Selling Therapy Through a Screen: Melissa Jakubowitz on Building a Teletherapy Business from Scratch
Most SLPs are trained to be clinicians, not salespeople. So when the biggest barrier to growing a teletherapy business turns out to be cold-calling school districts and hearing "no" over and over, the learning curve isn't clinical at all. It's emotional. Melissa Jakubowitz knows this firsthand. After running a brick-and-mortar private practice for 20 years and then helping build the clinical side of a telepractice startup, she launched her own teletherapy company, Alive Now Therapy, contracting with school districts across the country. And the hardest part? It's never been the therapy itself.
Twenty Years of Brick-and-Mortar, Then a Pivot
Melissa's career arc is anything but linear. She started in the schools, got frustrated with lunch duty and bus duty eating into clinical time, and opened a pediatric private practice that she grew to 12 full-time therapists across two offices over two decades.
But after 20 years, she hit a wall. Not failure. Mastery.
"I'd done everything I wanted to do," she says. "I didn't feel like I could grow much more in private practice."
So she put feelers out through her network. A colleague connected her with two young business school graduates who were launching a telepractice company to serve public schools facing SLP shortages. They knew business. They knew nothing about speech-language pathology. Melissa came on as VP of Clinical Services and built the clinical operation from scratch, hiring therapists, training them, and eventually training the sales and marketing staff too.
After several years, she left to start something smaller and more her own. That became Alive Now Therapy.
The Sales Problem Nobody Warns You About
Here's what catches most clinicians off guard about teletherapy contracting: the selling never stops.
Melissa is blunt about it. Securing contracts with school districts isn't as simple as emailing a special education director about an opening. Some states require a formal RFP process. Others require you to track down the right decision-maker, who could be a program coordinator, an assistant superintendent, or someone else entirely. And then you have to convince them that putting a child in front of a computer with a live SLP on the other end is real therapy.
"Even though I've been doing this for almost 10 years, it's still relatively new," Melissa explains. "People think it's putting a child in front of a computer, as opposed to putting the child on the computer in front of a live SLP who is actually physically there on the other side."
And you have to develop thick skin, fast. She's learned that when a call ends with a "no," the worst thing she can do is stop and take a break. Momentum matters. "If I say, oh gosh, I'm going to stop for a few minutes or stop for an hour or two, I sort of lose my momentum. And it makes it that much harder to get back in."
Funding Varies Wildly, and You Need to Know Why
One of the less obvious challenges of contracting across state lines is that every state (and sometimes every district within a state) operates on a different funding model. Melissa breaks this down from her vantage point in California's Silicon Valley, where school districts generally pay higher rates because the economic base supports it.
Compare that to a rural state like Kansas or North Dakota. Smaller populations, different economic foundations, lower hourly rates. As a business owner, Melissa has to balance those disparities carefully, paying her therapists fair wages while making sure she at least covers expenses in lower-paying markets.
"I know I'm going to get less in North Dakota," she says. "I need to make sure that I at least cover my expenses. I know that I want to serve those kids, and I'm clearly not going to make the same amount of dollars per hour that I would in California. So it's balancing."
That kind of financial awareness isn't something most speech therapy graduate programs teach. But it's essential for anyone building a teletherapy business that spans multiple states.
Employees, Not Contractors (and Why It Matters)
Melissa is based in California, and she's watching the regulatory environment closely. At the time of recording, the state assembly had just passed a bill (related to the gig economy debate around Uber and Lyft) that would require companies to hire workers as employees when those workers perform the company's primary business function.
For a telepractice company, that means SLPs can't simply be classified as independent contractors. Melissa hires all of her therapists as employees, both part-time and full-time.
"I really don't want to get audited by the Franchise Tax Board in California, nor do I want to get audited by the IRS," she says.
She believes larger teletherapy companies that have historically used independent contractors will need to adjust, at least in California. It's a business consideration that anyone entering the teletherapy space should be tracking, because labor classification affects everything from overhead to liability to how you structure contracts with districts.
Getting Found Online (and Staying Found)
Marketing a teletherapy business follows the same basic rules as marketing any private practice EMR client might recognize: you need a professional website, you need to understand SEO, and you need to keep your content fresh.
