While establishing a practice almost a decade ago, I experienced or narrowly missed several pitfalls. While the majority of these are minor by themselves, their accumulation could cost a great deal of time and money. Little things do add up. For example…
1. PERMITS.
Building permits are usually needed when remodeling a facility. They are especially needed if square footage is being added to an existing building. Make sure to apply for the proper permit or floor plan approval before beginning construction. A building inspector can haunt construction for an extended period of time if agitated, usually longer than it would have taken to follow the proper steps.
- Exterior signage
Many cities and counties require a permit for the placement of any exterior signs for a business. A description and/or picture of the sign(s) is usually required at the time of application. Be careful of some locations and historic districts; signage and building regulations are usually complicated and limiting. The regulations are usually meant to preserve or simulate a specific era of time. - Zoning
Locations of home/office combinations may be subject to subdivision or housing regulations which allow for minimal, if any, business development or signage placement. - Operating permits
Most communities require business permits for all businesses. The initial fee for a new business is usually a set amount with renewal each year, based on a percentage of the company income.
2. FIRE CODES AND ADA LAWS.
Check your facilities to make sure fire codes and Americans with Disabilities Act (ADA) standards are met. Every office should have two exits clearly marked and unlocked in case of fire. Smoke alarms, fire extinguishers, and carbon monoxide detectors are vital. Complying with fire code standards is often a prerequisite to obtaining insurance coverage for the building, grounds and equipment as well as for inclusion in many managed care plans.
Wheelchair accessibility as required by the Americans with Disabilities Act (ADA), is also important. A ramp for at least one entrance/exit is required and the rest room must be accessible.
3. WORKER’S COMPENSATION COVERAGE.
Many states require worker’s compensation coverage for all businesses, regardless of size. Even in a practice employing just one doctor and one chiropractic assistant (CA), coverage is required. A solo doctor with one chiropractic assistant may waive coverage as the owner of the business and only cover the CA. However, you are still required to maintain coverage.
Call your state’s Department of Worker’s Compensation to check your state law. A copy of the state law can usually be obtained for little or no cost. The regulations are good to have on hand as an employer and are of great use when dealing with work-related injury cases.
4. YELLOW PAGE DEADLINES.
Phone books are printed once per year. For example, the phone book may be issued in the community every April. Phone book advertising representatives usually begin contacting businesses in January to sell new space or make changes for the upcoming April release. Sales and design will continue for one to two months with a specific deadline for all new ads or revisions, let’s say the end of February. This allows one month for printing and shipping the book, due out in April.
Missing the deadline will result in not having an ad or listing for almost a year. Not being in the phone book can really harm a new practice.
To avoid this, contact the phone company to discuss ad placement, deadlines and costs. If the book is due to be released before the opening of the office, ask if an ad can be placed prior to opening. This will probably require the establishment of a phone number. If so, have a number installed at home and transferred later.
It would be better to have an ad for an inactive office for a few months, than to go almost one year without yellow page advertising. People who call the office prior to the grand opening can be contacted as possible new patients once the office opens.
5. ELECTRICAL WIRING.
A new building is easy to wire for the needs of a chiropractic office. However, an older building, especially one that was previously a home or some other type of small business, may not be wired sufficiently.
X-ray machines, therapy machines, film processors, computers, phones, dictation machines, viewboxes, diagnostic instruments, exterior lighting, televisions, radios, x-ray duplicators, signs and other required equipment can draw considerable current.
Homes and most small businesses usually have only a few electrical items plugged into the outlets of each room. A chiropractic office can have several in each room. Make sure the wiring and circuit boxes are large enough and that there are a sufficient number of outlets available.
6. HEATING AND COOLING VENTS.
Dark rooms are small, smelly and can become very warm. Be sure an adjustable vent is placed in the dark room, especially for cooling.
Some rooms in an office will tend to always be too hot or too cold. Placing an extra vent in these rooms can help avoid extreme temperatures, thus increasing the comfort for both staff and patients. Extra vents are not hard to install and the duct work is easily attached to the existing system.
