When did you first think I need to do this on
my own. What was that push to start at your service
psychiatry, would you say? I knew that I went
back to school to not be an employee anymore.
I went back to nurse practitioner school. I knew
I was not cut out for being working for someone.
I started learning about API and all the software
stuff. When was your like biggest burnout period,
would you say? I had a very public meltdown in
the inpatient in front of many people, two of
whom were my later so they didn't judge me too
harshly. I do have to tell myself you get 30
minutes and then you have to put this down and
I go over everything and I obsess for a while.
You know I don't like following rules so I think
it's... Everyone say you can't do that. A girl
can't start a health tech company and even if
it is just seeing patients you're caring for
hundreds of people. Hi, everyone. Welcome to
No Prior Off, the podcast where we celebrate
psychiatric NPs who didn't wait for permission
to build something extraordinary. I'm Lindsay
Hill, and today's guest is someone who didn't
just start her own practice. She saw a broken
system and decided to fix it. Alison Sikorski
is a board -certified psychiatric mental health
nurse practitioner with over 30 years in healthcare.
She built at -your -service psychiatry into a
multi -state telepsychiatry practice, and then,
because apparently running a practice across
20 states wasn't enough, she founded PMH Scribe,
an AI -powered documentation tool built by a
psych NP for psych NP's. And here's the thing
I love. PMH Scribe literally has a built -in
Prior Authorization Tool. So if anyone understands
why this podcast is called No Prior Auth, it's
Alison. Today, she's going to walk us through
her journey from the bedside to building health
tech and what drove her to create a tool she
couldn't find anywhere on the market. Also what
she would tell every NP who's been up till midnight
finishing charts. So let's get into it. Thanks
for being here, Alison. Thank you for that nice
introduction. Wow. Thank you. I'm honored. We
are honored that you're our first guest. Okay.
So you've been in healthcare for over 30 years,
starting as a pharmacy tech. Take me back to
that moment you realized you wanted to become
a psychiatric nurse practitioner. I did not start
there. I was, I will say my first job, I was
16. So that's my journey. That's when I started
as a pharmacy technician and started learning
a little bit about medications and calls into
the pharmacy and things like that. And then After
that, I knew I wanted to go to nursing school.
I didn't quite know what I wanted to do and worked
at an apartment complex for adults with physical
disabilities and built a team of unlicensed assisted
personnel there that did a lot of health care,
but they also were not nursing assistants or
anything like that and did a lot of the staffing
and fundraising and working with state. billing
and things like that and then became a nurse
in 1999 and At the time my father was ill so
I wanted a terminally ill so I wanted a job that
I Could have my nights and weekends and holidays
off. So I went right into an office. I did not
do bedside I went right to soft nursing and Went
into internal medicine in an office where I was
very much the youngest person there in my early
20s and quickly became the clinical coordinator,
building the team of clinicians there, staffing
with physicians and APPs and we had a laboratory
and we put a pharmacy in there and we brought
in some alternative treatment like a chiropractor
and integrated that into the system and then
did a concierge branch off of that and how that
all worked in 2001, I was often brought in to
maximize billing and coding and to clean up after
an audit and figure out the national coverage
determines all kinds of fun projects I had back
then and fix up the after hours coverage and
things. And after my father passed, I became
a hospice nurse for a bit and I did a bit of
bedside. And then I had been looking at what
degree I wanted, I wasn't Thrilled about nursing
at the time. It was okay. It was good, but I
don't like blood and guts I'm not a say I'm a
chat kind of person so it just didn't suit me
as well and I was looking into going into counseling
or something like that and It just didn't financially
make a lot of sense. And then I was looking into
psychology and then haphazardly someone said,
Well, why wouldn't you do psychiatric nurse practitioner?
And I had never heard of it. None of my nursing
instructors, I had called them, asked them what
to do. And I looked it up and ran home that day
and told my husband, I'm quitting my job and
going to school right now. I need to do this.
And it didn't happen that fast. But it was I
need to stop everything I'm doing and go to the
psych NP school. And so I signed up at Rush University
at the time it was the top one in the nation.
One of the first founding ones, they did not
like my soft nursing. So they made me go back
and get some bedside nursing experience. So I
had been a nurse since 99 and I had gotten in
the interim a bachelor's in behavioral science
because it was half psychology, half business,
and team leadership, and that fit me well. And
so though I had done a lot of volunteerism in
high school at a community mental health center,
and I had been a hospice nurse with a lot of
grief therapy and pharmacy and all that, and
managing an outpatient office and such, they
didn't feel it was the nursing experience I needed.
I had to go get some bedside nursing experience.
I went into geriatric psychiatry. I thought it'd
be close to hospice nursing. It was not. And
it was a very wild time. It was a wild floor.