Melissa admits she's fallen behind on her own blog and let some outdated presentation dates linger on her site. It's a common trap for solo operators. But she knows the cost of neglect. A website that sits untouched drops in search rankings, and potential clients rarely scroll past page one of Google.
Her advice: regular blog posts, email marketing through tools like Mailchimp or Constant Contact, and a presence on social media platforms that link back to your website. Video content, Facebook Live, YouTube, and Instagram all drive traffic. And every post should include your website URL.
"If you don't have a website, you're not a real business," Melissa says. "And if your website is kind of wonky or it doesn't look professional, that's their first impression of you."
Reaching Kids Who Need It Most
For all the business talk, what drives Melissa is access. Rural schools and low-income districts are the ones that struggle most to hire SLPs. Telepractice fills that gap by connecting kids with qualified therapists regardless of geography.
"It's the rural schools that tend to suffer, or the schools that are in low SES areas," she says. "Telepractice is a way to get those kids that really need these services great therapists, and getting it to them in a 21st century manner."
And there's an unexpected workforce benefit too. Melissa discovered early on that military spouses who are SLPs thrive in telepractice. When their partners get transferred to a new base, they don't have to quit and start over. They keep their clients and their jobs. For many, it was the first time in their careers that a move didn't mean starting from zero.
That's the kind of flexibility that makes teletherapy more than a business model. It's a way to keep good therapists in the field.
Running a teletherapy practice means managing schedules, therapy notes, and billing across multiple states and districts. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, keeping your documentation, scheduling, and billing in one place so you can focus on the kids you're there to serve. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist 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 Jackstadt, and thank you for joining me today. I'm speaking with Melissa Jakubowitz today, the owner of Alive Now Therapy, and this is episode eight.
Kadie: How are you, Melissa?
Melissa: I'm doing good today, Kadie.
Kadie: Good. We tried to record our podcast a couple of times, so thank you for coming back and joining me despite our tech troubles. I'm so thankful that you have continued to cooperate with me.
Melissa: No worries. I think those of us in telepractice know that sometimes there are tech issues and you just have to go with the flow.
Kadie: Yes, and that's a great segue because what's interesting about your private practice is that it is teletherapy. So can you give us a background about what your practice looks like today, and then we'll backtrack a bit?
Melissa: Sure. So my company provides telepractice services to school districts. They can be public school districts, charter schools, virtual schools. In addition to that, I am also building a platform for SLPs to use who want to provide teletherapy services. And also, once we get enough materials into our platform, we would also be offering it to SLPs who work in person with students so that they're not carrying around a whole big bag full of all of their materials and treasures that will all be incorporated into one website.
Kadie: Absolutely. So right now, these two businesses are really separate from each other. So what do you use in the meantime in your teletherapy company?
Melissa: Right now, we're using Zoom. It's a great platform to use. Some folks feel that it's a bit on the expensive side, but when you really look at it and analyze what they're offering, I think it is definitely viable if you've got more than a couple of therapists working for you. The Zoom platform that meets the HIPAA compliance standard and the one that they offer a business associate agreement with, which is needed for HIPAA compliance, is about $200 a month. But I can have 10 different SLPs working on that platform simultaneously.
Kadie: Okay. So if you have enough of a caseload and team members using it, it's actually not too steep.
Melissa: Correct.
Kadie: So the platform that you're developing will have not only the video integrated, but also the materials.
Melissa: Yes, it'll have materials. It'll have a number of other bells and whistles that allow you to schedule right from the platform. It will allow you to bill. It will allow you to essentially, it'll be sort of your practice in a box. It will allow you to do all the things that we need to do as SLPs. We want to have our schedule in front of us. We want to be able to take therapy notes. We want to have our materials readily available. And we need to be able to track our clients.
Melissa: The one thing that I would really love to do, but my tech folks tell me would be nearly impossible is to integrate with IEP systems. And they said one of the reasons why that's really difficult is there are so many different IEP systems around the country that it would be cost prohibitive to integrate with each and every one of them because they're all built very differently, which is unfortunate, but it's the way it is.
