7 Deadly Mistakes Made By New Practice Startups

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42. Interview with Roy Harmon, Fusion Web Clinic

In Episode 42, I speak with Roy Harmon over at Fusion Web Clinic and discuss the ins and outs of a speech therapy private practice.  There many advantages to owning your own private practice, but there are some negatives, too.  All of these aspects are discussed in this interview. Fusion Web Clinic also has a pediatric therapy giveaway for the Speech Therapy Private Practice Startup Podcast Listeners and you can register for that right here.

In this episode:
01:18 – If you do it right, it’s something that can change your life
02:05 – Name that can showcase services in community and that will grow with business
06:58 – You don’t have to have an LLC if you want to see some people on the side
09:25 – Main thing is to create relationships
10:15 – The best person to introduce yourself to any doctor’s or physician’s office is Referrals Clerk
11:45 – When you meet people don’t try to sell it, be yourself
14:58 – Nobody’s going to audit you because you’re not billing out insurance companies
19:46 – I don’t like working for anybody else but myself
24:46 – It’s my responsibility to make sure this thing rolls
27:35 – If you’re not responsible, you’ll be down for the count in a matter of no time

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Roy: So, thanks a lot for talking to me I really appreciate it. What I’m really interested in is, we are a Pediatric therapy EMR. So, the people that we serve are Pediatric therapists, whether they’re OTs, SLPs, PTs and we really try to provide them with valuable information that they can use, just really in every aspect of Pediatric therapy. And one of the things that a lot of therapies in general whether they’re pediatric therapies or not is eventually I think a lot of people start thinking maybe I should go out on my own, maybe I’ll start my own clinic. And you are the expert on this so I’m really looking forward to hearing some of the things that you think people need to think about before they get started. And I know that you’ve kind of talked about some things that people need to do before they open the doors. So, to speak could you go into that a little bit?

Kyle: Yeah, Nice to talk to you finally Roy. I know we bounced some emails back and forth and just finally nice to get some time where we both can talk about this stuff. This is I think important information for therapists who really want to start their own Private practice because if you do it and you do it right, it’s something that can change your life and really put you at that next level. But on the other side, if you don’t do it correctly it can destroy your finances. And again, I’m not a doom and gloom, but if you don’t do it right you can wipe you out. I’ve seen people shut their clinics cause health problems. I know of one lady she got really sick and I know a gentleman who just financially bankrupt from it. But starting out, it’s something that you got a plan and you’ve got a plan to do it right. So, I do have some thoughts on that. Yeah.

Roy: Awesome, I guess really the simplest thing is if you’re going to have a business you got to have a name for it, right?

Kyle: Yeah absolutely. And I’ve always said this is just personal preference. I like a name that can showcase my services in my community something that will grow with the business because I think what sets me apart from other people who were in this space. I teach people how to start a real business something that will take care of me, take care of employees, give the government their cut every month and give the state their cut every month. Everybody has something and I teach people how to start real life clinics not part time on the side, but real-life businesses. I guess people would say “headache”, that’s what a real business is. It’s not all peachy keen just roses.

It’s very difficult at times and I think for me I remember, I went and got some magazines and I was thinking what can I name my business and what can I name my Website. Because I didn’t want anything cheesy. I wanted to serve kids and adults, so I wanted a name that was kind of neutral and I found that name. And I remember looking at buzz words and magazines and this was a while back. So, when you could actually go to a convenience store and pick out a magazine. So, I picked out some of these magazines and look for these buzz words like support, prosper, things like that and I finally came up with Supportvoice.com. And that was for our clinic Therapy group of Tucson.

I remember this gentleman telling me, “No, you can’t do that. Your Website’s got to match your name because how are you going to rank on Google.” “Oh my god, I don’t know how to do that stuff. I never did SEO and I couldn’t do that.” This was 15 years ago and he said you just can’t do that. Well we did. Your name on your Website doesn’t always have to match your brand. I mean it’s part of us. We started this very early on so I just wanted to tell people, just start. That’s the main thing. You don’t have to sit there and over analyze everything you gain into that whole analysis paralysis thing. Therapists are notorious for ideas in no implementation, and I can say that because I’ve been a therapist for 25 years, Speech pathologist graduated from LSU Medical Center in New Orleans. So just get a domain name. Find you a good solid name that you feel that will work. Register it and just start and go with it. You can always change stuff later.

