How To Get More From Your EHR Reports ft. Mandy Wannarka

Uriah
Hello and welcome to the podcast! Today I got a chance to talk to Mandy, who's a therapist who owns a growing psychotherapy practice in Coon Rapids. And through her growth, she has navigated adding employees and therefore payroll benefits and buildouts of their space through expansion. Her combination of clinical and business knowledge allows her to provide practical knowledge to those interested in growing their private practice. Along with her husband, they have expanded into supporting other group practice owners with the pain points on the journey to successfully and accurately paying staff without the huge time commitments often involved with spreadsheets that need data to be refined. I hope you enjoy my conversation with Mandy and the very cool solutions that her and her husband have created. Hi, Mandy. Welcome to the podcast.

Mandy
Hi! Thanks for having me.

Uriah
Absolutely. I'm excited to talk to you today because I think you have created some solutions for group practice owners that are much needed. And I'm excited to get into the nerdy details of all of it.

Mandy
Yeah, I'm excited. We really tried to develop something that really comes from an organic place of my own needs as a practice owner. So it feels like a natural extension to try to cascade the solutions we've created to other people.

Uriah
That's good. They said the best way to start a business is to solve your own problem and then offer that to others. And that's exactly what I did with Productive Therapist, too. That's good. Yeah. You know what'd be awesome is if you don't mind sharing a little bit about your story and your practice and then get into mindful solutions as well.

Mandy
Yeah, absolutely. So I am a licensed clinical social worker. So my trade came up through the ranks as a hospital social worker. And when I decided I wanted to do something different, I joined a group practice locally here in the Twin Cities. And after I got my feet wet there and learned the things that I felt like I needed to learn, I felt a really strong desire to grow something a little bit differently that was my own. And so I hung my own shingle, as they say. And I started my practice, Mindful Wellbeing in 2017, I think it was. And no, that's not right. I don't know. The dates are always so... Covid, I feel like, has created this weird time warped for me. 2017 is when I started as a clinician in private practice. 2019 would be when I started my practice itself. And very quickly, I decided and determined that it wasn't going to be good enough for me to just see my own clients. I needed to create a larger impact. So that's when I pivoted to group practice ownership and started hiring some folks and saying yes. And it's been a journey ever since. We are growing and changing and moving all the time.

Uriah
Quick question on that. When you were working in the group practice previously, did you have the idea that at some point in the future, I want to do this as well?

Mandy
Not initially. I think initially I was very happy to be in the group practice and to be under the umbrella of someone else who could really provide the guidance. And honestly, the business pieces, I wasn't interested at the time. But as you grow and people start seeking you out directly, instead of just being part of a group practice when people start asking for you by name, something starts to shift. And so for some people, they're very happy to stay within that group practice model. And for me, it's a combination of you end up in under group practices, sometimes hitting a limit of what your earnings can be. Understandably, group practice owners need to keep some of the money that you're helping generate. And so that just was the natural iteration for me. Once I could drive my own referrals and people were seeking me out, I wanted to have more control over the business aspects, and I had a desire to learn those pieces.

Uriah
Absolutely. That's cool. So I'm curious, as a group practice owner, what are some of the routine things that take up the most time for you and maybe even for other people that you've talked to?

Mandy
It really varies depending on how you've grown into your practice. But by and large, a lot of us folks aren't trained professionally in business skills. So for me, that has been some of the most time consuming things are just the steep learning curve that is understanding everything from insurance base, which is where we are in insurance based practice, to understanding the cadence of paying taxes and quarterly pieces of that. And then things like, once you grow beyond yourself of payroll and managing people is obviously a humongous part of the job. So I think that those things really take a lot of time. The piece that I don't think, and I would be the first to say I probably did some things out of order of a lot of people because I do have a tendency to jump in and figure things out as I go. And I think they call that a quick starter. So I just jump in and do that. But that does mean that sometimes we have to go back and build out some systems and processes. And so that's the journey I've been on professionally of the last nine months or so has been to really try to firm up some of these things that we've been doing as we go to be more scalable and able to replicate across multiple people. And the other big piece is things about billing. So billing, payroll, anything numbers for me personally is a tall order.

