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Practice Management
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Practice Management
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Written by Peter G. Fernandez, D.C.
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Friday, 16 March 2012 19:45 |
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“Murphy's Law” is an old adage that is typically stated as: "Anything that can go wrong will go wrong". When you start a new practice you’ll experience many examples of Murphy's Laws. I’ve opened over 3,000 new practices. Just when I think I’ve heard them all, a new twist on Murphy’s Law comes along. Here are a few of my favorites. I offer them with the hope that they just might help you avoid getting “Murphied”.
An incompetent employee will rise to his or her own level of incompetence… and then remain there.
O ne of the biggest mistakes a new doctor makes is hiring the wrong CA. The average DC has 2-3 different CAs during his or her first year in practice, especially if the DC is male. The trend for the male DC is to hire based on how the CA looks. Obviously, with this criteria there will be practice problems. A potential new CA has to be tested for his or her skills, knowledge, and abilities with basic business knowledge (math, filing, communication, computer skills, etc.). By accurately measuring a potential CA’s skill level before hiring them, the doctor can avoid having to fire an incompetent CA. A new practice needs all the help it can get. Start by hiring someone whose skills can help your practice succeed.
 Depending on relatives to build your practice? It will never happen.There is only one person you can count on to build your practice…you. I’ve had hundreds of doctors who set up their practices in their hometown because their relatives were well known. Their relatives implied that they would refer hundreds of new patients to the new DC. Some did and most didn’t. The result was few referrals, and the patients that were referred were preceded by their relatives requesting that they be treated for free. These doctors soon learned that operating a “free clinic” is no way to make a living.
If you try to please every patient… no one will be happy.
When a new doctor opens his or her practice, they try to please everyone (e.g.: not collecting insurance deductibles or co-pays, family plans, cash patient discounts, etc., etc., etc.) What these doctors don’t realize is that deals don’t work…and always backfire on you. For example: Patients who pay their deductible and co-pays talk to their friends who don’t pay for these items, and you’ll lose all these patients. When the insurance company audits you, which they will, you’ll have to repay the insurance companies thousands of dollars and be blackballed. Having different fees for different members of a family doesn’t work either (i.e.: the husband pays the usual fee of $50 per visit, the wife pays $30 per visit, the children $20 per visit if they all come in at the same time). When the wife or children come in by themselves and you charge them your usual fee, you’ll lose the entire family. And there may be times when you bill a patient for their portion of an insurance claim and they demand that you reduce your charges to the cash fee. If you say “no”, you’ll lose the patient. If you say “yes”, the patient will believe that you overbilled their insurance company. That’s not the reputation you want.
The cause of “high overhead” is usually “low production”.
Having started over 3,000 new practices and consulted with over 5,000 DCs, I’ve had thousands of DCs tell me their overhead was too high. To solve their problem I hired a group of CPAs and efficiency experts to analyze the doctor’s overhead to determine how to reduce their overhead. After an exhaustive study, what they reported to me was simple. The most they could reduce a doctor’s overhead was 10 percent. The basic items that comprise a doctor’s overhead couldn’t be lowered (office lease, equipment leases, utilities, staff salaries, taxes, fees, etc.). Most of the high overhead that could have been reduced occurred when the doctor initially set up his or her practice (i.e.: expensive equipment, paid too much for rent, etc.). This is why The Practice Starters® Program recommends a low overhead practice, with low office lease rates, for its Practice Starters® Program clients. Before you open your practice is when you can establish a low overhead practice. Not after.
The “best friend” you start a practice with… will be your “worst enemy”.
Many new DCs think that their best buddy in college will be a great partner in practice. After all, what could be better than two good friends sharing overhead expenses and practice-building experiences? Unfortunately, few partnerships work, because no two people share the same work ethic, want to treat the same number of patients, work the same hours, or want to use the same equipment. All of these things build resentments. Maybe not in the first month or the first few months, but in the end, partnerships don’t go the distance.
