I’ve alluded to these stories before but I want to tell one of them again, with an up date.  These are things that you could never foresee when you plan a business.  Everyone who has never done this would argue that somehow they are too smart or talented to allow these things to happen . . . but in reality, there is nothing they can do. We we chose our office space, I picked the newest and prettiest office building on our island. I think it was a smart choice. As part of our SBA loan, we had to sign an agreement that I would not leave this space for six years, the duration of the loan. We we first moved in, and had given out our address to all important entities, we noticed we weren’t getting any mail. Now the Post Office is just up the street and I’m sitting here typing and can see the top of the building easily. But, to my horrors, the Post Office told me that they did not deliver to this building.  I spoke to the Post Master and he said they “never would and never will.”  That was the only reason given.  They had also sent back all of our mail as “no such address.” This caused a huge amount of nightmares including having our malpractice cancelled because we didn’t pay the premiums. It also caused a stir with many of our vendors, such as insurance companies. Finally we had to get a PO Box at the Post Office while we continued our fight.  We had to give a “change of address” to the PO Box. This created a month delay in getting our payments and almost caused us to go bankrupt last summer. I was about to give up the fight in December, when Regence and a couple other insurance companies announced that they would no longer do business with practices who receive their mail via PO Box.  One insurance company had already denied $3,000 in claims because of having a PO Box.  I had to move forward more aggressively. The Post Office finally agreed to deliver mail but only of the mailman didn’t have to get out of his truck.  There was only one spot where a mailbox could go. The landlords denied permission to put it there.  I had to make the empty threat to move out (empty because if we moved out we would violate our contract with SBA and I would be force to pay them $65,000 immediately). So, finally the landlord approved the site. The post master took another month to give his approval. Then we put in our “change of address” to all entities. Oddly, every single insurance company, which refused to do business with us because we used a PO Box, only had PO Boxes. They are bullies and hypocrites! So, while we remain working our asses off, suddenly our income started to dry up again.  Today, we finally had the chance to work on that. It turns out that if you do a “change of address,” in our case from a PO Box to a street address, it is counted as a “move.” So, if a practice moves, then the insurance companies denies payment until they credential you at a new site. This is so frustrating and they don’t care if this makes no sense. Any excuse to delay payments makes them richer. The last one, which had not paid us in a month, was medicare. We called them and said because we moved they would withhold all payments for 4 months. That was the last straw for me so I called my congressman this morning and we are working on fixing this. But who would have guessed that this would create such a nightmare for a small business.  

You know the image, the guy (or gal) keeping 20 or more plates spinning at the same time. That’s what owning a business is like. So Monday started my long-anticipated vacation.  On that day, I spent 6 hours in the office catching up and working on problems. Then Tuesday, I spent 5. Then yesterday I spent 4 hours in the office. Today I will spend 3 (or so I hope). Still, my office voice mail box had 10 at last count. I’m going to ignore them starting tomorrow. I’m leaving for Florida to visit my family. Sure, I will have hell to pay when I get back. But sometimes you have to put up some space for rest. I’ve been working seven days a week for almost a year now. Demi Moore was admitted for exhaustion? It seems like a lot of stars are admitted for exhaustion. Is there such a hospital? If so, what do they do for you there? I had a neurologist very willing to be my alternate supervision physician.  Unfortunately, his malpractice insurer is horrified by the thought. After all, PAs do hurt a lot of patients don’t they?  Hmm, they don’t?  They studies say no?  I’ve seen over 100,000 patients in my career and have never made a major error or mis-diagnoses.  There is a PA-paranoia out there, unfounded by the facts, but creates so much more complicating factors for a PA-owned practice. So, here is a toast to a few days of bliss, where I will try and pretend I don’t own a medical practice.

I is another one of those times that you pause, take a deep breath and think about your course.  I have to admit that my anxiety about going bankrupt drifted into a place of confusion, then (see last post) revelation and now some anger.  But the issue is what do I do with that? I’ve had two months of distress being fueled by one truth . . . I’m broke, very broke and nothing was coming in.  As I shared last time, I  made a huge issue about this from the beginning however my office manager kept assuring me that the billing was going well and my SP kept telling me this was normal for a new upstart practice (and he has been involved in the upstart of several). But I won’t rehash what happened on Thursday. But now I’m standing in the knowledge that part of the reason that we weren’t getting paid were the habitual mistakes our billers were making (I say “billers” because my office manager works with my  main biller). So what could I’ve done?  As I reflect back, I’m not sure I made any mistake in my approach to billing. I knew that it was extremely important from the start.  I looked at several options. First I started with national billing companies with long track records. They probably could have done a better job, however, they were very expensive . . . usually keeping up to 7% of the collections (so abut $21,000 a year).  Also, as I spoke to them, they were all located on the east coast and weren’t familiar with some of our insurance companies. Then I did a long search for a Washington state biller.  It was a long process and I came across several.  I finally settled on one who was highly recommended. But we ran into problems early on.  She was intrusive. She kept calling me (when I was still very busy winding down my old practice) and giving me orders, “I need this, and that and this by tonight.”  That was irritating, like the whole practiced centered on her.  Then she started making demands (remember the soup Nazi on Seinfeld?) such as all payments had to be made out to her company, then she would pass on to us our part.  I didn’t like that at all.  I needed to have more control and ways to check on the flow of money. The last straw was that she called up some of my vendors (without my permission) and gave them hell.  I fired her. Then, my office manager, who is doing a really good job, gave me the name of a my present biller.  A good woman with ten years experience. She was highly recommended and her references checked out. We met several times before I offered her the position. My biller is a hard worker. She is honest. She tries hard, but between her and my office manager, they have made some consistent mistakes.  To make it more complicated, my biller’s father passed away suddenly this week and I have not been able to talk to her. I guess my frustration/anger was magnified yesterday.  I had not checked the mail for two days and I was expecting some juicy checks. I got nothing.  By far most of the time I go to the mail box, there is no money but letters telling me about mistakes being made. This happened again Saturday. I ran my first foot race every Saturday morning and it was a half marathon.  Afterwards I limped up the steps of our post office and checked  my box. I’ve seen about 20 L and I patients so far, and here was a letter telling me that my company is not putting the L and I number on the bills so that they can not get processed. This is billing 101.  There were two other letters telling of mistakes my company was making. That’s why my frustration has gown. So, now what do I do at this juncture in  order to save my company?  There is the knee-jerk reaction of screaming “off with their heads!”  but you have to run a company with knowledge and rationality, not emotion.  Mistakes happen. It is not making mistakes that determines if a company succeeds or not, but what you do with those mistakes. I want to have a company meeting this week to deal with this head on. If my biller and office manager can work smarter (they can’t work harder) then we can stay the course. But I can not live through many more mistakes or this ship is going to sink fast. And an year ago I thought that getting patients was going to be the main challenge.