It is only Thursday and our income (actual checks in my  hand) for the week has been about $7,000. Hallelujah.

I thought it would be meaningful for me to bring back this blog from the dead, if only for another post or two. For one, I’m at headache conference at a resort in Scottsdale and have a moment to write and think for once. The major development since I posted last has to do with my continuing shake up of the business end of the practice.  If you knew me, you would how badly I crave a business place of peace and smooth sailing.  I really hate drama.  I want my focus to always be on patients.  So, I may not have the perfect personality type for running a business, but that doesn’t change things. Beside not being your Type A, executive persona, I am also quite candid.  I am candid about my fears and my mistakes.  I’ve watched many others scream of their great successes . . . all the way to complete collapse and failure of their ventures. Donald Trump is the opposite of myself. Why some see him as the ideal businessman, I see him as a very insecure little man. My big mistake was in billing.  It wasn’t a naive mistake.  I knew from the start that billing was huge for a practice.  I devoted months trying to find the best solution to my billing needs.  I never took it lightly.  At one point I outsourced to a highly reputable biller.  Before our doors were even open, I started getting calls from my vendors that this biller was pissing them off.  She had a very “negative” influence on people. So right or wrong, I decided to can her. Because of that, we were in a bind.  Our doors were opening in about two weeks and I didn’t  have a biller.  I looked at many different options. Most of the outsource billers are quite expensive. Some require thousands upfront and then as much as 10% of your collections. About that time my office manager recommended a lady who had been a biller for years, but then stopped for her family. I met her, I interviewed her, I checked her references. She seemed very confident that she could do a great job. Then came the firestorm of opening the practice.  I had patients pouring in from all directions (and still am).  I was working 80 hours a week trying to keep all the plates spinning.  I didn’t neglect the billing situation as I was looking over her shoulder every day.  Things didn’t add up to me (see most of my old post) and  I would have been much more concerned earlier, however my PA-Owner mentor and my SP both kept saying, forget about the money for the first three months. So I did. Then, when the fourth month rolled around, and money still was only trickling in, I launched a big audit of our billing from two sources. Both indicated something serious was wrong, but we couldn’t tell where. Finally I figured out  my biller was making big mistakes.  I gave her a warning and some bars to hurdle. She failed those goals miserably . . . so I had to fire her.  I felt terrible about that at first.  But then  my old biller (who I had worked with for 8 years and have a deep respect for) came in to help fix things.  As we unraveled the onion back, layer by layer, it was shocking.  Not only did my biller not know at thing about billing, she covered her tracks. She did bizarre things like submitting the same claim about 5 different ways, hoping that one would be paid.  It could even look like fraud to the insurance company. Four weeks into the clean up, my new biller is about 25% through the mess.  Money is starting to flow.  I’m not getting rich but each payroll is getting a bit easier.  There should be a large chunk coming in soon . . . enough to give us a bit of cushion for once. So, it is disappointing.  You want to trust people but yet you can’t trust anyone. You want to devote your energy to your patients, but if you don’t take care of the business end, you can’t help patients.  I look back and think what I could have done differently.  I’m not sure if I did anything wrong.  It is part of business that you can check references and still get burnt badly by any employee. So, we move on.  I feel that we are coming out of the woods now.  Most of the dragons have been slayed. One, Group Health Insurance, was one battle we lost . . . but we won the others. So, this week, for the first time in months, I’m relaxing, learning a few new things about headache, rubbing shoulders with several old SPs and friends, spending some time with my new SP (whom I brought to the conference). My wife is with me to relax and soak up some SW sun. So I may be back if there are any new lessons to share.

I always regret posting when I feel emotional. But when things are going well, I don’t get in the mood to write. I just came off my first vacation since starting this clinic. It was to celebrate my mother’s 90th birthday. It was a great trip and I got to spend quality time with all my kids and my siblings. But this morning I returned exhausted. It started yesterday morning with a 275 mile van ride at 3 AM (our time) then a flight from Nashville to Minneapolis, then a flight to Seattle arriving home at 11 PM. During the vacation I had on average five calls per day from the office, asking me to help with problems.

Of course I don’t plan on keeping this blog going forever, but I would like to continue writing until we are stable and on sure footing.  We are poised to make our fifth payroll on Thursday, but there won’t be much left in checking afterwards. So this brings me to my first observation.  If you are a PA or NP and want to start your own practice, and getting rich is one of your motivations . . . then don’t do it.

I’ve lost a lot of sleep over this issue, and this was a very difficult letter to write Dear Jane, I’ve given our situation a lot of thought this afternoon.   I know it sounds that I’m a Dr. Jekyll and Mr. Hyde because just a week ago I was sending out congratulations to you and Brenda. I was really hoping that we were on the right path and I only wanted to sing your praises from that point forward.