Roy: So, then what about when it comes to getting incorporated or the more legal aspects of the business. What comes next?

Kyle: Once you get your name you can go see a lawyer if you want but I use paralegals. I’ve got my favorite paralegal here in Tucson and she does only work here in Arizona. I threw her name out there but I know you guys have an international base of listeners so really wouldn’t do them any good. But I like paralegals I did a lawyer thing once and it was a lot of money. It was a bunch of money. But you can even get online and just get incorporated. Put your name in there put your address that you want your articles of incorporation mail to. You’ve got to get on that government Website and get your Tax I.D. number. And it’s a simple process it takes minutes and once you have that piece of paper from the government it says here’s your Tax I.D. and once you have your articles of incorporation from your paralegal or your legal team, you take that information to the bank and you can open up a separate Business checking account and throw some money in there and off you go. It’s really that simple.

And then I think the next thing would be is like for Speech pathologist you could get on the ASHA Website. I think they use Mercer insurance or something like that. They get a little deal. You can get you some general professional liability under that business name. It’s cheap as one of my podcast episodes where I actually talk about that and I even put a screenshot on there of the actual amount of the cost of that insurance. But it’s supercheap cheap and you just go with it.

Roy: At that point you’ve got a business, right?

Kyle: Absolutely.

Roy: Is there sort of any other steps? I mean I know that a Website is big. Is that something that you think you need right off the bat or should you focus more on finding patients at that point? What’s the process that you go through.

Kyle: That’s a real good question and to answer your question or to comment on what you said. That’s a business. I know people who and I just talked about this in a recent Episode 41, PrivateSLP.com in the podcast section. Some people don’t even need a corporation. I mean I wanted to start an empire I’ve always wanted to say that but I wanted a speech empire. People used to joke with me I’m like now I’m going to do it one day I will do it. But you don’t have to have an LLC if you want to see some people on the side. You can do that as long as it’s ethical and moral for you. Like if you’re a school-based Speech therapist and a parent hits you up and says, “Hey, can you see my kid after school today?” That might be a problem. I don’t know the whole legal ramifications for taking kids out of the school setting and seeing them privately on the side. I think that might not work.

We have a code of ethics at ASHA, there the American Speech Hearing Association. But if somebody off the street their mom had a stroke and they wanted you to see them for cash. You can do that. You got a license to practice in that state. You can do that. Sure, and you can have them write that check out to you and you can put that money in your checking account. You can be what’s called a sole proprietor so you don’t have to be a corporation. People say there is liability, you can get sued, but I’ve even made the example, I’ve had apartments for years in New Orleans I had apartments in here in Tucson. I’ve got rental property and I’ve always operated under a sole proprietor. I gave an example, I had a water heater blow up on one of our tenants. But it was their fault but I never got sued and I did the right thing I helped the lady out. And it’s a long story.

But my point is don’t be afraid to jump in. I think that’s where people shut down. They’re scared. They’ve got in their mind somewhere, you’re going to get sued for treating this patient. You just can’t do that. I had a lady recently. She contacted me and she wanted to know how to get paid. She said she got a referral and she wrote the report and sent it to the doctor and the doctor signed off on it and sent it back. And she says, “Well, how do I get paid?” I said you don’t have to do all that. You need to send that bill to the Insurance company. That’s what you going to do if you want to get paid because you’re not going to have a business if you don’t get paid. But I commended her because she started even though she’s not going to get paid for that. She is probably five steps ahead of the next person because she’s doing it and then she’s got more people coming in. So, I picked up the phone called here and showed her how to get credentialed and bill insurance companies.

So, I think the main thing is just to start in like you said if you want to get a website. There’re tons of places you can get a website these days for cheap. Even a lot of your registered names you can throw up websites in a matter of 30 minutes. But I think the main thing is to create relationships with those physicians’, pediatricians, all those doctors’, professionals in a community, be nice friendly respectful and tell them who you are and don’t be afraid to say, “Hey, we’re accepting new patients.” Get some business cards made.

