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Apr 20, 2016

Winter Slump

A few months ago I wrote a column about the Summer Slump. Let me preface this month’s column by saying that I realize most people have never heard of a “winter slump” in our field. In fact, for many mental health practices, winter is good for business. Short, dark days seem to carry with them client discontent and malaise. A study published in the American Journal of Preventive Medicine showed that, during the winter months, online searches increase for mental health issues including anxiety, OCD, bipolar disorder, eating disorders, depression, suicide, ADHD and even schizophrenia. Combine that with the fact that people don't have a whole lot else going on, and winter is just a good time for clients to work on their stuff in therapy. From December to February, practices have no trouble paying the rent.

But then, there was last year.

We’re used to harsh winters in New England. We’re used to that long wait for spring, and spying still-melting snow piles in June. But last year (with a record snowfall of 110 inches in Massachusetts) was one of the worst.

Emotionally, by midsummer most people have forgotten about the winter. This year, nobody’s forgotten. In fact, I have more than a few clients who say they “have had it” and are searching for real-estate south of the Mason Dixon Line.

Financially, last winter, a lot of people took a hit. Over 8 feet of snow in one month resulted in roughly one billion dollars in lost profits and wages in Massachusetts alone. Retailers and restaurants were hit hard, with sales reportedly falling about 50%.* When there’s multiple blizzards and a states of emergency, businesses and hourly workers lose. And while some can make up for the lost revenue—for example, if you’re an optician, people still need their eyes checked or if you’re a tailor, people still need their suits fitted—others, such as counselors, can’t make up for lost time (and subsequently, lost revenue). Nobody is doubling up on counseling sessions to compensate for the ones they missed. At my counseling practice, throughout January and February, we were closed almost as often as we were open. Hence, what should have been some of our busiest months were what will be recorded as the leanest of the year.

Recently, even southern states have experienced the effects of harsh winters. In Atlanta, the winter of 2014 brought record ice storms, which resulted in our therapists camped out at the office, or stuck on the highway, for multiple days. The entire city came to a freezing halt—twice! We’ve had similar harsh winters in Virginia and Tennessee.

Will lightning strike again in 2016? Are we living in times of more extreme weather? I have no idea. But, I’d say it’s best practice to establish an inclement weather plan with your clients. Here are three recommendations.

Talk with Your Clients in Advance:

This is something I tried at my headquarters location, Thriveworks Counseling Lynchburg: Talk with your clients about the possibility of using telephone or videoconference sessions, in the event of a winter storm emergency. Do this in advance of an actual storm. Show your clients how such a session would be conducted, and explain all the necessary disclosures about using technology for the delivery of mental health services. Note: the key-phrase here is “in advance.” You’ve waited too long if there’s already an impending storm, as you’ll find yourself trying to chase clients down after they’ve already cancelled their sessions.

I know of one therapist who is making his inclement weather policy a requirement for new clients. Clients can opt for phone, video, or pay a no-show fee, but they can’t cancel for the reason of weather. It sounds strict, and it is, but—financial motives aside—he’s adamant about the importance of uninterrupted and consistent clinical services.

Call Your Insurance Companies & 3rd Party Payers:

Every year, more insurance companies are allowing for the provision of psychotherapy sessions over videoconference. Cigna, Anthem and United Healthcare, in various states, have even created their own dial-a-doc programs. Contact every insurance company, EAP, and other third party payer you’re credentialed with to learn what they will allow as it relates to distance treatment. If they won’t covered online services as a general rule, ask about an exception for inclement weather situations.

If All Else Fails, Consider Reducing Rates:

If your practice, like many, is predominantly funded by insurance companies, and if those payers won’t cover phone or online therapy sessions, consider offering distance sessions to your clients at a reduced rate—or even a co-pay rate. Since you’re offering a service that the insurance company won’t cover, you shouldn’t be in violation of any contract terms (double check, of course). This is a steep cut in hourly pay for sure, but perhaps it’s better to (1) keep continuity of care, and (2) earn some revenue, rather than nothing at all. Your clients will likely appreciate your willingness to do this, as well.

Let’s all hope for a “winter bump” this year, not a “winter slump.” Still, let’s be prepared—just incase this winter brings another rough ride.

Anthony Centore, Ph.D., is private practice consultant for the ACA, founder of Thriveworks Counseling (with locations in 9 states), and author of the book, How to Thrive in Counseling Private Practice. Anthony is a licensed counselor in Massachusetts and Virginia. Find him on Twitter at @anthonycentore or @Thriveworks. 

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