From Telepractice Pioneer to Platform Builder: McKell Smith on Creating What the Market Wouldn't

"I kept getting the feeling like, no, you should try this, you should do it."

McKell Smith waited two years for someone else to build the teletherapy platform she wanted. Nobody did. So she built it herself, without a tech background, without startup experience, and with a three-month-old baby at home. Her story isn't just about launching a private practice. It's about what happens when a clinician decides the tools available aren't good enough and bets on herself to fix the problem.

Walking Into an Opportunity Most People Would Have Passed On

McKell's path into private practice ownership wasn't a slow, strategic build. It was a leap. After completing her CF and moving across the country, she landed at a practice that was already doing teletherapy. The owner trained her, showed her the ropes, and then decided to sell a few months later to go back to school.

McKell had a newborn. She had no business background. But owning a practice had always been the dream, even if the timing felt impossible.

"I didn't even know what it entails, but let's try it."

She purchased the clinic, kept the existing contract with a virtual school, retained the three therapists on staff, and immediately started looking for ways to grow. She searched for RFPs from school districts, scoured job boards for postings that had been sitting for months (a sign the district couldn't find anyone local), and reached out directly to schools in rural areas that she knew were underserved.

Back in 2013, teletherapy wasn't the mainstream option it is now. Brick-and-mortar schools were hesitant. But when a district hasn't been able to hire a therapist for months, hesitation gives way to necessity. McKell's team proved the model worked, and parent satisfaction followed.

The Licensing Puzzle That Comes With Multi-State Contracts

One of the less-discussed realities of running a teletherapy practice across state lines is the licensing headache. Every state has its own rules, its own timelines, and its own paperwork. McKell's team of nine therapists serves contracts across multiple states, and some live in a different state than the students they treat. That means dual licensing, fingerprints, background checks, and a lot of patience.

Some states, like Nevada, let you begin seeing students as soon as you've applied for a license. Others take six weeks or longer. McKell has learned to communicate early with schools and licensing boards so nobody's left guessing.

She also mentioned that ASHA has been working on an interstate compact that would streamline the process, allowing licenses to transfer more easily across participating states. It wouldn't eliminate costs, but it would cut down on redundant background checks and bureaucratic delays. For practice owners managing therapists in multiple states, that kind of change can't come soon enough.

Building a Platform When You're Not a Tech Person

About a year into doing teletherapy, McKell started noticing problems with the platforms available. They weren't designed with therapists in mind. The screen-sharing was clunky. Clients would click something and lose the therapist's video or the activity they were working on, then spend 30 minutes troubleshooting instead of doing therapy.

She waited. Surely someone in tech was going to solve this. Two years passed. Nobody did.

So she started building TheraV, a HIPAA-compliant teletherapy platform designed specifically for speech therapists. The journey was rough. She initially partnered with a business group that had an impressive resume but turned out to be "all talk." They held significant equity but never delivered. It took outside advice from the Utah startup community and a lawyer to get out of that arrangement.

"Not knowing who to trust has been difficult."

She dissolved the first company, started fresh in Utah, found a development team with actual telehealth experience, and built an MVP. Then she partnered with another team to improve on it based on therapist feedback. The whole process from initial concept to product launch stretched from 2014 to 2019. Five years of patience, frustration, and financial risk.

Solving the Problems Other Platforms Ignore

What makes TheraV different from generic video conferencing tools is the small stuff that actually matters in a therapy session. The platform includes an annotated whiteboard, multi-page document support so therapists don't have to clear and reload between activities, stickers and dice for engagement, and a screen-share feature that keeps everything inside the platform window. From the client's perspective, the video and the shared content all stay in one place. No more "Where did you go?" moments.

The payment model is designed for clinicians who are just getting started. Therapists pay by the minute, only for actual session time. No monthly subscription eating into revenue during slow months. For practices that also need a full therapy EMR to handle their documentation and billing, TheraV can run alongside that in a separate tab.

