Subject: Fees & Cancellations - Low-Fee-Scheme From: "Lacap" <mail@psychotherapy.me> Date: Tue, May 4, 2010 8:14 am Priority: Normal Mailer: SquirrelMail/1.4.10a Options: View Full Header | View Printable Version | Download this as a file Dear Student Therapists Following an interesting meeting with Andie Newman, I would like to draw three things to your attention. FIRSTLY: I have found a way to rejig the appointment manager so that the emails are now sent out in your own name, rather than LACAP & signed off by Phil Rickwood. Similarly, when the patient replies to this email, they will be replying direct to you, with LACAP receiving a copy of that. This will mean that you can take responsibility for accepting cancellations or rescheduling etc. This should go against the trend pointed out by Andie that you have previously been sidelined in such transactions, and which are obviously a clinical variable and a part of the therapeutic relationship. It will mean that you have to 'up' your administrative game. But the benefits of direct correspondence should be real. If you simply cannot face up to this addition of responsibility, please let Yoko or Phil know, and we will try to find a way to notice and work with the copy mails that we do receive. SECONDLY: What is your cancellation policy? For instance, while LACAP does make 'on-line' cancellation available to the patient at 48 hours notice, it is off course possible for you to agree other cancellation policies with the patient. You can direct the patient, and stipulate in your contract that you have a stricter criteria. For instance, more than one therapist with LACAP disallows patients from cancelling this way, and instruct the patient that they will only accept cancellations by mobile phone call direct with the therapist (thus raising the 'hurdle' for cancellations somewhat - the therapist can always pick-up!). You have other variations, permitting/disallowing mediums, but in essence agreeing with the patients that cancellations/reschedules are a matter between the therapist/patient and are in effect a part of the treatment. As it is, there is an argument that by proposing to accept cancellations by any route and medium available and to any person at LACAP(phone & mail to reception, on-line), the hurdle is neither a personal one nor a particularly significant one. You might wish to reconsider how you agree the terms of your contract with your patients, should you have concerns that the ease and fluidity provided by all mediums at all hours via reception is undermining establishing the working relationship. Should you wish to extend this to avoid your patient's making mistakes, we can (and do) put a prominent note on the records that reception are to not accept late cancellations/reschedules etc etc until it has been asked for by you, as their therapist. We note that across the student body as a whole cancellation rates are at 37%. We do think that this variable is worth your consideration. THIRDLY: In private practice fees are an important clinical variable. At LACAP this is interfered with: the fee is set and paid at reception. You are not always aware if ther are arrears or difficulties, and we have not made it clear if you are expected to take a stance about that. The patient often seems to run away with the idea that this can be a seperate negotiation with Reception, and you will never know about it. My suggestion is that if you are aiming at best practice, the fee should be 'in the room'. It would be possible, for instance, to stipualte to the patient that you would expect them to have paid each session, and that they should know to mention it to you if they have not paid (variable-lite). More robustly, you might ask the patient each and every session if they have paid up to date - either at the start or finish of the session (variable-full). These practices should make sure that the fee is in the room as something which can and should be talked about with you as a part of the treatment overall. If you want to keep on top of the patient's payments, this is and always has been available information to you. You have a PC in your room, and the web browser is set to open onto your 'Members Logon'. In the Appointment Manager - when you open up an appointment to look at it, at the top right you have a button marked 'PAY'. If you click on this a note of the fee due that session and any arrears outstanding will open in a pop-up box. So, you can review for fee balances and outstanding the night before, or in the 10 minute break between patients, and know if there are arrears that can be discussed. ____________________________________________________________________ What I am talking about is that there are Reception proceedures that are in place, and you can rely on these aspects of work being handled for you, if you want to neglect them. However, good practice will mean that cancellations, reschedules, and other negotiations for meetings are best handled by you, and that fees are a clinical variable that should be in the room - and that there are possible ways for you to manage and control these variable in the current set-up if you want to be more robust and assertive in your clinical prescence. I am of course available to discuss this further, if I can add any clarity to what I am talking about. Best Regards, Donald Kirkpatrick PS Historically the online cancellation and email to reception cancellations were put together because therapists were not handling their administration of these things timeously nor efficiently. These facilities do unfortunately need to remain, because some therapists choose not to administer in these areas. However, in my mind these are 'bottom line' safety nets. Therapists that are aiming at best practice and/or maximising the transference relationship can take more control of these variables by 'upping the game', and making sure that the patient understands what the therapist expects in the way of cancellation proceedures, routes, payments etc.