your specialty and how assertively you market yourself.
New clinicians are eligible for a "Practice Builder" option, which provides temporary overhead reduction during the first six months of practice. Your monthly overhead fees paid to NWPR are 40% of the revenue you generate in your first 30 days of practice. For months 2-6, it becomes the greater of $500 or 40% of revenue generated. If you are located in a
compact suite, your percentage will be 30% rather than 40%, reflecting the reduced office space. As commonly happens, a clinician under this contract may convert to a Standard Associate contract at any time within these 6 months if they believe they will save money by converting to the Standard Associate rate rather than continuing to pay 40%.
Shared Space Options
At times, two licensed clinicians may wish to share a single office suite, using the office for half the week and providing telehealth services from home for the other half. Since space needs are reduced, their monthly overhead is 80% of what
standard associates pay. For example, if a standard associate with an exclusive office pays $2,600, each sharing associate would pay $2,080.
Part-Time, Off-Site, and Telehealth-Only Options
These contracts are individually negotiated. Clinicians are considered full-time if they are providing at least 3 days of NWPR-supported services per week, regardless where they practice. A clinician may wish to practice only 1-2 days per week in shared office space, operate their full-time practice outside the NWPR building while paying their own office lease, or conduct a home-based 100% telehealth practice while allowing NWPR to handle most or all of your scheduling, billing, and accounting.
In most part-time arrangements, the overhead fee is a flat 30% of revenue collected on your behalf. For Off-Site or Telehealth-only practices, this is 25% of revenue. A disadvantage of either of the latter is that you may not be able to work with some insurance companies that contract only with clinicians on-site at NWPR. If you wish to contract with all insurance companies, NWPR can provide at least some office space per week for you to meet in person with clients as needed or appropriate. Having physical office space available typically meets the basic requirements of
most insurers. If this is your preference, the overhead fee is 30% of revenue. The overhead for an off-site associate is capped at the rate paid to other standard associates. In other words, part-time or off-site associates will never pay more than what a typical full-time associate pays.
Both part-time and off-site clinicians also incur monthly costs for maintaining their personal billing and scheduling software licenses.
Pre-Licensure Contracts
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 include practice amenities, a furnished suite, and professional supervision to meet your training requirements. These options are based on the availability of both office space and supervisors. This contract usually lasts until you gain licensure and become an independent clinician, but rarely exceeds 12 months.
Other Costs and Fees
Scheduling/EHI and Billing Software Fees: All clinicians pay separate monthly fees for their scheduling and billing software licenses. Combined, these total about $55 per month.
Overhead Stabilization Assessment: All full-time associates contribute an additional $50 per month to a fund called the Overhead Stabilization Assessment (OSA). The OSA is a savings account accessed when an associate leaves and a suite becomes vacant. This fund helps buffer remaining associates from major overhead increases by replacing the departing associate's lost revenue and bridging the gap until a new associate is recruited and up to speed.
It can also be used to cover the clinic's unanticipated expenses. Once this account reaches the defined ceiling amount, no further contributions are assessed.
New Clinician Start-up: Persons just begginning private practice require extensive support to become panel-eligible 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 contract directly with our staff, who are experts at this task. We strongly recommend the latter; it will be well spent. These fees range from $500 to $750, 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 remember that you are starting your own business and will need to market yourself effectively to build awareness within the referring community of your presence, expertise, and availability. There are many creative ways to do this. NWPR will help. Quickly developing a busy practice is good for all of us, but the final responsibility for making this possible rests with the new clinician.
Getting Your Practice Up and Running
How quickly your practice develops largely depends on how assertive and timely you are in joining the various insurance panels serving our population. Most new clinicians cast a wide net and join 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 depends on several factors. These include your timeliness in completing applications and your collaboration with our staff to guide you through the process. our clinical specialty area is also a major factor. Supply and demand rules apply in this business, as they do anywhere else. Providers who see only adults for common mental health issues are the slowest to develop their practices, as many providers compete 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) enables faster 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 latter referral type 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 in private practice. This puts us in competition for available referrals. An analogy we often use is a food court at a shopping mall. Shoppers are drawn to a single location to eat, knowing they have a variety of options. This model performs well despite competition, as it attracts a large number of customers to a single location. Shop owners who do well offer an attractive, high-quality, well-marketed product, with customers standing in line, even when their neighboring vendor is also doing very well.
Once the field is narrowed, the intake staff expertly and sensitively presents the client with options 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 decision on whether to accept or reject any new referral.
One of the major benefits of affiliation with NWPR is our strong, positive reputation and the breadth of services we offer. This is complemented by 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 marketing burdens on new clinicians. Nonetheless, it remains worth reiterating that new clinicians need to keep the following in mind:
1. Do not be passive and expect full caseloads when arriving.
2. Have your Washington license to practice and work closely with the staff to assertively complete and submit insurance panel applications.
3. Be prepared for some degree of financial stress during the initial start-up phase of your business. Income will be sparse in the first few months.
4. Be prepared and trained to accept a broad range of referral issues, but also have a specialty niche that complements and adds breadth to what other clinicians offer and meets a high-demand need within our community.
5. 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 currently an NHSC-approved site for their student loan repayment program. While we cannot guarantee approval, and the likelihood of new applications being approved is increasingly slim, NWPR will try to support your candidacy and assist with your application.
