Going back to a “cash practice”

I talked with a DC who has been in practice over 10 years and finally got disgusted with the games played by Medicare, Blue Cross/Blue Shield, and other insurance companies.  One day he just posted a notice on his office wall that he was done with them, and he went to a strictly cash practice!  He moved his office into his house to save money, and lost almost 50% of his patients, but he said his practice was more fun and less stress.
Now, I’m talking about this subject because it points out what Bill Esteb says – stay away from the medical “establishment,” including the HMO rackets, and ask patients to pay you cash.

One of my big rules is “Start out the way you want to go.”  That is, decide how you will run your practice, then work on that model.  If you don’t know how you will run your practice, get out there and talk to 100 DC’s until you find a practice model that resonates with you, and use it.  That’s it.  It’s that simple.  You might change your mind later, but do it for the right reason and make sure you understand the consequences of the change and are ready for a tough couple of years (like the example above)?.

Use a local bank

I talked with two grads today who were thrilled to have obtained loans for their practices.  Both used small local banks and were pleased with the results.  One said the bank was over 100 years old, still run by the same family.  He was looking forward to establishing a relationship with the bankers in the community.  The other said the bank did more SBA loans each year than the bigger banks, and was helpful in putting togher the paperwork for the SBA loan.
I have seen it over and over – the small local bank is much more willing to talk to new businesses – particularly professional practices. And what a great way to get a start on new patients – ask the banker to beome a patient!

What has been your experience with banks?

Resume Myths: The One Page Resume

Probably the biggest myth in resumes is that they must be one page.  NOT TRUE!  For a professional resume or CV, the resume should be as long as it needs to be.  BUT STOP before you start putting that resume together.  While the resume can be longer than one page, the most important informatoin MUST be at the top, where the reader can see it first.  If he/she stops reading at the end of the first page, you want to be sure no significant information was missed.  Here’s what I suggest:

 

First- your education – where did you graduate and when?  Include your undergrad institution(s) here too.

Second – your particular skills and abilities, including any techniques, seminars, events that you attended.

Third – your professional activities while in chiropractic school.  These indicate your willingness to get involved and that you know the value of being in the community to bring in new patients.

Fourth – (hopefully you’re still on the first page here) your professional activities.  Include your preceptorship, Clinic Abroad (if you haven’t included it above anywhere), and your clinical experience while in school. Include the names of the doctors you worked under; you never know who might know that doctor.

With this, you’ve commanded the attention of your reader.  You can, and should, go on from here to discuss your other work experience and other activities. 

At the end, state “References available upon request” and put together a separate page for these references (after you ask their permission, of course!). 

I have a FREE resume review on my website.  Go to http://www.planningforpracticesuccess.com/Resume%20Review.doc  Fill out the form and submit with your resume.  I’ll respond promptly with suggestions. 

PS – Don’t forget the COVER LETTER – You should never send a “bare” resume!

 

 

 

Applying for an Employer ID number

The Employer ID Number (EIN) is ESSENTIAL and one of the first things you must do when you know your legal form.  You can apply online; it’s incredibly easy and you obtain the number immediately.  Here’s how:

1.  Go to the IRS website and get the SS-4 form – print it out and fill it in.  Note:  If you are an LLC, choose the Partnership option (unless you want to be taxed as a corporation).

2.  Go to www.irs.gov/businesses and find the EIN application form.  Fill it in completely.  The SS-4 won’t be accepted unless you do everything correctly.  You might have to start over and do it a couple of times, but just follow the directions and you’ll be fine.  When you have completed the form according to the IRS guidelines, you will IMMEDIATELY receive your EIN.  You’ll also get a confirmation in the mail, but you will have the EIN to use:

• To set up your business checking account
• To apply for Medicare and insurance provider accounts
• For all your business tax purposes

If you have questions about this process, don’t hesitate to email me (jean@dcpracticesuccess) or respond to this posting.

Pre-startup expenses – are they deductible?

Question: My husband heard that equipment purchased as a student can serve as a tax deduction after you open your practice.