It was all of the local geriatric psychiatric
units. When they couldn't handle the patients,
they transferred them to Rush. And so for context,
the nursing ratio is one to two. So we had two
at the max patients because it was so highly
acute. So I did that for a while and that was
terrible and then I was having babies at the
time and I was going to school and I had three
babies in three and a half years and I got a
bit burnt out and said I just can't do school
and everything and work in this unit and all
of that so I ended up quitting for a while and
then Just went back to hospice, but more management.
I did weekend team leader. I built the after
hours team We went from 1 to 35 within a year
building that team and front loading all of our
home health and hospice Staff on the weekends
and nights when it made more sense to do a lot
of those intakes. So we built this whole after
hours on call triage telephone triage system
and sending people out we covered about eight
counties so back then we were faxing people other
things and we had all this cool remote work but
it was back in the day we were printing up map
quest directions and faxing it to their paper
faxes at home on their beepers it was it was
wild so i did that for a while and then my heart
hurt that i wasn't a psych NP. Of course, I went
back to school and graduated. By then it was
2011. So it was quite the journey to get there.
Wow. What was your experience like at Rush? And
how did that shape the clinician that you are
today? I had a lot of rigorous as I said, they
made me go back and get some bedside. They said,
don't come back until you have at least six months
under your belt. Don't apply. I also didn't have
the best registered nurse grades, so I had to
really push myself into Rush and say, I will
get the good grades. I was a kid. My dad was
dying, like all of the things and working full
time. And yeah, I got seasoned my nursing degree,
but I will be the top of my class here. So I
pushed and pushed and was, but it was an interesting
time. Back then we had to interview to get matched
into a system that would take us on. I had a
community mental health provider who was amazing,
took me on into a facility. So back then we stayed
in the same place. So we got to manage the same
patients for over a year and have our own patient
panel. And they really plugged me in there so
I could learn all about the billing and the fundraising
and state funds and how to balance it in a community
mental health center. We had a capstone back
then so we Mine was on cardiometabolic monitoring
of seriously mentally ill patients on atypical
antipsychotics. So we did chart reviews and then
trying to get like a blood pressure station so
they could learn self -efficacy and then the
fundraising for that. So it was a really long
capstone process, which was fun and cool and
rigorous. And we got to do some inpatient work.
all the different run groups and run individual
therapy and then have our own caseload. So it
was a really amazing experience. That sounds
incredible. It was. It was a very high quality
experience. It was good. When did you first think,
I need to do this on my own? Like, what was that
push to start at your service psychiatry, would
you say? I knew that I went back to school to
not be an employee anymore. I went back to nurse
practitioner school. I knew I was not cut out
for being working for someone. So I initially
went and wanted to learn all the things about
psychiatry. So I went to a practice where as
self -employed contractor. that could plug me
into outpatient, do inpatient rounds, partial
hospitalization rounds, long -term care. I still
wanted the gerosike and hospital consultant liaison
for a few hospitals. So I knew this place could
get me into all those places. A lot of times
I got to be the first nurse practitioner in a
hospital system, which was Strange and fun also
going and trying to explain our role to a panel
of people who weren't thrilled to have us there
and talking myself into getting into the facility.
So I had been doing that about seven years and
even before that thought about telehealth and
concierge and could I do this? I came up with
the name in 2013. So I had only been practicing
a couple of years, but I just kept putting it
off because felt like I needed to see everything
in psychiatry and I did not but I saw all but
what I felt like it was all of the things and
then around 2017 I Decided I wanted to keep my
insurance practice I thought at the time and
then have this little side gig where I would
see go to other places Illinois had dropped the
ball on full practice authority they didn't we
just couldn't get it to go through and it that
went through and it was still limited and I still
needed a physician collaborator for if I ever
prescribed a benzo and I we had all been fighting
so hard like going to the Capitol and and talking
to legislators that I just became very frustrated
and signed up for all the full practice authority
states. I said, that's enough. I'm just going
to go and I'm going to spread my net wide because
telehealth was not a thing that everyone was
doing back then. So like, well, I'll just have
patients throughout the different states. That
also was intentional to not mess with my Illinois
insurance contracts or Medicaid contracts. So
I wasn't. some of them specified you can't be
charging out a network and things like that.
And I said, well, if I'm not even in Illinois,
it's not going to mess with my contracts. It
won't mess with my non -compete. And so I started
applying and then looking at the rules. And back
then nothing was in a concise place. Like now
we have the Center for Connected Health and you
could just look it up and you have all the backlinks.
