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

2
(No Transcript)
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

11
Assessment Services Assessment Services  
Intellectual Abilities Vocational Career Interests Learning Disabilities Attention Memory Personality Adjustment Spanish Language Testing Post-Traumatic Stress Disorder Attention Deficit Hyperactivity Disorder Fitness for Duty Disability Evaluations Competency Sanity Evaluations Death Penalty Appeal Evaluations Personality Assessment Psychological NeuropsychologicalIndependent Medical Examinations Personal Injury Evaluations Worker's Compensation Evaluations Assessment of Malingering Dissimulation Neuropsychological Functioning -Child, Adolescent, Adult Assessment of Neurodevelopmental Disorders
12
Treatment Services Treatment Services  
Adult, Child, Marital, Family Issues Adjustment to Career, Family or Life Changes Individual and Group Psychotherapy Depression, Anxiety, Mood Disorders Post Traumatic Stress Disorder Stress Reactions Panic Disorder Other Anxiety Disorders Alcohol Substance Abuse Dependence Victims of Crime Attention-Deficit Hyperactivity Disorder Childhood Behavior Problems Pediatric Psychology Medical Health Psychology Adjustment to Major Medical Illness Pre Post Surgical Evaluation Intervention Adjustment to Child Adult Pain Disorders Behavioral Headache Management
13
ADHD SERVICES
We provide quality consultation, comprehensive, psychodiagnostic assessment, and  psychotheraputic services for children, adults families who may suffer from (ADD or ADHD) Attention-Deficit-Hyperactivity Disorder and other related disorders. We offer several types of services. Assessment Parent Training Group Therapy Individual Therapy Referrals                                                                             ADHD disorder is common yet, it is complex and often misunderstood. Proper diagnosis is the foundation on which effective treatment and management is based. ADHD disorder is common yet, it is complex and often misunderstood. Proper diagnosis is the foundation on which effective treatment and management is based.
We provide quality consultation, comprehensive, psychodiagnostic assessment, and  psychotheraputic services for children, adults families who may suffer from (ADD or ADHD) Attention-Deficit-Hyperactivity Disorder and other related disorders. We offer several types of services. Assessment Parent Training Group Therapy Individual Therapy Referrals                                                                            
Associated Disorders Proper identification and treatment of these disorders, when present, often improves the overall prognosis. Children with the disorder may be described as immature, may tend to always be on the go as driven by a motor, may be impulsive, and frequently act before thinking. They may suffer frequent reprimands from parents and teachers. Self-esteem is at risk, and they may become rejected by peers. Adolescents with the disorder may show less overactivity, but may have difficulty meeting the increased demands of middle school. Trouble with organization, planning, and meeting increased productivity requirements are common. Adults with the disorder may continue to have difficulty tolerating routine types of work, may shift jobs more frequently, and may have difficulty attending to details and organizing. There is increased risk for marital Children with the disorder may be described as immature, may tend to always be on the go as driven by a motor, may be impulsive, and frequently act before thinking. They may suffer frequent reprimands from parents and teachers. Self-esteem is at risk, and they may become rejected by peers. Adolescents with the disorder may show less overactivity, but may have difficulty meeting the increased demands of middle school. Trouble with organization, planning, and meeting increased productivity requirements are common. Adults with the disorder may continue to have difficulty tolerating routine types of work, may shift jobs more frequently, and may have difficulty attending to details and organizing. There is increased risk for marital
Common Symptoms Common Symptoms
  Disorganized or messyTrouble paying attentionEasily distractedInconsistent performanceDifficulty completing tasks ImpulsivenessDistractibilityFrequent fidgeting
14
Our Group / Testing Room
15
Waiting Room
16
Are You Ready To Fly?

• Dont 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
Youve 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
Assessing Your Strengths and WeaknessesWill you
at minimum Always being able to maintain an
acceptable Standard?

• 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 wont you do?
• What cant you do?
• What shouldnt you do?

23
Avoiding Horror

• Dont 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

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
• Workers 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

• .

40
(No Transcript)
41
Always Strive To Excel
42
(No Transcript)
43
Take the Moral High Ground

• We are accountable to a higher power.
• Alan Gessner, referring to APA Ethical Standards.

44
(No Transcript)
45
And dont 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