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NOTES FROM THE EDITOR

You're not a cookie

When I lived in Colombia, there was a common saying: “Bueno, bonito y barato.”

It translates to “good, pretty, and cheap”, and it’s used to describe anything that sounds too good to be true.

I'm bringing this up because I often see the internal conflict that therapists struggle with: trying to stay available and affordable to people in need, while also being good at their job.

But the inevitable outcome of that combination is burnout. And the byproduct is financial un-sustainability.

At some point, you have to choose two of these three adjectives, or in some cases just one. Being everything to everyone is not only difficult, but unnecessary.

In reality, the clients who need your work don’t require you to be all three. They want you to be effective, consistent, and well-supported.

If you decide to focus on being good at your job and providing the best service possible, you'll need a system that supports you in charging your fees and attracting clients who are the best fit for your practice. A system that you own and control, not the other way around.

Does this reduce your availability and affordability? Yes. But in return, your most valuable assets (your time and energy) are protected. And your practice can grow sustainably instead of burning you out.

Let me know what you think about this.

And now to the news!

AD BREAK

NOTEWORTHY

Medicare Telehealth Rule Changes

New November 2025 updates outline shifting Medicare telehealth requirements, including minimum in-person visits needed to bill certain services.

Why it matters: If you treat Medicare clients remotely, these updates can affect scheduling, compliance, and revenue.

BUSINESS AND PRIVATE PRACTICE

Insurance Delays Push Toward Private-Pay

Recent pauses and slowdowns in Medicare and telehealth payments exposed how vulnerable small practices are to insurance-driven cash-flow gaps.

Why it matters: Depending heavily on insurance increases financial risk. Adding private-pay options helps create more stable, predictable revenue.

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INDUSTRY NEWS

BCBS Vermont Postpones Billing Changes

Blue Cross Blue Shield VT has delayed planned modifications to therapy billing after provider pushback.

Why it matters: Even local payor changes can affect margins. Staying aware of policy shifts helps you plan pricing and payer strategy proactively.

FINAL THOUGHTS

The goal isn’t to be good, affordable, and available.
The goal is to build a practice you can actually sustain.

See you next week,

Avivit.

P.S. Next month, I’ll be sharing more about the Private Pay Method™, the framework I’ve developed to help therapists build sustainable private-pay practices.