Where do our best articles come from? You, our readers! That’s exactly how the following comparison of two new practices came about.
Dr. Denise Natale called our editorial offices one January afternoon about her subscription and ensuing conversations resulted in she and her friend, Dr. Steven Sanfilippo, documenting their journey from student intern to active practitioners. They judiciously set about tracking and documenting every purchase and nuance of starting a new practice. And they share their surprisingly similar experiences despite vastly different demographics and budgets on the following pages.
The Country Doc: Dr. Denise Natale’s Story
Square Footage Rented:
300 s.f. for two treatment rooms and a business office. Shared space includes reception area, rest room (both handicap accessible), kitchen, laboratory, x-ray, parking (includes winter snow removal).
IBM clone 486 80 mHz, IBM PS/2 color monitor and keyboard $754 + $157 for used replacement monitor. My poor patient levitated at least 3 feet off of the adjusting table when the old monitor blew up.
HP LaserJet IIP (Purchased before chiropractic school in 1989 for $1000at the time, a great price!) All forms, business cards, brochures, letterhead, signage, posters printed in-house.
Quicken (used for home and business), TrackingPlus (chiro software), Windows 3.1, MS Publisher, MS Works, Fonts!Fonts!Fonts!
2 week 4×4 ad in the local free weekly paper that everyone reads.
- 12 posters at businesses in surrounding towns.
- Personal introductions to local businesses.
- 6 issues of the local weekly newspaper (yes, the local paper is weekly), with a large percentage mailed to second-home owners living out-of-state.
5/96 to present:
- Business card ad in the free weekly paper with new ad at 13 weeks.
- Listing in the Cavendish Chamber of Commerce Business Directory.
- Local yellow pages.
Note: Vermont local phone books only have 1-2 towns in them encompassing maybe 3,000 people. Therefore, you need at least 6 phone books to find anyone’s number. For example, I live in Town A and have a Town B exchange carried by NYNEX. The Town A phone book has the office number, but not my home number carried by TDS. If you call the information number and you are in Vermont, they might give you my home number, but if you call from out-of-state, neither me nor the office exist! Why am I paying extra on my phone bill for extra listings?! I am allegedly listed by “Business Name,” and by “Dr. Name” in both the yellow and white pages.
Starting 6/97, I will also be listed in a second local phone book that is distributed to everyone in Southern Vermont. We’ll see if I get in the information directory this time. You would think that by having two local phone companies and one long distance carrier (AT&T) that someone would be able to find the office phone number by calling information!
Patient % Mix To Date:
- W/C 1%
- PI 1%
- Medicare 17%
- Cash 81%
All but the worker’s comp. and private insureds have paid at the time of visit. As a non-participating provider, these patients pay at time of visit.
A note on Worker’s Compensation and Personal Injury (Auto Accident) cases:
I have found that for a new practitioner with little experience in the required documentation, required forms and formats for these claims, that help and guidance from an experienced DC is essential. Do not be afraid to ask for help from other chiropractors and their office staff. The insurance company’s job seems to be to keep those premium dollars in their accounts. Even if you meet all of their requirements, pre-requisites and general rules, they will still deny a valid claim just because they know it will buy them time. The longer they can collect interest on their policy holders’ money, the happier they are.
100% not counting W/C and PI, which will pay eventually, but have not paid as of yet.
Practice Management Help:
- William Esteb Books
- Local chiropractors in the Vermont Chiropractic Association
- NYCC Professors
- SCORE of SBA
I found this gentleman to be quite personable, but when it came down to help, he really had none to offer. He kept saying it looked like I had covered all bases, and could he please have a copy of my business proposal because it was the best and most complete format he had seen.
- 1 hydrocollator with 2 packs given to me by a local chiropractor.
- 1 used ultrasound purchased from the same generous chiropractor at a really great price (and he paid to have the company do a complete check up on it.)
- 1 AlphaStim machine that doubles as IF, does non-needle Meridian Therapy (acupuncture), does trans-cranial electric stimulation, and in general, a great job of pain control.
- 1 used circa 1965 Zenith hi-lo with no drop pieces, recovered for $35 at home.
- 1 new Williams Advantage Elevation table with a pelvic drop. I wish I had invested in the thoracic drop too. The horizontal elevation is both a great equalizer and back saver for a 5 foot tall practitioner!