I have consulted in the opening of over 3,000 new practices and in this process have only seen one partnership work. There were two brothers that practiced together for 10 years… and haven’t talked to each other for the next 20 years. Save yourself a lot of grief, don’t start a practice with a partner.
I once had two doctors heatedly disagree with me when I taught this point at a seminar. They loudly told the rest of my clients that I was wrong and they were going to prove it. They started their practice in a 2000-square-foot office—the right size for two doctors—equipped the office for two doctors and borrowed over $100,000 to start the practice. Within 60 days, one doctor announced that he didn’t want to treat many patients per day, devote any time to marketing, work more than part-time, or pay his portion of the monthly overhead or their $100,000 note at the bank. He walked out on his best buddy.
Unfortunately, the remaining doctor was now stuck with a very high overhead and high loan payment. He worked hard, very hard, struggled and finally became very successful in spite of the fact that he was screwed by a partner that didn’t want to work.
The office site that you fall in love with… won’t be the office site you choose.
New DCs want to start their practices as fast as possible. Usually the first office site they inspect becomes “the best office site in town”. They don’t want to look elsewhere because they’re impatient and ready to start their practice. I’ve guided over 3,000 new DCs into practice and perhaps only one percent end up practicing in the first site they found. Why? Here’s a little known fact: there are always better locations, better deals, lower lease payments, and more accommodating landlords. All you have to do is find them. No DC should choose a practice location until they have explored all their options. No DC should begin looking at practice locations without being armed with a specific list of criteria the location must meet. A knowledgeable consultant can provide that criteria.
The opening date you have in your mind… won’t be your opening date.
Don’t try to establish an opening date for your new practice… you’ll never open on that date. Your opening date will be when everything that needs to be done is completed… not until then. Remember, everything takes twice as long as you anticipated… and then double it. If you pressure yourself to open on a certain date, all you’ll accomplish is greatly increasing your stress… unnecessarily.
Did you encounter a different Murphy’s Law when starting your practice? If so, I’d like to hear about it. Send it my way at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
. I’ll see that it gets published along with your name. For more information on starting a new practice go to www.practicestarters.com.
Peter G. Fernandez DC, is the world’s leading authority on starting a practice. He has 30 years’ experience in starting new practices, has written four books and numerous articles on the subject, and has consulted in the opening of over 3,000 new practices. Please contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476;
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
, or visit www.practicestarters.com.
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Practice Management
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Written by Claude Cote
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Friday, 16 March 2012 19:07 |
A t a glance, opening a new practice seems easy. But in reality, opening a new chiropractic office can be a significant financial challenge. Opening a new office is exactly the same as opening any other kind of business. You will have to rent office space, buy equipment, set up a marketing plan, hire employees, and the list keeps going on, and on... All the above tasks have something in common. They are all expenses. Until your new office gets in operation, you will have to face many expenses which can become very large. You get yourself committed to monthly payments for years to come. This can be very scary because, although you have lots of confidence, you never know exactly how open-minded the community will be for your health services. How many patients will you have the first month? Will your marketing plan be efficient? What is your plan if patients are not coming in as expected to cover your expenses? Then, you may have to face reality, which can include the possibility of bankruptcy.
 This is why you need to be very careful with your expenses when opening a new office. There are many ways to delay some big expenses until income is coming in regularly. Today, I want to give you a few ideas to think about that will help you lower your expenses and be even more.
Marketing and Office Location
Marketing and office location should be analyzed together. In order to have new patients, the community has to see you somewhere or somehow. This can be done by renting an office space on a very busy street or commercial building. You may pay more for the rent for your office, but the traffic generated at a prime location can provide you with big savings on marketing. If your new office is hidden somewhere else, you will have to spend much more for marketing to attract new patients. Renting an office in a prime location is not a guarantee that people will stop in to get health care either. You need to have a very good strategy for your marketing and nothing should be done on a "trial and fail" system.
