Private Practice Ownership is really hard. So here are the 13 mistakes we made so that you don't have to.
Dr. Tea 0:00
owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise, the doctor gets full autonomy in how they care for patients and how they get paid. They have chosen this path with a love of medicine. This is the direct care way.
Dr. Tea 0:24
By listening to this podcast, you may even start to believe that you too can have a successful direct care practice, come listen with an open mind as I share my personal journey and how I pivoted from an insurance based practice to direct care right in the middle of the pandemic. And the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice. I'm your host, owner of a direct care podiatry practice Dr. Tea Nguyen.
Dr. Tea 0:53
Hey, there, Happy March a couple of weeks ago, I went to LA, California, Los Angeles. And I gave a talk on direct care Podiatry in front of all of these doctors. And I was so excited to be able to talk about direct care on the stage because you know, it's been pandemic season four, it feels like eternity, right. And we've not been in person for a very, very long time. So this is, this was the first time I got to be standing on stage in front of real life people and give their real life feedback. And it was really incredible, I was really happy to see the movement of direct care move in the positive direction, because you and I know the system is totally messed up. And we cannot create change on a big scale, before starting small. So my duty here is to create small waves. And hopefully one day, it'll just take effect and snowball out and create huge changes for the system. But that is just one of those ambitious dreams that I have. So besides that new stuff that's happening around the hood here, my daughter, I looked at different public schools for her kindergarten experience coming up this fall. And man, it's really throwing me in for a loop.
Dr. Tea 2:15
You know, I've been a business owner for as long as she's been alive. And every single time every single year, I feel like I have to pivot my practice in one direction or another to accommodate her needs with her school schedules. And this year is no different except she's going from private school to now public education. And I have to kind of just reset myself and just re imagine what practicing medicine looks like. And I'm really grateful that I'm able to do this through direct care. Because with the lower volume practice, where I can charge more per interaction, the stress is much lower, I don't have to worry about calling back 30 to 40 people to reschedule their appointments for a day that I'm not going to be in there. Or if something unpredictable comes up, you know, that's that's staff time, that's money had to pay for. Either you have to do yourself or your staff has to do it. And it's just it feels like it's always, it's always been disruptive when I needed to change something in my schedule, when I was employed or when I had to deal with insurance stuff. So this year has been really phenomenal. And moving into my fifth year this July of establishing my private practice. But you know, it'll be one full year by the fall of being completely out of insurance. So a lot of transitions for me this year. And then now I have to take care of my daughter driving her to school to her home figuring out what to do with her after school because kindergarten ends like at 1230 or 230 or something.
Dr. Tea 3:48
Anyway, so that's, that's the stuff that's on my plate. What I wanted to do with this episode really is to share with you some mistakes that US Private Practice owners have made so that you don't have to whether you are fresh in starting your practice, or you been well established, I think this is worth you listening to, over and over again. Because there might be some things that you've learned here that maybe you thought about doing and just never got around to or maybe this is the first time you're hearing about it and know that you can make some positive changes to your practice, so that you can be more efficient in collecting and you're not losing a whole bunch of money and dealing with a bunch of stress.
Dr. Tea 4:27
And you know, all the stuff that's that is the makeup of business ownership. So let me help you out with some of these things that I've asked colleagues to share what their top mistakes were so that we don't have our colleagues making it as well. And so I have 13 things for for you right here. Number one is a big one. It's a lot of these mistakes that we make is always related to money. And that kind of goes to show you how deficient we might be in dealing with money ourselves or in training our staff. So what I mean by that is number one here if you have a credit card on file when you don't collect their credit card and have it on file because the patient refuses, declines, whatever it is, everyone will say that has always backfired. So if your policy is to have a credit card on file, but your staff or yourself don't follow through, or the patient gives the staff a hard time, and the patient still manages to come through, this is terrible, especially if you have an insurance model still, because when deductibles kick in, and you need to collect, you have no way of getting that money.