"I wouldn't want to pay a lot of money monthly, especially in those summer months when our contracts are much smaller, if I'm not bringing that money in."

It's a smart approach. For SLPs who want to dip their toes into private practice through teletherapy without a huge upfront investment, the per-minute model removes one of the biggest barriers to entry.

The Emotional Reality Behind Every Startup Story

McKell is honest about something most founders don't talk about openly. The emotional toll. The fluctuation between "this is going to work" and "I don't know what I'm doing." The financial anxiety of investing family money into something uncertain. The isolation of watching other companies' highlight reels while living through your own behind-the-scenes struggles.

"You, as a consumer or as a follower of some company or brand, see the good. You see the positive. But you don't see what happens behind the scenes."

Today, Salt Lake Speech and Language Therapy holds three contracts, delivers about 75 hours of therapy per week, and has even expanded to serve American international schools abroad. McKell still sees clients herself because her heart is still with the kids. She runs the business side, manages the contracts, and coordinates her team of nine therapists.

It's a lot. But she loves the balance of doing therapy and running the business. And after years of learning the hard way, she wouldn't trade the experience.

Running a teletherapy practice means managing contracts, licensing, and documentation across state lines. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, handling your documentation, scheduling, and billing in one place so you can focus on your clients. See how ClinicNote works.

Transcript

Kadie: You are listening to Clinic Chats, the speech therapist's private practice podcast. A podcast full of personal journeys where we not only talk about success stories, but also real life struggles of small business startups. Clinic Chats is sponsored by ClinicNote, a HIPAA compliant, cloud-based EMR platform used specifically by private practice owners and university clinics. I'm your host, Kadie Jackstat, and thank you for joining me today.

Kadie: Today on the podcast, I have McKell Smith, and she is the owner of Salt Lake Speech and Language Therapy. Hi, McKell. Thanks for joining me.

McKell: Hi. Thanks for having me.

Kadie: So McKell is primarily in teletherapy, is that correct?

McKell: Yes, that is.

Kadie: So I'm excited to hear the balance between the portion of clients that she may see in person as well as those contracts that you have developed to get a teletherapy business going. So McKell, I'm going to give it to you from here if you want to tell us your story.

McKell: Sure. So I really feel as though I have been very blessed in the sense that I feel like I kind of walked into this whole thing. I, after graduate school, completed my CF and then moved across the country and got a job in a private practice where they were already doing teletherapy. And so I was trained by the owner at that time, and she showed me how she had been doing things and how her therapists were running things. She had an established contract already, which was wonderful. And then a few months later, actually, she decided to sell because she wanted to go back and get a second master's degree. Owning a private practice had always been my dream, and I didn't think it would happen, you know, quite so quickly. But I thought, oh, I've got to give this a try. I don't even know what it entails, but let's try it. And so my husband was very supportive, although we had a three-month-old baby. And so we jumped right in and took over, and it just kind of took off from there.

McKell: As I mentioned, she had an established contract with a virtual school in the state in which we practice. And so she was able to work it out with them that if she sold, that contract would hold. So we were able to keep that contract, and then I decided that I just wanted to branch out. I wanted more hours for myself. My therapist also wanted more hours. And so I began reaching out to other schools in our area and in nearby states. I looked for places that I knew might have difficulty getting therapists on site, either because their posting had been listed for a number of months or it was a rural area. So I just started reaching out, and, you know, it was very interesting. I mean, this all started back in 2013, and so the idea of telepractice wasn't necessarily new, but it wasn't as well-received, I guess I would say. And so a lot of the brick-and-mortar schools were still hesitant, but there were a couple that recognized, we need a therapist. We have to offer these services. So they allowed us to see their students, and it really worked out very nicely. I think they were impressed, very happy with our services, and so were the parents. You know, sometimes parents would be like, I'm not sure, how's that going to work? And then they were pleased as well.