And back then I had to get a lawyer to do a lot
of that research for me and figure out I figured
out which states were independent, but then which
ones had good telehealth rules. The rules were
very different in 2017 and then started. I had
this vision of how patients would come to see
me. They would find me online. I already knew
I'd been eight years in, in a outpatient practice
that what the pain points were. And I said, I
don't want them having to call the office. I
don't want them filling out these big packets
and waiting for a call back. And I don't want
to hire. just a staff member for its scheduling
and then another one for a prior office and then
another one for this and all that. So I did the
self scheduling and how to kind of make sure
that the correct patient to come on that it wasn't
drug seeking, but it was people who wanted care
and that they were the right fit, but in a digital
way without having any touch points of a person.
So kind of built. found I couldn't find any HR
for it. I kept looking, I did 50 demos, I did
150 more other ones looking at them. And I couldn't
find it. So I had to build my own system. And
that's where I started getting excited with technology.
I was like, wait, what is this? Oh, this is really
cool. Like, I started learning about API and
all the software stuff and really just had so
much fun with it. So I spent about six months
looking at different systems, building it out.
Back then, again, we didn't have all of the places
I demoed. All I need is the patient to see the
availability first, so they can decide if they
want to wait or not, and then get through the
consents, and they want a brief, and I want them
consistent with what I would need. Like, we don't
prescribe this, but we do this. Are you okay?
And then pay to secure the visit. And that flow
didn't exist back then. So I had to build that
out. None of them. They all said you have a unique
use case. And so I said, OK, I'll just build
it. I feel like you were always like ahead of
your time. It feels like when I hear about all
the different things you were doing early on,
like even doing telehealth, like before it was
mainstream. Did you see somebody else doing that
or like what made you kind of go all in on telepsychiatry?
I did call, or no, I Facebook messaged someone,
and for the life of me, I don't even remember
who it was. It was this lovely lady, and I said,
I wanna do concierge, and I wanna do telehealth.
Can it be done? She said, yes, I do that. And
I said, how long have you done it? I've been
doing it for three years. And I said, that's
all I needed. Thank you. I just needed to hear
you could do it, and that it was okay. And then
I was in... the office and my colleague was attacked
and stabbed by a patient and that shook me more
than it probably even shook her. She was a trooper
and went back to work within three days but I
was rattled and I had been through inpatient
and I always rounded with a guard and I had done
hospital CL and you have to take all the precautions
and I didn't want to And I started taking Krav
Maga and doing things to protect myself. And
then it just clicked that if I was telehealth,
I wouldn't be exposed to the violence and I won't
go back in person. And so at that moment, when
that happened, I, it kind of clicked that I'm
just going to do all telehealth from now on.
And it again wasn't instantaneous, but it was,
I'm not going in person anymore. And then At
the same time, I had already been doing a little
telehealth, but I got the idea for online ADHD
care where I could pre -screen someone, see them
in person one time, and then we could just forever
be telehealth, and that would be great. I love
my ADHD population. I had already been just seeing,
when I had regular outpatient psych, I would
just do ADHD on Saturdays. It was like, we're
just talking and everyone's quick and we're like
having fun. And I was like, what if I did that
all the time? So that's where I specialized in
ADHD. We had a little system for an in -person.
And then right away I called up a girlfriend
at Raj and I'm like, what are you doing? You
want to do telehealth with me? Where do you live
right now? And so I added her right away. And
so we had a system where we had some other locations
where someone could be seen in person one time
and then transfer them to telehealth. That was
a little known kind of loophole back then was
there was a few ways of getting that one time
in person visit and was the in person visit even
needed and there wasn't a lot of drama around
ADHD. So it was that you could have a live visit
like we're doing right now with the patient.
So one, two, three, you're sitting with the patient
in another state. You're the DEA registered primary
care provider. I'm the telehealth and you can
do a pass off with all the contracts and things
like that in place. So at the time, I can't recall
anyone else doing. ADHD care that way. And then
COVID hit and a lot of my friends in the field
said, you know, I need to figure out this telehealth.
A good friend of mine said she was taking care
of her husband who had a physical disability.
And she said, I can't be going in the hospital
and bring this disease home to them. And I can't
get caregivers in the house anymore. Can you
teach me how to do telehealth? I went just join
me, it'll be fun. And so she joined me and then
a few others joined the group. And then we also
had before any of the waivers, then we had a
few offices throughout the different states that
they had a little practice here or there, maybe
were struggling to get it going, or they had
a location where they'd see someone one time
in person, then convert them to telehealth. And
then the waivers went through and then we then
no one knew how to do telehealth back then. So
there's a big surge, especially ADHD. No one
knew if they could do it or not, we had already
been doing it for years. So it was a natural
progression. to do that. And then then some bad
actors came in after and kind of started up ADHD
focused, but their focus was opposite instead
of us looking to make sure they had ADHD. And
if not, okay, we're going to treat your bipolarism
or we're going to treat your other things. Other
companies seem to be convincing people they had
ADHD or not, or starting them on medicine for
Maybe nefarious reasons are not for good reasons
and then not having a system if it went bad And
we had already had years of a system if it went
bad what to do next. Yeah Wow, that's interesting.