Dr. Tea 5:33
If you don't have a credit card on file, patients will ghost you when they owe you stuff. So make sure that once you create that policy, that it's on paper, it's written and consented for, and your staff understands that there's no way patients can be seen without these particular things, including the credit card on file. I think this day and age, it is totally acceptable. To make this the norm. It is norm in all under industries. I've booked appointments for photography for tattoo artists, for my makeup for my hairdresser, a variety of the services, and it has all been the same, they need a credit card on file, or even a booking fee deposit before they even consider you an appointment. So Madison really needs to catch up because people are getting really disrespectful about your time. And this is one way to ensure that you have some kind of liability, where you're not losing money on these appointments slots that were non committal by non ideal clients or patients. So I use the term client and patient interchangeably, it's the same thing, it's the potential appointment slot for you. So just think about it. If there's a person who finds the credit card on file, uncomfortable, imagine how much more uncomfortable they'll be when they start owing you lots of money, because their deductible was never meant. So use this as an opportunity to pre screen eligible patients for your practice. So that is just number one.
Dr. Tea 7:08
Number two, someone had mentioned, not getting the driver's license or photo ID, or having an updated address in the patient profile. This is more this is equally important in the insurance based practice and direct care for a couple of reasons. Number one, having a photo ID is a business protection, it proves that they came in the office that they had some kind of interaction with you. And it also provides with you the evidence that they are who they say they are, the last thing you really want to encounter is credit card fraud where somebody just hands you a credit card, and it's not even in their name, or it's just a stolen card, you will never know. So you want to use that ID as backup to confirm the credit card that they're using matches up and make sure that you train your staff so that this is not overlooked, there should be a list of things that must be met before they ever get to the back office. And that includes completing new patient registration forms. Maybe you have a practice policy that tells the patients what your policies are, what your fees are, what is required from you and them in order to make this work. And having an ID on file is equally important. Along with updated addresses. Updated addresses are important even if you're a direct care practice, because if you have to send out statements, maybe their email is inaccessible, you still need to know where to mail bills to should you ever encounter such a phenomenon. You know, in direct care, we I have not had to mail out a bill for any reason. Once in a blue moon. If I do something on the side like I like a patient wants to order a certain item in their out of state, but they want me to mail it to them, I might do that. But that's you know, I've already established a relationship with a patient. So you know, it's just a few few dollars back in my pocket, if they were to mail a check or debit card and file, but in bigger financial transactions, you don't want to put yourself at risk for that potential loss. So make sure you have your staff trained to get the photo ID and to keep the address and phone number updated. So at every appointment, make sure your staff is trained to ask, is this phone number still updated? And is your address still the same?
Dr. Tea 9:29
Number three, this is a huge one. So lean into this one. Someone had said terrible billing company. And I think we've all encountered some version of the bad contract a bad billing company. So again, this applies to insurance based practices or even hybrid where you're sticking it out longer than it was necessary, hoping it would work out and many of us will also agree that we know it usually doesn't something gets missed money. As long as there's a bunch of fingers being pointed left and right, and so when you own your private practice, you need to make decisions as a CEO of a successful practice. And sometimes these decisions include terminating a contract that is not serving you, I have had experience with a bad with a billing company that was not really that great.