Kadie: Right. I agree. It's probably nearly impossible to not have to complete those separately. If you're contracting with schools, you know, being on their IEP system, in some sense for progress reports and IEP writing and probably another platform for the rest. But I think that's kind of the way it goes. What will your teletherapy platform be called and advertised as?
Melissa: It will most likely be under the Alive Now name.
Kadie: Well, you'll definitely have to keep me updated as that continues to come to fruition. And let me know once that's officially out there for the public to purchase.
Melissa: I definitely will do that. I'm looking forward to it and hopefully it will happen in less than a year.
Kadie: That's exciting. So a little background about your overall experience as an SLP and experience in private practice, because I know you've gone about it a few different avenues.
Melissa: Yeah, I have. I started out my career working in the schools and I worked in the schools for a few years. But at that time, I decided that I was not happy with the time I was spending doing paperwork and having to do lunch duty and bus duty and those kinds of things that I really wanted to focus on working with the clients. So at that point in my career, I left the schools to open a private practice and I had a private practice for about 20 years. And I focused in those 20 years on pediatrics. It was strictly pediatric practice. We did from birth through high school. Part of it was private clients and part of it was contracting with the schools.
Melissa: At my largest with that practice, I had 12 full-time therapists working for me in two offices. After about 20 years, I was sort of burnt out. I'd done everything I wanted to do. My therapist and I all had various specialties that we enjoyed working in and focused on attracting clients so that my clinicians who wanted to specialize were able to do that. And the clinicians who wanted to be generalists could remain generalists. And I had done everything that I really wanted to in terms of growing it and didn't feel like I could grow much more in private practice.
Melissa: So I decided to look for some new opportunities. Long story short, as I sort of put the feelers out among my network, a colleague of mine introduced me to two young men who were just a few years out of business school who were starting this business of providing telepractice services to public schools due to the shortages that we all are very well aware of. They are businessmen. They knew how to run a business, but they knew nothing really about the field other than what they had read and through interviews with many people in our profession.
Melissa: So I joined them as the vice president of clinical services and I essentially built the clinical side of the business from the bottom up. None of us really knew what we were doing. There was a little bit of research out there. I talked to the folks that had been doing it for a while and met some amazing people that I'm still in contact with now. And I helped that company by doing everything. It was like starting a business all over again, building from the ground up, hiring therapists, training them.
Melissa: And then once the company got to a certain point, then they started hiring marketing people and salespeople rather than having the two co-founders doing the marketing and the selling. They needed more staff to help them out. So at that point, I began also training the salespeople and the marketing people. They were hired, but they really knew nothing about working in public schools. They really didn't have any idea of what speech-language pathologist was.
Melissa: I really enjoyed that piece, trying to put into layman's terms what it is we do and to understand what they do. I think the biggest help for the employees that were non-clinical employees was really seeing therapy sessions in action. It was exciting for them to see the kids light up when they were able to have fun things happen on the screen and to interact in online activities. I think it was pretty amazing for everybody and that company grew pretty large and they're still around today. But about three or four years ago, we parted ways because I wanted to go back to something a little bit smaller, a little bit more manageable and wanted to do some things differently than the company had been doing them. So that's kind of how I landed in telepractice.
Kadie: Wow. Yes, that is quite an impressive background and amazing that in the brick-and-mortar private practice, you just felt like, okay, I've mastered this and I need something more challenging, which is so impressive to me. So in the meantime, you have successfully started your own teletherapy business. I'm sure you had a little bit of background on the business side, obviously, from your previous position with the larger teletherapy company. But can you tell us, for those also interested in this avenue, how do you secure contracts with school districts? Are they local? Did they branch out to various states? Tell us a little bit about that.
Melissa: Sure. So I think the best thing is to start relatively locally, or at least within your own state. If you've practiced in the schools in your state, and I focus on the schools, although there's telepractice being done in other venues, it's being done in private practice. But right now, most of the telepractice that's being done is in the schools, primarily because that's where the reimbursement is.