McKell: So we just started growing that way. We also, throughout the years, have always had the ability to take private pay clients and would take some on as we could fit them in, but we've started taking more of those as well as the need has just increased. More people have been reaching out, and they just find us organically. They find us through the website or through word of mouth from other patients that we have seen, which is really great. And they always asked, well, what is this teletherapy? I see that you do online services, but I'm not really sure what that is or what that looks like. So it's been really great for us to, we always do a free screening or a consultation, and so it's been really great for us to be able to provide that online and then give them a little demo of how a session might work virtually. Most parents love it.

Kadie: I love hearing that you have created success in private practice through teletherapy. You began seeing clients privately. You began offering teletherapy. At this point, had you developed your own platform?

McKell: No. I developed that. I had the idea, oh, I had been doing teletherapy for about a year, and I didn't love the platforms that were available. And I kept thinking, surely somebody's doing it because obviously that side of the market is just growing and is going to continue to grow. So I waited and waited because I'm not a tech, really tech savvy person. I'm not a startup person in the sense of building a company from the ground up. So I thought, I'll just wait. And I kept getting the feeling like, no, you should try this, you should do it. So it was probably two years after the initial thought that I just thought, you know what, I've got to give it a try.

McKell: And it has been quite the learning process. It's a whole new avenue, but I had some really great support and lots of great feedback from other therapists who have done teletherapy, those who are looking to get into it, as well as from clients, either patients themselves or their parents, and what types of things they like to see, what they haven't seen and would like to see. So from that feedback, we built our platform as you see it today, and we have people utilizing it each week and get really great feedback. It's wonderful for me because I know a lot of people in any setting in our field, a lot of people want to start to see clients on their own, but they don't know how or they're afraid to jump with both feet in because how do you get clients? How do you make sure that your caseload is full? So this is a great way for people to do it on their own time frame. You can see just a few clients at a time and build it up as you go. And we only charge cents on the minute of when you're actually on with a student. So you're not paying this high overhead when you're not seeing clients, which is really nice and our therapists have really loved that aspect of it.

Kadie: Wow. Yeah, that's a great payment model. So for someone just starting out, like you said, it's not this huge expense.

McKell: Right, right. And that was important to me because I felt like even with my private practice as a small business owner, I wouldn't want to pay a lot of money monthly, especially in those summer months when our contracts are much smaller, if I'm not bringing that money in.

Kadie: Right. Why pay out more than what you're bringing in?

McKell: Yes.

Kadie: So I want to backtrack because I'm not sure how to navigate this whenever you are doing both at the same time, right? You are doing your private practice, doing your own therapy clients, and also developing a teletherapy platform. So at this point, this is before contracts, were you by yourself or had you hired out?

McKell: When I took over and I purchased my clinic, the previous owner had that one established contract and then she had, I think it was three additional therapists on board. So I kept them and then we kept, we were able to keep that contract as well and we just grew from there. So we established additional contracts, some more private pay clients, and since then we have added to our team. So we do have nine therapists now that see students online and our contracts vary throughout the states. And we actually last year began seeing students outside of the US as well.

Kadie: Oh wow.

McKell: Abroad who are attending American international schools.

Kadie: And how have you secured these contracts from the start? That very first one outside of the one you acquired and then now, you know, that process might look differently.

McKell: Well, I first started searching for RFPs or requests for proposals online because many districts or virtual schools are regulated and they have to put out requests for proposals and that just means they're saying okay we need a therapist, send us your information, how you would run a contract like this if we were to give it to you, how many therapists do you have. And then they assess it based on price usually and then they award the contract to companies. So we have done that. I have also searched places like Indeed and any other place where a job might be posted to see what areas or what districts are in dire need of therapists.

McKell: So I tried to find those who have had a listing for a number of months and it's still listed so it's clear that they haven't hired anyone. So most often still I would say they are looking for initially somebody in person but if they can't find anyone they still recognize we have to provide this service. So we have had it before where initially they'll say, you know, thank you but we want someone on-site, and then they'll come back and say okay let's give this a try. It's usually gone really well and they, I feel like the admin, the teachers, students, parents are all surprised and happy with the results.

