Practice Management


Your New Partner for Success: The Local Family Practice MD in Your Community
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Practice Management
Written by Williams Owens Jr., DC, DAAMLP, CPC   
Friday, 16 March 2012 22:56
I
t wasn’t until 1983 that the American Medical Association changed is stance on affiliation with chiropractors as being unethical.  That is not too long ago and it seems that, in some circles, the medical community is coming around faster than the chiropractic community; chiropractors are good at holding grudges.  The truth is, it is not about chiropractic, physical therapy or medicine, it is about patients.  The research is building on the benefits of chiropractic care and many (not all) of our educational institutions are contributing to the literature.  It is time that you stop confusing the politics of medicine with community medical providers; they are generally not the same.   Many of the local MDs that I work with on a daily basis and the ones I learn about while consulting across the country are open to learning about chiropractic.  That openness includes genuine interest in a drug-free and non-surgical option for their patients as well as simply loving chiropractors because we refer patients!  In the end, it doesn’t matter because we are trained to care for patients, and the more we can do that, the better.  
 
handshakedoctorpatientI am not talking about assimilating into the medical model, running a MD/DC practice or being afraid to talk Subluxation to medical providers.  I know for a fact that you can have the referrals and stay genuine to the chiropractic model, which is why the MD sends referrals to me and not the physiatrist or PT. The beauty is in chiropractic being a separate and distinct profession doing what no other health profession does.  MDs will listen to and understand the chiropractic model, as long as it is not given to them as though they were a patient.  There is a HUGE difference between a patient report of findings and an MD report of findings.  The major tenets of chiropractic are why we are the third largest healing profession in the United States, and we need to be better at explaining it instead of running away from it.  After all, it has gotten us this far hasn’t it?  
 
The chiropractic Achilles heel is our self doubt when it comes to communicating effectively with medical professionals around our practices. For 116 years doctors of chiropractic have been the very best at educating our patients.  We have stellar reputations and enjoy the highest patient satisfaction rate of any healthcare profession. What we are lacking is translating that ability in teaching to the medical community.  The trick is to understand how to communicate in the fast-paced healthcare environment with the same effort and effectiveness we have at spinal screenings and patient education seminars.  The number one way to communicate effectively is through reporting. In my private practice, I have learned a lot about orofacial pain management, orthopedic and neurological surgery, trigger point, epidural and facet joint injections as well as how a rheumatologist or neuropsychologist evaluates a patient.  I learned over time which doctors were thorough and which ones cut corners.  I looked at which ones provide information as part of a team and include chiropractic and which ones don’t.  How was all this possible?  I read their reports!  Medical doctors are trained to create and read reports. That is how they communicate and it allows them to be instantly updated.    
 
Currently the chiropractic profession is severely deficient in modern reporting techniques and this is hurting our ability to break out of the 7% utilization rate.  After 116 years we continue to treat less than 10% of the population. Why?   The reason is we have not been able to build advocates through reporting. Our reports are filled with technical chiropractic jargon, which would be great if chiropractors referred to each other, but we don’t.  We need to focus on reporting the patient’s condition in a manner that builds confidence in our clinical abilities and the assessments of our patients.  We need to be out in the community giving MDs reports of findings and building advocates all around us.  It is only then that we will see the other 93% of the population.    
 
Dr. Owens has established the nation’s first chiropractic elective in a Family Residency Program with the SUNY at Buffalo School of Medicine and Biomedical Sciences.  He has developed and credentials chiropractors to teach courses approved for CME credit to the medical community.   He can be reached at 716-228-3847.
 
Why Chiropractors Need a Coach to Succeed
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Practice Management
Written by Tom Owen III   
Friday, 16 March 2012 22:49
A
lthough chiropractors are generally hardworking, dedicated professionals who strive to correct subluxations in order to benefit the overall well-being of their patients and community, they still might be clueless on how to run an efficient and profitable practice. Technique expertise and talent are not enough. 
 
blackboardcoachingMatter of fact, the myth upon graduating simply isn't true. We've all heard it before: Get your degree, drive down the road until you run out of gas, throw up a shingle, and watch the new patients flood in. Any chiropractor practicing in today's economy will tell you it's simply not true!
 