Roy: What would you recommend as far as that other do you go to networking events or do you just kind of go to the doctor’s office and introduce yourself? What’s the best way to go about starting to build those relationships?

Kyle: Yeah, that’s a very good question and I think going back to the example with the lady who wanted that doctor to sign off on the report so she can get paid. This day and age where the reimbursement rates are just shrinking and everybody’s just so busy, productivity has doubled and everybody’s just go. I think the best person to introduce myself to any doctor’s office or physician’s office is the Referrals Clerk. That person is the one responsible for sending those patients out to referral sources. So, for instance if you’ve got a Pediatrician down the street and they’re going to send somebody to your office, it’s going to go through that Referral Clerk. The physician really doesn’t have the time to stop treating patients and pick up the phone and call you. That’s like my son says he’s 12, he says Dad that’s so 80s. It’s funny because the physician’s is not going to pick up the phone and go, “Hey Kyle, we’ve got a 4.2-year-old male with a speech delay you think you could.” I mean people still call, Yeah, but they’re going to send that to that referral person in their office and send in on out. And then you’re going to get it on your fax and then you’re going to start that referral process.

But I think just going out and meeting those referral clerks. But again, I don’t know about you guys but I know when people come to my office I can spot a salesman. I mean a mile away they come in and they got their law suit and tie on. I know they’re going to try to sell me something and I’m a real hard sell. But I like the people who don’t try to sell you stuff. I like the people who come in and introduce themselves and kind of talk about, “Hey, it’s a nice office.” Kind of fluff it up a little bit. That’s what I think is important. When you meet people don’t try to sell it. Be yourself, be authentic and tell them what you’ve got to offer. Say we help kids in by the way we just happened to accept all these insurance plans and Medicaid plans. And I see that you guys accept these Medicaid plans too. I know there’s a waiting list across the street for six months. What incentive does we’re ready to go. And then you’re talking solution, because at the end of the day that doctor, that pediatrician, those professionals they want one thing for their patients and that’s help and that solution. And if you can offer that solution you’re in business.

Roy: Is the referral Clerk going to be right down upfront or you think that they usually hide them somewhere in the back?

Kyle: Yeah, they hide them. Yeah, they’re busy they’re wheeling and dealing all day getting prior authorizations and check in benefits. You’ll see a lot of times that referral clerks. They’ve got multiple hats that they wear in an office. They’ll do have referrals and maybe have prior authorizations for the office they worked for or they might be doing answering phones or shuffling papers but they wear multiple hats in that clinic and they keep them in the back. But what you could do is, I mean you’re a father if you were starting your own practice when you take your child to the pediatrician you just say, “Hey, by the way this is what I do and who is your referral Clerk?” Start with your own doctor’s office or somebody that you know. That’s the best way to do it.

And then when you go to the dentist tell the dentist too because they have networks in their dental community for Speech therapy. My son’s getting braces. I talk to the orthodontist. I mean they’re right there might as well take that opportunity, right?

Roy: Right. And also, to kind of go back a little bit. You were talking about how maybe you don’t really need all the things that you think you need just to get started. Of course, optimally you can have a website you can form an LLC if that’s something that you feel that you need to protect yourself. What would you say is the absolute minimum that you need just to jump in and to get started and to say that you’ve taken the first step?

Kyle: I think you need that desire to start. I mean it’s really that simple you need a license from the state that you’re practicing and that’s it.

Roy: And a patient?

Kyle: And a patient. Yeah. Because if you want to see somebody and you’re not credentialed with Medicare, if you’re next door neighbor says, “Hey, your sinter cutting the grass. I mean you guys are cutting the grass on the East Coast. We don’t have any grass to cut here in Tucson Arizona.” Man it’s 111 degrees yesterday. I used to cut 10 acres of grass in Louisiana. So, the lady next door you cutting the grass and she says, “My husband just had a stroke and you just got to the hospital and he’s got Dysarthria and he’s got a speech problem. You think you could see him?” And you look around your shoulder and you look through the window and through the window you see your Speech therapy license. “Yeah, I’ll see him. Give me 60 bucks.” And she says, “OK. Your 60 bucks. We’ll go see the man. Go ahead.” That’s all you need. You just have to do it and nobody’s going to audit you because you’re not billing out insurance companies. Nobody’s going to come knock on your door. The Speech therapy police are not going to come bust your door down and say, “You saw Mr. Jones, your next-door neighbor.” That’s not how it works. If you want to see that patient, see him if you have an agreement. And that’s a minimum. You want some paperwork. You want a release of information you want a case history form that’s really important. And you can Google this stuff.