Kadie: And are you the primary person who's doing all of this as far as securing a contract, being the communicator with the administration, and kind of setting up the therapist? And I guess from there on the therapist has more responsibility?

McKell: Yes, yes. So I run both sides, you know, the admin and then I also still see clients.

Kadie: That's awesome. Have you liked that balance, getting to still do therapy but also doing some business on the side instead of just a full back-to-back week of therapy?

McKell: Yes, I love that part of it. I love being able to divide my time between the two because I like the business aspect and what I've learned, being that I don't have a business background, that has been a learn as you go type of experience for me and I've really enjoyed that. But still, my heart is still with the kids and so being able to do therapy is really important to me.

Kadie: Yes, I am sure. As far as some of the logistics of teletherapy go, I'm intrigued that, you know, you might have started out with maybe an in-state contract. What does that look like for the therapist or for your contracts whenever you're looking, first let's address out of state. Do they need to be licensed in the state that they are providing services for and from their home state, or not necessarily?

McKell: Yes, thank you. Right now they do. So we have a couple of therapists who are licensed in multiple states and so some live in our state and see students out of state. We also have therapists who live out of state and see students in our home state. And unfortunately that is the case right now, but I do know that ASHA is working on an interstate compact. It just means that any state that is a part of that compact would allow for licensing to be accepted across state lines. You still would obviously have to pay the state for having a license there, but it would alleviate things like fingerprints, you know, those background checks, those things that are just time consuming and be so much easier if we could just skip over. So that is something to look forward to.

Kadie: Yeah. Is that just something like if you have secured a contract and it's August 1st and you know that the state of Illinois is going to take, you know, six weeks at the least to get this process, is this just something you have to communicate with the school and say we'll let you know as soon as this is finished?

McKell: Yes, and there are some states like Nevada, as long as you have applied for the license you can begin seeing students. And so we did have that as an example with one of our schools. And so I was in contact with the school as well as the licensing board and they too were in contact with the school. And so we all just communicated to make sure we weren't crossing any lines. But they said yes, she has applied, she can see students now, and then obviously once the license comes through we're all set. And if there were any trouble, any difficulties, then they would let us know. But we just made sure to stay in communication to make sure that we have all of that clear.

Kadie: So much research on your part, you know, just figuring out each different state's rules and regulations. I'm sure is quite a challenge but also a fun one for some. I think it would be anyways.

McKell: Yes, yeah. There's something different for sure, but it has been fun to learn as you go.

Kadie: Yeah. You know, I've had this question before, it might seem a little bit off topic or so, but I've had someone ask me before regarding RTI students. If students are not on an IEP, I imagine that your therapist still can treat in an RTI model. Or how have you approached that situation as far as, you know, do you still speak with parents and send out a release form? What have you done in those situations?

McKell: Yes, yeah. We do still speak with parents. The schools have taken the initial responsibility of educating parents on the delivery model that their students will be having. And then because we contract directly with the school, it's like we are not employee but a contractor of the school. And so we don't do release forms just because it's all covered under the school setting still.

McKell: Some of the schools have been really great and will have an on-site aide. And so the aide assists us in doing things like transformations. And they'll take an iPad in there and let us observe and work together with her. So then you can collaborate with the aide and just explain the things that you're looking for, what kind of data you want. And also if you're going to do RTI or even therapy sessions that need to be, you know, pushing in, explain what it is you want to do and ahead of time decide on activities and resources and strategies. And then you can make sure that while they are the ones hands-on, you can provide that feedback and that teaching model that they need in order to provide the student the best service.

Kadie: Gotcha. So if a student does need RTI, so they don't have an IEP plan in place, really it's just the same model. As far as we can get them on our schedule, we can see them, and the school kind of does that communicating for you if needed?

McKell: Yeah. They still allow us to reach out to parents.

Kadie: Now maybe we can branch into your teletherapy platform. You spoke about how it's not necessarily a documentation system. You're primarily utilizing school IEP systems or whatever plan that they have in place. You can just acquire that. So for now you haven't needed a separate sort of EMR, right?

