How to Survive in Neuropsychological Private Practice

1. How to Survive in Neuropsychological Private Practice Ernest J. Bordini, Ph.D. February 20, 2004 Presented at U.Florida Dept. of Clinical and Health Psychology

3. Clinical Psychology Associates of North Central Florida, P.A Providing Quality Consultation, Assessment and Psychotherapy to the North Florida Community 2121 NW 40th Terrace, Suite B. Gainesville, FL 32605 CPANCF.COM 352 336-2888

4. Our Mission Statement Clinical Psychology Associates of North Central Florida, P.A. (CPANCF ) is dedicated to providing psychological care at a doctoral level by individuals trained in Clinical Psychology programs approved by the American Psychological Association.

5. Our goals are to maintain: • Excellence, service, & leadership in our field. • Clinically, ethically, & scientifically sound evaluation & treatment services. • A cohesive professional & clerical staff

6. Professional and office staff are expected to interact with patients, referral sources, and third-party payers in an honest and ethical manner. • Professional and office staff receive and maintain training to perform their duties with confidence and expertise, to remain appraised of ethical and legal demands of their roles, and to respect the diversity of the clients and referral sources we serve

7. The Website

8. CPANCF Professional Staff – • Ernest J. Bordini, Ph.D. , Lic. Psychologist • Benjamin Phalin, Ph.D., Lic. Psychologist • Angela Allen-Peck, Ph.D. Psychology Resident • Amanda D. Ross, M.A., Psychology Intern

9. Independent Practices (located at same office) • Charles Russell Clifton, Ph.D.

10. Support Staff • Office Manager • Receptionist

13. ADHD SERVICES

14. Our Group / Testing Room

15. Waiting Room

16. Are You Ready To Fly? Don’t be afraid to Dream – or you will not go far. Creating your own practice or being part of a practice you identify with involves knowing where you want to go. To enjoy the ride you need great spirit and a sense of adventure

17. You’ve done your pre-flight Check • Train with the Best • Know your areas of expertise • Fluent in your skills • Are you ready for Practical applications? • (Go Gators!)

18. Know your Risk Tolerance Solo vs. Group Limited vs. Comprehensive Services Where will you be if things go wrong? Owner, Partner, vs. Employee? Shared Space - Blended Practices Single vs. Multi-Specialty Types of Clients/Practice? City vs. Town Competition

19. Can you survive in a hostile environment? • Pressure from price competition • State Boards • Critical Colleagues • Increasing Standards • Conflicting and confusing State and Federal Regulations • HIPAA • Unhappy or Even Dangerous Clients • Deadlines

20. Avoiding Agony • Reduce and Manage Debt • Identify A Practice Attorney • Have a Comprehensive Patient Agreement Form • Have Adequate Insurance • Have Formal Contracts • Choose your Associates • Seek the Counsel of Peers • Determine your Short Term and Long Term Needs • Establish a Business Plan to Meet Those Needs

21. Do a realistic Assessment of Your Strengths and Weaknesses

22. Health Marriage Perseverance Responsibility Ability to Work Independently Organization and Efficiency Ability to Perform consistently Under Stress Ability to Market Are you user friendly? What hours are you willing to work? Can you work extra hours when you must? Ability to Initiate, Sustain, Complete? Can you collect for your services Generalist vs. Specialist How do you fit in with the practice you are joining or the community you are entering? What unique skills and expertise do you have to offer? What interests you? What motivates you? What won’t you do? What can’t you do? What shouldn’t you do? Assessing Your Strengths and WeaknessesWill you at minimum Always being able to maintain an acceptable Standard?

23. Avoiding Horror • Don’t forget to consider your personal needs • Consider maximizing Board Complaint insurance • Keep current on State Statutes as Well as Rules • Treat other Psychologists as you would like to be Treated • Practice within your Competency • Limit the number of high-risk Cases • Keep records up to date

24. Avoid the Quacks Psychologist Emptor Research the Background and History of your Potential Associates and Business Partners You will be judged by the company you keep. The good will your group, referral sources, and associates generate is a critical asset – Guard it! You are liable for who you refer to. Are your potential associates team players? Avoid destructive internal competition What are the expectations of your group or referral sources? Do they match your goals and values?