I’ve got a forum, I’ve got a private community that I work with Speech therapists like this all the time and if you go to a privateSLP.com/coaching, we have an all access community and all these forms are right there. And it’s really affordable. You can just download everything, change the name to your name or business. For example, demographic sheets where the patient puts their name and address. They’ve got a case history sheet where they actually fill out what the problem is or what they think they need to be working on. If there is insurance, if you’re going to even take insurance, you can fill that section out there and then maybe like HIPPA privacy section there where this is how we handle your information, something just to kind of cover yourself. If you’re going to charge cash or fees just a little agreement we agree that for every hour that we spend together I’m going to charge you 60 bucks and I’m going to take cash, credit card or check. It’s really that simple. And just keep some notes. Give him a manila folder, go to Costco and get your pack and manila folders and off you go. I used to buy those packs and manila folders like you wouldn’t believe and our new business was getting better because I’d get more paper, more ink and toner and I just knew we were growing because I was spending more money in ink and toners the biggest scam in the world. I mean that stuff costs more per ounce than titanium. It’s a toner.

Roy: Yeah. A big markup yeah.

Kyle: Oh, it is. Yeah but it’s really that simple. I don’t know if you’ve ever been to like any private therapy sessions like counseling after Hurricane Katrina. I got really sad because of the hurricane and I remember going to this counselor for about three or four sessions. I said, “I think I’m depressed.” She says, “Well you probably are. You just went through a major hurricane you just kind of lost.” I said, “Yeah, but I remember she just whipped out a piece of paper and she just started writing notes and it wasn’t all fancy. It is a pen and a piece of paper, and she just scribbled and shoved it in this photo when I left and I paid her 120 bucks and we were done. That was the agreement. So, I don’t think it takes that much these days to just start. But the main thing is once you start get ready and don’t quit before the miracle because if you do it right and you sell it, again not really sell but if you tell people solve their problems when you can show people how you solve problems that’s been in business because people who are going to be knocking on your door down to get the help they want their problems solved too. And it just goes from there.

Once you kind of figure out how to do it, triple it, that’s the easiest thing to do just keep going. Because I really mean this from the bottom of my heart when I say this I think when people start, when they really start seeing their caseload ramp up, they’re going to start making decisions. Okay, do I really need to work until 7:00 or 8:00 at night? Especially in the speech therapy where people want services after school. So, some therapists will work until 8 o’clock at night. But you’re going to make those decisions but you can’t make those decisions until you have that customer base.

You’re also talking about the office and I’ve seen so many people shut down in two to three years because they got these fancy offices with the perfect paint the big letters on the wall says “Welcome to our clinic” and they’re real pretty pictures of children and the beautiful waiting rooms with all that expensive furniture. And sometimes when I look at these pictures, I’ll say something like, “Ma’am, my therapy children at our clinic they will destroy this waiting room”.

I used to have books, coloring books, crayons and magazines, all that stuff. It disappeared in our office. I used to have a train set, it disappeared. I couldn’t even tell you where the train set went. People these days, it’s funny but it’s true, they steal my Fair breeze, they take my toilet paper, they steal my hand towels, they take my toys, so I don’t even have that stuff at my clinic anymore. People say, “Wow, you can’t have stuff for children while they’re waiting”. Well, they don’t wait too long. We keep our appointments right on time. So, when people come in they’re there about five minutes before their appointment. And boom, they’re in. They don’t have time to sit there and play with toys.

Roy: And then you say that when you have that much overhead you really don’t have your own business you have your own job.

Kyle: Absolutely. Absolutely. And then you working for the bank. I don’t know about you but I don’t like working for anybody else but myself and I don’t want to work for the bank. And that’s why I just don’t want to do the bank loan thing.

There’s no way it’s going to work, because you’re just making payments type credit card payments. I remember early on I needed a little bit of a loan to get started. And now I really did get started which is kind of have a little cushion, if you don’t mind me talking about this.

