When deciding to start a new practice my first piece of advice is usually, “Don’t Quit Your Day Job”!  Well unless you have unlimited funds to back up your start up.    To build a successful practice can take time and depending on the type of practice your are starting you should plan on it taking about a year.  So if you need to generate income to live, support your family, or to pay all of your bills, without draining your bank account or emptying your retirement fund then starting your practice by building a client base first would be recommended.   This can be done using after work hours or weekends and may prove to be the best move.   Starting, building and managing a private practice is a lot of work and is NOT for the faint if heart!

Depending on your specialty, your financial needs and the reimbursement in your region you need to determine how many patient visits it will take to get you to that sweet spot, ensuring just enough income to move forward in your practice.   For example, it is possible that a steady caseload of 20-25 patients a week for a therapist at a reimbursement rate of $80 per visit would come close to earning $6000 a month.  Now taking into consideration, possible billing errors, denials, and payment delays you will want to err on the side of caution and estimate 5K a month income.   If that is enough to survive on until you can finish filling your schedule and the 20-25 patient base is consistent and solid you may find you are generating enough income to allow you to quit your day job and focus solely on your practice.

Physicians and Nurse Practitioners are a bit of a gamble as their patient base may not require weekly or monthly visits therefore requiring a much higher caseload to meet their minimum financial demands.  Then add to the mix physicians who are specialists and this can get even more complex to calculate or predict.  

So the first important decision you need to make is what can you afford and how long can you survive with no or a reduced income stream.   Once you are able to decide HOW to start (dive right in or slow roll) you can begin to plan the next steps needed to ensure your ability to generate revenue as soon as you open your “doors” whether real or virtual.   

So you know HOW you need to start to remain viable during this start up.  Now you need to analyze what your patient population will look like.  This will help to guide you in the direction you need to go based on this determination.

If you are in a field that thrives on cash pay clients like Plastic Surgery, Dermatology, and others  whose practice lends itself to “Cosmetic Procedures” that are not covered by insurance, you will be able to have a quicker ramp up in regards to reimbursements and revenue streams.  As every time someone comes in they pay cash at the time of service.  Almost every provider would love to be able to have a thriving cash pay practice.  This unfortunately is not always possible.   For example, those like Mental Health and Primary Care that will often have a practice built on insurance based reimbursements will take time to ramp up due to the credentialing and contracting required to begin seeing these patients,  Unless contracted AND credentialed by the payer (or unless they have out of network benefits) you will not have the ability to bill and be reimbursed for your services.

So once you determine how you will be reimbursed by the majority of the patients you serve you can further plan your next steps.

Early in this process you will need to identify and set up an EMR/EHR.  For startups with low income we recommend our entry level system that is affordable and can grow with your practice.   If you want a system with a few more features just let us know.  We have systems that are built out for specific specialties or we can customize the base system to your individual needs without breaking the bank.

OK so you have decided on how to start, you know who your patient base will be, you have contracted with and been credentialed by your primary payers, and you have selected your EMR/EHR and you are ready to see patients!   GREAT!

You are now ready to get patients referred to you  to build and maintain your patient base.

This is one of  the most important abilities you will need to cultivate, one that can make or break your practice.   How do I find and generate referrals of new patients to the new practice. And once I get them how do I keep them?

How to generate new Referrals and quickly fill your practice?

Let’s See….. Can you bring your current patients over?  Some practitioners can bring a part of their current caseload to the new practice, depending on their contract or employment agreement.  Others, due to non-compete and non-solicitation agreements can not.  Answering this question can provide you with insight into early growth and revenue predictions.

If all of your referrals currently come from your current job, can you cultivate those referral sources to continue to refer to you in the new practice.    Again, know your contract, does your non-compete and non-solicitation extend to referral sources or just to patients?  If you are told you can offer services at your new location to your current patients,  GET IT IN WRITING!  It doesn’t have to be a formal document but an email from the practice owner would help to avoid any potential issues down the road.  Do this BEFORE approaching patients or referral sources as a precaution.

Below I have added a host of low cost to high cost strategies for generating new patient referrals:

In today’s technology everyone often jumps on SEO, Website optimization and Social Media Marketing and although these can help, spending a lot of money here has NOT lead to better results when starting on a budget.   These methods can eat away at the dollars available for your startup so starting with some low cost traditional methods may be prudent.   We recommend to start with a basic website design and entry level SEO and Social Media unless you yourself are a wizard at these functions.   Costs here can skyrocket way out of control with little bang for your buck. Don’t get sucked in to the hype!

We recommend a few lower cost projects that have stood the test of time and helped me build a practice from earning less than 100K in year one to generating 2 Million by year 6!