Uriah
I agree with you on that one. Yeah. And it seems like anybody who starts a group practice almost across the board starts by doing absolutely everything from the top to the bottom, which in some ways is a good thing because you're forced to learn, like you said, all the things, the ins and outs of insurance and whatnot. But then slowly over time, as you grow, you need to delegate those things because it just doesn't make sense. It's not sustainable to do everything. And then there becomes certain things that take up the most time, at least in my experience, tends to be like handling intake is a big one, insurance billing is a big one. And then at some point when the group practice grows, certainly payroll can become a beast, can't it?

Mandy
Yeah. And there's so many rules and those kinds of things that you really want to be cautious of and be following, both federal and federal oversight. And it just obviously has this extra layer of responsibility because for a lot of people, this isn't just... I mean, for handful of people who are doing part time, sure, it's just extra income, but for a lot of people, this is their income. And so it's a mindset shift. When I went from just me and maybe there's an insurance payment that's just hanging out, it's been three months, I could be like, Well, I can look at my bank account, I can make it work. I'll make that call to the insurance company later. You don't have that privilege to do that when you end up having people reporting into you because they are depending on those pieces. So you do have to focus in on that systems component to make things running smoothly.

Uriah
Yeah, because the last thing you want to do or the last thing I want to do is not pay somebody or pay them incorrectly because you don't want to mess with somebody's livelihood.

Mandy
That is super critical.

Uriah
I remember when I started my group practice, it was back in 2015, and I actually started with independent contractors because I just felt like there was too much complexity with W2s and paying taxes and running payroll. So I wanted to do it as simple as possible, which was fine. And it worked out well for about a year. And then I decided to switch over because it just made sense for many reasons to do so. And then I found out actually it wasn't as bad as I thought with the right payroll company and the right support. It was actually not too terrible. But then I think when I got to 10 clinicians or so, definitely payroll was taking a lot of time. And I know on your website you talk about wanting to work smarter and not harder. So I was wondering if you could say something about that. I mean, it sounds self explanatory, but I'm curious what that means to you.

Mandy
Yeah, absolutely. One of the things that I learned really early and I continue to learn is that there's really no need to reinvent the wheel. So even though we've got this new endeavor of our business supporting folks and that thing, everything that I have grown and added, whether it's that business or even in my practice, I go to people who have gone before me. I ask a lot of questions of people in the industry. And in some circumstances, of course, we need to compensate people for their time and attention to those things because that's valuable information. But leaning into that collective, the community of people and really diversifying your community or your people you go to when there's different things in front of you is really important. So for me, working smarter, not harder is about building community with one another so that I can... If I've got a new wrench that I haven't anticipated before or seen before, I have three or four people I can quickly do a call or a text or, Hey, have you seen this? And we can come together and they can share their knowledge. And it truly can go both ways. So I try to also give back to other people who are on the road of establishing practices because I've been gifted and granted so much time and energy from people who are doing the same thing. So it's like a pay it forward system. The other thing that comes up when I hear work smarter, not harder is that no matter where you're going in group practice, it's very important, in my opinion, to have clarity around your vision and your values for yourself and your company. If you give yourself that gift early, and it's not an easy process by any means, it's a lot of rumbling. But if you can be really clear on that, nearly every challenge that you can encounter, you can come back to those vision and values and say, Okay, there's misalignment here. Now I know what my answer is. It just provides you clarity around vision making, and that's around people. It's around decisions about growth or not. And it's even around what is the best use of your time, energy, and skill set. So I think that's really, really important.

Uriah
I love both of those things. So number one, use your network and your community and don't try to just figure it out by yourself. And then also focus and refocus on your mission and values. That's always a good idea. I like that.

Mandy
The last thing that came up for me with this particular question comes up for me is around understanding what you're good at and what you should maybe pay someone else to do. Because like you said, when you get into practice, private practice, many of us wear all the hats and it is out of necessity. We're too lean, you can't afford it. All those things are true. But eventually you start to realize what you are really good at and what could be done by somebody else, even better, quicker, better quality, and also what it frees you up to use your energy where you actually are uplifted instead of the stuff that's draining you. So those exercises on the front end about vision values and what's my jam and what is something I would happily, if I had a bunch of money, pay somebody else to do is a very helpful thing and getting clear on where should you focus your time and energy.

