Dr. Susie Warden’s one stop healthcare shop
Planning and branding poise her clinic to grow — again!
By Todd Stumpf • photos by Michael Hudson

Evolution may be a heated topic in some educational arenas. But for Dr. Susie Warden of Wheaton, Illinois, evolution is a way of life.

A multi-functional mom - Warden is not only a full-time practitioner and manager of a thriving multidisciplinary practice, she is also the mother of four active boys. Her husband Chris (right of her) is her clinic director of operations.

In fact, Warden counts on evolution to keep her practice growing, which is a one-stop healthcare work in progress.

So far, it has worked: Less than five years ago, she was a new solo practitioner who billed only $35,000. Now she owns and manages Advanced Healthcare Associates, an 11-member integrated healthcare clinic that billed $1.7 million in 2005.

And in the near future, she’s allowing the practice to evolve into a multi-clinic venture with her associates.

Of course, to attribute her success merely to evolution would be inappropriate — and inaccurate. Warden has planned for it.

Warden first became inspired to offer patients more than she could as a solo practitioner when she attended a conference on integrated (multidisciplinary) healthcare — at a conference of the Illinois Chiropractic Society in 2001.

“I said to myself and to my husband, ‘This is what I have to do. This is what I want to do,’” Warden recalls of her epiphany. “I wanted to have the practice in my area where people could know they were going to get the most consolidated treatment plan in one spot.”

Warden wasn’t necessarily looking to make sweeping changes at the time. But as a relatively young and new practitioner, she was certainly hungry for ideas.

“I am positive this is where chiropractic is headed,” Warden says of integrated practices. “It’s the one-stop shop where people can get medical, chiropractic, and physical therapy all in one place and everybody is working together on one patient.”

CONTINUAL CHANGE

Like most ideas, the concept of an integrated practice didn’t mature with its inception. It evolved. In fact, Warden’s practice continues to change. She is searching for a full-time physical therapist, for example. But once she made an initial move toward a multidisciplinary environment, she stuck to it fast.

And like anything else, the transition wasn’t a simple flip of the switch. A number of major changes had to occur — structurally and philosophically. She found it particularly challenging since she had already begun establishing herself as a one-person show.

“The procedure is not easy, especially when you start off as a solo practitioner,” Warden says. “In Illinois I had to do the corporation, then add the medical doctor and get his credentials added in with my corporation. It was a long process. His [identification] number wasn’t recognized with mine. It was a tough transition, but it was worth it. It took two years to get the kinks out.”

The kinks included a lot of tax and coding considerations. As a solo practitioner, she only had to account for herself and her massage therapist, but now she has four doctors on staff, plus a part-timer. She also has two part-time physical therapists and a massage therapist.

Suddenly she found herself needing to learn how to bill as a medical corporation. Each practitioner has a different license number and a unique tax ID number, but they all bill under one medical corp.

“When it was just a chiropractor, I had a different tax ID number,” Warden explains. “If we didn’t do the transition correctly, they’d ask, ‘If you are the chiropractor, how can you be billing for this medical doctor?’ That was the kink.”

Then there’s coding — a big issue, says Warden. Big enough that she has a compliance officer to make sure everything falls in line. Physical therapists, for example, can’t bill two codes without a certain amount of time dedicated to a procedure. Every insurance company accepts different codes for different services. With an MD thrown into the soup, there are numerous permutations of possible coding answers.

As Warden added staff, the patient numbers and billing numbers grew quickly, if not exponentially. She used to engage an outside billing person who was paid a percentage of the bills. Now, the cost of that type of arrange-ment would be too high, so she had to restructure how billing was done.

“That was another transition,” she says. “Everything’s a transition. It’s not always easy.”

Those transitions could have been overwhelming if Warden felt she had to do them on her own. Rather than try to find all the answers by herself, she sought those who already had them. She enlisted the services of a practice-management team and suddenly found herself armed with protocols for every situation. Every scenario, every treatment, every condition, was covered. It became a matter of implementing the assigned protocols.

