From Home Office to 20 Therapists: How Lori Kaplan-Cologne Built Montclair Speech Therapy
Lori Kaplan-Cologne didn't plan on pediatrics. She came out of graduate school chasing a hospital position in adult rehab. But life had other plans, and those plans led to a private practice in Montclair, New Jersey that now spans three buildings, employs 20 therapists, and sees over 400 clients per week.
The part that makes her story worth paying attention to? She still carries a full caseload. On purpose.
Early Intervention Changed Everything
Lori's path into private practice started the way so many do: pregnancy. When her first daughter was born, she left full-time employment and started picking up contract positions, covering maternity leaves and working across different settings. That variety reignited the thing that drew her to the field in the first place, the sheer range of populations and environments you can work in as an SLP.
Then a colleague introduced her to early intervention. She fell hard for it.
"Being in the homes with families, I really got to see how much we could do as therapists and how much impact we had on these children." Working birth to three, she could build long-term relationships with families from the very start. That connection became her north star.
But driving house to house across counties, hauling toys, burning hours in the car, it wore on her. She needed a central location.
Building the Practice One Room at a Time
The pivot from home-based services to a brick-and-mortar practice didn't happen overnight. Lori started by seeing a handful of private clients in her home office while still doing early intervention work. The split shifted gradually: 50-50, then 60-40, then all in.
When she and her husband found the right space, a contractor converting an old bank into units during build-out, they committed to just two rooms. The contractor pushed them to go bigger. They stayed conservative.
"Even though the guy was like, just take another room or take a larger space, we just felt like this is all that we could do."
During the eight-month build-out, Lori hired a clinical fellow who worked alongside her in the home office. That proximity turned out to be one of the best decisions she made. Her CF absorbed the practice's mission firsthand, and she's still with Montclair Speech Therapy today.
Within the first month of opening, they needed to hire again. Four years later: three buildings, 20 therapists, including four OTs providing occupational therapy services.
Insurance: The Necessary Trade-Off
Lori made a deliberate choice early on to credential with every major insurance company. She didn't want to be a practice where families could only get therapy if they could afford to pay out of pocket. That meant hiring a biller and a credentialer before the revenue justified it.
"Everything was a huge expense and there were a lot of sacrifices at the very beginning that I would do over and over again."
The insurance math forced some practical decisions. Reimbursement rates dictated session length, and 30-minute sessions became the standard. But Lori's team found a rhythm that works: 27 minutes of direct treatment, three minutes of parent education at the end. Families who aren't in the room watch via tablet and join for that final check-in.
Not every insurance relationship survived. A few carriers were dropped, not because of low reimbursement, but because of inconsistent authorization. They'd approve services, then deny claims months later. For those carriers, Montclair Speech Therapy went out of network and shifted to courtesy billing.
"It felt dishonest, things that were happening. We'd try and appeal and it just spent a lot of time and was very frustrating to our families."
Pivoting to Teletherapy During COVID-19
Operating near the epicenter of the COVID-19 outbreak in New Jersey, Lori knew face-to-face sessions had to stop. The question was whether insurance would cover teletherapy.
She made the call to switch anyway. Overnight.
"It was like a light switch. One day we're in the office, the next day we're doing everything teletherapy."
The team took webinars, read ASHA guidance, and figured it out through trial and error. The results surprised everyone. Less than 5% of families opted out, and the ones who stayed showed incredible commitment. Parents were doing the work on their end between sessions in a way Lori hadn't seen before.
"I've always loved our families, but I love them even more. I see how committed they are to their kids."
A couple of clinical fellows had to be furloughed briefly since supervision couldn't happen remotely with the same confidence. But those employees were brought back and the practice actually hired more staff.
The reopening plan was still taking shape at the time of recording: phased, alternating teletherapy and in-person sessions so staff could clean between clients, with PPE, UV wands, fogger machines, and thermometers ordered for the buildings. Nobody had a playbook. They were writing it as they went.
Surround Yourself with People Who Get the Mission
When asked for advice for practice owners hoping to grow, Lori didn't talk about documentation systems or marketing tactics. She talked about people.
"Surround yourself with a really supportive team that knows the mission. If everybody's operating from that position, people are going to recognize that."