Melissa: So in looking at contracting with schools, it looks really easy from the outside. Hey, just pick up the phone or email a special education director where there's an opening, and I'll get a contract. It's not quite that easy. Some states, you have to fill out an RFP, which is a request for proposal. When the district decides they want to do telepractice, then they put out a request for a proposal. You have to fill out certain forms. And then everybody else that wants that has to do that. It's essentially, they look at the proposals and decide which proposal is going to best fit their needs in that particular school district.
Melissa: In other school districts, it's a matter of contacting the right person. The right person could be the director of special education. It could be a program manager or program coordinator. It could be an assistant superintendent. And you have to dig a little bit to find out who that person is that makes those kinds of decisions.
Melissa: And then it takes a fair amount of selling. You have to sell people on it. Because even though I've been doing this for almost 10 years now, it's still relatively new. And a lot of school districts are not aware of telepractice and what it is. And still, people think that it's putting a child in front of a computer as opposed to putting the child on the computer in front of a live SLP who is actually physically there on the other side of the computer, but not necessarily in the same state or even in the same country for that matter.
Melissa: So it takes a lot of selling. And I think a lot of people going into telepractice don't realize how much selling it takes. And you have to develop a thick skin very quickly. Because you will get a lot of no's. And you have to learn how to get past those no's. And it was one of the hardest things. It's still a hard thing for me to make those sales. Because I don't like hearing no. But I've learned to, once I get off a phone call where I've got no, I have to get right back onto the next phone call. If I say, oh gosh, I'm going to stop for a few minutes or stop for an hour or two, I sort of lose my momentum. And it makes it that much harder to get back in. So selling is the really big piece that most of us as clinicians don't have any experience doing.
Kadie: Right. And especially whenever you're having to speak in layman's terms to some of these outside professionals who don't have the speech background. Like you said, it seems obvious to us that we're still doing therapy. And we're still using best practice. But I understand that you might have to dig a little deeper and try to get that across to someone.
Melissa: Yeah, exactly. And then in terms of selling, you also have to understand what the sales cycle of the school district is. There are good times and not so good times to be approaching school districts. When school first starts, it is crazy busy for everybody. And unfortunately, districts may not be focusing on a shortage in their district. They've tried all summer to look for someone. They may have gone to ASHA Connect and had a booth there and recruited. But they haven't had much success in hiring someone. But now at the beginning of the school year, they are totally focused on just getting school started and making sure the kids are where they're supposed to be, teachers are in the classrooms, and that sort of thing. So that's not necessarily the best time to approach folks. There are other times that are good. And it's just a matter of learning what that sales cycle is.
Kadie: That makes sense. So once you secure a contract, I'm sure you have your own forms that you've developed. What typically does, without getting into numbers, what does a payment cycle look like for you? Are they paying by actual clinical hours? Or are they paying per day?
Melissa: It really depends on the school district. It ranges from being paid hourly for direct contact time only to being paid for direct contact and indirect contract, the paperwork prep kinds of things, to being paid a per day rate. It really just depends on the school district and what's going to work best.
Melissa: People also have to understand that the rates that school districts pay for contracted service ranges. There's a pretty big range. And it really depends on the economics of the state of education in each individual state, as well as within districts, and how funding is done within a state. In my own state in California, it used to be a local control thing. The taxes were collected locally. So the school districts, unfortunately, in the wealthier area, got a lot more money from property taxes than the school districts did in a less affluent area. And so there was this imbalance in the monies that school districts got based on SES, essentially, because that's how the taxes were collected and used.
Melissa: A number of years ago, that all changed when we had what we call Proposition 13, in part, that changed property taxes in that property taxes could now, after Prop 13, can only go up 1% a year. And the only time they can go up more is when a property is sold. And then because the valuation of the property tends to be higher, then the tax base becomes a greater amount based on the current value of the property. But funding is a little bit more equitable now. They've changed the funding formulas. And I don't even purport to understand a tiny bit about how education funding is here in my own state.
Melissa: But this is just to illustrate that funding for districts varies from state to state. Some states, it may be everybody gets an equal amount of dollars per student. Others may have some variation on that. And then, of course, there's all kinds of title funding, Title I, et cetera, that help out school districts as well. So you have to have a knowledge of that going into the state that you're going into to provide telepractice service. You have to understand that funding. And you really have to dig a little bit. And most of this information can be found online is what are school districts typically paying for contractors?
