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.

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.AProviding Quality Consultation, Assessment and Psychotherapy to the North Florida Community

2121 NW 40th Terrace, Suite B.Gainesville, FL 32605

CPANCF.COM 352 336-2888

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.

Our goals are to maintain:

  Excellence, service, & leadership in our field.

Clinically, ethically, & scientifically sound evaluation & treatment services.

A cohesive professional & clerical staff

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

The Website

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

Independent Practices (located at same office)

Charles Russell Clifton, Ph.D.

Support Staff

Office Manager Receptionist

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

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

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.

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

Common Symptoms

  Disorganized or messyTrouble paying attentionEasily distractedInconsistent performanceDifficulty completing tasks ImpulsivenessDistractibilityFrequent fidgeting

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 Train with the Best

Know your areas of expertise

Fluent in your skills

Are you ready for Practical applications?

(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 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

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

Do a realistic Assessment of Your Strengths and Weaknesses

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 won’t you do?

What can’t you do?

What shouldn’t you do?

Avoiding Horror

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 QuacksPsychologist 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

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

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

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 - IIIStaff 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

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

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

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

Look out OVERHEAD!!! Overhead costs can range from 35-50%

Office SpaceFurnishingsOffice HelpUtilitiesComputer and Communications EquipmentTest Equipment and SuppliesOffice Equipment and SuppliesAdvertisingPostageInsuranceAttorneysProfessional DuesSubscriptionsEducation and TrainingCleaning and RepairSecurityBilling SoftwareAnswering Service

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

Billing and Collections – I

Medicare fees and allowable hours BCBS fees and allowable hours’ Managed Care Worker’s Compensation Auto Insurance Indemnity Private Pay

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

Collection Agencies

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.

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…..

So, quit complaining about your job

….

Always Strive To Excel

Take the Moral High Ground

“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.

Business Plan Personal Plan Does it fit your

Environment? Periodic Assessment Corrections Reassessment Exit Plans

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.

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