So where does one start? 
Many successful entrepreneurs will tell you their success stemmed from some form of coaching or consulting. 
 
What? You've never seen yourself as an entrepreneur? 
Well face reality because you are! It's up to you to go out and build a business around your definition of chiropractic. Unlike medical doctors, you don't have the luxury of joining the local hospital in order to draw a paycheck. Your time, energy, and entrepreneurial spirit are what pay the bills. 
 
Some doctors believe success lies in establishing good rapport and having a positive reputation within their community. Even though those things are essential, they aren't the foundation of a successful business model that's part of an efficient system toward future growth. These types of chiropractors would avoid many mistakes, pitfalls, and loss of money simply by following the guidance of a well-seasoned coach.
 
For the graduating chiropractor, even more variables come into play. You need to thoroughly understand your market and the potential patients you'll serve. One way this is done is by performing a thorough demographic analysis. This helps you identify your target market as well as how many chiropractors are currently practicing in your chosen market. The physical location of your chiropractic office is also very important. But the aforementioned is just the start. Consider this: what should you consider before signing a lease? What about leasehold improvements? Do you know how to negotiate with a landlord for optimal financial benefits? That's just scratching the surface. We haven't even talked about how to determine what type of marketing works within the community you've chosen!
 
Although it is hard to make any accurate comparison between chiropractic and top athletes, sports coaching might serve as a good example. Even when reaching a high level of expertise, skill and recognition, top athletes still require a coach to supervise their training. This is because no matter how hardworking and dedicated they may be, they still might forget or miss certain details that will impair their performance in the long run. Being able to control and keep track of all nutritional requirements, vitamin supplements, motivation to train harder or any small injuries is frequently beyond the abilities of even the most disciplined athlete. Additionally, it is difficult to push themselves hard enough in their training to reach peak performance. Although a few adjustments to this comparison are required, it does not have to be different with a skilled and dedicated chiropractor.
 
Additionally, once your practice is up and running, maybe you'd like to spread those entrepreneurial wings even further. What better way to do so than by utilizing a coach that understands the dynamics of running either an associate practice or multiple practices spread out through various different communities.
 
By utilizing an experienced coach, you can avoid many headaches! A highly trained coach who possesses the necessary expertise with financial details, advertising and promoting, and business management will benefit you greatly in the long run, leaving you focused solely on your practice and on refining your skills.
 
 
7 Steps to a Sound Financial Policy
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Practice Management
Written by Ray Foxworth, D.C., FICC, MCS-P   
Friday, 16 March 2012 20:02
1 Know Your Numbers
M
any doctors do not really know the cost of doing business. We THINK we know about what it costs to run our practice. You may know what your monthly expenses are, but do you know the actual cost of providing an office visit? Don’t fool yourself into thinking it costs the same to adjust 10 patients as it does 25, just because you are already there.
 
According to whose numbers you read, overhead in a typical clinic runs about 50%. Don’t assume this is your number! A recent article I read suggested the following formula to determine your overhead.  While it may not be 100% accurate, it will give you a ballpark number.

chartssoundfinancialpolicy
 
Unless you know your numbers, you are at a serious disadvantage when it comes to deciding to participate in your managed care contracts or other provider agreements. While it may be great to be “on the list”, if the list you are on is paying you LESS than what it costs to provide care, you are better off being OFF the list!  
 
Otherwise, it’s like buying oranges for a dime and selling them for a nickel and wondering why you aren’t making any money. Getting a bigger truck is NOT the solution! Signing MORE contracts for less money than the cost of providing care is NOT the answer to improving your practice! You can’t make up for a loss by increasing volume. 

2 Let’ Talk Fees….or Perhaps Let’s DON’T! 
You never want to “talk fees” with your colleagues. This is considered price-fixing and there is a law against it that can land you in hot water.  You would be amazed how many times we hear doctors say they just asked friends around their area to see what the going rates were. This is flat out illegal…so don’t do it! Don’t take our word for it; here’s the definition of price fixing and a link to the Department of Justice:  
 
Price Fixing 
Price fixing is an agreement among competitors to raise, fix, or otherwise maintain the price at which their goods or services are sold. It is not necessary that the competitors agree to charge exactly the same price, or that every competitor in a given industry join the conspiracy. Price fixing can take many forms, and any agreement that restricts price competition violates the law. In many cases, participants in a price-fixing conspiracy also establish some type of policing mechanism to make sure that everyone adheres to the agreement. http://www.justice.gov/atr/public/guidelines/211578.htm
 
So, for obvious reasons, we won’t get into how much YOU should charge, but we can encourage you to at least review where you are in relation to others in your area using the resources that are available. 
 
