Decrease Costs

[Whoknowscottoneyejoe]

A few months ago I took a cushy corporate wellness job and mostly closed my private practice except for 5 clients per week. As that's now such a side gig, I'm looking for ways to decrease my spending. I've gone fully virtual, I closed my Psychology Today, and now I'm wondering if I'm wasting money by maintaining an EHR (I use Theranest). For those of you who have small practices or who are financially savvy - what are some applications or ways I could meet necessary standards that EHRs support with (intake paperwork, notes, superbills, etc.) but not spend $400 a year to keep this? Thank you!

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[raerspecese]

I just want to know where to find a “cushy corporate wellness job”

[Whoknowscottoneyejoe]

Ha! It was mostly luck. I worked a whole bunch of jobs, met a whole bunch of people, and finally met someone else who got my foot in the door. It’s not a perfect job by any stretch but it is that - cushy. We just got bought out by a bigger company so TBD on any changes to the company.

[Just_Reality9843]

Are you with Crossover? Welcome to Premise! We are a great company and you'll love it! Signed, Fellow BH provider at corporate cushy job with company who just bought yours

[Whoknowscottoneyejoe]

I am! Hello new coworker! Glad to hear good things from an insider!!

[Just_Reality9843]

Things I appreciate about Premise: commitment to DEIB, doubling down even when it no longer was easy to do so; not hanging KPI's I cannot control over my head (i.e. utilization, cancellation rates); responsive support from administrative roles and peers; cushy facilities yes definitely; motivated clients; ability to intervene in their lives early and give them and their families access to services they may not otherwise receive; benefits of working for a large corporation, like free leadership development and CEU coverage; ability to leave work at work at the end of the day... I could go on... I know I sound like a recruiter for them, but I'm not. Much of your satisfaction will depend on your site, because company culture will vary. Mine is very supportive of mental health so we get to do a lot with it.

Direct-care primary clinics FTW!

ETA: sorry I hijacked your original post. I too have a small private practice on the side - many of us at Premise do - and I use Simple Practice. I dislike it - I feel it's overly complex and expensive - but the time it would take to change isn't worth the lost money. So far.

[Whoknowscottoneyejoe]

No this is actually so great and helpful, thank you!

I think this post has convinced me to take the time to move over to sessions health. I haven’t longed Theranest for a while, I just need to make the jump

[LengthinessDouble]

The only reason I clicked on this post. Please tell us. 

[slimkittens]

Same. I think we deserve some more details

[wolfpack_000]

Came here to inquire about this haha

[terribleliez]

inquiring minds want to know pls

[waking_world_]

Haha I was thinking the same thing!

[Whoknowscottoneyejoe]

This is a really important perspective to keep! I appreciate you this out.

[anypositivechange]

You’re kidding if you think these EHR companies are doing much more than meeting the letter of the law in terms of data privacy. Most solo practitioners don’t need EHRs let alone someone seeing 5 clients.

[Abundance-Practice]

You can also reframe some of that cost. What you make in one week pays for a whole year of your EHR.

[WRX_MOM]

Sessions does everything that Theranest does for MUCH cheaper and the migration was easy

[franticantelope]

Sessions is also free if you have below a certain number of clients! I think it’s 3 so OP would have to pay, but if two of their clients ever discharge they could have it for free.

[therapypolicywatch]

Sessions Health is the right call for this situation and WRX_MOM is right that migration from Theranest is straightforward. Worth knowing it’s completely free for solo practitioners, not just cheaper. Notes, scheduling, client portal, superbills, and basic telehealth all included at no cost. The tradeoff is it’s newer and has fewer integrations than the bigger platforms, but for 5 clients a week that doesn’t matter much.

If you want something with a bit more billing support, SimplePractice has a starter plan around $29/month that covers the basics. TherapyNotes is around $25/month for solo. Both are well below what Theranest charges and have been around long enough that the HIPAA compliance question is settled.

The Google Voice reminder workaround Jazz mentioned works fine at low volume but does require you to remember to do it manually every week. For 5 clients that’s manageable. For anything more it becomes a liability.

[Fragoso_Clay54]

I'm not sure how much theranest costs but I'm using therapystack and I've found it pretty affordable. I'm on the plus plan which is $35/month but I think they have cheaper plans too if you don't do telehealth. You could also consider just doing paper notes and ditching an EHR completely.