Her husband handles backend operations, ordering, billing oversight, vendor research. Her mom came on board too. Lori hired people for the roles she didn't want so she could keep doing what she does best: treating kids and families.
That's the thread running through her entire story. Every decision, from the two-room build-out to credentialing with insurance to switching to teletherapy in a weekend, was made in service of staying connected to the clinical work. The business grew around that priority, not the other way around.
She's not done either. Her dream is an intensive feeding program for children transitioning off tube feeding, something between acute care and outpatient. She doesn't know what it looks like yet. But if her track record is any indication, she'll figure it out.
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Transcript
Kadie: You are listening to Clinic Chats. Clinic Chats is a multidisciplinary therapy podcast that was created for students, professionals, clinic directors, and supervisors. Clinic Chats is bridging the gap between graduate programs and professionals, sharing personal journeys of the smallest of private practice startups, large and expanding practices, as well as university clinic triumphs and tribulations. We hope you'll find our podcast informative and helpful in your career endeavors. Clinic Chats is sponsored by ClinicNote, an electronic medical record company for private practice and university clinics. ClinicNote was designed to make scheduling, documentation, report writing, and billing effective, efficient, and HIPAA compliant.
Kadie: Today on the podcast, I would like to welcome Lori Kaplan-Cologne. Lori is the owner of Montclair Speech Therapy in New Jersey. Hi, Lori. Thank you for joining me today.
Lori: Hi, Kadie. Thank you so much for having me.
Kadie: You had given me a bit of your background, which is very impressive. It sounds like you started out as a small business owner and have since grown quite a bit. If you don't mind going back to the beginning, telling me how your practice first began.
Lori: Sure. I had a really great graduate program. My externships were really rich professionally. I learned a lot. That was in Boston. I got a really great taste of the adult rehab world. I really wanted to initially start off in the medical model with adults.
Lori: Then, of course, when I graduated and I moved to New York City looking for a hospital position as a CF, it just wasn't available at all. I tried very, very hard and it just wasn't available. I knew I still wanted to be with adults at that time, so I looked at some subacute and more like a long-term care facility. I had my experience in more of like a subacute rehab. I worked with adults in that setting for about a year and a half and transitioned to a hospital finally.
Lori: I thought that I landed where I wanted to be until, like many of the therapists that you bring in, it's when they have these life changes. When I got pregnant with my first daughter, I decided at that time that I no longer was going to work for a company. I wanted to really start to have a more flexible schedule.
Lori: It was the day that my daughter was born, 11 years ago, was the last day that I really worked full-time for any place. I started doing just some contract positions covering maternity leaves for others and really diversifying my experience, which was my initial draw to the field, so how diverse and how many populations that we're able to work with in a variety of settings.
Lori: I was able to get a lot of really great experience working in different settings and a colleague of mine was working in early intervention. That was when I really just fell in love with that early intervention population and that birth to three. Being in the homes with a lot of the families, I really got to see how much we could do as therapists and how much impact we had on these families and these children.
Lori: We're at that starting point where we can offer so much and we really can stay with these families for so long, which was really important. The way I was able to develop relationships with my clients and the families and have a really big impact.
Kadie: So you really went from adult population, then you really fell in love with the early intervention population, but of course saw some drawbacks. Is that when you kind of thought, I need a central location?
Lori: Yeah. That was when my daughter was maybe a couple of years old, but going house to house and really seeing, I loved doing what I was doing and I loved seeing about eight to nine kids per day, but driving around across counties got to me and all the toys at that time that we were carrying around. It still felt so rewarding, but it got to be really hard on my car and it took a lot of time away from things that I wanted to be doing with my family.
Lori: I really couldn't not work. At that point now I had like two kids. I needed to continue to work as I was building my private practice, but what was so great about going from early intervention was I really got to establish myself. I was able to take on a few privates and then I would see them in their homes initially and then as I was taking on more, I really started to get enough of a caseload where I could just have them come into my home office.
Lori: So it was going from a mix of still traveling to early intervention, going to even still like a pediatric hospital and then I'd end my day in my home seeing clients out of my home office and it slowly transitioned. It was a 50-50 and then 60-40 and then really once I was 100% seeing enough clients that I could still pay my bills, that was when my husband and I decided that we were going to look for a brick and mortar and really start to expand.