Kadie: That is so complicated.
Melissa: It is, it is.
Kadie: Yeah, I guess I didn't realize when you're going state to state that you don't just have a flat rate probably because the competition is all over the map when it comes to jumping state to state.
Melissa: Yeah, exactly. And certainly in California, I can typically get more per hour than I could in a state where the economy is not like it is in California. I live in Silicon Valley essentially. And so there's a lot of money here and a lot of companies actually put money into school districts and help them out with a whole variety of things. So there's more money there as opposed to maybe a more rural state like Kansas or North Dakota, where number one, there's a much smaller population but also the funding and the economic base of those states are very different than what it is in California. So they're not going to be able to pay the same hourly rate.
Melissa: And what I as a business owner need to do is make sure that I balance those rates. So number one, I'm paying my therapist adequate rates for their services which I think is really important. And number two, I've got to balance that income because I'm getting more in California and I know I'm going to get less in North Dakota. I need to make sure that I at least cover my expenses in North Dakota. I know that I want to serve those kids and I'm clearly not going to make the same amount of dollars per hour that I would in California. So it's balancing. So when it comes to the bottom line, I'm still making money.
Kadie: That definitely makes sense. And on the flip side, are your employees primarily independent contractors for you, or do you ever employ as full-time, part-time?
Melissa: As I mentioned, I'm from the state of California. And actually, just yesterday, the state assembly passed a bill that would stop companies like Uber and Lyft from hiring the drivers as independent contractors if the job of the independent contractors is the primary business of the company. So drivers for Uber or Lyft, that's their primary business. So they really will be required to hire them as employees. The same for a telepractice company.
Melissa: I am based in California, and I really don't want to get audited by the Franchise Tax Board in California, nor do I want to get audited by the IRS. And because right now, the contracting business is the primary activity of my business, I'm hiring all of my SLPs as employees. But I hire both part-time and full-time.
Kadie: Yeah, there's a lot of changes. And kind of speaking to those larger teletherapy companies that have been around the longest, I know that they usually hire as independent contractors, I believe. Do you feel that they will have to make a change as well with these new laws?
Melissa: If they are practicing in California, yes. I do believe they will have to make changes unless these companies somehow get exemptions from themselves. And I know that the Uber and Lyfts of the world in California have spent and are spending millions of dollars to try and get them exempt from this new bill that passed. Now, it's passed in the Assembly. A similar bill passed in the House, and now they have to go to the two sides, the Senate and the Assembly, have to get together and reconcile bills. And once they do that, then it'll go to the governor's desk for signature. I am thinking, at least in California, they will have to change that. We'll see. It all depends on how much lobbying money the companies have to spend.
Kadie: Right, how much fear is behind that decision. As far as marketing, advertising, I'm sure you can speak to not only teletherapy, but also your brick and mortar private practice that you had previously. What is some advice that you have for others to get your name out there?
Melissa: Yeah, I think one of the biggest things is you need a website these days. It's really interesting, because when I first started my practice many, many years ago, the internet really wasn't a big thing. But now, if you don't have a website, you're not a real business. And make sure that you have a good website designer. A lot of folks do it on their own, and they do a good job. But if your website is kind of wonky, or it doesn't look professional, that's their first impression of you. And if it's not a well-done website that's easy to navigate, it can be a real barrier to people wanting to use your services.
Melissa: So certainly having a good website, and then knowing about search engine optimization, the SEO, is really important. That's what gets you essentially to the top of the list, or closer to the top of the list, when people search teletherapy, or speech therapy, or what have you. And those pieces are all really important. And then doing things, and making sure that you keep content up to date on your website.
Melissa: And I must admit that I recently realized that I had some old content on my website. I had listed dates that I was doing presentations, and I realized that I hadn't changed it in over a year. And I thought, oh my gosh, I need to do this. And because it's just me, and because I'm still very small, it's hard to keep up on everything. When I first started, I was writing blogs at least once every other week. And unfortunately, I haven't done one in a while. And I need to figure out a way and get myself organized, where I can do that on a much more regular basis. But those are the kinds of things, and marketing kinds of things, that bring people to your website.