McKell: So we are a HIPAA compliant platform. As you mentioned, we don't have documentation in there. Right now it is strictly the streaming. So we have a whiteboard with annotated features. You have the ability to upload documents to the whiteboard. You also have the ability to create multiple pages so that you don't have to, after you've completed a worksheet, clear everything and then bring something new in. But you can consecutively work on things in different pages and then scroll back and forth to review and whatnot. We've got stickers and dice to make it more interactive.

McKell: We also have screen share which allows you to share any part of your computer. You can share either your home screen or just any one application that you have open. And it could be anything. It could be a PowerPoint presentation, it could be a Word doc, it could be YouTube, you know, whatever you are capable of bringing up on your computer, you're able to share that way the student or the client can see it on their end as well.

McKell: And we've done our screen share a little bit differently than others because for most other video conferencing platforms when you go into screen share mode it's almost as if you leave the platform and the video is just right on top of whatever it is you're sharing. But what I have found personally and other therapists have shared this as well, is that when clients start clicking, then they lose your picture or they lose whatever activity it is that you're sharing. And they're like, where did you go? Or I can't see the activity. And you end up troubleshooting for 30 minutes. So we did ours a little bit differently in the sense that from the client's perspective, it looks like it all has come into the platform. So they can click all they want, but they're never going to lose you or the activity as long as that window is still open because it's all within the platform itself.

Kadie: I can't imagine how you went about getting this started. Like you said, you had the ideas. You probably knew what you needed and what you wanted. But then what? Did you contact a developer?

McKell: I contacted a lot of different people. And honestly, starting from the ground up, I initially started reaching out to business people. So I found this group who was introduced to me through a family member. And their background was impressive. Their resume was impressive. And so I partnered with them. And they were supposed to help me get it developed, market it, raise money, the whole nine yards. It just did not pan out. But at the time, I felt like it was my only avenue. I didn't know where to go from there. And so I stuck with it quite a bit longer than I should have.

Kadie: Were you paying this group?

McKell: I was not. I was not paying them, but they were equity partners. And they owned a lot of equity. So luckily, I am in Utah. And here in the last few years, there has been a big boost in the startup community here. And so there are lots of resources and lots of gatherings and meet-up opportunities, networking opportunities. So I started going to those and met with some people. And they would obviously ask what I was doing. And when I told them what was happening, they said, oh, you've got to get out of that. You need to get a lawyer. You need to get out. So I mustered up the courage and did that. And we ended up just dissolving the company. It was in another state. It was in Florida. And so we dissolved the company there and created a new company here in Utah. And I, from there, just started reaching out to developers and found one that was within budget and would help me. And I loved that they, in particular, had a background in telehealth and telepractice and built another platform that has gone on to be really successful. So I partnered with them. And they helped us build out the initial MVP. And then we also partnered with another development team to improve upon what they had built. And as we got feedback from other therapists, we added more features.

McKell: Of all of the business experiences, that one has been, I think, the toughest and, at times, most frustrating, just because it is a big learning curve. And not knowing who to trust has been difficult.

Kadie: Right. With your next business partner or whatever these developers were, did it feel like a risk financially or business-wise to invest in someone else?

McKell: Well, luckily, although the first partners had equity, we didn't ever end up doing anything, because I realized they were just all talk. They didn't actually get anything done.

Kadie: Wow.

McKell: So I felt like I was working so hard on the things they asked me to do. But then they never followed through on their end. And so there really was nothing to the company. And so I felt like I was starting from ground zero. I knew not, or I knew what not to do. I knew not to give up so much equity. But all aspects of it definitely felt like a risk. It's not cheap to get something like that going. And so to invest your own money or family money, if you raise a family and friends round, it is nerve-wracking. But so far, it's been worth it. And so I'm glad that I took the risk.

McKell: And speaking with other entrepreneurs, many have said, you are going to have fluctuation in your experience and in your emotions. And sometimes it's going to feel really rough. And then something good will happen. And so I knew that others had similar experiences, which made me feel better at the time. But it still was hard.