25. Use the Right Tools • HIPAA Forms • AUTHORIZATIONS • RELEASES • APPROPRIATE TESTS • RULE 26 Document • CE Documentation • State and Local License • Progress Notes • Discharge Letters • Practice Policy

26. Keeping Your Practice Secure – Part I • Malpractice Insurance • Premise Liability Insurance • Workers Compensation • Auto Insurance • Life Insurance • Disability Insurance • Overhead Insurance • Health Insurance • Your National and State Psychological Associations may have good rates • Buy Disability and Life Young!

27. Keeping Your Practice Safe and Secure - Part II • Record Security • Computer Security • Telephone Systems • After-Hours Contact / Policies • Passwords and Encryption • Ownership, Transferring and Disposing of Records • E-mail • Referral Sources / Trade Secrets

28. Keeping Practice Secure Part - III Staff Safety – Who is on premise, late appointments, Staff Scheduling. Building Security – Lighting, Alarms Training Staff to Deal with Paranoid and Agitated Patients Dealing with direct and veiled threats from patients: - Board Complaints -Fitness for Duty and Disability Evaluations -Custody Evaluations -Armed Patients Patients who Stalk

29. Part IV? • "Criminals are afraid of only two things: Big dogs and guns. They stay away from cops because cops have both." - Mossad Ayoob • “Grrrrrr….” - Rocky

30. Participate and Benefit from your State and National Professional Organization FPA and APA • Lobbying for fair trade practices and our livelihood – member participation vs. (who spends the most money?) • Defending Psychological and Neuropsychological Assessment • CE on State and National Ethics and Regulations • Business oriented training • Establishing and Maintaining Networks • Marketing Opportunities • Support

31. Bill for your time: It is your product and most precious commodity.

32. Look out OVERHEAD!!! • Overhead costs can range from 35-50% Office Space Furnishings Office Help Utilities Computer and Communications Equipment Test Equipment and Supplies Office Equipment and Supplies Advertising Postage Insurance Attorneys Professional Dues Subscriptions Education and Training Cleaning and Repair Security Billing Software Answering Service

33. Financing your Practice… Do as I say, not as I do. • Pay off high interest unsecured loans first • Banks are not really interested in your future unless you have some collateral • Commercial Property usually requires at least a 20% down payment • Utilize leases to avoid excess unsecured debt • Take advantage of no interest 6 month financing for furniture and office equipment if you can pay it off • Consider SBA financing if you have some collateral and a good business plan • Keep Personal and Business finances separate • Consider tax and interest rate implications • Set up retirement plans early and contribute to them even if it means living modestly • Things can change rapidly, aim to have three months of operating expenses in cash reserves

34. Billing and Collections – I • Medicare fees and allowable hours • BCBS fees and allowable hours’ • Managed Care • Worker’s Compensation • Auto Insurance • Indemnity • Private Pay

35. Billing and Collections - II • Billing Programs and Equipment • Paper vs. Electronic Claims • In House vs. Outsourcing Claims • HIPAA Considerations • Billing and Collections Staff • Credit Bureau • Attorney Based Collections

36. Collection Agencies

37. If you are not afraid to Crash and Burn… • Most people who succeed in business have had failures • 4 out 5 small businesses fail • Most within the first 2 years • Usually due to limited capital and difficulties with cash flow.

38. Have the Proper Attitude • As psychologists people look to us as leaders in how to handle tough situations. • We need to demonstrate good leadership attitudes with our staff, patients and in our community. • People also look to us to be idealistic caring and empathic individuals. Volunteering time to our community and organizations vs. the Me Generation. • We need to have the attitude of a winner…..

39. So, quit complaining about your job ….

41. Always Strive To Excel

43. Take the Moral High Ground • “We are accountable to a higher power.” Alan Gessner, referring to APA Ethical Standards.

45. And don’t get too grandiose….

46. Keep your bearings and awareness of your surroundings……………. Check your perceptions. • Business Plan • Personal Plan • Does it fit your Environment? • Periodic Assessment • Corrections • Reassessment • Exit Plans

47. Avoid Burnout – Stop and Smell the Roses • Commit to scheduling time and budgeting for recreation, exercise, family. • Schedule time for attending conferences and seminars • Make this a habit ASAP • You must not only cover your expenses …. You have to earn a salary, care for yourself, pay your school debts, practice debts, and provide for you security as well as respite. • Go back and review the slide about billing for your time and study it carefully. Figure how much you have to charge to make it all happen. • You have to live.

48. I hope you will find smooth sailing and fulfillment in your practice ventures