Starting a Professional Private Practice
Written by Iris Kimberg, MS PT OTR
[Starting a Professional Private Practice ]
This workbook is geared specifically for therapists in the beginning stages of starting a professional private practice. This workbook is given out at the Starting a Professional Private Practice Seminar but is also a stand alone workbook that therapists who cannot attend the workshop can follow. The workbook is updated twice yearly, and is available as a downloadable PDF file ($95), a CD($100) or a hard copy($125). * Starting a private practice is a multi faceted process in which the end product is an entity that matches both your business capabilities and your professional abilities. The purpose of this workbook, which is geared toward PTs, OTs and STs to offer a concrete, step by step approach to discussing all aspects of starting a practice. * Workbook includes reviewing the legal forms that the practice can take, minimum start-up requirements and costs, identifying marketing strategies and contacts to build a referral base, beginning billing set-ups, and ideas to sustain your practice once it is up and running. It is newly revised to include all HIPAA documentation. This 72 page work book is a comprehensive in depth guide with sample forms, letter and extensive on and offline resources
INTRODUCTION
Many of the e-mails and telephone calls I receive begin with “ I have always wanted to…” or “I dream of one day starting”… This is the best time to seek advice! You are motivated, no mistakes have been made and you are probably gainfully employed! Not all therapists go into private practice and not all therapists want to. Those who do seem to possess a need for autonomy, a desire to be their own boss, and an entrepreneurial drive. Notwithstanding the honorable intention that a therapist wants to provide a service to people with a disease or injury, it is important to always remember that starting a professional practice is starting a business.
Starting a private practice is a multi faceted process. The end product results in an entity that matches both your business capabilities and your professional abilities. The purpose of this workbook is to offer a concrete, step by step approach to discussing all aspects of starting a practice for PTs, OTs and STs. This will include reviewing the legal structure that the practice can take, minimum start-up requirements and costs, identifying marketing strategies and contacts to build a referral base, beginning billing set-ups, and ideas to sustain your practice once it is up and running. Be prepared to wear “many hats” at first because most likely you will be responsible for doing all of the above! Remember too, that a successful practice requires both patients and patience!!
No part of this workbook may be reproduced in any manner without the expressed written consent of Iris Kimberg and NYTHERAPY GUIDE. Newly revised and updated 7.2011
© 2011 Iris Kimberg. All Rights Reserved.
Please note: I have worked with therapists all across the country. While there is some information in this workbook that is specific to the state where I live (New York), it should still be useful if you live elsewhere to guide you as to the proper questions to ask regarding certain laws and compliance issues. The common challenges we face in building and maintaining a practice far outweigh the differences in the individual states. In the back of the workbook is an extensive list of both on and off line resources that have proven to be very helpful. They are also included in the body of the workbook when applicable. Please note that website addresses constantly change, and some of the addresses listed may no longer be valid.
DISCLAIMER: The information presented represents the view of the individual presenter and is offered for educational purposes only. While intended to provide accurate information on the subject matter listed, this is sold and /or given out at workshops with the understanding that the presenter is not engaged in offering financial or legal advice, which can only be obtained from professionals credentialed in these areas.
Table of Contents
INTRODUCTION 1
About the Author 5
STEP 1: IDENTIFY A NEED THAT YOUR PRACTICE CAN MEET 6
Three Pieces of the Health Care Pie – Who is Eating the Biggest Piece? 7
STEP 2: WHO, WHAT AND WHERE 8
STEP 3: DETERMINING THE LEGAL STRUCTURE OF YOUR PRACTICE 9
UNINCORPORATED BUSINESS ENTITIES 9
STEP 4: CHOOSING A NAME: When the “I” becomes “We” 13
STEP 5: MINIMUM START UP REQUIREMENTS 15
A. THE BUSINESS PLAN – FORMAL OR INFORMAL 15
B. INSURANCE (MALPRACTICE, GENERAL LIABILITY AND RISK MANAGEMENT FOR RELATED SERVICES) 19
C. THE PLACE OF BUSINESS 20
D. CONTRACTING WITH INSURANCE CARRRIERS 23
E. Financial Considerations 26
STEP 6: MARKETING 36
STEP 7: GROWING YOUR PRACTICE
Healthcare Reform and Private Practice………...... 41
RESOURCES /WEBSITES/SAMPLE FORMS 70
Many thanks to Carrie Strauch OTR/L for her help in editing this manual.