Dr. Tea 10:24
And I did end up having to terminate it. And it was a little bit of a nasty termination, because they felt very entitled to my income, but they weren't doing a whole lot to get that money. So unless you have your billing contract, read through line by line with a lawyer, this ends up being a small claims court on either side, depending on who's claiming what, and it can just cause a lot of headaches. Luckily, I was able to get out of that situation and moved on. But that was an early experience I had with the billing company that really was not as good as I had wished it to be. And I did kind of hold out a little bit on making changes, which what I ended up doing was, I moved my billing services in house to somebody who was willing to work hourly. And she was fantastic. She was really wonderful. But then I opted out of all insurance, and then she didn't want to be receptionist. So that's my little story. So if you have a bad billing company, listen, there are hundreds of billing companies, there are even billing companies that can track back to stuff that had never been built out or had never been followed up on. So you can ask around in your specialty to see who the expert biller is what other people are using or not using. And then just know that having options can really empower you to move forward. So hoping that it would work out is not a really good strategy, making sure that it does work out by hiring and firing accordingly usually works in your favor. You never want to be in a situation where you feel stagnant, or stale, because of an underperforming contract, or even an underperforming employee, I had an employee that was not performing well. But you know, I had some loyalty to this person. So it took me a long time before I decided to say that I have to make a CEO decision, make some significant changes in order for me to expand and move forward. And so that did include having to let go of an under input, an underperforming employee that I cared about, but just was not fit for the practice number for not taking full payment upfront.
Dr. Tea 12:32
Again, a problem with insurance practices is that we don't really know what we're supposed to collect up front, especially when each individual patient's deductible is as unique as they are, we have no clue what they spent or owed re but we can only guess, to the best of our abilities with what's provided to us via an online insurance portal to tell us what their deductible is and how much of that was meant. Or you have a staff member who calls the insurance company for these insurance verifications. So when you don't take payment in full, you can expect to lose a lot more money, it's better to collect, it's better to open collect than to not collect at all. And again, this is a staff training issue that is related to insurance practices. So knowing what a deductible is, knowing what allowables are. So just because you charge $100 Does it mean the insurance allows you to collect $100 I know it's the dumbest thing. But you have to know what your contract is. And that's why I don't work with insurance anymore. So we'll make sure you know what those allowables are, create an Excel form so that your staff can follow it and know exactly what to collect. And it's always better to over collect, and certainly don't bypass the copay, which is kind of crazy how often this happens practice after practice after practice that I've spoken to. So many people have skipped collecting a copay. I've had a I've had an employee who is brand spanking new, let a patient walk out of the door. Because what he said to her was just Bill my insurance, I don't owe anything today. And you better believe I heard that conversation. And I looked at her with her camera on. And I was like you let the patient walked away, you need to chase them out in the parking lot and make sure you collect what is owed to us. This is not acceptable behavior to let your responsibilities slide. And I say she had a camera because I had just treated her for chronic tendinitis. So I knew she was functionally fine. But also it was a lesson for her to just know that the policy is in place for a reason. And you don't let patients push you around. Because they certainly will if you let them. She was a nice girl. I was not always that mean to her. But you know, she learned always to collect what is owed to us by insurance. The insurance contract is the copay. And also with the copay.
Dr. Tea 14:47
The difference between a PCP versus a specialist is a different number. So make sure that clicked in the correct amount away and going back to the copay. You know if you waive your copay for whatever reason, that can be a violation. Have your contract with that insurance. So let's say you have a really good friend or a really good colleague who you're like, I won't bill insurance. Okay, fine. It's one thing to not bill insurance. It's another thing if you bill insurance, but you don't collect their copay, because that is their financial responsibility, there's going to be a little bit of an argument between courtesy exams and stuff like that. But I'm just going to tell you what's on the contract says very clearly, you are to collect the copay, and I don't like gray areas. So you either bill or you don't just make sure your staff understands what is owed, and that they collect in full upfront, okay, now, number five, my mistake, my contribution to this list of mistakes is assuming that, that my staff knew basic math. And it turns out, I'm not the only one who made this mistake. Lots of people think their staff knows basic math. And unfortunately, even though they went through high school and got their high school diploma, or a GED or equivalent, just because they made it that far does not mean that they know basic math, like 10% of $100, I had told one of my staff members, great, let's make sure that patients are offered 10% off if they were to purchase two of these, for example, and, you know, staff, they're polite, they're like, Yeah, I'll do whatever you say, sounds great. And then it comes to the end of the day, and I review the financials.