X-ray Machine
X-ray machines are expensive. For the first few months, you may find a nearby health office that could provide the x-ray service for you. You can negotiate a discount price and still make a little profit to compensate your time. This is a win-win situation for you and the x-ray provider. When your clinic gets to the desired volume of patients and your finances get healthier, then you can buy your own x-ray machine. If you opt for this strategy, then make sure you choose an office location close to your x-ray provider. The closer, the better. This will make it easy for your patients.
Chiropractic Assistant and automated Electronic Health Record system
Until your new office gets in operation, you will have to face many expenses which can become very large. Employees are, by far, the biggest expense for all businesses, including chiropractic offices. The good news is that new technology can tremendously lower that expense. Those new fully automated electronic health record (EHR) systems will make your work very easy without any assistants at all. Not only are they fully automated and customizable, but they are very, I mean very, easy to use. Also, some of them can be used as a free trial for a long period of time. Let me give you a brief description on how you would operate your office with no paper and no assistant. First, you buy two or three computers and install one at the entrance of the waiting room. Since you may have planned a desk for your future front desk assistant, you may install a computer at this desk also. Then, you install the last computer in your treatment room. You give every new patient a chiropractic health card, enter his chiropractic exams in the EHR system, and set up his treatment and billing. Believe it or not, you are ready to go.
Then, while you treat the patient, you enter the SOAP notes pressing a few buttons on a touchpad.
The Clinic Patient Flow Without Any Assistants
Every morning at the waiting room computer, you will start the waiting room management software. Throughout the day while you are in your treatment room, patients will arrive and swipe their chiropractic card at the waiting room computer. This action will insert the patient in the clinic flow system. From your treatment room you will see how many patients are waiting for treatment and who they are. From your treatment computer, you will release your room and the first patient will be automatically called through speakers to come into the treatment room. This can be done with multiple treatment rooms also. Then, while you treat the patient, you enter the SOAP notes pressing a few buttons on a touchpad. When you are done, you will close the patient file and another miracle will happen.
The billing will be automatically triggered according to what you have done and relative to his or her insurance. Do you hear something in the waiting room? Oh yes... on closing the file of the previous patient, the next patient is being called to come in now. You may take patient payments and quickly enter them in the system from your treatment room. With one mouse click, you may give him his next appointment or multiple appointments if you wish to. Once a week, you click one button to send all the claims to a clearinghouse. Once a week, you click another button and all the insurance payments get automatically posted in each patient file, with no possibility of mistakes.
With new technology and some ideas, it has never been easier to open a new chiropractic office at such low costs. Claude Cote is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years. He has installed EHR system in 18 countries over 5 continents and nationwide in USA. He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com). For comments or questions, please email to
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Practice Management
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Written by Dennis Perman, D.C.
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Wednesday, 29 February 2012 14:43 |
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T he most important things in life come from inside out – happiness is inside-out, love is inside-out, health is inside-out, and indeed, success in chiropractic practice is also inside-out.
 So, what do you need inside you to experience the level of success and satisfaction in practice that you desire? There are many qualities that figure into this equation – discipline, creativity, presence, healing consciousness, willingness to do whatever it takes, decisiveness, confidence, technical skill, motivation, passion – to varying degrees, such characteristics seem to be predictors of practice growth and development.
But there is a single attribute that seems to drive all the others, and that is self esteem. You cannot develop or demonstrate any of these other traits unless you believe yourself to be worthy of so doing. Self esteem is the foundation of all positive movement, professionally and personally, so it will help you to understand and appreciate the importance of self esteem, and the ways to evaluate your own self-image to make the most of yourself and your practice.
Dr. Nathaniel Branden, author of The Six Pillars of Self Esteem, says that self esteem is feeling “competent to cope with the basic challenges of life” and “worthy of happiness.” He goes on to say, “It is confidence in the efficacy of our mind, in our ability to think… our ability to learn, make appropriate choices and decisions, and respond effectively to change. It is also the experience that success, achievement, fulfillment — happiness — are right and natural for us.”