These are my recommended strategies for year one:

1. Reach out to colleagues, family and friends.    Send out emails and text messages to all your contacts announcing your new practice.
2. Develop a list of common referral sources for your specialty and reach out to them personally via phone or by scheduling an appointment to meet with them if at all possible.   Take business cards and flyers that they can then hand out to their clients as needed.
3. Think of less common referral sources or talk to colleagues as to where they get their clients from. (If they are willing to share the information).  Things like:  For mental health providers reach out to the courts or the jail system to see if they need a referral source for those in the judicial system (as long as you are able to work with that population).  Or if Primary Care, reach out to local high schools and sports teams to offer Sports Physicals or get DOT (Department of Transportation Certified) with direct referrals from them to complete DOT Exams.
4. Participate in local events and if possible set up a table with your information on it.   Talk to potential clients AND referral sources during the event.  Offering free screenings at health fairs and other events can lead to new patients.   Be prepared to schedule an appointment for a potential new client on the spot if you want to capture an interested patient.  You may also offer to be a speaker at a local event on a relevant topic or area of interest to you.  Mental health counselors may want to cover a difficult topic such as self-harm while a Family Nurse Practitioner may want to talk about Diabetic Education.
5. Establish relationships with local businesses such as wellness centers, gyms, schools, pharmacies and your local hospitals and emergency rooms.  As a practice that offered mental health services I would fax a sheet over to the ER everyday telling them how soon we could see a patient.  This was invaluable to ER physicians required to discharge patients that do not meet the criteria for inpatient care.  Maybe they feel the patient could benefit by being seen within 48 hours and need a referral to a local providers that has opening now.
6. As a physician you can offer consultations at your local hospital if you have a specialty they need like Cardiology, Gastroenterology or other specialties.  Schedule a meeting with the Medical Director and build on that relationship.
7. If you can take referrals from hospitals you will need to get to know the Case Management and Discharge Planners!  They can be instrumental in getting you included in the referral rotation.  A tray of “Thank You” cookies here may go a long way.
8. Gather a list of potential referral sources and their contact information and have your staff (or hire our team) to call and/or fax your practice information and availability to these sources weekly.  For example, if you are gastroenterologist and you get your main referrals from PCPs.  Generate a list of local PCP and send out information about your practice and your availability.
9. Develop a simple process for referrals!!!  The easier and faster that process is the more they will refer!  For example, we developed a single page referral form with consent built in for providers to send patients to us.  We made sure to handle the rest AND provided feedback about the patient and their ongoing care to our referral source.     Today an easy digital or online method may help to increase referrals.
10. Next you may want to have an easy online appointment booking system that links to your EMR.   This way patients can schedule without the need to call the office whenever they want to come in.
11. Offer online telehealth appointments.   Since COVID many people prefer to have a virtual appointment for things like sore throats, colds, flu and such rather than having to lose a day of work to come in to the office.  This can help backfill no shows and cancellations.  This can significantly help minimize revenue losses due to no shows and cancellations.

As your referrals increase you will shift your to focus include patient retention.

PATIENT RETENTION

To retain a patient the most important thing is the patient experience during their episode of care.   We all know that the patient experience needs to be one of excellent patient care and superb customer service, and many people lay that responsibility at the feet of the doctor alone.  But I will tell you from experience, your staff are as important if not more important then the 10 minutes spent in front of the physician.  Your staff can make or break your practice!    It is important to create a culture of excellence and listen to your patients.  They will tell you if someone doesn’t quite measure up to the picture of care you have painted for your patients.  Be sure to nip bad staff behavior in the bud!  If it continues and can’t be corrected, fire and rehire someone who matches your vision and helps to create that culture of excellence.  What does a Culture of Excellence Mean?

SETTING EXPECTATIONS:

One of THE most important things I learned in the management of a practice is setting realistic expectations.  For patients, for providers, for staff and for yourself.  First you need to make sure your expectations are in line with the possibilities of reality.   For example, setting a goal for the company to achieve that is likely to fail is harmful to your team and the culture you are trying to create.   Be honest in your appraisal especially in the beginning.  Set a goal that pushes for just above what you are likely to be able to achieve. Give yourself and the staff a chance at being successful. Small successes lead you to even greater success.

When you are new to owning and managing a practice your vision of anticipated revenue can be off, by a lot!  In the world of healthcare and reimbursement so many variables can and will impact collections.   Data entry errors, clearinghouse rejections. payer rejections. delays in payment and so much more can impact your revenue stream.   DO NOT count your income based on anticipated revenue.  You will be sorely disappointed! Get to know your payers, watch for trends like slow paying over the holidays, shifts in the healthcare market, this will help to ensure adequate revenue to meet income needs.

Before projecting further growth or trying to fly to soon, make sure to put aside a safety bucket of revenue that will cover 6 months of operations in case of revenue emergencies.   This can be a critical step.   For example, at one point Tricare switched payment processing and carriers, when Tricare is your primary payer and they stop paying for 3 months during the transition you need to be prepared.  All kinds of unexpected hiccups can impact your operations.  Be prepared, your family and staff depend on you to make the best decisions.    It is also important to train staff and providers to collect patient payments before or at the time of service!  Once a patient walks away from that appointment the chance of collecting the amount due is reduced by about 60%.  Being compassionate and kind has its place but take that decision away from staff and providers and set specific policies about collections and stick to them!   This may be hard for therapists as many find it difficult to discuss money with their patients.  Remember, keeping financial obligations may actually be a part of helping your client to lead a balanced life.