Dr. Tea 16:18
And I'm looking at the numbers, and I'm seeing discrepancies and like I said, 10%, but why did you take off $10, there's a difference, especially if the total amount was not $100. Right, you can be losing a lot of money. And luckily, this was, you know, dollars here, dollars there. But still assuming that your staff knows basic math, they won't. Or if they do, they'll forget, or they have these minor mistakes. So the better thing to do is to create a worksheet, create a column that says 10%, and do the math for them. So that they don't really have to think, or you know, they don't have to have that mistake. Unfortunately, we do have to do a little hand holding from time to time, and it doesn't really hurt for them or for you to create that worksheet, tell them to calculate 10%, create the column and then you know, it's exercise for them. And then you can just confirm, and everything is good to go. No assumptions in this situation. So not everybody knows basic math, it's, it's terribly sad. I know. Number six, someone mentioned, never use a consulting firm when starting a new project. And I think this has to do with the cost consulting firms are incredibly expensive. And if you don't have experience with a consulting firm, they can really take advantage of you and physicians are one who are willing to spend a lot to solve problems. So I think this is kind of a cautionary tale by somebody who used a consulting firm. And maybe they didn't get as much as they wanted out of it. I kind of agree with this, because they also had use a consulting firm in the past, I didn't get what I really wanted out of it either.
Dr. Tea 17:51
And they were very expensive. And so if you know, if you're going to bootstrap, I do highly recommend some professional to help you. But it doesn't have to cost you an arm and a lake to do that. And in fact, you might just want to start up just to start up and then as you generate revenue, and then consider some kind of consultant to help you in your business entrepreneurship. So this one I kind of agree with, I kind of have some hesitation about consulting firms that don't have a good reputation. So make sure you just evaluate them, talk to them, see what you get out of it, make sure that they're holding up their end of the bargain, and then decide if that's worth your investment. Number seven signing up for long contracts for anything, whether it be financing, or rental space, these long contracts. So you might have heard me in the past, I'm just resurfacing some of the mistakes I made, because you might be a new listener, and I'm happy to share my entire experience with you. But if you're going to find a lease, just make sure it's not five years long, because you never know what your practice is going to look like in two to three years. Things change quickly. And when you're stuck in a contract, there's no getting out of it. In this day and age, there isn't really a demand for commercial spaces. And so being tied down to a long term contract means you're going to be financially stuck for that long. So I was stuck in my rental space for five years. And you know, in the year three, I wasn't even using that space anymore.
Dr. Tea 19:21
So that's something to think about long term contracts may sound really favorable when in fact you don't really know what your finances are going to look like you don't really know what circumstances you'll be faced with and you want to be able to have a backup plan. So definitely considered a leases that are much shorter you know, one to two years unless you own the property which I wish I did of course, so long contracts, be wary even for equipment you know, equipments always have financing opportunities. Just remember that equipment technology does fizzle with time and does become irrelevant with time and if you buy it in equipment that has like a 10 to 10 year lease on it, or technology, I would be really wary about that. Because there's always something new coming along, that's better and probably cheaper. So if you're looking into investing on equipment, I kind of always think about it as like a car, you know, once you drive off the lot, it loses value, I feel like equipment is the same thing. If you can buy it use certified, I would highly recommend that or use from maybe from the medical office that is no longer using it don't want to use it. And there's no issue with the thing or a company that regularly refurbished is use technology, I would consider that instead of buying something brand new. But it's funny, I say that because I actually buy everything brand new. Because I'm just the type that just likes really nice things that are not used. And you know, sometimes it comes back to bite me back in the you know, it is what it is. So that is my advice. Do as I say not as I do, right? Number eight, thinking staff comes pre loaded with knowledge. And knowing how to do things the way that you like it.