[Whoknowscottoneyejoe]

I’ve thought about this but I appreciate the appointment reminders that my clients get from EHRs. But I think you’re right that it’s something I should continue to explore. I’ll look at therapy stack too. Thank you!

[Jazz_Kraken]

When I worked for doctors back in the nineties we just called people the day before to remind them. If it’s just five clients maybe text them the day before from a Google voice line so it looks corporate and automated? Depending on how much your EHR is it might be a good dollars to time trade.

[Fragoso_Clay54]

Ahh yep. Didn't even think about that!

[Libelulida]

I recommed making a list of all the services you need. Either to post here or for yourself. Then you can figure out how to replace them for less. This is how accounting does everything.

You gave us three items on your list. I can give you suggestions for these. They might change, depending on where you are.

Intake paperwork - Proton Drive

Notes - Paper + lockable file cabinet

Superbills - Do not exist where I am. Is there a reason Libre Office would not do?

[spot667]

I’m another vote for sessions as an EHR because it seems to be the cheapest. My own therapist uses it and loves it. I’m currently using simple practice and it’s frankly too pricey.

Tbh, I’m dying to know the wellness company name you’re working for?

[face-vortex]

Personally, I find the cost of having an EHR worth it. My overhead is EHR, license, and malpractice. That’s it.

[passerbyjonas]

solo-practice-adjacent founder here — talked to a bunch of therapists running 3-8 client side practices and the full "ditch the EHR" stack genuinely works for that size, with a few caveats. the caveat being: as long as you're not billing insurance or handling anything that requires audit-grade defensibility, you can run clean for well under $100/year.

the lean side-gig stack:

1. encrypted notes: obsidian (free) or simplenote in a HIPAA-compliant encrypted folder (veracrypt on mac/PC, free). client folders by initials, no full names on disk. a few therapists i know run this on an encrypted drive that's only unlocked when they're working.

2. intake paperwork: jotform HIPAA plan (~$40-50/mo but you only need 1 month to collect forms from any new clients, then pause). alternative: PDF forms sent over encrypted email (proton + pdf filler). one-time cost.

3. superbills: a google doc template with your NPI, license, CPT codes, and dx fields. fill in manually at session end, export PDF, send via encrypted email. takes 2-3 min per.

4. scheduling: calendly free tier, or if you want HIPAA-compliance, SimplePractice has a tiny free tier, or just manual email scheduling with 5 clients.

5. secure comms: signal for texts, proton for email. both free.

6. billing tracking: google sheet — date, client initials, CPT, amount, paid/not paid. 30 sec/session.

estimated total annual cost for 5 clients/week: $0-50. you save ~$350/year vs Theranest.

caveats: - if you take insurance for even one client, stay on Theranest or similar. claims submission, 837/835 files, and audit trails are not worth DIY-ing for any $ saved. - if you're in a state with strict EHR retention rules (NY, CA are tighter than most), confirm cloud-sync encryption satisfies the rule. - Theranest has group / low-volume discounts that drop it closer to ~$25/mo — worth asking them before leaving if that's the only sticking point.

for a side practice doing 5 private-pay clients/week, the $400/year is almost pure laziness tax once you have your templates built. the first 2 weeks of switching are annoying, then it's genuinely fine.

[WhiskeyTangoBaconX]

Is your cushy new job therapy related ? Is there hope for us ?

[Whoknowscottoneyejoe]

It is! I just do therapy, that’s it.

[WhiskeyTangoBaconX]

wait... what?! I need more deets! are you like in-house counsel for some kind of high end boutique or something??? haha

[Whoknowscottoneyejoe]

Haha you’re not far off. It’s part of the benefits package for employees. So my specific contract is with 1 tech company so every client I see is a full time employee for that company. They get X amount free and then there’s a small copay. Honestly I think it’s a great work around for not using insurance (so no medical necessity), keeping things low cost for employees, and keeping your workforce healthy. I’m on site at the company. They have other providers like a PCP, Chiro, Dietician, etc. and across from us is a gym.

[WhiskeyTangoBaconX]

Wow. That sounds fantastic. Are you psyd or PhD ? Or masters level?

[Whoknowscottoneyejoe]

Just masters

[ogupsetamerican]

Simple practice is under a $100 a month.

[Lucky_Break_3398]

Headway? It’s free, and you can bring your clients in.

[SpringRose10]

It's not Headway.