Answer: This stuff is tricky. It’s quite possible that you can deduct expenses incurred within 12 months of opening your practice. BUT, only your accountant (and the IRS!) know for sure what kinds of expenses, how much, and when. The best advice I can give you is to SAVE ALL RECEIPTS and give them to your CPA. Include receipts for travel and expenses in finding a practice. You might also want to set up a separate business email account during practice startup. Use your free email for personal stuff and a “real” email account for business. See the P4PS website for more information on this subject: http://www.planningforpracticesuccess.com/pages/faqinformation.html

PC, LLC, PLLC???

What’s the difference between these?  In some respects, it depends on the state.  Here’s a quick overview:
 
PC is a Professional Corporation – same as any other type of corporation  – I’m not sure if you can be a Subchapter S and be a professional corporation.  I’ll find out and post a follow-up here.

LLC is a Limited Liability Company and PLLC is a Professional LLC – In Iowa there is no visible difference between the two, except as you designate.  In the LLC concept, you can choose to be taxed as a sole proprietor and still have the protection that your liability is limited to your investment.
If you’re not sure, start out with the PLLC if they have this option in your state.  It’s easy and inexpensive to set up.  If someday you want to incorporate, it wouldn’t be difficult.

Time of service discounts

I was asked a question about “time of service” discounts – where you give patients a discount if they pay at the time of service. You must be very careful with this, to avoid getting into trouble with insurance carriers and Medicare.

If you don’t file insurance claims for people, then you should not be in danger.

If you file Medicare for people, you must be sure that these people are being charged the lowest rate. Medicare rates must be the lowest charged.

My question to the DC who was asking about this – why are you discounting for cash paid at time of service? Isn’t your service worth paying full price for? Why not just direct your staff to set up procedures to assure that people are paying at time of service! What a concept!

Here are a couple of ideas to help you and your staff do this:

1. When someone enters your practice, include a financial responsibility statement in your packet, and DISCUSS IT with each patient specifically. Set up the expectation that you will be asking for payment for EACH VISIT at the time of service.

2. Get credit card and debit card processing, if you don’t have it. Many people will pay by credit or debit card who don’t have

2. Set the “ask” into your sign-out procedures. As patients leave and book their next appointment, have your staff ask “Will you be paying today by cash, check, or credit card?”

3. Put a sign on or near the front desk stating “Payment is expected at time of service.” It may not work with everyone, but it works on people’s unconscious.

4. Don’t be afraid to get tough with people who don’t pay. There is no reason why you should perform services for people who don’t want to pay. Have someone on your staff talk to this person.

Bottom line: Rather than discounting your services for so many people, set up one level of fees (except for a few people who have temporary financial difficulties) and work your system obtaining money at time of service.

If I can help, let me know!

Jean

Practice Valuation Question

How do you know what a practice is worth?

Someone asked this question today.  Here are the details:  Practice sees about 45 patients a week in 25 hours and gross collections were about $100,000 last year.

Rule of thumb is that the value is about 70-75% of last year’s collections, since it’s assumed that about 30% of patients will be lost.  But the value of the patient base is whatever can be negotiated by the parties.  There are lots of variables here, like whether the selling doc is willing to stay on for a transition period.  (Sometimes that is good, sometimes not.)  It also may depend on how the new doc is presented to patients and staff (don’t neglect the value of staff support here).

Resume Myth-busting – One Page Resumes?

A student brought in a resume for me to review. She said she had been told:

1. You must limit your resume to one page. NOT TRUE! BUT, you should put the most important information – Education and Most Recent Experience – at the top of the first page.

2. You can’t use “Professional Experience” until you have the degree. AGAIN, NOT TRUE! (Where do people get these ideas?!?) ALL of your experience, yes, even McDonald’s, is “professional.” But you might want to limit your listings to those that most directly relate to your new career.

3. A note about the “OBJECTIVE” section at the top of your resume: If you have a specific position you’re applying for, you might want to include this; otherwise, it’s pretty meaningless.

Check my RESUME REVIEW page and submit your resume for review – it’s free!!!
(http://www.dcpracticesuccess.com/resumereview)