Did you have a lot of naysayers or like skeptics
that were like kind of? Instilling fear in you
or trying to trying to let them but at my old
practice I was balancing both I had this insurance
practice I had this telehealth practice for a
while I was overlapping especially building up
a direct -to -consumer model where there's no
insurance you don't you have to do a lot of marketing
and a lot of networking so I just assumed I would
have both all the time until COVID hit, then
I couldn't manage them both because the other
one blew up. But at the time, people are like,
no one's gonna like telehealth. That's just for
rural care. Like I was doing talks about this
cool new thing called telehealth that's like
can be used for the convenience factor and trying
to explain to people what telehealth was and
why it's so cool and why telepsychiatry is the
perfect fit for it. Back then, a lot of clinics
would not see someone on an atypical antipsychotic
because they couldn't fathom how to do an abnormal
involuntary movement scale or something like
that. So I had a lot of naysayers there. I also
had a surprising phenomenon that people were
a bit aggressive about Not taking insurance like
they they were really offended that someone would
take on that model instead and there was a misconception
that there was that concierge or direct -to -consumer
model meant patients could come and order up
drugs like of abuse and it was no that they don't
even come in because they've been filtered out
to not be Attempting to get drugs of abuse by
paying direct to consumers. So that was a big
stigma that I had to overcome. Yeah, absolutely.
I feel like you're one of the few group practices
I know that's direct to consumer. And that was
kind of what always intrigued me when I first
heard about what you were doing. I was like,
that's very unique because I feel like I run
into this all the time with my mentees where
They're like, do I take insurance? How did you
make that decision? Like, did you kind of I felt
like taking insurance initially helped me understand
how to navigate the health care system. No, I
had been in the health care, navigating outpatient
offices and such since 1999 and even Medicaid
before that. So I knew I would go into the insurance
world because I wanted to learn. acute psychiatry
and all the different facets. You can't really
work in a hospital and be direct -to -consumer,
that kind of thing. And I wanted to have all
the settings to be well -rounded. So for that
reason, I always thought I would take insurance,
but I had that concierge where they pay a subscription
fee model or just direct -to -consumer pay in
the back of my head because I had that exposure
back in 2000 when we took a physician who had
I think his clinic had two or three thousand
at the time it was internal medicine and we brought
it down to five hundred and turned them into
concierge and and did that break off of the insurance
process back then and so I had that in my mind
and then knowing that psychiatrists about forty
six percent of them are out of network don't
take any insurance that it's The way our insurance
is set up with separating mental health from
medical and all of that. I knew psychiatry is
a place where people often can do out of network.
But if I also knew that it took would take a
lot longer because I had to rebuild a panel.
I didn't take my 880 people from my insurance
panel over. I knew that would be a huge burden
for them. And I wasn't even going to ask of that
or anything. So I figured It would take me double
the time to create an out -of -network panel.
That's why I did two. But if I were a new grad,
I would start out with insurance. You learn the
ins and outs. You get it. You get filled right
away. It doesn't take you two and a half years
to get 300 patients. Yeah. And are you talking
about in private practice or just like in general?
I'd say in general but in in outpatient office
or private practice. Yeah, I think it helps to
understand the insurance. I also I think a lot
of people are willing to pay out a network or
want to because I have experience and they'll
say I need an expert and They'll come, they'll
say, okay, I need a second opinion. I also don't
have a lot of things like if you're not keeping
up and seeing me, I don't want to see you. If
they're coming to me just for a second opinion,
that's no problem. And then I've served them.
one time and I'll be here if they want it or
if they want a bridge person because we're in
different states and they say, I gotta pop in.
I move around every six months for my work. I
say, okay, you're always with me. Just come back
in when you move back into one of my states.
That flexibility, so the things I knew people
would pay out of network for, so flexibility,
not having As some people calm boundaries I don't
have a lot of rules other than I do have a lot
of controlled medication rules before they come
in but the ones who come in I'm flexible if if
they change their appointment the last minute,
okay, and they've already paid for it They just
move it around I I don't fuss about some of the
small things that get that you need to an insurance
on a big big scale Right. How much did it? cost
you do you remember roughly to kind of do your
own thing? About $30 ,000. Okay, so I had a pretty
big marketing budget. A lot of telehealth platforms
out there to contend with. I was going in 30
state or I think I applied to 25. I think I ended
up with 22 or something around there. So there
was that cost of the licensure which was typically
about $1 ,000. It wasn't a huge cost, but there
was a pretty big marketing cost. And how do I
set up marketing when you don't have a Google
My Business account and those things. But if
someone is just starting telehealth in their
state, they're not going to need a huge budget.