Kadie: I bet that was such a great feeling to officially have your own office. Did it start with a one room office or were you able to jump into multiple rooms?
Lori: We're in a great town, but some of the rents were really very high and so I knew what I was looking for. I was able to delegate that to my husband. He had a whole other idea and he wanted something that was going to be built out, customized for the practice.
Lori: So he found a local builder who has a great reputation in our town. He was able to get in touch with this contractor and he had bought an old bank and was in the build-out stages. So if you got in as they were building out these different units, you could really say what you wanted.
Lori: At that time and knowing the price tag that came along with it, we said, you know what, we just want two rooms and that's it. Because we weren't sure what was going to happen and we also had to commit to a certain timeline. What we had to pay times a certain number of years felt a little scary, even though the guy was like, just take another room or take a larger space. We just felt like this is all that we could do.
Lori: As we had about eight months for the build-out, at that time I hired a clinical fellow who is still with us today. She worked side by side with me in our home office and traveling. So we built both of our caseloads to be very full-time, very quickly.
Lori: It was so great because her being right next to me in a lot of ways, I really got to see her work and she got to really understand the way I worked and how I worked with the kids and the families and really absorb the mission of the practice better than anybody has because she was right next to me. It was just so intimate.
Lori: Then that place opened and it was just a big celebration and all within that first month we needed to hire. So since then, and it's only been four years in September, we've gotten another two buildings and we're at like 20 therapists right now.
Kadie: Oh my goodness. Do you feel like there is just such a need in your area, the population in general, and it just happened naturally? Or is this something you've really had to market and work towards?
Lori: I mean, it's a big effort no matter what, but I always felt like I knew the business was there. If you build it, it'll come. I just felt like we were putting out such great things and doing such amazing work and reaching so many families that I knew what we were doing almost had to come back from the universe. It was a lot of word of mouth.
Lori: What helped us a lot is that we did credential with every major insurance company initially. So we hired a biller and a credentialer during that time. And of course all of these things cost money. It was a huge expense. Everything was a huge expense and I definitely, there were a lot of sacrifices at the very beginning that I would do over and over again because I just knew that even though I can't afford anything right now and I'm throwing all of my money back into the business, I knew what it meant. I knew what my big goal was even back from undergrad.
Lori: I remember not being able to afford anything. Every amount went back into the business or back into our bills. It was only a few years ago that things felt really, really tight. But even with that, we hired people because I knew that no matter what, I didn't want to spend my time fighting with insurance companies. I didn't want to spend my time marketing. I really wanted to do what I love, which is always just actively treating and helping families and clients.
Kadie: At this point, do you still have a semi-full caseload or has the business side of things just completely taken over your specific role?
Lori: My husband actually has come on board and I actually had my mom, she's on board too. So I've hired people to do the things that I don't want to do. My husband does all the backend stuff. Everything with the ordering of tools or the ordering of toys or dealing with the billing aspects. We do have the billing, the credentialer. I have somebody handling the front desks and things like that.
Lori: I never wanted to have my role be that. Of course, I'll handle if there are any issues and I'll always do the check-ins with all of our families. But we have 400 some people coming into the office each week. So I want to be able to still stay in touch with our families but my favorite part and the best hat that I wear is that of a treating therapist. I know that's where I'm supposed to be and what I do best. So I do have a very full caseload. With COVID now, it's even greater because I'm not spending time answering a lot of therapist questions because we do our weekly check-ins, but I'm not getting pulled away from treating.
Kadie: I'm just so curious about where you see this going in the future. Do you think you're content here with the amount of employees and the numbers that are coming in or do you foresee it continuing to grow?
Lori: I think I probably, it could be perceived as a flaw but I just don't ever feel like, I always have big goals ahead of me. We have occupational therapy on board too. We have about four OTs with us and I would love to be a place that is like a real whole wellness center where we have RDs on staff and lactation consultants and even, the big thing for me, my passion is that pediatric feeding.
