How to Survive in Neuropsychological Private Practice Ernest

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

Clinical Psychology Associates of North Central Florida, P. A Providing Quality Consultation, Assessment and Psychotherapy to the North Florida Community 2121 NW 40 th Terrace, Suite B. Gainesville, FL 32605 CPANCF. COM 352 336 -2888

Our Mission Statement n 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.

Our goals are to maintain: n Excellence, service, & leadership in our field. n Clinically, ethically, & scientifically sound evaluation & treatment services. n A cohesive professional & clerical staff

n Professional and office staff are expected to interact with patients, referral sources, and third-party payers in an honest and ethical manner. n 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

The Website

CPANCF Professional Staff – n n 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

Independent Practices (located at same office) n Charles Russell Clifton, Ph. D.

Support Staff n n Office Manager Receptionist

Assessment Services Intellectual Abilities Vocational & Career Interests Psychological & Neuropsychological Independent Medical Examinations Learning Disabilities Attention & Memory Personality & Adjustment Spanish Language Testing Personal Injury Evaluations Worker's Compensation Evaluations Post-Traumatic Stress Disorder Attention Deficit Hyperactivity Disorder Assessment of Malingering & Dissimulation Fitness for Duty Disability Evaluations Competency & Sanity Evaluations Death Penalty Appeal Evaluations Personality Assessment Neuropsychological Functioning Child, Adolescent, & Adult Assessment of Neurodevelopmental Disorders

Treatment Services Adult, Child, Marital, & Family Issues Attention-Deficit Hyperactivity Disorder Adjustment to Career, Family or Life Changes Childhood Behavior Problems Individual and Group Psychotherapy Pediatric Psychology Depression, Anxiety, & Mood Disorders Medical & Health Psychology Post Traumatic Stress Disorder Adjustment to Major Medical Illness Stress Reactions Pre & Post Surgical Evaluation & Intervention Panic Disorder & Other Anxiety Disorders Alcohol & Substance Abuse & Dependence Adjustment to Child & Adult Pain Disorders Victims of Crime Behavioral Headache Management

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 www. cpancf. com/adhdservices 2. html ADHD disorder is common yet, it is complex and often misunderstood. Proper diagnosis is the foundation on which effective treatment and management is based. Common Symptoms Disorganized or messy Trouble paying attention Easily distracted Inconsistent performance Difficulty completing tasks Impulsiveness Distractibility Frequent fidgeting 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

Our Group / Testing Room

Waiting Room

Are You Ready To Fly? Don’t 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

You’ve done your pre-flight Check n Train with the Best n Know your areas of expertise n Fluent in your skills Are you ready for Practical applications? n n (Go Gators!)

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

Can you survive in a hostile n Pressure from price competition environment? n n n n State Boards Critical Colleagues Increasing Standards Conflicting and confusing State and Federal Regulations HIPAA Unhappy or Even Dangerous Clients Deadlines

Avoiding Agony n n n n n 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

Do a realistic Assessment of Your Strengths and Weaknesses

Assessing Your Strengths and Weaknesses Will you at minimum Always being able to maintain an acceptable Standard? n n n n 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 won’t you do? What can’t you do? What shouldn’t you do?

Avoiding Horror n n n n Don’t 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

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?

Use the Right Tools n n n n n HIPAA Forms AUTHORIZATIONS RELEASES APPROPRIATE TESTS RULE 26 Document CE Documentation State and Local License Progress Notes Discharge Letters Practice Policy

Keeping Your Practice Secure – Part I n n n n n 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!

Keeping Your Practice Safe and Secure - Part II n n n n 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

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 who Stalk

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

Participate and Benefit from your State and National Professional Organization FPA and APA n Lobbying for fair trade practices and our livelihood – member participation vs. (who spends the most money? ) n Defending Psychological and Neuropsychological Assessment n CE on State and National Ethics and Regulations n Business oriented training n Establishing and Maintaining Networks n Marketing Opportunities n Support

Bill for your time: It is your product and most precious commodity.

Look out OVERHEAD!!! n 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 Answering Service

Financing your Practice… Do as I say, not as I do. n Pay off high interest unsecured loans first n Banks are not really interested in your future unless you have some collateral n Commercial Property usually requires at least a 20% down payment n Utilize leases to avoid excess unsecured debt n Take advantage of no interest 6 month financing for furniture and office equipment if you can pay it off n Consider SBA financing if you have some collateral and a good business plan n Keep Personal and Business finances separate n Consider tax and interest rate implications n Set up retirement plans early and contribute to them even if it means living modestly n Things can change rapidly, aim to have three months of operating expenses in cash reserves

Billing and Collections – I Medicare fees and allowable hours n BCBS fees and allowable hours’ n Managed Care n Worker’s Compensation n Auto Insurance n Indemnity n Private Pay n

Billing and Collections - II Billing Programs and Equipment n Paper vs. Electronic Claims n In House vs. Outsourcing Claims n HIPAA Considerations n Billing and Collections Staff n Credit Bureau n Attorney Based Collections n

Collection Agencies

If you are not afraid to Crash and Burn… n n 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.

Have the Proper Attitude n As psychologists people look to us as leaders in how to handle tough situations. n We need to demonstrate good leadership attitudes with our staff, patients and in our community. n People also look to us to be idealistic caring and empathic individuals. Volunteering time to our community and organizations vs. the Me Generation. n We need to have the attitude of a winner…. .

So, quit complaining about your job ….

Always Strive To Excel

Take the Moral High Ground n “We are accountable to a higher power. ” Alan Gessner, referring to APA Ethical Standards.

And don’t get too grandiose….

Keep your bearings and awareness of your surroundings……………. Check your perceptions. n n n n Business Plan Personal Plan Does it fit your Environment? Periodic Assessment Corrections Reassessment Exit Plans

Avoid Burnout – Stop and Smell the Roses n Commit to scheduling time and budgeting for recreation, exercise, family. n Schedule time for attending conferences and seminars n Make this a habit ASAP n 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. n 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. n You have to live.

I hope you will find smooth sailing and fulfillment in your practice ventures