And if they're not hiring a bunch of people right
away. And I brought on staff day one because
I wanted to build this into kind of an enterprise
where nurse practitioners could join. Right.
Yeah, I know that makes sense. So there's a misconception
that tools like PMH scribe are only for cash
pay practices. Can you talk about how you specifically
designed the templates for insurance billing
and audit readiness and whatnot? Yes. When I
was in the insurance world, I was audited quite
a bit. I was told I was a high numbers provider.
So received audits more is what The reason UBH
gave me to audit me every year, I saw about 100
people a week. And so it might've looked different
to insurers because I'd be in a PHP in the morning
and like the place of service is changing all
the time. And I would do Saturday rounds at a
hospital. So that's 20 people right there. So
I was audited at least every year, if not a couple
of times a year that I was in the insurance world
for eight years. So really built it. based on
how the auditors, knowing that they are not always
medical people, they don't always have a degree
in it, they have the checklist that they would
just go down and they would be looking for particular
words. And now with AI doing that, and a lot
of these audits, setting it up for the words
that they look for. So every year since 1999,
I would get the CPT, AMA CPT book, and I would
pour through it, see the changes, and adjust
the templates to really capture every word that
they're looking for. So yeah, I have I probably
even have it in here. Like there's a book with
tabs every year that I go through and get all
of the new billing codes, everything. Oh, here's
the twenty six. Twenty twenty six had a lot of
codes for us. So get all of the codes that we
could ever build. I also was always into maximizing
collections for outpatient practices in internal
medicine labs and home health and all of those.
And then psychiatry, when I was billing on my
own, I was out. So I would always set up the
templates to follow along all the new parameters,
every new checklist that they're looking for.
and spell it out the way the auditors, they take
their sheet and they go down. It's probably not
a sheet anymore, but they take their audit tabs
or the AI is programmed to look for these things.
So really doing it in a manner that captures
what they're looking for and making it. Should
I say dummy proof make it try to make it real
dummy like spell out the words they use for example
the psychotherapy add -on is is it separate and
distinct might I'll say Psychotherapy outside
of the E &M visit this like spelling it out for
the auditors though. Same with all the phone
calls and the collaborative calls and any asynchronous
telemedicine and nursing homes. I had a very
big Medicare audit in the nursing homes where
they froze all my collections past and anything
in the future until they finished their audit.
So really looking at like getting it real clear
for them. My audit passed very quick compared
to my colleagues because I had it templated for
the auditor. So all of us were audited, me and
everyone using it, my templates were fine. And
it passed in a couple of weeks, everyone else's
took months and then they got down coded. So
that, and then the state audits when they, I
don't know if it's Jayco, who the state is anymore
in nursing homes, but how they would audit the
gradual dose reductions and spelling it out for
them and things like that. Gotcha. Gotcha. Gotcha.
So you've been a psych NP for how many years?
Since 2011. So about when was your like biggest
burnout period? Would you say I had a very public
meltdown in the inpatient in front of many people,
two of whom were my students later. So they didn't
judge me too harshly. It had been a period of
time where one Something happened with the insurance
reimbursement. So my collections were off which
was making upsetting me because I believe they
put me through as an FNP instead of PMA 10p.
So my rates dropped in half and at the same time
I had lost a few patients to suicide in and We
can't know what someone's gonna do when you discharge
them. And if you're in that discharge period
of seven days from inpatient, then you all have
to sit in a root blame analysis. It's called
a root cause analysis meeting or any of those
and they ask they kind of part your charts and
how'd you let them die and all of this. Gosh.
And that kind of scenario and then you're proving
the nurses did everything they could. This wasn't
anyone's problem. No one did this. We spelled
out, you know, the assessments we did. It's a
tragedy. And everyone's very stoic. And I'm like
my mushy, squishy self, like sobbing for this
person whose family is left. The family understood.
They weren't upset, but that was probably my
biggest burnout is like sitting there trying
to explain to non -medical people how someone
may pass from suicide and how that occurs when
you discharge someone and the limitations of
what you can do inpatient with all the feelings
of that and how heavy it was and you know they're
well how can we support the physicians and I'm
like well you know the nurses are here too like
there's was on the floor. No one stopped and
held space for them. No one stopped and held
space for this person who lost their life or
their family. And it had just been a bit too
much. And the level of violence had been escalating
in the inpatient unit that I really didn't feel
comfortable there anymore. So I probably sobbed
through the eventually sobbed through the meeting.
