Is it time for a contrarian approach?

I spent last week in Florida. One fine day on the beach, I witnessed an interesting natural event. Some beach goers began to toss bread into the air and immediately 30 to 40 seagulls flew over to get some food. It was a frenzy and the birds seemed to be fighting each other over food. It reminded me of life as a doctor in NY.

Then I saw something amazing.

One bird--and only one bird--stopped participating in the melee and instead flew in the opposite direction toward the sea. Once there, beyond the cresting waves, this bird hovered and then made several dives and pulled out a fish. While his competitors were fighting over crumbs and hand-outs, this contrarian bird went solo and came out ahead.

It got me thinking. Do I fly with the other birds and fight like mad for some scraps. Or do I go the other way, beyond the cresting waves, so I can feed in the blue waters of no competition.

It was a nice day on the beach!

To send to collections or not, that is the question.

The decision to send people to collections or to simply write off bad debt is a difficult one to make and should not be taken lightly.  You and your managers need to balance the difficult economic times that we all face with the business's own needs for cash flow.  In addition, sending people into collections is unpleasant and I think it just feels wrong.  As a human being, I can understand that difficult choices that many people face in deciding where to spend their hard earned yet meager wages.

Despite these challenging times, most people pay their bills conscientiously and feel ashamed at not
having the ability to do so.  Even people who can not pay the bill in full are eager to pay in installments, even if it is a small amount per month and others are happy to accept a settled amount and pay it on the spot.  Most people just don't like to "stiff" another person. 

However, there are others, a very few, who brazenly withhold
payment as if they can do it with impunity.  They answer their phones and simply refuse to pay or they say they'll call back some other time and then never do.  Others say that the check is in the mail when it is not.  A very few even write bad checks.

They are the deadbeats and
these type of people plague every business, even
medicine.

I recently, 2 years and 9 months into my own practice, have decided to outsource my deadbeat accounts to a collection agency.  This was prompted by several events:

• I have been seeing a patient I know to be a deadbeat around town, eating out in restaurants and having Starbucks coffee.
• I have had several people simply refuse to pay their co-insurance because I did not "do anything"--other than provide them with information and advice.
• I've had a few people become very belligerent to my staff as they tried to collect moneys.

In my practice, deadbeats owe me in excess of $10,000 dollars.  That is a lot of money.  I need that money to pay my staff and my vendors and my bills.  Though I only came to this decision after several years and some glaring examples of "how not to act when you owe money", I have finally come to grips with the notion that sometimes you just need to resort to a collection agency.

I just never thought I'd have to do so.

Dr S

A new blog.

I just started a new blog at WordPress on andrology. I want to see how long it takes me to get it noticed by the organic search engines.

Check it out: The Andrology Blog.

My New Years Business Resolution

Someone in the Enteprenwur Group ask the question about business plans for next year. Here is my answer.

• reviewed and revised my business plan for 09.
• upgraded to EMR-PM system
• Hired coding consultant
• Hired lab consultant
• Plan to expand lab test menu
• Improve marketing: email, direct mail, targeted mail, blogging, adwords, twitter
• Increase referral base
• Outsource collections for deadbeats
• Improve collections: check scan, cc's, EMR-PM, cash
• Answering phones 24/7
• Making it easy for new patients to book and be seen

Anything else that I'm missing?

Dr S

Disney's use of technology and what a doctor can learn from it.

I spent the past few days at Disney World and among other things, I was amazed at how they have improved their technology usage since my last visit, only 3 years ago. While I have no doubt these improvements did not come cheap, I also know they enable Disney to make money more easily and efficiently. Here are just a few that come to mind immediately.

• Smart room keys: your room key doubles as a charge card and park entrance pass
• Biometric scanning: upon entrance, adults have to scan their index fingers which get matched to the park pass and to the kid's entrance passes
• Photopasses: photographers line Main Street and Hollywood and Sunset taking pictures of guests. Image numbers are infrared scanned onto cards which can be usd by guests to purchase the pictures on line
• Ride-photography: at the end of roller coasters and flumes, guests are shown pictures of themselves during the "big drop" and the pictures can be purchased right there
• Remote card processors: all vendors, even the portable street ones, accept credit cards, room keys, or any sort of electronic form of commerce, as payment

So how can doctors learn from this. Technology that enables more efficient billing, verification, and documentation will help you save money and make money.