Activator, G5 Machine, Medical/Neurologic/ Orthopedic Evaluation Tools (ie. the Doctors bag)
Diversified, Applied Kinesiology (Goodheart), Meridian Therapy, Nutrition , Manual Soft Tissue Work.
While covering for a vacationing (male) chiropractor, I walked into the exam room and greeted the patient. His response was, “Oh no, a woman!” I was bound and determined to not let this guy throw me so I replied, “Thank you for noticing.”
I do not yet have a personal attorney or accountant. Should the need arise, I will hire one. I will have my taxes done by the company who has always done my taxes. I sent him a print out from Quicken which has both home and business on it. I keep monthly business statistics. Data is taken from TrackingPlus.
My Very First Patient:
I could hardly wait for that first phone call asking for an appointment. Well… O.K., I was excited and nervous at the same time. Yes, I wanted to finally work as a “real” doctor, and not just a mere student intern. I was ready to take the world by storm. I was going to show the all the paths just how incredibly effective chiropractic was. The longer I have been in practice, the more I realize that my own attitude (confidence level, my own energy level, stress in my personal life, etc.) has as much to do with how many patients call for appointments, as the amount of money I spent on advertising. Finally it happened the phone rang. It was two and one half weeks after I had officially opened my office. If I was truly ready to set the world on fire, I now realize the phone would have rung much sooner! At any rate, the phone rang. I answered it professionally using the business name and asking if I could help them. Yes, I could help them. They had never been to a chiropractor before, but had heard me speak at one of the Chamber of Commerce meetings. They wanted to know if I had any experience with getting people off prescriptions drugs and using vitamins instead. Their history included four myocardial infarctions, two cerebral vascular accidents with occasional epileptic seizures since the second CVA, diabetic neuropathy with foot drop, and well you can see that this was not your average sacroiliac joint or low back pain patient. I don’t know who was more nervous the patient didn’t want me to do a physical on him. When I asked why, he stated that every doctor he had been to recently had given him two months to live. He didn’t want to hear it again. I assured him that I was not in the habit of telling patients how long I thought they were going to live. Information such as that was only available from a higher power, and I was not privy to it. We got over that stumbling block, and have had a few setbacks, but progress continues and I still see this patient once a month. He is still on his prescription medicines with a few nutritional supplements added to his diet. This patient is one of my most staunch supporters today. He has told the local hospital that they should replace the physical therapist with me because I charge less and actually make progress with my cases. We have learned a great deal from each other, and I look forward to seeing him each visit. And yes, he has lived longer than two months.
The City Doc: Dr. Steven Sanfilippo’s story
980 s.f. consists of three treatment rooms, x-ray room, one bath room, x-ray processing room, doctor’s office, reception/business office and reception area.
Pentium 133, color monitor and keyboard. Cost $700 for computer. (I upgraded my old computer recycling disk drives, monitor and keyboard.)
Okidata OL410E laser printer, cost $350 purchased in the second year of chiropractic college. All forms, letterhead, and most brochures printed in-house. Panasonic 24 pin printer for HCFA forms.
Eclipse for Windows, Peachtree Accounting, MS Publisher, Corel WordPerfect Suite.
6 Open House ads in Asbury Park Press, 4 Open House ads in local paper (Courier), Direct mail piece to friends, family and local business inviting to open house.
Chatterboxmonthly newsletter to residents of adult community., Getting to Know You (similar to Welcome Wagon) each person who buys a new home receives a personal phone book that includes telephone listings and advertising. The book only contains one of each business type., Yellow Pages, Talks at local schools and organizations, Quarterly newsletter to my patients. Direct mailings to local residence (done completely in-house). Member of Rotary International. Northern Monmouth Chamber of Commerce.
- PI 1.7%
- Medicare 16.7%
- Insurance 80%
- Cash 1.6%
Two Zenith tables with pelvic drop (new), Two hydrocollators (new), One Dynatron 850 (new), One Summit Nova x-ray generator with adjustable tube (new), One x-ray processor (used)
Diversified, Meridian Therapy, Manual Soft Tissue Work
I am located on a busy highway between two major towns (dare I say cities?). Approximately 120 cars pass by (in one direction) every minute. I have a music system piped through the office that sometimes picks up some “very private” cell phone conversations. Luckily, there were no patients in the office at the time, or I may have had a sexual harassment suit on my hands!