First, I was mad that we were having it. And
then I said, you know, don't worry about us because
I quit like I'm done. And I just kind of walked
out and was done with that chapter. And so that
was probably my biggest burnout moment is the
emotional stuff with it. And make sense. What
would you suggest to Psych NP who loses a patient
to suicide. I know that's a heavy question. I
just I've had mentees in my boot camp who have
gone through it And so I've been in situations
where I'm like, okay How do I best support this
person and I just didn't know if you had any
I've had things I do that's not right and things
that do and so my not right thing is obsessively
check the charts for I do have to tell myself
you get 30 minutes and then you have to put this
down and I go over everything and I obsess for
a while and yeah I blame myself and I fall in
a puddle and I just sit there and I've even gone
on social media and look them up just to see
their face again and then I tell myself that's
enough I can't keep doing that and then I reach
out I do therapy modality called breath work
where you I have a lady I go to on speed dial
and I say I need a breath work session and we
just It's very outside of what we typically do
in psychiatry So it takes me out of like I can
CBT myself all day long I can great therapy myself
quite a bit from being a hospice nurse, but I
can't breathe off the trauma and scream out what
ever is in my subconscious like One time it was,
why didn't you try as hard as I did? Or, damn
it. Like, damn it, we didn't catch it. Or I'm
sorry, or any of that stuff that comes up. And
so doing that in a safe space, there's this beautiful,
if you're going to have someone else on a podcast,
there's this beautiful nurse practitioner out
in Virginia who does all this breath work. What's
her name? Mary Crutchfield is the beautiful soul,
yes, who does that breath work. And I believe
she does it for nurse practitioners and other
clinicians. I have someone local who does it,
but it's a very powerful way of processing that.
I like active resolution therapy is another interesting
therapy modality, but I like the breath work.
I'm a bit spiritual, so I put their name. and
something about them, just their first name,
and put it in the Bible. I don't read the Bible,
but I just put it in there. I don't even know
where my Bible is. It's just my symbol of I'm
giving this up to God. And that's kind of my
routine after having been inpatient and PHP.
And my specialization was high suicidality and
treating people with electroconvulsive therapy
and all of those things. probably in that space
lost a patient a year and sometimes a couple
and and with people with substance use disorder
and and when they relapse they often Pass from
that. Yeah having been through that I kind of
picked up a thing to do and then I would always
call my collaborator and say what did I do? It's
a it was a very kind man. He'd say else and do
you remember where they started you met them
in the icu after their first very serious attempt
you took them through impatient you took them
and this was a cycle that you couldn't stop and
you're watching a derailed train off the tracks
going down a hill and you're trying to jump in
front and you can't always stop it yeah Thank
you for sharing so vulnerably because I think
it's something that a lot of us have dealt with
and it really makes you feel burned out and just
like, what's the point? It feels very bleak,
you know? And I will say, I always call the family.
I know that's controversial, but I call the family.
And I'm usually sobbing like a mess, but I call
the family and I even invite them in. and I even
sit with them and spend space. When we lost someone
in PHP, I had to go in that room. There's, you
know, 10 other people who were sharing space
with that other person and saying they didn't
make it. And you all are in this very vulnerable
spot. So I talked to the people around them.
I invite the family in. I've had a few come in
and I don't charge for it. It's just I sit with
them and share space with that sorrow. Yeah,
that's really beautiful. To pivot a little bit.
Your streams of income now. If we were looking
like in a little pie chart. I feel like it's
a hemorrhage out because I'm funny. Because I
was self funded for the startup of the a pH scribe,
the health tech. So yeah, I don't know if it's
a stream. It feels like a tiny little drip right
now is how it is. Yeah. Yeah. With your businesses,
have you like, did you set out to build a business
that you would eventually sell or maybe not?
I love creating things. So I like I could see
At your service psychiatry maybe one day as I'm
spending less and less time in there and just
mostly Focusing on the AI scribe, but it also
runs itself now. So I just get like I want to
do something new and the AI scribe has been Cool
because I'll hear something. I'm on social media
all the time and someone will say like oh and
you could charge for a phone call. And I was
like, yeah, you just chart for it. And someone's
like, well, how do you chart for it? I'm like,
oh, well, I'll just build that. Let me show you.
And I'll go and build it and bring it. And like,
that's so exciting for me. So those things, and
we have all kinds of things on our roadmap for
PMH scribe to build this AI layer into psychiatry
practice that that will just be continual development
with our team. That's cool. What would you say
makes PMH Scribe different from all the other
AI scribes that we're kind of like inundated
with now? Like, try this one, try that one. You
know, what's the specialization for psychiatry,
the setting it up to be audit ready for the auditors,
the practice management tools. So things outside
of just the scribe and as we're building onto
it and onto it, it's been interesting because
a lot of our users are nurse practitioners and
how much they like to chart. They like to do
these very long charts. So we had to tweak them
for like the psychiatrists use these and then
some of the nurse practitioners. Sometimes there's
overlap, but we learned pretty quick. We better
make a system where we can get more verbose charts.