Notice the impact of self esteem on your evolution as a professional and as a healer – you’ll have to see yourself as being competent to deal with challenges and being worthy of happiness to generate any personal or professional progress. Why would you work at improving yourself if you didn’t feel competent and worthy? These are the precursors to optimal performance, and an invitation to achieve at the highest level possible.
And that’s why it’s so important for the doctor of chiropractic to understand the role self esteem will play in his or her practice success and satisfaction. Let’s compare those with sufficient self esteem and those without, and note the distinctions between them, so you can identify where you are in this continuum and take the necessary next steps.
Doctors with high self esteem feel good about themselves and their work. They are proud and confident, inspired to share their ideas, and driven to provide an outstanding service. These doctors invest in themselves, through seminars, reading, online courses, coaching, masterminding, and otherwise enriching their internal maps, imprinting new ideas, constantly learning, and sharing with patients and other doctors.
Doctors with high self esteem have fair policies and effective, enforceable procedures. They are comfortable discussing finances with patients, and confront gently and professionally to guide patients toward compliance. They are neat, timely and organized, and they lead their teams with integrity, while caring attentively for their patients. They are reliable and service-oriented.
Doctors with poor self esteem, on the other hand, may feel insecure, indecisive, and weak. They resist change, are defensive, and underachieve for lack of drive to succeed, since they don’t feel competent or worthy of success.
The same thing happens when you get squeezed – what comes out is what’s inside.
You can build self esteem by reinforcing positive habits and behavior patterns, and by establishing a constructive inner environment, so you perceive the world optimistically and respond accordingly. You can use affirmation, visualization, empowering self-talk and goal-setting to shift your self-concept, among other self-development tools and techniques. Self esteem influences every aspect of a chiropractic practice.
It encourages confrontational tolerance in asking for referrals, addressing delinquent payment or re-delegating staff responsibilities. It turbocharges your patient compliance, because patients will automatically gravitate toward and follow the recommendations of a doctor who is certain and authoritative without being unpleasant about it. And finances are managed more efficiently because the doctor and staff with good self esteem expect to be properly compensated for their excellent work, and won’t settle for less, since it would be out of balance any other way.
Like Wayne Dyer says, when you squeeze an orange, what comes out is orange juice, because that’s what’s inside. The same thing happens when you get squeezed – what comes out is what’s inside. In practice, every day you’ll need to perform professionally, charismatically, and compassionately. You’ll also have to deal with patients or staff who may need extra guidance to stay on course, families who struggle to afford the care they need, and people’s very real health challenges.
For those reasons and many more, you must feel good about yourself as a person and as a doctor to effectively handle modern-day practice. Who you are determines how well what you do works – success comes from you, not to you. Show up as a better version of you and your patients will be better served, and your overall practice experience will be more fulfilling.
Dennis Perman DC is co-founder of The Masters Circle, a leadership coaching, practice building and personal development company for chiropractors. The author of numerous CD albums and books, and the executive producer of TMCtv, the world’s largest online video success library for chiropractors, he has published “The Column” every week for over thirteen years. Contact him at
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Practice Management
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Written by Dr. Peter G. Fernandez
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Wednesday, 29 February 2012 11:45 |
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“Murphy's Law” is an old adage that is typically stated as: "Anything that can go wrong will go wrong". When you start a new practice you’ll experience many examples of Murphy’s law. I’ve opened over 3,000 new practices. Just when I think I’ve heard them all, a new twist on Murphy’s Law comes along. Here are a few of my favorites. I offer them with the hope that they just might help you avoid getting “Murphied”.
Everything takes twice as long as you think it will – then double it.