Knowing what ALL doctors, not just chiropractors, are charging in your area is just a good business practice to make sure you maximize your income when possible. You could be charging less and getting paid less than everyone around you and never know it. There are several resources to assist you in finding out the fees in your immediate area. You’ll want to use these resources to help you determine your ACTUAL fee.  More about what your ACTUAL fee is in a few minutes. 
 
So, How Many Different Types of Fees Can You Name?  
Here is a sample list from the National Association of Heath Underwriters to get you started! 
  • Actual Fee – What you actually charge for a service.  (Typically your “highest fee”, also known as “my normal fee” or “what I would like to get paid”!) 
  • UCR fee schedule – Charges of health care providers that are consistent with charges from similar providers for identical or similar services in a given locale.
  • Global Fees – Negotiated fees that are all-inclusive (one fee is paid for the entire range of services provided for a specific episode or episode of care.)
  • Negotiated Fees – Managed care plans and providers mutually agree on set fees for each service. This negotiated rate is usually based on services defined by the Current Procedural Terminology (CPT) codes, generally at a discount from what the provider would usually charge. Providers cannot charge more than this fee. 
  • Prevailing fees – Amounts charged by health care providers that are consistent with charges from similar providers for identical or similar services in a given locale. 
  • Allowable fees – Fees permissible by health plans, or mandated programs such as Medicare, Medicaid or Workers Compensation and PIP. 
  • Contracted fees – Fees agreed to under a managed care or preferred provider agreement.
  • Mandated fees – Fees set by state and or federal programs such as Medicare, Medicaid, PIP and Workers’ Compensation
  • Approved Amounts –The amount Medicare determines is reasonable for a service covered under Medicare Part B. It may be less than the actual charge. For many services, including physician services, the approved amount is taken from a fee schedule that assigns a dollar value to all Medicare-covered services that are paid under that fee schedule. 
I am sure there are more types of “fees” but obviously this is enough to confuse the issue for most of us.  Now, here is YOUR challenge. Regardless of how many types of fees there are, YOU should have ONE fee in your clinic as your “ACTUAL FEE”. Your ACTUAL FEE is part of your FEE SYSTEM.     
 

This is a ROCK solid way to set up your fee system

Your fee system reflects the range of fees you accept as part of your managed care agreements, your participation in mandated programs such as Medicare, Medicaid or PIP and Workers’ Comp, if they are regulated in your state.  
 
While all of these fees may be different, this does NOT mean you have a dual fee system. Why? Because they are “contracted discounts” off your Actual Fee, or they are mandated fees set by either the state or federal government. 
 
Did you notice that nowhere in this list did you see my cash fee, my PI fee, my workers’ comp fee, my family plan fee, my Uncle Dudley fee,  or my buy 10 visits get one free fee! Why...because they shouldn’t exist! 
 
3 Develop a Fee System and Stop Playing Let’s Make a Deal! 
Your fee is your fee is your fee. Period!  Or it should be!  

Step back from the laundry list of “fees” you may now have in your office and start thinking in terms of “what is my ACTUAL fee” for each procedure in the clinic. Break the habit of your fee being based on payer type. Insurance companies ARE sending letters to doctors asking if they offer any type of discounts to patients, and IF so, how they are reflected on the claim form. Guess what?  There is NO place on a CMS 1500 claim form to SHOW a discount. Do you smell a rat?
 
If you have your fee system set up properly, you should be able to answer the above question like this, “I only have one fee for my clinic services and the only time that fee is discounted is when it is part of a contractual network agreement or a documented financial hardship.” This is a ROCK solid way to set up your fee system and IF you follow it in practice, you’ll be able to practice with much more peace of mind! 
 
Now let’s look further at this “fee system”.  Within your fee system, there are layers.  (UCR Fee Schedule, Contracted Fee Schedules, Mandated Fee Schedules and Hardship Agreements). 