Kadie: Right, right. But it was comforting to know I wasn't the only one.

McKell: And even still throughout the process, everybody's going through that feeling of, I don't know what I'm doing. Am I doing the right thing? Am I making the right decisions? I'm just going to go for it. All of those different emotions, everybody's going through it. And you, as a consumer or as a follower of some company or brand, see the good. You see the positive. But you don't see what happens behind the scenes. And so I think it's important to know everybody, all the brands go through that. But they keep working hard and putting one foot in front of the other and push through.

Kadie: Absolutely. With the first team of developers, until you were able to release, what was the timeline?

McKell: Oh, I initially made contact with them in 2014. And then we released our product last year.

Kadie: Wow. That is a lot of patience and so much work.

McKell: Yes.

Kadie: Now, your whole team uses TheraV. How have you advertised?

McKell: I haven't actually spent dollars in advertising. I have been mostly advertising in social media, in the telepractice groups. But even lately, I haven't been doing that as much. And I think that's just because other aspects of life have gotten kind of crazy. And so we have a website. And people are able to find information through the telepractice groups when they're searching. And we have wonderful users who recommend it, which is awesome. So we still get people coming.

Kadie: Yeah. And you're kind of right in the smack dab middle of a school contract. So I'm sure a lot of teletherapists might not even be up for a switch at this time of year. So maybe May and June is the time to push. I don't know.

McKell: Yeah. And that's kind of been my thought, too. And a lot of them, if they are contracting with other companies, the companies have a platform they're providing, whether it be a proprietary platform they've built or they are licensing something else.

Kadie: Right. Closer to the end of the year when people are starting to think about, oh, maybe I should pick some clients up in the summertime. Or maybe I should, now that I have the time, maybe I should really give this a try.

McKell: Well, I know I'm keeping you maybe longer than expected. But I just had so many questions considering your unique experience. And I feel like we didn't even get probably half of it. But I'm curious, at this point, how many contracts is your business currently holding?

Kadie: This year, we have three. And we do about 75 hours of therapy a week.

McKell: Yeah. And have you set a firm rate that is pretty much standard across state lines? Or are things flexible? I mean, I know everything's negotiable. But do you go in offering your rate to the schools, and then you have your rate for your contractors? And obviously, there has to be a middle ground for you to make a profit.

Kadie: Right. Yes. I have a specific rate that I try to stick to. Obviously, it's flexible because different districts have more or less budget than others. But I did go through and run numbers. And I figured out, at what point is it worth it or not to take on any given contract based on what I pay my contractors?

McKell: Yeah, I'm sure there has to be some sort of number that you can count on. And thinking from the school side, too, I think you said this earlier. And it kind of stuck out to me. If they're paying an aide to sit there as well, a teletherapy rate is going to be higher for them than hiring in person, I believe. And then you get on that, whatever they pay the one-on-one person to sit at the computer, whether that's minimum wage or whatever it is. But it's an expense for a school to take it on. But like you said, it seems like people are satisfied. And it's the way that things are going.

Kadie: Right, yeah. So it all just depends on the situation of the school. But we try to be as flexible.

McKell: Yeah, anything that you wanted to touch on that I didn't give you a chance to bring up?

Kadie: I'm happy to, you know, if people have questions, I'm happy to answer questions and dive into those things a little bit more.

McKell: Yeah, well I'm happy to recommend and refer ClinicNote's customers who are interested in teletherapy to TheraV because, like you said, it doesn't quite have that EMR component, but it might work nicely together, so kind of a cool idea.

Kadie: Yes, I think that would be really nice because they could have it open in a separate tab and they can utilize it live in session while they are with a student.

McKell: Absolutely. Well, we will be in touch then, and I just thank you for coming on to the podcast. I know people will be so intrigued to see how you're juggling this journey into private practice with the teletherapy platform also. It's very interesting.

Kadie: Well, thank you so much for having me. It's been great.

McKell: Thank you.