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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
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