Transcript STARTING A PRIVATE PRACTICE

THE KEYS TO
STARTING A PRIVATE
PRACTICE
Part III
THE NITTY-GRITTY
A Presentation of the AACAP
Member Benefits Committee
John E. Dunne, MD
16040 Christensen Road, Suite 217
Tukwila, WA 98188
[email protected]
INITIAL START-UP
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Opening your office
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Medical and business licenses
Telephone and fax/copier
Emergency contact system
Scheduling process
Intake form listing pt. name, address and BD; parents’
names and addresses; insurance information
Office policy and HIPPA privacy statements
Charting system (paper vs. EMR)
Prescription pads and DEA registration
Stationery, business cards
Checking account
Billing system
PRACTICE MANAGEMENT TOOLS
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Appointment system
Credit card processing
Billing system
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Accounting system
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recording charges and payments
tracking insurance claims
Paying bills
Paying employees, if any
Calculating, paying local, state and federal taxes
Medical record system
Transcription service
Banking services
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Credit card
Line of credit
Reserve fund
Medical Records
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Paper charts
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Inexpensive
Easy to handle and review
Handwriting may be easier than typing
Storage is a problem
Electronic medical records
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Expensive, long term costs
 Purchase in-house system vs. secure hosted EMRs
 Critical questions re. costs, updates, transferability, long term
storage
Easier to handle ROI requests, share info
Storage is easier, cheaper
May eventually be required
Practice Website
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Helps people looking for help find you
Can post intake forms and information
FAQs
Post patient information and links to helpful
websites
Can post emerging information: e.g., out of office
dates, who is covering for you, rate changes
E-mail link
Creates additional expense and time
commitment
SETTING FEES
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Dunne’s Rule for setting fees, negotiating contracts and
just about everything else in life
“If you feel resentful about providing the service at a
certain rate, you are not charging enough. If you feel
guilty about how much you are charging, you are
charging too much.”
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Usual and Customary fees
Sliding scale, discounts and surcharges
Handling fee increases
Differentiating services
 Intake appointment
 Psychotherapy
 Medication management
 Forensic
 Consultation
 Reports, school forms, telephone consultation, prescriptions
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INSURANCE AND MANAGED CARE
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It’s not all or nothing
How quickly do you want to fill your
practice?
Selection criteria
Large insurers and large employers
 Allowed amounts
 Hassle factor, i.e., the effort required to get
authorizations for treatment, medications
 Negotiating with contracting companies
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Remember Dunne’s Rule
 “Negotiating with Managed Care Companies”,
Healthcare Access and Economics Committee
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BILLING
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HCFA (“hic’va”) Health Care Finance
Authority, standardized form 1500
Electronic billing
Billing services
Payment at time of service vs. balance
billing
Contract restrictions on balance billing
Coding, DSM vs. ICDM
MANAGING YOUR
SCHEDULE
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Set your work schedule and stick to it
Not all hours are created equal
Designate time for certain activities
Dealing with emergencies and urgent
issues
How busy do you want to be?
Maximize service?
 Maximize income?
 Maximize flexibility?
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TIPS AND TRICKS
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Create forms that gather routine information or
serve administrative functions
 Sample practice forms are posted on AACAP
website
Use handouts, e.g. medication info, Facts for
Families
Create shortcuts
Use stickers, labels and ink stamps
Program commonly called numbers into your
phone and fax
In private practice you are a part of
your community.
Find a way you can make it better.
REFERENCES
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Entering Private Practice: a Handbook for
Psychiatrists. Jeremy Lazarus, ED., APPI, 2005
Money and Outpatient Psychiatry: Practice
Guidelines from Accounting to Ethics. Cecilia
M.Mikalac, MD, Norton & Co., 2005
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References provided by Jill Carlson, MD
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2010 AACAP Meeting Programs
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“The Transition to Practice” symposium
sponsored by the Early Career Psychiatrist
Committee
“Starting a Private Practice” workshop
sponsored by the Member Benefits Committee
“Private Practice 101: Strategies and Tips for
Running an Efficient Practice” workshop
sponsored by the Member Benefits Committee