- 5/20/96 to 12/31/96: 50% collected
- 1/1/97 to 3/31/97: 64% collected
Advice to new practitioners opening in a similar area:
Stay with local, less expensive newspapers and newsletters. It was very nice to see a big ad in the paper that serves central New Jersey; however, it was very costly and dollars to donuts, you will not see any return on investment. If you are computer savvy, create your own newsletters and brochures; they will say exactly what you want, and save BIG money. If you are willing to put the time in, join the local Rotary, Chamber of Commerce, and other local organizations that will get you out there to meet other influential people in the area.
Owning your own business:
Make sure you have plenty of capital for the down times and keep a positive attitude. The first few years of owing (the “n” is left out intentionally) a business is a roller coaster ride. Treat your patients correctly and don’t be afraid to ask for referrals. You will find that referrals are your bread and butter; once you are established, your advertising expenses should be next to nothing!
Equipping the office:
Remember, you are paying for your equipment!
Seven tips on getting the best deals:
- Start looking for equipment months in advance.
- 2. Find several vendors who offer the same/similar equipment. Usually you can get your tables/hydrocollators and electric stim from one vendor, x-ray from another, and office equipment from another.
- 3. Put together a “wish list” that contains all the equipment that you want and get a package price on the whole list from each vendor, as well as a breakdown of the cost on each piece. Shop, shop, shop! and let each vendor know that you are talking to their competition.
- 4. As you begin looking for an office, keep in touch with each vendor. Let them know that you are looking for space, or even if you are in lease negotiations.
- 5. Once you have signed a lease, call each vendor, tell them that you are making a decision today on what you are going to purchase and from whom. “Wish list” aside, tell them exactly what you want and when you want it. When they call you back with a price, let them know that you are waiting on a few more calls and will call them back before the end of the day. When you get all your bids, make a decision on who you want to go with it may not be your lowest bid, yet!
- 6. Call the vendor that you want to go with, let them know you received all of your bids. If some were lower, let him know (don’t give exact numbers; just tell them they were beat by about $400 or whatever). Tell the vender you want his “best” price; he probably will want to call you back. When he calls you back with his bid, if you are satisfied with it, ask him if that is the best he can do? He will inevitably ask you how much you want to spend, give him a lower, but realistic dollar amount (if he says $9,600, you say $9,000); he will probably meet you half way ($300 doesn’t seem much when you are spending $25,000 opening a practice, but each $300 you save adds up, and within the next two months you’ll be wishing you had it!)
- 7. Next, ask if the price includes taxes and shipping? “What?! Are you crazy?” is usually the response. So, you may settle for half, but if you don’t ask, you don’t receive.
MANAGED CARE- My First Tango…
I applied to my first managed care organization a few months ago. The fee to join was $500; if you were not accepted you got $400 back. Compared to many others this is not so bad. In short, I was accepted. I got a book explaining what I was to do if I had a patient come in with one of the policies under the managed care organization.
What I didn’t know was:
- 1. You have to use their patient entrance forms, their past medical history forms, and their physical exam forms.
- 2. I had to fax everything to the managed care organization along with my suggested treatment plan for approval. They then gave me an authorization number, (and may have modified my treatment plan.)
- 3. I needed to mail all my claim forms to the managed care organization, they billed the insurance company, they get paid from the insurance company, take out their fees and percentages (which were not written down in any contract or manual, so before long I could be owing them money), and then paid me, (also not specific as to when I would get paid).
- 4. A “Limited Power of Attorney” was the final straw. It was limited in which it stated that I was to bill through the managed care organization, and they could take out their fees and percentages (how much? unknown). It also had no expiration date.
- I must say, however, I requested a refund and got a check one week later. Managed care is not for me.
- These are things that you should ask prior to joining a managed care organization:
- 1. What insurance companies do you represent? (Remember they may represent PPO’s of patients that you already have; this will severely cut your fees).
- 2. How many people in the area have these insurance companies? (Why join if no one in your area has these insurance companies?)
- 3. What are the fee schedules? (Remember, they may look good, but what percentage does the managed care organization take from each bill?)
- 4. When does your contract with the managed care organization expire?
- 5. Ask for names of local doctors who use the managed care organization, call them up and ask how their lives have been affected by managed care?
- 6. Above all else, have your attorney read everything before you sign it!