Roy: Not at all.

Kyle: I saved up about eight thousand bucks from when I was working in the nursing homes. I had about three jobs at one time. I was ready to make that move. And I had about Eight grands in my pocket and I hope this is enough. But I’ve also had about 25 to 30 patients on the other side waiting for me too. So, I was doing all these math calculations but I just wanted about Ten grands because I’d already spent that money but nobody would give me a loan even though I had perfect credit. I had this new business and I couldn’t get a loan. And finally, I was able to get just a personal line of credit. There’s little overdraft line of credit that you get and one of the bankers still tell me about this story today. And she gave me a Ten thousand dollars line of credit, and I would jack it up and pay it off, but I use that Ten thousand dollars buffer to start. And now we see thousands of people a month. We have over 35 employees and I haven’t used that line of credit in a long time but it’s still there.

I have a significant line of credit that I’ve asked for and had on hand if I ever need it but I’ve had that now for four years and never touched it. But it’s nice to have when you need it but you definitely don’t want to get into that rat race of borrowing money like credit cards. I mean what’s the point, that your 30-dollar meals ended up costing you 60 bucks when you’re all set and done four months later.

Roy: There’s a lot of benefits to having your own business to run your own clinic. What would you say are the best parts about it the things that you love the most and that make you really happy that you did this? And then what would you say are the toughest times the biggest challenges and the things that maybe if people don’t think they can handle it then maybe that’s a sign that they’re not ready for this?

Kyle: That’s a real good question. I think the thing that I like the most I wanted time with my kid. When I started this business, I just want more family time. I used to get resentments against this big nursing home companies when I was working. I was the one who had to go in on 4th July or Christmas Eve. Its like everybody’s barbecuing or having a family time and here I am going to work. I was making good money but I was trading my time for money. I didn’t know any better at that time I was a good provider. But I wanted more time.

And here it is like soon as I get finished with this call I’m going to pack and we’re going off on a Disney cruise here. We’re leaving today and flying from Tucson to Phoenix, from Phoenix to Orlando. We’re going to catch a Disney cruise and we’ll be back on Monday.

Roy: Oh, that’s cool.

Kyle: Oh yeah. It’s family time. I get to spend with my son and his best friends going, and his best friend’s mom. She’s the paralegal I was talking about. We’re always talking about businesses so it’s a business trip right. That’s what I like about this. But the time it costs money to have this kind of time it cost. And the second thing I really enjoy seeing these kids and families get the services that they need. That’s the first thing really is just watching these kids get the services they need. Because in our clinic we take all the payers. We take all the Medicaid plans, we take all income levels. Everybody gets the same treatment.

That’s what I really like and it’s funny because people say they’ll see me out in the lobby. I’m cleaning up and picking up, and some mom will say, “How long you’ve been working here?” I go about 11 years and they have no idea that I am the owner. I’ve heard other people kind of talk negatively about this. But I’m the one who will go into the bathroom three or four times during the day and make sure there’s no poopy diapers in there. I’m cleaning up the bathrooms put in common in the toilets and make sure my bathrooms are clean. Then we have toilet paper that somebody didn’t steal it or the chairs are straight or the trash is picked up in the parking lot. I’m a worker among workers. I just don’t treat patients all that much these days and that’s what I wanted to do early on make sure that kids get their services. I didn’t want to treat them. I wanted to provide jobs.

And so that’s another thing I like seeing the employees make a really good living. They all have free healthcare now, free vision, free dental insurance, 401k in retirement and time off. I mean it’s a real good place to work and all these great benefits. And for me offering all that the employees get the work; the patients get the help and everybody’s relatively happy but that cost a lot of money. But it’s my responsibility to make sure this thing rolls.

And to answer that other part of your question if you have trouble with money or you have trouble relating to people, if you’re not one of those people who can’t handle conversations about money or if you’re real defensive and you tend to chew people out this might not be for you because people all don’t want to be treated like that these days. You’ve got to be able to treat people with respect and be like I said a worker among workers. You can’t be like the rich business owner at the beach all the time. That’s not going to fly.