Good technology can well worth the cost of implementation.

Dr S.

The 5 Key Elements of Any Business Plan

Whether you plan to open a bagel shop or a solo medical practice or to attempt to advance your own career while an employee within an established group, you must develop a business plan.  Here are the key elements to a good business plan:

Revenue Sources
Operational Costs
Capital Requirements for Start-up
Critical Success Factors
Key Risk Factors



Think about each of these 5 elements and brainstorm as much about them as possible.  You'll find that with this disciplined approach, you'll avoid making some costly mistakes and maximize your chances for success in the venture.

If you don't understand or have the time to make a plan yourself, you can use a number of resources, such as The Entrepreneurial MD, et.al. 

Good luck,

The IU.

Size Does Matter: Go Small

Everyone wants a large office.  I think that is an ego thing.  For me, I'll take too small rather than too large anytime.  Larger offices, like larger houses, have costs that smaller spaces just don't have. 

• Rent--most of us pay per square foot.  Obviously, the more square footage, the more you pay.
• Cleaning--larger offices cost more to clean that smaller ones.
• Heat--see cleaning
• Cool--see cleaning and heat
• Wallpaper--see above
• Carpet--see above
• Clutter--more space = more clutter = decreased efficiency

The only exception to this rule is if the office does not have sufficient working space to maximize patient flow.

If in doubt, in my opinion, go smaller rather than larger.

Dr S

Going Solo? The Turnkey Medical Practice: 2.0 Style

I know I have written previously about how to start a practice from the embryo stage on up, but here it is again, parred down to its bare essentials:

1. Get or develop a detailed business plan that will serve as a blueprint.
2. Get a mentor or coach or other such trusted adviser.
   
3. Get credentialed with insurances, hospitals, et al.
4. Get professional liability insurance.
   
5. Get a phone number.
6. Get a web-presence.
7. Get office-space; sublease, lease, or purchase depending on your unique situation.
   
8. Get a good EMR-PM system.
9. Get a payroll service (also does statutory insurances for small businesses).
10. Get an employee.

That is the list. Easier said than done and each step has many and multiple sub-parts. Still, just 10 steps.

Good luck.

Dr S

A New Car--A Vas Reversal

I recently traded in my Honda Accord with 114,000 miles for a used, mint condition, 2005 Accord with 26,000 miles. What could have been a difficult and cumbersome transaction was smooth and pleasant because all parties involved assisted each other and were motivated to make it happen.

My experience int the car dealership got me thinking about the differences between exceptional medical practices and typical ones.

• In a typical practice, staff is harried and just wants to push you through the system with as little effort as possible.
• Exceptional practices provide assistance and encouragement with all aspects of the experience and go the "extra mile".
• The typical practice just wants patients with good insurance; i.e. insurance plans without much hassle factor.
• Exceptional practices want cash paying paying patients.
• The typical practice is not equipped, psychologically or operationally, to handle cash pay patients and the challenges that this type of patient brings to the business.
• The exceptional practice has developed the skills, techniques, and mechanisms that make it easier for patients to WANT to pay out of pocket.
• The typical practice adds little added value to the encounter.
• The exceptional practice does little things that add value for the patient, and in turn the patients--or their insurance carriers--are willing to pay extra for them.

Essentially, my experience a the dealership taught me that when all people involved are motivated to make the sale or provide the service, business gets done.

Kind of like when we see our vas reversal patients.

Dr S

December Goals

Thanksgiving is over and December is upon us.  December can be a slow month.  Do you have plans to turn it around?  Here are things you can try.

1. Send a mailing to all your existing patients, either as a holiday card or a flyer.
2. Make a newsletter and send that to your existing patients and referring docs.
3. Update your website.
4. Blog and then blog some more.
5. Review your online marketing campaigns.
6. Send "thank you baskets", etc, to your good referrers.
7. Invite your best referrers to dinner.
8. Send something useful to your referring docs, like an article or hyperlink.
9. Keep your phones on and manned.
10. Open extended hours.

Good luck and have a good December.

The IU.