It may be a little corny, if not melodramatic, to be talking about giving thanks at Thanksgiving.  But there is a point to all of this. You know the saying that you don’t know what you had until it is gone.  Well, it works both ways. You don’t know how bad things were . . . until they are better. I’ve shared openly about the uphill battle to get this ship upright and at sea. I can say, now six months later, that it is full steam ahead. I had lived through about 8 months of extreme stress.  I got to a point where I literally felt sweaty palms each time I opened an e-mail or a real letter. Over and over it was bad news.

Today we closed the books on our ninth payroll with no help from the bank. This time our margin was about $5,000 in the black.  That is much better than the $35. just a month or so ago.  We are not out of the woods but my bills are paid and the schedule remains mostly full. My sleep tonight should be sweet.

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.

As a PA you know what it is like to be gone for a week. Then you come back and you have hell to pay for your absence. It is worse when you have no real backup. But this week is coming to a close and things should be better next. On the money front, I feel more encouraged since I posted last.  I had $4,000 come in on one day.  This will allow me to cover rent, payroll and taxes at the end of next week.  I’m still looking forward until the day that don’t have to hold my breath before each pay day. We are unraveling more and more problems with my old biller.  I ask myself often how I could have done better.  I took hiring a biller, very, very seriously. I tried hard to find the right one.  There were no warnings.  She was highly recommended by my office manger and others. But you can do a lot of damage as a biller if you don’t know what you are doing.  You can do far more if you cover your mistakes with layers and layers of deception. My SP today told me a story when the main hospital in town hired a head biller. They recruited very seriously and checked credentials.  She too was a fraud. She did not have the degrees that she professed. It took the hospital a year to discover that she didn’t know the first thing about billing because she covered her tracks so well.  So, she felt like it was worth her keeping her job for a year and earning 40K while she cost the hospital (her employer) millions in lost revenue.  How do people live with themselves? But, you have to pick yourself up, dust yourself off, learn some lessons and move on.  At least I know that our billing department is in very good hands now.

I had a long post I was working on but honestly, I feel exhausted. I will simply post that tomorrow at 1 PM I meet with Group Health Cooperative, the major insurer in our region, who has decided to boycott our clinic apparently because it is PA-owned.  I walk in to meet the VP as a David against Goliath. I will keep you posted.  I’m nervous a bit.   I am disappointed that neither the AAPA, the previous state PA chapter president (who was on the board with Group Health) nor my own attorney has shown any interest in this case. So, I’m on my own.  On days like this, I wish I were an NP where I would have a crowd of supporters at my back.