Review the diagram to better understand the Fee System Concept:

chartssoundfinancialpolicy2
 
4 Build Your Fee Schedule and Your Financial Policy! 
Once you’ve identified your Actual fee, then make SURE you are letting your patients, EVEN YOUR CASH PATIENTS, know these are your REAL fees! Many doctors have been giving discounts to their cash patients and have NEVER let them know what their real fees were!  If you’ve been in practice very long, you’ve probably had this come back to bite you when the cash patient gets involved in an auto accident and gets the Explanation of Benefits and sees your REAL fees for the first time. NOT A PRETTY SIGHT!  Once you have determined your actual fees for services, stick with them until you evaluate your fees in the next year or at some given interval.  
 
Now let’s talk about an Office Financial Policy. Having a proper Fee System allows you to set up a simple office policy that can be summarized on a single piece of paper!  Keep it simple and straight-forward.  
 
If you find yourself or any of your staff saying, “Wait until Suzy comes back and she can review our financial policy with you”  then it is too complicated. Anyone who is at the front desk should be able to discuss the basics. If they can’t, you have to ask yourself why not. Is your fee schedule really dependant upon who is paying the bill? 
 
If your fee system is set up properly, and you have an ACTUAL fee established for your services, then the only time that you should charge LESS is when there is a contractual obligation or special circumstances.  After you have set your policy,  follow it! All patients should be aware of the financial policy.  Here is a good example of a simple but solid policy:

formsoundfinancialpolicy
 
What about pre-paid care plans and time of service discounts? Are they legal? 
That depends on whom you ask and where you practice. In some states, collecting in advance or offering “unlimited care at a fixed fee” is considered the business of insurance and is prohibited, unless you want to go apply for an insurance license! 
 
Some states require doctors to “escrow” the funds you have collected in advance and only draw down funds as services are rendered. IF you have determined they are legal where you practice, make sure you dig deeper just to be on the safe side. Don’t rely on the word of your colleagues who may say, “We’ve been doing that for years,” so it must be ok. Because something is commonplace does not mean it is legal. 
 
If you are offering these plans you should find out if you can offer the plan to insured patients. Some provider agreements prohibit collecting any part of the deductible or copayments IN ADVANCE of services rendered. So, read your agreements closely.  Our consultants advise us to NEVER collect in advance on federally insured patients like those with Medicare. 
 
We obviously like patients to commit to treatment plans and pre-pay plans seem to help them stick with it.  A popular alternative that avoids the problems with some pre-pay plans is a good auto-debit system that incorporates legal network discounts offered by a Discount Medical Plan Organization. This type of system allows you to offer discounts to insured patients on their NON-covered services. You simply set them up on auto-debit and have the patient sign an agreement to receive care and debit their credit card or bank account weekly, bi-weekly or monthly. You should NOT offer discounts on deductibles and co-payments, but only on non-covered services (like the visits when insurance runs out). With auto-debit, the patient is simply paying on their account, after services are rendered, which avoids the problems of collecting deductibles and copayments in advance. 
 
I would also suggest you avoid offering free services as a reward for someone committing to 10 or 20 or X number of visits. These offers are still an inducement if someone else (like the government) is paying the bill. There is a $10,000.00 fine PER occurrence for this type of violation.   
 
Now, a bit more about Time of Service or Prompt Payment Discounts.  Here are the facts as we know them:
  1. Time of service discounts ARE permitted in a few states.
  2. Not all states define the percentage allowed. 
  3. Even if your state DOES permit Time of Service Discounts, state laws do NOT supersede federal laws and you should be mindful of federal regulations regarding charging “Fair Market Value”. 
  4. The OIG did issue an opinion to a hospital in 2009 indicating that between 5% and 15% could be considered a “reasonable” prompt payment discount. BUT… there were restrictions on WHEN it could be offered, and it could not be advertised (and that does not mean an ad run in a newspaper…word of mouth can constitute advertising!) There were some other caveats as well. 
While a time of service discount may be permissible in some states, the problem is that far too many doctors hide behind this term when what they are really doing is trying to hide a dual fee schedule. The discounts they offer are FAR above any reasonable bookkeeping reduction. Our advice is to confirm what your state permits and, if NOT defined, err on the side of caution and follow the OIG’s guidance of 5%-15%. 
 