NOW ALSO AVAILABLE: FOLLOW-UP WORKBOOKS
Practice Analysis and Strategies for Sustained Growth and Success
This workbook is geared to those therapists already in practice who want specific strategies to bolster their long term viability, growth and success to help reach the full potential of their therapy endeavor. The workbook presents concrete ways to analyze a practice to determine strengths and weaknesses and then develop strategies for continued growth and success. Ideas on how to adapt to the changing business conditions we face are discussed. Plans for expansion, including considerations for opening a second location, starting a staffing/contract agency, trends for the future, as well as the sale, acquisition, merger and valuation of a practice are also covered.
This workbook is a comprehensive in depth guide with sample forms, letters and extensive on and off- line resources. It is a logical follow-up to the first workbook “STARTING A PROFESSIONAL PRIVATE PRACTICE”. The workbook can be purchased as a hard copy for $125 plus $4.50 S/H, PDF $95.
FOCUS ON PEDIATRICS: Addendum to Book 1
55 page supplement to Starting a Professional Practice focusing specifically on issues relevant to setting up a Pediatric Practice ($75 hard copy, Plus $4.50 S/H $55 PDF)
NEW PERSPECTIVES ON MARKETING FOR THERAPY PRACTICES AND BUSINESSES
Therapists in private practice need to adjust their marketing campaigns because of the current economic climate, increased competition for healthcare dollars, and our fundamental shift from a healthcare referral system to a consumer choice system. This 37 page color workbook presents an overview of the dramatic changes in healthcare marketing in the last decade, and explores what made significant 2009 marketing campaigns in healthcare successful. It includes over 20 actual examples from the award winning marketing campaigns of the Cleveland Clinic, Visiting Nurse Service of NY, and Mount Sinai Medical Center, and how these high price successful marketing campaigns can be implemented by therapists in a low cost effective manner. ($85 color hard copy, $75 download)
Taking Care of Business- 50 columns from the OT Advance
Written by Iris Kimberg, this is a bound edition of columns covering many aspects of private practice – all columns from 2004-2010
$55, hard copy only plus $4.50 S/H
POLICY AND PROCEDURE MANUAL
All practices are unique and reflect the individuals that are their creators. Yet there are commonalities that must be present in all practices by virtue of the fact that we are all compelled by similar professional practice acts, work and professional ethics as well as state and federal regulations including OSHA and HIPPA. The onus is on each private practitioner to establish and be able to demonstrate policies and procedures that adhere to national standards and the continuance of improving business practices.
The purpose of this book is to offer generic guidelines, policies and forms from which a therapist can then customize their own policies, procedures and forms to best meet their individual practices. Remember that policy and procedure manuals should be reviewed yearly and updated as often as necessary to reflect current standards of practice, new regulations and any changes in state and federal law. The following topics are covered in this workbook. It can be purchased as a hard copy for $195 plus $4.50 S/H, PDF $160 (Table of contents on next page)
SECTION ONE: FORMS FOR DIRECT PATIENT CARE:
Introduction to a Policy and Procedure Manual
1. Initial Intake Form- One for General Adults and One for Pediatrics
2. Generic Evaluation Forms (Adult and Pediatric)
3. Generic Progress Re-evaluation Note
4. Generic Discharge Form
5. Assignment of Benefits Form
6. Patient Notification of Billing/Cancellation/Discontinuance of Services Procedures
Financial Policy Form
7. Medicare Beneficiary Form
8. Authorization for Release of Confidential Information (HIPAA)
9. Notice of Patient Privacy Practice/ Patient Information Consent Forms (HIPAA)
10. Patient Satisfaction Survey
11. Referral Source Satisfaction Survey
SECTION TWO: FORMS AND POLICY STATEMENTS FOR GENERAL OFFICE PROCEDURES
1. Incident Reporting and Form
2. Child Abuse
2. Confidentiality, Release and Handling of Information including HIV Information
3. Confidentiality for Emails/Faxes
4. Emergency Preparedness Plan
5. Health and Safety Issues Including Universal Precautions, Infection Control/ Handwashing Procedures
6. HIPAA Policy and Procedures
7. Rehabilitation Update/Documentation for Medicare Patients
8. Clinical Chart Review Form
9. Photo Release Form/Waiver Form for Onsite Classes/ Permission Slip for Caregivers
10. FERPA Compliance
11. Child Protective Services
12. Confidentiality Statement for Faxes and Emails
13. Off Line Authorization Form
SECTION THREE: FORMS FOR HIRING THERAPISTS