L
ook at your projections … then double the length of time you’ll need to open your new practice. You’ll find that whenever you set out to do a task, something else must be done first. And if you think you don’t have time to do something right, you’ll always find time to do it over again. I’ve had many clients who tried to rush into practice. The day they arrived in town they put up their “open” sign. Unfortunately, the city noticed that they didn’t purchase their city and county licenses and closed them down. Then when they solved this problem they rushed into practice… forgetting to apply to and sign up with Medicare, HMOs & PPOs. Therefore they didn’t get paid. All that work and stress resulted in extremely little income and more stress. Trying to speed up the process doesn’t work. Unfortunately, you’ll find that out when you skip a step, it will take longer because every shortcut breeds new problems. This results in the saying, “A shortcut is the longest distance between two points”.
Don’t try to establish an opening date for your practice. You’ll never open on that date. Your opening date will occur when everything that needs to be done is completed…not until then. Remember, everything takes twice as long as you anticipate. And if you pressure yourself to open on a certain date, all you’ll accomplish is greatly increasing your stress…unnecessarily.
Nothing is as easy as it looks... nothing. EVER!
The best made plans usually go from bad to worse. Most of the time when you apply for a remodeling permit the city won’t approve it. When they do approve it they will usually change their mind. When you are ready to sign your office lease, the landlord will lease your office space to someone else. That’s Murphy’s Law.
When you cheat… you’ll get caught… KARMA
When a doctor tries to remodel his/her office without a permit, he/she will usuallly get caught. Too many times a doctor will try to save money by not paying for an architect to design his/her office to city specifications, not paying for building permits, etc. He/she is trying to outsmart the system. This doesn’t work. City codes are made to protect you and your patients. The city building inspectors and fire inspectors will notice construction going on at your office site and close your office. At this point the city will be furious at you and will make you tear out your drywall to make you re-do the electrical, plumbing, spacing of studs and fire protection. I’ve actually seen cities make doctors tear out all the walls and re-do the process (i.e.: architect, permits, inspections, etc.). Because the city is furious at the doctor for cheating, they will be twice as stringent on their codes and inspections… and take their time approving anything the doctor does. I’ve seen cities take 1 ½ years to approve the remodeling. Imagine the loss of income you’ll suffer by delaying your opening by 1 ½ years, e.g.: $250,000 – $400,000 all because you cheated. Cheaters get caught. Every shortcut breeds new problems.
Anything that can go wrong… will go wrong.
 If there is a possibility of several things going wrong, the one that will cause the most damage will be the first one to go wrong. And, if there is a worst time for something to go wrong, that’s when it will happen. It’s amazing how contractors, subcontractors and suppliers can screw up your plans (e.g.: they will have a $3,000 X-ray tube protecting a 10 cent fuse… the x-ray tube will blow first).
If your X-ray equipment is to be installed on a certain date, it will be late. If it is on time, the floor will be uneven. If it is delivered on time and the floor is even, they will forget the lead for the walls. If it arrives on time and the floor is even and they have the lead for the walls, then the electrician has installed the wrong wiring. Does it sound like I’m being cynical? I’m not. One of my clients purchased her used X-ray machine against my advice. She had it installed and then had a contractor build the walls around it. You guessed it. The machine didn’t work and it couldn’t be fixed or disassembled in order to be removed from the room. Therefore the doctor had to have her contractor tear out the door and the walls to remove the old unit, and then place a new X-ray in the room and then replace the walls. By trying to save a few thousand dollars on a used X-ray machine, it cost her over $20,000 for the contractor to tear out and reconstruct the room. And, she still had to purchase a new X-ray unit.
Lastly, all equipment you purchase will break down after the last payment or when the warranty expires… whichever comes first.
Everything will cost you twice as much as you think it will – then double it.
Trying to save money will usually cost you more money. You’ll find that the few pennies you save will not be worth very much… considering the money you’ll lose trying to save a few pennies.