5 Keep it Current! 
Do you review your fees annually? Some carriers raise their fees at the first of the year, others in April and some in June. Talk to provider services and get the date on your reminder system to have someone verify the allowable; they do change and you could be leaving revenue on the table. 
 
6 Train Your Staff! 
Congratulations, you have developed a fee system, and you put it in writing, now what? Train your staff! There are rules and regulations when it comes to operating your own clinic. Is your staff up on the latest information available? If not, then you are putting them and yourself at risk! There is a wealth of information and training material available through your state association and companies/consultants that specialize in the field of chiropractic.

What you measure improves. Monitor to ensure your staff fully executes your financial policies. Review your financial policy during weekly team meetings and see if every new patient the prior week had their financial policy formally covered. You know how important a good report of findings is for patients. Treat the financial review with just as much importance. Money or confusion about responsibility is one of the top reasons patients drop out of care. This is an easy fix with a sound financial policy. If your staff receives resistance from any patients about your new policy, problem-solve it together. Talk about it and remember to congratulate them for following policy. 
 
7 Things to Avoid!
  • Do not undermine your front desk and insurance staff by talking fees with patients UNLESS that is YOUR normal office policy. Set and follow your policy and let them do the talking. 
  • Do not have inconsistent collection policies. Set and follow your policies on collections and apply them equally to all patients. 
  • Do not tweak your coding to allow for “lower fees”. This is called down coding and many doctors do this if they are trying to lower the fee to a cash patient. Consider using a proper Discount Medical Plan Organization which will eliminate the need for this improper coding and will allow you to document, code, bill, AND discount correctly. 
  • Do not base your fees or codes on payer type. You should have ONE fee and stick with it. The only time you should discount is when there is a contractual agreement or mandated fee schedule or the patient truly qualifies for your hardship policy. Base CPT coding on payer type ONLY if it’s required by contract or mandate.  
Okay… there aren’t just 7 steps; here are a few more pointers!
 
8 Do you offer discounts? 
If so, there are TWO areas of concern to consider:
  1. Legal Implications: If you do offer discounts, BE CAREFUL! Offering discounts the WRONG WAY can cost you. There are real fines and penalties associated with improper discounts and inducements. If you’d like to review an article on the legalities of offering discounts go to www.chirohealthusa.com/DoingTheRightThing
  2. Financial Implications: You must know your profit margin to determine if the discounts you are offering allow you to remain profitable. We see far too often that docs are willing to offer discounts without regard to their expenses or maintaining a profit margin. What they fail to realize is that offering a discount to the uninsured or underinsured may be helpful, but it should also be reasonable and not at or below your cost of rendering the services. 
How can a discount impact your practice? Did you know that if you were seeing 100 patients a week, and you collected 100.00 per visit, that if you decided to cut your fees by 25% to “attract” more patients, you would literally have to see 133 visits to collect the same revenue!  So do the math and make sure you are maximizing reimbursement by at least having your Actual Fee at UCR for your community, and if you offer discounts, offer them within reason and make sure you aren’t charging less than what it costs you to deliver the care.  
 
9 Action Steps!
  • Review and set your fees – Determine your ACTUAL fee and stick with it! 
  • Implement your Financial Policy based on your Fee System
  • Consider joining a DMPO if you are offering discounts. These plans allow you to document correctly, code correctly, bill correctly and, IF you are offering discounts, discount correctly and practice with more peace of mind. 
 
Article submitted by ChiroHealthUSA
Dr. Foxworth is a certified Medical Compliance Specialist and President of Chi­roHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He is a former President of the Mississippi Chiropractic Association and served 12 years on the Mississippi State Board of Health. He is a Fellow of the International College of Chiropractic, as well as member of the ACA. You can contact Dr. Foxworth at 1-888-719-9990 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
Murphy’s Law (2) When Starting a Practice
Practice Management
Written by Peter G. Fernandez, D.C.   
Friday, 16 March 2012 19:45
“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.
 
manwithclockDepending 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.
 
Opening a New Office... How to Lower your Expenses
Practice Management
Written by Claude Cote   
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.
 
walletwithmoneyThis 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 This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
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