Uriah
That's great. Listen, it sounds like you read the book that I'm just writing right now because we're speaking the same language on a lot of these things. That's fantastic. That's good. So I'm curious, I know you have a unique partnership with your husband. I'm curious about how that came together, but how did you come to decide that you wanted to create a solution for payroll and for other aspects of the business? I think you call it data management. Is that correct?

Mandy
Yeah. So it really was born out of a pain point. So as you mentioned at the start of our conversation, a lot of the solutions that people come up with are the best business models or model after things that were pain points. And this is very true for me. So after many, many months of him hearing me, like, it's payroll. Oh, my gosh, this is a big task and feeling the stress of it. And he developed an awareness of how long it was taking me to do. So he would say, you're still working on that or things like that that would just be a nod to his expectation it should have bent down a lot sooner. And so one day, a long time ago, we've roped him in on different business things, so he's got the right credentials, if you will, to be able to help me out in the business where we need it. And so he sat down with me and said, show me what you're doing. And the reason he asked that is because his background is in all of these IT processes. His literal, full time job is organized around simplifying things for people and automating or attempting to automate the processes and standardizing them. So he watched me do my whole payroll cycle, which meant downloading the information from the EHR, big messy spreadsheet where you've got to take out zero payments and all kinds of things, sort it by clinician, apply their splits correctly by copy pasting, right? Just like from the past payroll, things like that. And he said, That doesn't have to take you that long. There's so many things that I could do to make this simpler. And so he built out a program for me where we would upload the file. It runs through that data. It knows what to expect. It knows the parameters that it needs to pull out and simplify. And then it spits out this beautiful report that split into the per clinician piece and also gives me a practice summary so I can see really quickly where is the practice at in any given month. After just doing that just a handful of times myself, I shared with a colleague and she said, right there, that's a business. That's a business. People will pay for that. So we wrestled with it for a bit and what we ended up deciding was, yes, let's build this out for people. And the biggest piece was when we tell people what we do, the immediate piece is like, okay, well, they really ask about the affordability of it. They're asking me questions like, well, you're going to jack up your prices in two years or a year. And I'm like, I don't have intention of doing that. I mean, as a mid practice owner, small to mid, I had to imagine it at a price point that I would pay for. We're not trying to just get a bunch of people enrolled and then jack things up because who wants to pay for that? This particular population I'm trying to target are people like me who don't want to pay a payroll person full time yet. Maybe I'll get there someday, but I'm not big enough. I still want knowledge of my numbers and I want some control over it. But I need some help with the pieces because I have 100 % paid people the wrong thing from the wrong spreadsheet, the copy paste, the wrong splits. All of it has happened to me.

Uriah
And it's because of my own human error. So having these things automated removes a lot of that risk for me of doing that and allows my people to get paid in a timely fashion and correctly without me interfering, if.

Mandy
You will. That's wonderful. Can you give me an idea about the time savings? So like, prior to using this program that your husband created, how many hours was it taking you to prepare payroll on every two week basis? Yeah. So I pay twice a month. And so I would say on average, it was about an hour and a half each payroll. So about three hours a month for me. Certainly, there's people who do it a little quicker or what have you. But there was inevitably something that needed my attention or correction or something. So I would say start to finish. That's what it took. Then now it takes just a few minutes. So I have to download the report, upload it, and then we run the program. Technically, our business says we have up to two business days to get you back the files. So there's a little bit of prepping people in, ensuring the timeliness of things isn't too disrupted. But thus far, we've been able to get the data back actually the same day. We just built in that cushion to grow a little bit. But once you get that report back, it's just a few minutes going into the payroll system and putting those numbers in. We also offer opportunity to automate that a little bit more, too, and get a custom spreadsheet you could just upload to some of the payroll software out there. So you can even remove that potential for error of just even like the miss keying the numbers or copy pasting errors there too.

Uriah
So there's some things like that that we can offer people, which is helpful. So it's really hours to minutes is like truly. And we've had a few people who report that too. I feel like if you can stack some of those types of solutions, you can save so much time. And this goes back to what we were talking about, too, working smarter, not harder, absolutely using technology and services like yours to buy back your time and save time is a huge advantage. That's so cool. It occurs to me, I've thought about this many times, that the structure of most group practices and the way we compensate people is more complicated than a lot of other service based businesses. Even just to compare my group practice to productive therapist, everybody at productive therapist is hourly and they're hourly based employees. So like, calculating payroll is so simple. It's not hard at all. But in my group practice, it's like 10 levels harder, but it's like significantly harder, right? Yeah. So that's a factor. And I know we were working with one of our members just in the last month, and it was taking her like five hours to do payroll twice a month. And that situation was mostly because of the complexity of her compensation structure. So we helped her way simplify that. And then the actual crunching of the numbers became easier. So that's really nice. But the information that most people can get from their EHR doesn't come ready to go, does it?