If there’s a cancellation I’ll jump in and see a kid. I’ve done it before and I’ll do it again or if there’s a plumbing problem I’m the one out there doing this stuff. My dad was a plumber. Growing up I grew up on plumbing trucks I know how to work. I changed light bulbs. I’m on the roof changing sodium halogen lights for the parking lot making sure people are safe at night. So, you just got to have that can-do attitude but you had to be nice and respectful about it and if you can’t do that, it just may not work for you. I hope that answers a question.

Roy: Yeah definitely, yeah. So, I mean it’s very rewarding it sounds like because you create jobs you’re able to provide a great service for all these patients. And if you do it right, you’re able to have that additional time with your family or be able to spend your time the way you want to. But it sounds like what comes with that is a lot of responsibility because you’re responsible for all of those people’s jobs, you’re responsible to still provide for yourself and your family and to keep that level of care really high. So, you’ve got to jump in and see patients. Really it sounds like you have to be ready to do anything, well a lot of hats, which I think that’s kind of a pretty good picture of an entrepreneur in general.

Kyle: Yeah, you just said it. And I remember growing up my mom told me what that word was. I even not know how spell it but I knew I was one. And I always wanted to pay my own way and it was scary at first. I mean real scary but I manage my money well. I got great credit. I’m a good person. I genuinely care about others and I really want people to get the help that they need. And I just don’t accept no for an answer. No is not in my vocabulary. It’s one thing that I can honestly say if the government shut down tomorrow we’d still be in business. I could flip this thing for months. And that’s the thing that’s what sets me apart from other private practice owners. I don’t need a bank. I am the bank. And it’s taken 11 years to become the bank. But with that level comes responsibility. And if you’re responsible it’s going to take real good care of you but if you’re not responsible, you’ll be down for the count in a matter of no time.

I’ve seen it so many times people are freaking out getting payday loans to pay their employees. I mean can you imagine if you think about it. I mean you’ve got money you can buy a house but it’s not a home or you can buy a bed, but it’s not a good night’s sleep. Money buy a lot of stuff but that other stuff that good night sleep comes from inside and being able to sleep at night. And I think part of that’s the financial responsibility and being an honest loyal person. So, if you have problems with that stuff I don’t think private practice would be for you. Because I mean just don’t waste your time. It’s not worth it. And there’s nothing wrong with working for other people. There is nothing wrong.

I enjoyed some of the places that I worked at. I mean I got paid great. When I left I was done. I didn’t have to think about running. We were running payroll here in a little bit and that’s one of these things I’ve got to do. I’ve run payroll from foreign countries at 3:00 in the morning or 2:00 in the morning. But it gets done because what you said Roy was so true. People were relying on that paycheck and those benefits like the apartments I was talking to one of my tenants the other day he’s always late on his rent. I said, “Man, you need to step it up and now I was real respectful about it but it’s like what if I just decided not to pay the water bill.” He’s like, “Well that wouldn’t be good.” Exactly. So, what makes you think you can just wait and pay me my rent two days later. It’s like I’m not being mean about it, it’s just business. That’s another thing with therapists, I think we’ve got to have that confidence to say this is what I am worth. I need you to pay your bill. So, if not we’re going to send you collections. There’s nothing wrong with having that conversation because it’s part of what we do and if we can’t pay the bills nobody gets anything. The kids won’t get their help, the employees won’t get their wages. Nobody has anything, we would just shut it down. And that’s no good for anybody, Right?

Roy: Right. You got to keep the boat afloat.

Kyle: Absolutely

Roy: Well, thank you so much for taking the time to talk to me. I think this is really valuable information. And so again over at Fusion Web clinic where the only EMR that’s designed specifically for pediatric therapies. And so, we’re going to write this up as a blog post and we’d also loved to offer, anybody listening to this. We have some boxes of Pediatric Therapy activities and some other fun things in there. So, if anybody wants to sign up to be eligible to win one of these boxes they can go to FusionWebclinic.com/privateSLP and they can do that there.

Kyle: That’s great. I might just can sign up and if anybody need some help on the speech therapy private practice side, you can always reach me at privateSLP.com. Like I said earlier I’ve got an all access community whether it’s a private coaching forum. I don’t do Facebook groups and things like that. This is all private and if you need something you can just find me there.

Roy: Have a great vacation Kyle.

Kyle: Thanks Roy. Thanks for everything.

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