Dr. Tea 21:04
Okay, this is this should have been number one, right? When we hire staff, we have this level of expectation for them. We think that because we selected them that they come pre loaded with knowing everything or knowing at least baseline. But unfortunately, doctors were finicky people, we like things a certain way we are perfectionist. And we also maybe don't always have, what's a nice way to say it, we don't really have the skill set to train staff the way they need to be trained. Like we're really good with reading, and giving academic lectures, stuff like that. But when it comes to peopling the HR stuff and hiring, if that's not something we do on the regular, then we can certainly do better. And thinking that staff comes pre educated, like there is a level of competency that you do need to screen for. But you really need to set your staff staff up for success by training them in exactly how you want to do things the first time around. And then of course, when you train your staff and you find a staff member who can train other staff, then you're golden. But in the beginning, as you're building, you must train your staff, you cannot expect them to read your mind to know exactly how you like everything. And what's going to be really helpful is creating a manual on how to do things. And I have a document in the Google Drive. If you're interested in that copy, I'm happy to send it to you. But it's a document that it has a table of contents, and the each item in the table of contents, it might be like how to answer the phone, how to maintain the autoclave, stuff like that, for my practice, it includes a hyperlink, so they can quickly reference the title of a topic that they're interested in, they can click on that hyperlink, and it pulls them directly to that area in the manual. And you can do this easily in Google documents.
Dr. Tea 23:01
So use or create a manual to help your staff be successful, instead of assuming they should just know this, they should just know that set them up for you might consider a checklist for me a checklist could feel very numbing, because if you have an excess of checklists, you know, people just stop paying attention to it. Somebody needs to be accountable. It might be an office manager or a lead medical assistant or somebody, there's some kind of a checklist that your staff can follow easily so that they are also accountable. And that if there's ever any issue, you can say, Well, what was unclear on that checklist that I can help clarify you do that with a weekly meeting. For example, in really I'm going to share this kind of silly incident. But there were so many times in my office where I found dirt or debris or trash just laying on the ground, and kind of observing the staff to see if anybody would pay attention to pick it up and clean it up. Nobody, nobody seems to care about your office as much as you do. Right? That was me. I would ask over and over again, like did you not see this trash here? Why didn't you think to pick it up? Why don't you care? There are dead bugs in the corner. Why didn't you clean it up? Like, would you want to come into an office like that? Right? So we push our values onto our staff without having telling them that it's important to us. And that's kind of unfair, everyone is just a little bit differently. So just make sure you catch them the one time and say, Hey, you see trash, make sure we clean it up, make sure that the space is tidy that it's a space that you would trust to come to for surgery. Right. We want to make sure that we are demonstrating hygienic practices and making patients feel safe that they came to the right place that a patient can may say that they went to another office.
Dr. Tea 24:49
They didn't like it. It was unhygenic they were reusing instruments. They were just pulling it out of a drawer and they had no idea who was sterilized because it never came out of a package. There was lint in the The air filter like all the things they were just, and it was really funny, because the person who told me this, she is a house cleaner. So she had a set of her standards. And she said, I chose your office because it's actually clean here. So that's, that's why it matters. If we're going to be doing procedures in the office, we need to be clean, we need to be anyway. So number nine mistakes, you made it so that you don't have to. I don't know if this is the mistake, but this is something to pay attention to stealing, especially if you handle cash in the office, or even if somebody else is managing, like checks that come in from insurances. It's very hard to avoid dishonest staff stealing, you know, I've not experienced it myself. But I've heard over and over again, that it's not uncommon to experience some kind of stealing, whether it be money cash that patients hand over to the staff or even products, if you sell medical products, you know, it's really easy to just, if your staff is dealing with the inventory, you know, who's to say they're not walking away with one? And I don't know if I have a really good answer for this. Like, we can put up all the cameras in the world, in our office and witness stealing, which really sucks when you do witness that. God, I don't have a good answer about stealing, you know, you want to be able to treat your staff, well, you want them to be trustworthy. But sometimes you just eat sometimes you just get these things and hopefully you catch them fast enough and you let them go, I don't know how to deal with stealing, I have not experienced it in my office, I don't try to look for it, I certainly would be heartbroken if it has happened. And I didn't catch it.