Mandy
I think that they do their best in a lot of ways. And through this process now, I've had the privilege of seeing quite a few different EHRs in a different light through actual data, which is really cool because when you sample them to test an EHR, it's not the same experience at all. And I say they all take a stab at this. And yet there's still room for improvement. And as we know, the EHRs are really good and handy, but they're not necessarily exclusively focused on and shouldn't be treated like an accounting software. And they also have this limited application even for payroll. So I prefer the messier report, the better. What I mean is the most raw data we can get, rather than using some of the reports that some of the EHRs create exclusively for payroll where they do the calculations or what have you. We really prefer the raw data because we can dive into just some nuances. One of our earliest clients, we found a mistake really quickly that was actually more of a human error piece, but it just, again, highlights how blind we can be to our own processes and understanding it, especially as people, again, trained with those business and numbers pieces in mind. So I think there's a lot of empowerment we provide by getting people these numbers a little bit differently and educating them on some of the nuances of how to maximize their EHR capabilities as well.

Uriah
That's really good. Yeah, we used to have to do a lot manually because I use simple practice and their payroll report was not really usable for a good long time. That was mostly because it didn't export the actual... It didn't show you what sessions and what fees were going into their calculations. Now you can, fortunately, for a while, a couple of years now, you probably know this already, you can export the payroll report, which is pretty reliable and pretty good, and then show it to the clinician as needed to show like, Hey, here's your paycheck and here's what actually where that's coming from. So that's useful. But it doesn't do any calculations. It doesn't do any of the heavy lifting for you, which it sounds like your tool does, which is cool. Your service. Yeah.

Mandy
We also find that people with EHRs are doing a lot of shortcutting, which is really understandable in the moment. You get a retraction from the insurance company and you're trying to make it look pretty for your people and all of that. And so there's a lot of understandable fudging, I guess I would say, people do within. And so part of this process is also helping them understand that we do it in these really calculated ways that work with your EHR. You can get reporting out still that's very accurate, but also is really a good capture of what actually happened versus something you're just trying to correct because it's difficult for some people to make that shift, but it's been, I think, really helpful for them to understand that the data is there. We just have to work with it. And instead of shortcutting it with this solution or this application of a credit or what have you, let's not do that. Let's trust that the EHR is going to spit that out. And it does. So there's just some learning for practice owners, too, about a lot of aspects about things that they don't have the capacity to do, or they just don't know that they should even know about.

Uriah
And how do you support practice owners in getting up to speed with those ideas and making that change? How do you help that happen?

Mandy
I'm not of the opinion that I am any expert over a lot of other people, and I'm right along learning with them a lot of the times. So what I do is just provide, as far as our cadence or our flow is that we filled the inquiry, we offer a free consult to just make sure it's aligned, make sure that what they're asking for is something in the bucket of what we're offering right now. And then we do an onboarding period, and it can be anywhere from two to four weeks, depending on all kinds of pieces of it. And in that, there's a lot of communicating back and forth about trying to get some historical payroll calculations and data as well as the EHR raw data and trying to start building out the pieces that we need. And then we do a lot of checking back and validation to make sure that we're getting close to or at the same calculations. And I only say close to because, again, because of human error and some of the things that people do to just make it work, sometimes we have to make an adjustment there that we don't see to be completely lined up until we're a little bit further. So it can take upwards of that four weeks to really refine how to do it. But it really ends up being a very simple process for people. Every subsequent payroll, once things go live, they have that raw data they upload as well as what we call a clinician data spreadsheet where they record all of the splits, whatever the compensation model is. So splits or hourlies. We're currently working on a client who's got some pretty complicated group data. And so there's really not data that we can't work with. As long as the EHR can capture it, we can write out the... And I shouldn't say we, my husband, is the brains behind all the coding. But he says as long as there's a rule we can follow, we can write a code for it. So there's a lot that we can do to manipulate that data to be what people need on the back end.