And so having these prompt engineers and hiring
people to put together people's templates and
making systems. to build templates and all the
things behind the AI building. So we also have
medication education specific for psychiatry.
So the way you would talk to your patient, if
a patient is a sophisticated patient and really
wants all the details, we'll have that where
like Prozac, it's can be used for depression
or OCD or this or this and explains to them the
way we would talk to a patient so that the provider
can send it or patient is in ADHD medicine it's
like well if you're traveling just bring the
exact amount you need it's often still in there
keep it in a safe place like all of those little
things you wouldn't see on a printout from the
pharmacy or if you have an anxious patient who
you might say you might not want to read the
printout from the pharmacy, but here's the actual
information lots of details might get an upset
stomach for a few days, but it'll go away and
and those kind of things so that specialization
to psychiatry and Trying to build a tool with
care as the underlying care of the clinicians
care of the patients When I'm telling a patient
about it, they're like, Oh, I need this letter.
I got AI to do it. Lindsay's great, but you need
some noise canceling headphones, and I'll shoot
it off to you in a minute. And they're like,
Oh, that's cool. I like that. So it's been I
love your both. Yes. Yeah. You've always wanted
things to be automated. Yeah, I don't like doing
the stuff. Perfect sense, you know Yeah, I use
PMH scribe and I love it I'm not this isn't sponsored
or I'm not an affiliate or anything like that.
But one of the things I've noticed about it is
it's I Think it's much less verbose than a lot
of the other. Yes. I did at the baseline templates
It's it's concise like a typical like a psychiatrist
might chart or someone who's passing notes on
to I like Yeah, because I don't like to put too
much in there, but if they want it in there,
build a template for it for all the including
more and more stuff. But yeah. What's your proudest
moment across both businesses? I had this woman
reach out and she was she was frantic. She was
like, my job is going to take away this because
I can't produce security documents. I got that.
Don't worry, I'll look at it for you. She's like,
I have, for the first time in four years of practice,
I watched a movie with my son after work, and
she had not done it in four years. She had been
spending hours, she said, I have ADHD, I can't
do this, I'm running my own practice, I am a
single mom, I make all the money for the household,
I can't cut down, and I got to watch a movie
after using the software, and I was like, So
touched and even I brought on this like wonderful
salesman and he says I can't believe how nice
all these people are and they tell us these great
stories and he came from Like facial recognition
software and all this other kind of software
that doesn't seem related He's like we're just
making a difference here. These people need us
and it was such a touching moment that even Someone
outside of our field who doesn't quite get it.
Yes Wow This is impactful. You're helping people
help people. And when I'd see a provider say,
hey, I'm, you know, I had a busy day and we don't
really look into it, but they said, I saw 40
people, a Saturday provider, not a nurse practitioner,
but a provider who sees that they spend the whole
Saturday, that's their week. And they said, I
could see them all. And I got home and I was
done. and that's my week and that's all I do
and that was really cool to see it work for two
and then I got to do a talk with another gentleman
who does like slow visits he sees like he does
acupuncture and he does all these like cool like
fun things which I'll give you his name too because
he's a great speaker I just got to speak with
him and And he uses AI so he can do all the other
things. So he's not a pace person. He's a I want
to share space and do these cool things and just
have it in the background. So I don't have to
think about the charting and then just really.
Yeah. Touching how many ways people can use these
tools. Yeah. And there's like there's a lot of
pain associated with it. If you know the pain
of like just having those charts built up and
then you're carrying the emotional heaviness
and then it's like most of my weekend, I'm going
to be charting. It's very heavy. So that's incredible
to hear. I know that's one of the biggest things
I've loved to in private practice, like how present
I can be. You know, that's part of kind of why
I felt like I needed to pivot because I was more
worried about my checklists, not more worried
about them, but it was taking away from the focus.
Right. Right. It's pretty incredible what you've
built. Okay, one last question, I guess. You
recently became the co -chair of the Telemental
Health Special Interest Group at the American
Telemedicine Association. What does that role
mean to you? That organization has been amazing.
It's typically for enterprises and because I
was in so many states, I joined that and back
when I started, so I think I've been a member
since 2018 or 19. It was a larger investment
for me because it's an enterprise thing, but
to have them ask me to join and help do talks
about either AI or telemedicine and then Speak
with all these people who are in the field and
they just love to it's like all they do they
love telemedicine they think everything's great
in that world and then the president is his mother's
a nurse practitioner and so it's one of the rare
organizations that brings enterprises payers
individual providers and physicians and nurse
practitioners and physician associates all together
and they have the stance that nurse practitioners
and physician associates should be to the top
of their license. And so they really promote
independent practice and telemedicine and nursing.