1. Orientation and Minimum Requirements of Therapists
2. Reference Forms
3. Clinical Competency Review Form
4. Employee Health Assessment
5. Hepatitis B Consent/Decline Form
6. Freedom from Impairment Form
7. On Site Clinical Competency Form
8. Sample Employee Handbook
9. Code of Ethics – PT OT ST
10. Employee Application including EOE regulations
CONTRACTS
1. Sample Temporary Personnel Services Agreement
2. Sample Home Care Personnel Services Agreement
3. Sample Contract for School District Service Provision
4. Sample Independent Contractor Agreement
5. Sample Employee Contract
6. Sample Buy Out Form
About the AuthorIris Kimberg MS PT, OTR has worked in the non-clinical aspect of therapy for the past 27 years. She transformed a one person solo practice into a multimillion dollar rehabilitation agency that she later sold to a public entity. After 9/11, Iris, a longtime downtown resident formed a fund, The Downtown Therapists Assistance Project, to aid the fourteen physical and occupational therapy practices located within the vicinity of the World Trade Center. She raised over $35,000 for them, mostly donations from therapists across the country. This past fall, she organized a drive in NYC on behalf of Operation Medical Library to help replenish the medical libraries that have been destroyed in Afghanistan over the last 30 years.Iris now enjoys sharing her expertise with others in the field through workshops, seminars and private consultations. She is a Professor at Columbia University DPT program, teaching a marketing and business entrepreneurship and has also guest lectured at both Touro College and Long IslandUniversity.Since 2004, she has beenMerion Publication’s (parent company of Advance Magazine) business columnist, writing over 70 columns on business practice and management. Iris regular participates as a speaker in both NYSOTA and NYPTA conferences. Shewas a panelist at the March 6, 2005 symposium The Crisis in Reimbursement held at the NYU Department of Occupational Therapy. More recently, Iris was a keynote speaker at the Fall 2009 and 2010 NYSOTA Conference and at the Fall 2010 Private Practice Section of the NYPTA Conference in Washington D.C. She has been asked to be a contributor to the Fall 2011 Private Practice Sections, IMPACT MAGAZINE, and will be writing an article about service management in therapy, entitled If Disney Ran Your Practice.
STEP 1: IDENTIFY A NEED THAT YOUR PRACTICE CAN MEET
While it is important to have internal needs and dreams and desires that motivate us to create and pursue opportunities for ourselves, it should be the needs of the patients and not the needs of the therapists that form the core of your practice. You cannot easily create a need or demand for your service; you want to be able to identify a need that already exists. Ideally you want to be able to match your personal needs and your clinical skills with a need you have identified in the community where you intend to practice. It takes more than an idea to get started. Remember, ideas are like bellybuttons, everyone has one!
Sometimes this is easy. In my own case, thirty years ago, I worked at a world renowned in patient rehabilitation center in New York City. When patients were discharged home, they often asked their treating therapists to see them at home after discharge. A need was clearly identified: follow-up care at home after a hospital stay. I spoke with the department head twice telling her we needed to start a home care program. To make a long story short, they did not start one, so I decided to do it on my own, and my practice was born. (Thirty years later this facility still does not have a home care program).
Oftentimes, the need for a particular practice is obvious as was in my case. Other clear examples are needs in underserved communities, or when specific doctors approach you stating they need a place to send their patients for treatment. If you are not sure whether there is a need for the type of service you want to provide, you might start by trying to find out if there are waiting lists for patients to be seen in the outpatient department of your local hospital. If your specialty is pediatrics, see whether there are school aged or pre- school children not receiving their mandated therapy services at school. If the answers are yes you can be sure that there is a need out there. If there is a shortage of pediatric therapists in your area you can assume there will be a need for therapists to treat pediatric patients and thus a market for your service. In general, if the supply of a particular kind of therapy practice is low, the demand is generally high, and so is the need.
TRENDS TO KEEP IN MIND AS YOU THINK AND PLAN
· Consolidations in the healthcare industry now are occurring on two fronts: SERVICE PROVISION AND NOW IN THE PAYOR SECTOR