7. BUSINESS AND TRADEMARK REGISTRATION.
Many states require the registration of your business title, trademarks or logos. Once these are registered, they can only be used by the person owning the title. If someone applies for a title, name or logo already assigned, they must retitle their business or redesign their logo.
Registration should be applied for prior to investing in signs, stationary, forms, business cards and other items that will display the business name and symbol.
Businesses in operation without registration have been forced to change their name or logo by those who did register well after the first business was established. He who registers first usually wins.
8. WINDOWS.
Be sure to have windows that open. Make sure they are not painted shut or stuck. The fresh air is great for everyone and usually adds a fresh scent to the office. Open windows are especially good for transitional periods between heating and cooling seasons.
Windows that open can also be a life saver when accidents happen. Unexpected smoke, overflowing toilets, gas fumes and other problems are less stressful with functioning windows.
9. ACCOUNTANTS.
Accountants are difficult to choose. However, following these rules will make the search easier. First, find an accountant who has several doctors as clients. It helps if some of the doctors are chiropractors.
Second, ask if the accountant simply completes the necessary forms or goes a step further to help with tax planning. A good idea is to find an accountant who will schedule a meeting in late September or early October of each year. During the meeting, by averaging the first three quarters of the year and projecting figures for the fourth quarter, you can get a good idea of how much will be owed on April 15th of the following year. This allows four or five months of preparation before paying taxes.
Third, employ someone who is willing to list and explain all of the taxes required of an employer. An ignorance of the tax is no excuse. The penalties can be harsh.
10. ADVERTISING.
Know your state laws regarding chiropractic and professional advertising. Make a list of do’s and don’ts that are consistent with the law and provide the list to anyone selling advertising to the clinic. Give the list to the clinic’s local printer, newspaper representative, phone book representative and so on. Keep a copy for the office and always have someone review the ad proof, with the do’s and don’ts in hand. Always ask for a proof!
An advertising violation can be an expensive fine. The State of Kentucky’s fine is $2,000 or greater. Fines may be levied even in the absence of a consumer complaint or any evidence of actual harm.
If other health care professions are violating the laws, do not incorporate their bad habits. Their licensing board may not monitor their activity or care. Just because someone else got away with it does not mean everyone will. Many licensing boards subscribe to a “clipping service.” These organizations scan multiple publications, clipping every article and advertisement relating to a specific subject. The clippings are then sent to the subscribing party. The board in your state may receive every article and ad pertaining to chiropractic each month. Even if the board does not catch the doctor’s advertising mistakes, the doctor’s competition down the street is usually glad to make it known.
Summary
Avoiding these pitfalls saves valuable time and money. Fines can often be much greater than the expense of doing things the right way initially. The new practitioner can then transfer the time and money to practice building and promoting chiropractic.
Editor’s note: Recently I observed first-hand the down side of not obtaining building permits. A man in line ahead of me at the Building Department was attempting to sort out a real mess. He had hired a contractor to construct a garage, and it turns out construction was completed prior to even applying for any of the permits. The visibly upset man claimed the person he hired had assured him he was licensed in the State of Florida, but a quick check revealed that he was not. (One of the first things you need for a permit is the license number of your contractor). If you are in doubt as to whether someone is properly licensed, call your local Building Department. It is much easier to verify this before beginning, because in the end, it’s your money and your liability.
K. Jeffrey Miller, DC is a Diplomate of the American Board of Chiropractic Orthopedists (DABCO), a Fellow of the Academy of Chiropractic Orthopedists (FACO), and a Certified Strength and Conditioning Specialist (CSCS). In his tenth year of practice, he serves as a company doctor for more than ten local industries in Shelbyville, Kentucky, is a post-graduate instructor for Parker College of Chiropractic in Dallas, Texas and a consultant/teacher for KATS Management Services in Lincoln, Nebraska. Please contact Dr. Miller at PO Box 1057, Shelbyville, KY 40066-1057; 502-633-1073, fax 502-633-4424.