Lori: I don't even know how this would work or what it looks like, but I would love to one day figure out how to have an intense feeding inpatient program. I would love to be able to really treat these clients, patients that come out of the acute care hospitals and they're on their tubes and they need intensive therapy to be able to be full PO or to be able to consume an age-appropriate diet. So I'd love to have a full team to help these kids and families around here, but I have no idea what that really looks like at this point. It's just an idea.
Kadie: What an amazing goal though. I mean, that's a first. So you're talking inpatient.
Lori: I would love that, or I know with that comes a lot of regulations and things. Or figuring out how to do a camp, but not just throughout the summer. Maybe starting an intensive program where it's really daily and they get dropped off at eight and they get picked up after dinner. We really work for a month and then they would transition to our outpatient practice where they would come twice a week, three times a week to maintain and improve those skills once they're out of that more acute phase.
Kadie: What a huge goal. I love it. I will have to continue to follow along with your journey to see once you're able to do that. With insurance, you said from the beginning you and your husband knew you needed to accept all insurances. Has that been a dilemma in some sense? I'm in Illinois and I know that in some cases, insurances aren't even reimbursing enough to cover the therapist's pay. Is that a problem where you're at?
Lori: The thing about insurance is that it can be so wonderful because we want to be able to help people, all people, and not be a place where you would only get therapy if you can afford it. So I knew that was part of it, but they really dictate because of their reimbursement rates, they had to dictate our number of minutes that we could see clients.
Lori: We have found that 30 minutes is a sweet spot for therapy. It's not just necessarily governed by what insurance says, but we found it to be, okay, this is what we knew based on the reimbursement rates, and then we realized how much we can really get done in 27 and then talk to the families for the last three minutes. In our space, if our families don't join us in the room, they're sitting outside and they're listening from the tablet and they're watching. So they're able to be part of the session and then join us for the last three minutes.
Lori: We've gotten a lot of referrals through insurance. We've only had to drop a few insurance companies because of not even their low reimbursement rates, but the inconsistent authorizations. They would say, yep, you're good to go, you have authorization. And then they'd say, nope, not true and this is why. We'd be seeing these clients for weeks because reimbursement can be up to a few months later and you get these EOBs and it's not covered.
Lori: That happened a lot with a few insurance companies. Because it felt like it wasn't fair to our clients and it also became an issue for us, we did end up going out of network with a few. It just felt dishonest, things that were happening. We'd try and appeal and it just spent a lot of time and was very frustrating to our families. That's what really made me think, let's just stay with the insurances that we know.
Lori: As well as any of the companies, you go back and forth and there's always gonna be denials, but we have dropped a few and we will continue to courtesy bill, but the patient will be responsible for payment on those and then they get reimbursed by their insurance company.
Kadie: I'm sure over the years you just realized what was going to be more beneficial, being in network or switching to out of network for some insurance providers, which is the way it goes sometimes. So I'm sure you all experienced quite a drastic change once all of the shutdowns due to the coronavirus occurred. Was there obviously a quick transition to teletherapy and now what are you planning as things potentially reopen?
Lori: We knew things were happening in February, but nothing was closing down until about March. I think it was the first or second week of March. Where we are has been hit pretty hard. We're right very close to the epicenter of this virus. So I knew for our families, for our staff, for our clients that it wasn't safe for us to be seeing them face to face anymore.
Lori: But what I didn't know was did insurance agree with this and were they gonna reimburse on this. That was my really big dilemma and it kept me up at night. I was trying to figure out all of these things and I just felt like I didn't have enough resources to handle this. I spent a lot of time trying to figure it out.
Lori: When I made the decision, we really didn't want to go into it thinking we were gonna have to furlough any employees, but we also had to stay afloat. That was the big thing, get through this, let's get to the other side.
Lori: So what I said was that we're gonna continue to see our clients that want to be seen, we're gonna switch over to teletherapy and it was like a light switch really. It was like, okay, here we are one day and then the next day we're not coming in, we're doing everything teletherapy. We just had to send emails and figure out, we had to take a lot of webinars and read a lot from ASHA and really figure it out very quickly how to make it work. Of course it was trial and error.