Once the protocols were established, building the practice became more about personality and cultivation of actual doctor-patient relationships, which Warden believes are what sets good doctors apart from the rest of the field.

“It’s all personality, but it’s laid out for you, as far as what to do,” she says. “The baseline is there. We have the road map we’re going to use. Now we can use our clinic personality; we don’t have to think about it. It really helped me organize things better to concentrate on other things.”

An expanding team — Warden’s team includes (bottom row) Lisa Gallegos, Donna Noble, Lindsay Parrish, Dr. Divya Sharda; (back row) Carolyn Molskow, Dr. Sonia Zeisberger, George Wilson, and Anna Warden. Not pictured are Drs. Gerald Cerniak and Chris Morgan, Erin Pieta, John Leedock, and Jackie Ellinger.

THE RIGHT COLLEAGUES

Things like hiring other professionals. Warden implores those looking to integrate their practices to find like-minded professionals. This requires an extensive search, she says.

During her search, she queried doctors and chiropractors about styles and philosophies. She wanted to know what MDs thought about chiropractic, what DCs thought about medical doctors, what each of them thought about growing a practice. She needed to know the goals, long- and short-term, of professionals. She asked:

• Did they want to come in and get their hands dirty or sit around and collect a paycheck? Are they willing to go out in the community to communicate chiropractic?

• Would they have the personality she was looking for, the kind that would make them work well with her patients?

• Did they want to help and educate people and teach patients how to take care of themselves?

• Would they be interested in expanding with our team?

Warden’s search ultimately proved successful. She is now to the point where the practice has nearly outgrown itself. In 2001 her practice consisted of just her and an assistant, with sometime-help from students. The regular staff topped out at three people.

Now she has 11 people and the walls are bowing.

BUSTIN’ AT THE SEAMS

Warden is now looking at expansion and taking on a partner for other clinics. The plan is for an office in Naperville, about 15 miles down the road. She’s going to leave the two DCs at her current office in place, and let them run the show. She, meanwhile, will start a clinic at a new location.

At her new clinic, Warden will take advantage of a local chiropractic college and employ students as interns and hopefully train them to the point where they can one day be a full-time part of her organization as her practices continue to expand. She sees herself continuing to launch new offices, building the practice, then moving on, and repeating the process as many times as she can.

“Some people just want to be an associate, and that’s fine but some have the desire to run their own offices,” she says. “Once they prove they can do it, I’ll know they’re ready. I will at that time offer a partnership for an expanded location. It really is risk free for the associate although they must prove themselves worthy of running a clinic and more importantly manage people. I never stop looking for new associates interested in growth opportunities.”

It took her awhile to reach that point at the original office. Of course, that’s her “baby.” Letting go isn’t easy, but it’s something Warden believes won’t be as difficult during future expansions.

She says she is comfortable with the way things are in the Wheaton office and that her office staff is imploring her to get out, move on, take vacations, and let them prove the practice is in good hands without her. “I have finally found a group of doctors that have a great work ethic and a desire to grow with me and don’t have to be pampered.”

“I can call in, get the stats, see what’s going on,” she says. “I can tell from the stats if everything is OK. And if something’s wrong, I’ll know what to ask. And if it’s serious, I’m only going to be 10 minutes away. In most cases I can count on my docs to handle all situations and that is a prerequisite to getting a partnership opportunity.”

Warden is also confident the Wheaton patient base won’t follow her to Naperville, where she wants to establish an entire new roster of patients. Those who live in Naperville, of course, will likely switch offices they visit. A handful who want to see Warden in particular may also make the trek.

But she believes it’s the office staff and location that the patients enjoy. The theory is that with the practitioners being “like minded,” it shouldn’t matter much to the patients which doctor they will actually see. “My staff of doctors are tremendous!”

SIDEBARS:

The making of a brand
A path to an integrated practice
Forming an MD-DC bond
Learning to work together
Vital Statistics

Todd Stumpf is a freelance writer. He can be reached at tstumpf22@yahoo.com.