The nursing has grown in the last few years of
having a whole department. So being able to even
facilitate these important talks about getting
the rules and regulations out there and how to
safe prescribe and telemedicine and deliver care
in a safe manner has been really impactful in
that part and getting to talk to the DEA directly
and say, hey, I'm a little guy. Compared to these,
I'm the little guy and this is what it means
to treat either ADHD or prescribed testosterone
or how that impacts the world and if it's taken
away for no reason, you know, the communities
that we're supporting are going to have that
cliff where all their care drops off and that
those of us doing it do it well and safely. And
I even argued safer than it was inpatient or
in person because I didn't get pinned in a room
threatened if I don't prescribe. If that occurs
in telemedicine, I can And I could check all
the prescription drug monitoring before they
even come in across all the states, cancel it
out before it happens, call everyone. So just
being able to bring that to the DEA advocates
there and talk directly to them, the rule makers
has been exciting. Yeah, that's awesome. OK,
Lide, I have two more questions. What does no
prior auth mean to you, not just the insurance
term, but as a philosophy? Well, you know, I
don't like following rules. So I think it's not
waiting. Now I follow the rules, but I will push
it to the edge of the rules or help foster change
in the rules. So just like with telemedicine,
someone says you can't do that. And so I go to
my lawyer and I say they say I can't do that.
And the lawyer says, yeah, I don't know. I don't
know if you can do that. Instead, I say, how
can I do that? Within these rules, how can I
do that? So not letting Everyone say you can't
do that not You can't a girl can't start a health
tech company You can't change careers while having
children You can't do any of this. I didn't ask
for Authorization or to do it. So to me, that's
what it means especially in this field as advanced
practice providers and advanced practice nurses,
we have the capacity to do all these different
things. Yeah. And even if it is just seeing patients,
you're caring for hundreds of people and they're
caring for hundreds of families and caring for
hundreds of others. So your reach as all of that
and and not Letting the box getting put in the
box. Hold your back Yeah, that's incredible Where
can people find you and then also I think I think
you made my audience a custom code that They
can get a discount, right? Yes. I think it's
Lindsey Lindsey in the coupon then they can get
the discount I'm on probably Facebook the most
because of I don't know my age there or Alison
at PMH scribe .ai LinkedIn I try to stay active
on that yeah I'm not active on TikTok other than
watching and lurking and liking people's stuff
so one day I'll get active on it but I haven't
had time for that one but yeah any of those places
Cool. Well, thanks for being on. I'd love to
have you on again. You're the kind of person
that I know nurse practitioners want to hear
from. And I know your time is limited, but yeah,
I think I found you in the big PMHMP group is
how I first came across you. I think I do. I
moderate quite a few of them just to see what's
going on. And because I'm on social media so
much because of the businesses, like might as
well moderate the groups and make sure they're
Usually, I'm just the one checking the licenses.
The people at NURCES know me well, the N -U -R
-S -Y -S system. I got to meet them. They talked
to me about how I use it. We're using it in Facebook
groups to ensure that the people are who they
say they are. I'm checking the licenses. That's
usually my role. We provide a lot of free value
on there, too, because I see your responses to
people, and I'm like, wow, that was jam -packed.
Try to pass it on to empower anyone. to just
go do it, do your thing. You can learn. There's
so much you can learn. You can ask questions.
Sometimes it's just reaching out to someone who's
been there, done that, get some support, go to
mentors like yourself. I've always had a business
coach or business mentor or... personal coach.
I know it's easy, but I like life coaches and
things like that. So I employ all of them in
the journey. It helps me have someone on my side
and then things I can't see if if we need to
see force for the trees and have another pair
of eyes on that. So having a good mentor the
whole way is probably the most helpful, especially
when starting businesses or navigating family
and practice. Yeah, that was one of the biggest
things I did different was starting to invest
in like coaching and mentorship when I went out
on my own. I was actually just at a scaling workshop
this last week. Do you know who Alex Hermosi
is? Not yet. You might not. He's all over social
media. He's a marketing guy. And I got to ask
him a question. So I was like, damn girling.
Naturally, I came up with the practice in a set
of breathwork session with my life coach lady
and I said I'm going to call it at your service
psychiatry because it'll be a service based tech
enabled practice and it was having a coach just
kind of take me out of my head for a bit and
think about what's possible or same with the
scribe I was in a mastermind group and even unrelated
to healthcare and they're like you just light
up when you talk about technology I don't know
any other nerds that are that excited about automation
but you light up you need to Put your energies
on that because it brings you so much joy. So
yeah, having that mentorship to have those areas
in your life where you find joy. So. OK, well,
thanks, Allison. Thank you. Talk to you next
time. All right. Take care. Thank you.