Dr. Tea 26:41
I don't know, I don't think I know what to do with this. If I were to catch somebody stealing, whether it be medical products are money, whatever it is, I would probably immediately terminate them, I just don't, my practice is so small. And if I can't trust my staff, that would just crush me. So I don't have a good solution for stealing it, it might happen, it's gonna happen. Make sure you have a clear protocol in place to deal deal with that. So number 10, not having a cache fee. If you're a direct care practice, you must have a cache fee, it must not be confusing, it just needs to indicate your services, the price. And if you have a discount column for one reason or another, make sure that's all spelled out. And then you train your staff to read it line by line so that they know what they are to collect. In some instances, it might be confusing to consider charging an office visit plus a procedure, just make sure your protocols are clear that every appointment includes the consultation, and then you add on X rays, injections, procedures, and so on.
Dr. Tea 27:43
Number 12. This is across the board and number 11 trying to save money can actually cost you. So a lot of different examples on this one. Like if you're trying to save money by doing stuff yourself, but you're not really good at it, you can, like Tinker and try to figure stuff out, you might be wasting your time, a lot of your time. And there's only so much time in a day. And you know, you're an expert at these things. But if you step out of your zone of genius, if you step out and do like this it thing you know, you're troubleshooting a computer that takes you two hours where it could have just been fixed by an IT specialist in 15 minutes, like you're going to look at the dollar amount that is being spent and the opportunity cost that is lost because you're trying to save a couple dollars, right? If you are a physician and you are effectively worth $500 an hour, and it cost $100 to get it to come out and fix your computer. Wouldn't you just rather spend that $100 On your IT guy or gal? So just think about how you're trying to save money? Is that really going to save you money? Or is it costing you opportunity time where you could be spending those two hours of youth tinkering, doing stuff that you actually enjoy and can generate money. So trying to find ways to save money can can actually cost you so just work it out. See if you can outsource it before you spend lots of hours on in on trying to solve all the problems yourself.
Dr. Tea 29:12
As a business owner you're gonna get a lots and lots of problems to solve. Just be mindful about your energy and your time number 12. Don't skip background checks. I think that's self explanatory. This is something that some people do try to skip because it cost I don't know 50 To $100 to do a single background check on an a potential employee Don't skip it you the one time that you do skip it, you're probably going to regret it and it's such an easy thing to do. So just make that investment make sure that you trust your staff that you are hiring on quality candidates in do the background check number 13 is the last one man we made a lot of mistakes together huh? All right, last 113 not auditing your money not auditing your money. Yeah, you need to find time. came every single month to look at the money that you're spending that's coming and going right? What you are having to spend to maintain your practice and what money is coming in, you are the only one that's going to care that much about your money, not your accountant, not your lawyer, not even your spouse, it's going to be you, who cares the most about what's happening with your money. So you really need to have the eye on the ball. Early on, in my practice, when I was opening my account, I had the assumption that my accountant wouldn't be helping me manage my money. And they certainly didn't, they were only just recording things for tax purposes. So don't make that mistake in assuming that hiring an accountant, that they would take care of that for you. You are responsible for your business, how money comes in and how many leaves. So just make sure you periodically are auditing your money so that you know what's happening and you don't suddenly get surprised with a negative balance in your bank account. Which, again, it happened to me, so I know it's happened to others. Yeah, I'm imperfect. These are just normal mistakes that we've made, but hey, we've made them for you up till now. So there you have it. This is the longest list of mistakes that we've ever made so that you don't have to. That's all I have for this week. I'll catch you next week. Take care.
Thank you so much for being here with me. If you enjoyed this episode and want to hear more, please, like share and subscribe so more people like you can have access to another way of practicing medicine, the direct care way. Let's connect, find my info in the show notes and send me your questions. It might be the topic for future episodes.
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time.