Uriah
That's really terrific. I want to put a footnote in here, too, because not only is it important to handle payroll efficiently and effectively for the benefit of your team, but also for any potential audits that happen because it could happen. And it actually happened to me about two years ago. I got a payroll tax audit in the state of California, and they wanted to look at everything for two... I think no, it went back three years. They wanted to look back for three years, and I must have given them hundreds of documents, at least 200 documents. And I needed to show that what I paid people was exactly matched up with how we recorded their time and everything. Everything had to match up, right? So the ability to have records to show that are reliable and that will pass audit is so critical. And it sounds like if people work with you in Mindful Solutions, they will have really good data and records for all the payroll going forward, right? Yeah.

Mandy
The piece that we haven't really fully incorporated yet because there's a lot of nuances a little bit related to the hourly, like the recording of people's actual time worked. There's a lot of interpretation that people do with that. I certainly provide some suggestions and coaching on how to demise it. Usually it's a separate piece that's probably one of the only pieces of manual input we still ask the employer to do. So we ask the group practice owner every payroll to go in and report out number of hours of supervision, that thing. We haven't graduated to just pushing a spreadsheet to them to complete or anything that they... We ask them to have that moment of clarity, mindfulness, intentionality to really round out with the raw data. So that is one piece that we still leave in their camp. Additionally, a lot of payroll companies already have that built in. So they already have the hour tracking component. It's the raw data that they need to put the calculations in. That's what we typically focus on.

Uriah
That makes sense. Well, I'm really impressed with... I haven't even seen anything, but just hearing about it and visualizing it when I hear you talk about saving hours of time every month, every payroll period, I think. I know a lot of people that could really use that. I'm really glad that you and your husband put this together. It's very cool. And where can people find out more and maybe even sign up for a consult? Yeah.

Mandy
So we have a website, Mindful Solutions, mn. Com, and there you can see a little bit more about what we do. In addition to the payroll piece, which has been the primary focus, we've fielded some inquiries and earmarked some projects that are opportunities for growth as we continue to grow. We're looking at potentially publishing some EOS dashboard things, so some more places for people to come and do. Most of the things that we do are subscription based models, so they would be provided like a client portal where they would provide some data to us and we would spit out some metrics and reporting. So that's an area we're looking to grow as well. As well as just funky spreadsheet requests. If you're wanting to do a deep dive in like, Gosh, I need to figure out why this part is happening to my finances or why that piece. We're not necessarily trained formally in those accounting pieces, but especially if it involves raw data and you're just needing some more evidence for or against, should we keep this group up? Or, man, I think we need to incorporate this or this. We can pull some of the revenue and help people understand the data to help make informed choices. So all that is on the table. We have different price points for both the payroll stuff, which is more of the subscription based or the project based work, which we would do with some estimates of time involved and that thing. So there's lots of spaces we're going to be growing. So definitely keep your eyes filled for that, too. That's good to know.

Uriah
Can you give your husband an upvote for me for the EOS dashboard? Because I think that could be amazing. I've actually been looking for and or wanting to create, but I don't have the knowledge and skills like your husband does, some dashboard for group practice owners because there's nothing out there that's... I found some really good spreadsheets that people have created, and those are fantastic, but nothing that excites me. So definitely let me know about that when that comes down the pike.

Mandy
Yeah, absolutely. I mean, that's, again, like personal journey, my business journey and taking that. So the first step is to try to I'm like the test pilot for all the things, right? And then we'll work on it. So that is certainly on the list of things to focus in on. And I think dashboards are definitely a big piece of what's coming for practice owners to understand as we work on continuing to carve out our space with all the different levels of competition there are. Everybody can hang their own shingle, which is great. And there's certain group draws to group practice ownership, but you have to be making informed decisions about where to invest your time, your energy, and your money. And these kinds of things like dashboards are going to be really pivotal for those of us who are in that arena.

Uriah
Absolutely. Yeah, making decisions based on the actual numbers and the data versus just intuition or gut feeling. It's really smart. Excellent. Well, thank you so much for coming on the podcast. It was wonderful to talk to you. Yeah, thank.

Mandy
You so much for having me.