Lori: Then it was waiting to see what the reimbursement would be. We kept, I would say we lost maybe less than 5%, which is just so amazing. Just less than 5% were like, we really can't do teletherapy, we don't think it's gonna work for our kid, and we had to respect that.
Lori: It's been mostly just amazing. We're so proud and so thankful. I've always loved our families, but I love them even more. I adore them because I see how committed they are to their kids and how much they're doing the work on the other side with our training and we're just so proud of them.
Lori: We did have a CF, we had to start to, because we couldn't watch them and we didn't know, even though ASHA said it's okay, we did have to furlough a couple of employees, which we've since regained back and actually hired. So now we're on the flip side. When do we go back? How does that look? What are we purchasing as far as PPE and the foggers and the wands and the thermometers?
Kadie: How do you even know where to purchase that? Maybe in New Jersey, like you said, you're near the epicenter where maybe it's all a little more clear cut, but I just don't even think most people know how to get their hands on the proper equipment.
Lori: That is what I had my husband doing. He is the one reading up and reviewing the reviews. I think that we're going to probably see what's working, what's not working, but we've put a lot of effort in. He's done the research and he said, okay, this is what I think. Then I think once we get on the other side of this, we're really going to have to see what works and what doesn't.
Lori: We've done the masks and then the shields and the thermometers and we got the UV wands and the fogger machine and the lamps. We're hoping that it's going to do the job, but we don't know. We have a lot of spaces to cover and it's not cheap. Nobody has any real information. I've spoken to people in New Jersey and in other states, and I don't really think anybody knows because we've never been here as a profession or as a nation.
Kadie: No one knows. So what is your goal date? What do you have in mind for resuming?
Lori: We don't even know. What I know is that I sent an email out just yesterday to my lead therapist and I said, let's get on a meeting and figure this out. I know next week I have the meeting with them. The following week we're going to have a meeting with all the staff on Zoom and we'll say, this is what we're thinking.
Lori: I do want to get the therapists back in the buildings before we get the clients back in. Ideally I'd like to have clients coming in if they feel comfortable and they want to, and as long as our staff feels comfortable. Then I'd love to be able to scatter some so that we have the time to do the cleaning. So one client is teletherapy, one client is in person. We're alternating so that people can clean and disinfect and do all of the things that need to be done to maximize the safety for everyone involved.
Lori: But again, it's insurance. Until last week, we thought Aetna said we're not covering beyond May 28th. But then they took that away and they said, we're just not sure. That was really scary because we do have a big portion of clients with that insurance company. So we don't have a start date and we are just beginning to figure out what that reopening process looks like. I'm hoping to do it in phases if possible. I'd love for insurance to say, we'll cover it for as long as needed.
Kadie: We're all in this. I think everyone is understanding and we're all just doing our best. So let's hope that insurance follows suit.
Lori: I hope so.
Kadie: It just sounds like things run so smoothly. You and your husband are a team, even your outside family is helping in the business. Are there any words of advice that you have for private practice owners who are hoping to grow to a size like yours?
Lori: I think the really important thing is to really surround yourself by a really supportive team that knows the mission. They really understand why we're doing what we're doing. If you continue to remember that, and you have people around you that really get that mission, I think that is going to help you throughout the process to grow. Because if everybody's operating from that position, people are going to recognize that.
Lori: There's no shortage of need for what we do. We see people from birth through to end of life and all of these different diagnoses. There's just so much that we can do. I don't think there's ever going to be enough therapists to treat all of the need. So I do believe that it's really important that the people around you get it and you have support for when it gets really hard because it does get really, really hard.
Lori: Just keeping your eye on what your big goal is. Some people don't have the plans to grow and don't want that. I think just remembering what you want and what your goal is is going to be really important.
Kadie: You're definitely an inspiration. This just seems like it's all been a breeze, but I know it hasn't. I know a lot of blood, sweat, and tears have gone into the business. So kudos to you. Well, thank you for your time and for sharing your private practice journey.
Lori: Thank you so much for having me.
Kadie: Thank you for joining me and listening to Clinic Chats, the speech therapist's private practice podcast. If you have a moment, please leave a five-star review for Clinic Chats to help other SLPs find our podcast. If you'd like to share your own personal journey through private practice, please email me at kadie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.