ENHANCED COMMUNICATION:  

Enhanced and frequent communications with patients can show your care about your patients.   I mean why would my provider share this with me if he didn’t care?  With Tarevo we can build communication algorithms into your system to provide regular follow up emails or text messages to your patients to check on their progress.  WITHOUT increasing staffing costs.   Through the patient portal you can send screening tools to measure client improvements over time or simply to measure their satisfaction with their care.

Providing simple automated appointment reminders and email reminders can help to reduce your No  Show rates which then increases potential revenue.   We have a built in push “C” to confirm or “X” to cancel that updates the calendar and flow board saving a lot of staff time and allowing for staff to backfill cancellations minimizing lost revenue.    If you have patients that need a call to remind them of their appointment versus an email or text message, flag that patient and run a daily report that can trigger the staff or system to call and remind patients of their upcoming appointment.

Providing remote patient monitoring and chronic care  management can also improve communication and patient education as well as generate revenue for those clients that qualify.   Build a system that works for you and not only enhances communication but does so at no or low cost to the practice.  For more information on this and other strategies fill out the form below.

PERSONALIZED CARE:

Train staff and providers to recognize patients by name.  Use simple alerts to note important details about the patient.  We have a reminder for birthdays built is but I encourage staff and providers to enter simple alert reminders for us to ask about significant events they have previously mentioned.  For example, patient states during check in that they are going on vacation and are very excited about the trip,  how nice it is when they return to hear you or your staff to say “Well hello Ms Smith,  So how was that vacation?”  This shows your patients that you care and are interested.  Create a “staff of the month” by recognizing the person that noted the most memorable events for patients during their interactions.   These small moments of warm interactions with your patients where all staff are able to reference special life events or previous visits will easily demonstrate your practices commitment to them and their care.   Simply asking “Hello Ms Smith, If I recall, on your last visit we went over this or that, how are things going today?”   In other words, MAKE IT PERSONAL!

PROVIDE NEEDED INFORMATION:

Find ways to provide health tips and health education to  your patients.   Monthly “Health Tips” newsletters or handouts available at the counter or on the tables in the waiting room can be a way to impart health tips to your patient population.   Newsletters, website blogs and automated messages with targeted health tips based on current diagnoses or trending health events can provide important information to all patients about their condition(s) or community health events that could impact them or their family.  This provides not only valuable information but keeps your practice on the forefront of their minds whenever a health issue arises.  Use your social media to share health tips, practice updates such as introducing a new provider or staff member, or simply sharing patient success stories with their written consent that is!  Anytime the  practice has an emergency closure or inclement weather event POST IT so your patients not only receive notice through your Tarevo System but also can visit your site or social media account for updated information.   This and other information sharing shows you value them and their time and in turn they will value yours.

CARE MANAGEMENT:

Care Management is an important part of patient care.   This is not a part of chronic care management per se but includes things like scheduling timely follow ups so patients can stay on top of their care.  Making sure your system can track visits and alert your team when a call to care is needed to bring a patient back in for follow up.   Automated processes are good but a personal touch now and again goes a long way to encouraging patients to follow up.   Use Tarevo’s Call Center to manage this for your practice if needed.  We can work as an extension of your practice and make sure your patients get a warm welcoming voice linked to your practice to encourage follow up care.

STREAMLINE SCHEDULING:

Make access to care easy.  This can be done in many ways but with Tarevo you can make scheduling an appointment easy with our patient portal or a linked online calendar.  Scheduling walk in hours once or twice a week  can also help get those urgent care clients in as needed.   I can’t tell you how many times I have had to go to an urgent care to be seen because access to my doctor was limited and it would take a month to get an appointment.  Having time to “fit in” ongoing clients can be critical and prevent patients from opting out of your care and opting in to the care a more responsive clinic would offer.   Just sayin!

STAFF TRAINING:

Staff training so extremely important.  When you have a small practice it can be difficult to provide all the education that staff needs.   It can become on the job training which is great but can leave  out critical elements.  If you would like a training program for your team on important issues such as HIPAA, OSHA, Risk Management, Corporate Compliance, Safety, Sexual Harassment, Anti-Discrimination, Documentation and Record Keeping, Role based Tarevo Training, Avoiding Unintentional Fraud,  Setting Expectations, Your Company Culture, Your Vision for Care to Your Patients, Crisis De-Escalation, How to handle the difficult patient, and more.  Ask staff and providers what training needs they have and build to suit.   For example, after ensuring role based expectations are clear, get into the nitty-gritty of the job or function they will be doing and train, train, train!

We can  help build your training program to make sure you and your practice are always in compliance. Just ask.

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