Unfortunately, the temporary joy of a lower price will soon be replaced by the sorrow of poor quality. I’ve always instructed my Practice Starters® Program clients on the brands of equipment they should buy… or should not buy. Naturally some of my clients didn’t like my advice and bought equipment that was of inferior quality, or had a history of breaking down. I remember being berated by a doctor because I told him not to buy a certain brand of adjusting table… he bought three. After a few years, I asked him how his tables were working. He got red in the face and said all three of his tables had broken down… and the company had gone out of business.
Lastly, no matter how good of a deal you get on your equipment, it will be put on sale later. Count on it.
Did you encounter a different Murphy’s Law when starting your practice? If so, I’d like to hear about it. Send it my way at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
. I’ll see that it gets published along with your name. For more information on starting a new practice go to www.practicestarters.com.
Dr. Peter G. Fernandez is the world’s leading authority on starting a practice. He has 30 years’ experience in starting new practices, has written four books and over 100 articles on the subject, and has consulted in the opening of over 3,000 new practices. Please contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476;
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
, or visit www.practicestarters.com.
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Practice Management
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Written by Claude Cote
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Saturday, 28 January 2012 06:04 |
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T o the benefit of chiropractors, there are more and more full automated paperless systems available for their practice. This rapid growth in the chiropractic software industry is due to the high demand of the product, which is great for chiropractors because it keeps prices down. With all these choices of software systems, how can you make sure you choose the best fit for you and the way you practice? How can you make sure you choose the provider who will meet the service level you need? Choosing the right software system and the right provider to suit your needs is very important. This important choice will reduce your stress and will turn your money into an investment instead of an expense. Here are a few good tips that will help you to make this important decision.
Online demo
With Internet, it is very easy to shop software systems with online demos. An online demo can be a good start for your shopping and should be a step during your decision process, but should definitely not be your one and only step. Software vendors will demonstrate your online demo using small databases, showing you great speed, while in reality, with eight or ten thousand patients in the system, the speed can be very different. Since a full automated E.H.R. system includes complete patient flow management, it is just impossible to show you that aspect.
Online demos can only show you a few screens here and there but you miss the most important aspect of the system, the patient flow management. Ask for online demos from a few vendors you are interested in and do not make any decisions at this point. Don' t make up your mind yet and stay neutral as much as possible.
Visit a practice close to yours
Ask vendors if you can visit a practice close to yours that uses their system so you can see the system in action. The software provider will arrange this visit for you. If they have a good service and a good product, users and doctors are very happy to help their colleagues and show their system.
During this visit, the users will give you some great tips on how to maximize the system based on their own experience. By far, this live visit will give you a totally different perspective of these systems. Good chances are you will see happy patients coming in, swiping their Chiropractic Health Card in an arrival station, being called and being directed to a treatment room automatically. The doctor will show you how he sees all X-rays on the screen, how he enters his accurate SOAP notes in the system and so much more.
Try before you buy
At this point, you had an online demo and you visited an office that is using the system. You saw the system live and you really liked it. Your decision is made. But wait! Seeing it and using it are different, much different. Maybe your chiropractic technique is different from the doctor you visited. Your office may be designed differently and your patient flow may also be different. Don' t take any chances to lose your money or sign a contract for a system that may disappoint you. Try before you buy. Software providers who stand behind their product and service will give you this option. A minimum of six months to a year of free trial will give you enough time to use the system and make sure it works as expected. Not only will you try the product, but you will make sure you will be receiving the service and live training you need. Worst case scenario, if the system does not work as promised or if the service is deficient, you leave and you do not have to spend any money for the software.
This is a very simple and effective plan to shop for a software system. You can't miss and you will be assured you will be using the best automated software system for you. This buying process can be the difference between a nightmare and the greatest investment you have ever made for your practice and for yourself.
Claude Cote is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years. He has installed EHR system in 18 countries over 5 continents and nationwide in USA. He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com). For comments or questions, please email to
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