Sliding Scale Without Sinking Your Practice
A sliding scale works best when it's in the budget, not when it’s a case by case, on the fly decision. Decide in advance how much reduced-fee work your practice can carry, write down the criteria, and apply them the same way every time. Without those three things, a sliding scale quietly drains revenue and lands unevenly. It usually favors the clients who are most comfortable asking.
The 8 Numbers I Check Every Month Running a 40-Clinician Practice
There are eight numbers I look at every month, and they take about ninety minutes to review. Not thirty metrics on a dashboard — eight, each with a range I expect and a specific point where I stop and do something about it.
Before You Hire: Can Your Referral Pipeline Actually Feed a New Clinician?
Here is the test, and you can run it this afternoon with your intake log: count the qualified inquiries you received each of the last three months, then divide by the number of new clients one full-time clinician needs per month to reach and hold a full caseload. If that ratio is below about two to one, your pipeline cannot feed a new clinician yet — and hiring will convert a referral problem into a payroll problem.
What Hiring an Associate Actually Costs You
The fee split is not the cost of an associate. It is one line in a stack that also includes payroll burden of roughly 15 to 25 percent on top of wages, your own supervision time at its opportunity cost, two to four months of credentialing before a single claim pays, and a ramp period where the caseload is not full. Most owners I coach are surprised by the total, and it is the surprise — not the number — that causes the damage.
Private Pay vs. Insurance (and Medicaid vs. Private): Choosing Your Payer Mix
Your payer mix — private pay, commercial insurance, Medicaid, Medicare, or a blend — is one of the biggest decisions you'll make, because it shapes both your revenue and who can access your care. In short: private pay usually pays the most per session and is simplest to run, insurance reaches far more clients but pays less and adds admin, and Medicaid reaches the people with the fewest options. Here's how to weigh them.
W-2 vs. 1099 for Group Practices: How to Classify Your Therapists
Whether a therapist is a W-2 employee or a 1099 contractor is a legal classification, not a preference — and it comes down to control. In general, if you control how, when, and where the work is done (set schedules, require your systems, supervise the work), the person is likely an employee, not a contractor. Most group practices that want an integrated team end up with W-2 employees. Here's how to think about it.
How Much Should You Pay an Associate Therapist? (Fee Splits Explained)
Most group practices pay associate therapists through a fee split, and a competitive share is often 55–65% to the clinician when the practice covers admin, billing, marketing, and space. But the percentage alone doesn't tell you whether a deal is fair or sustainable — that depends on what your share actually pays for and whether the math works for both sides. Here's how to think about it clearly, so you land on a number you can stand behind.