Melissa: And then there's also marketing campaigns. And there are websites and software that you can use to do that. Mailchimp is one of them. Constant Contact is another one, where they make it easy for you to send out marketing emails. The only thing that you have to do is make sure that you have email addresses of people that you want to send those marketing emails to. It's a matter of getting those email lists or figuring out how to get the emails of the folks that you want to market your services to.
Kadie: Along those lines, with continuing weekly or biweekly blog posts and staying active in several ways on your website, all of that helps boost your SEO presence. Is that correct?
Melissa: Yes, it does.
Kadie: And then what other ways have you kept your website and your name at the top of that Google Search?
Melissa: Those are the primary things that I've done so far. There are other things that I haven't done that help out doing videos. I know some people who've done some things on Facebook Live, which is really interesting. And then posting those on your website, having a YouTube channel, Facebook, Instagram, Pinterest are all ways to attract people to your website. And whenever you're posting on these other social media sites, it's always important to include your website so that people are constantly linking back to it.
Kadie: I think that's great advice, because I know a lot of people will create a beautiful website, but then it just sits there. And without any updates, you just keep dropping and dropping and dropping. And you might be on page 10 when someone searches speech therapy. And if you think about how most of us operate when we search for something, we look at that first page of 10, and we pick one from the first page. Not very many of us will go beyond the first couple of pages, especially when somebody either searches for you or searches using keywords. If your SEO isn't high, you're not going to pop up, and people don't go all the way down to page 10.
Melissa: No, they just don't. And it might be the best therapist or the best company. Who knows? But it's just natural. We click on probably the top three.
Kadie: Yeah, exactly. Well, that is just incredibly helpful, I think, because teletherapy is the new up-and-coming thing, you know? So the more people and children and families that you can access, the better. So it sounds like a wonderful adventure thus far.
Melissa: It has been, and I'm really excited about it. It's really re-energized me and gotten me excited again about working. And I love seeing kids thrive, especially kids with disabilities. And it's so important that these kids get the services that they deserve. Even though telepractice can be done in any place in the US or even around the world, for that matter, it's the rural schools that tend to suffer, or the schools that are in low SES areas. People tend not to want to work in those areas.
Melissa: And telepractice is a way to get those kids that really need these services, great therapists, and getting it to them in a 21st century manner. So that's always really exciting. And the kids get exposed to some technology that they may not have otherwise been exposed to. And I think it really helps them to get excited about essentially STEM activities, the science, technology, et cetera, that a lot of schools are pushing. And it helps our kids with disabilities to be exposed to that in a very different way and in a way that benefits them.
Kadie: Oh, yes, absolutely. And I do think it's really interesting the different types of therapists that you probably get to employ, therapists who might want to step back and work part time or have a family. It's just a really great opportunity, I think, in the teletherapy world to kind of get to create your own schedule in a sense.
Melissa: Yeah, absolutely. And one of the things that I found very early on in my foray into telepractice was military spouses. I can't tell you how many military spouses I worked with who were SLPs who said to me, once they were hired and had worked for the company for more than a year, it was the first time in their careers that when their husbands were transferred to a new base, they were able to keep the same clients. They didn't have to get a new job. They didn't have to figure out where they were going to work or how they were going to work because they already had a job. And that was one less thing that they had to do when they had to pick up their families and move to a new area. And that was pretty amazing.
Melissa: And I have a friend and colleague who is part of a Facebook group that's military SLP spouses. And there are a lot of them looking into telepractice because it's hard if your spouse moves every couple of years to have to pick up and find a new job every couple of years.
Kadie: Oh, yeah, I can only imagine. How cool is that that you are also having a hand in helping those families also? Well, I definitely hope that you will keep me updated as things continue to progress with your platform development. And I know your business will continue to thrive in the teletherapy world. So I just appreciate you taking the time to join me and fill us all in on what this looks like for you.
Melissa: Thank you. I will definitely do that. And I'll let you know when my platform is up and running.
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 kadie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.