Disclosure: I am a practice consultant and, after 31 years in the industry, I have been on both sides of the fence. I see and speak to many new consultants in the industry and some are excellent, yet I see many leading doctors down a “slippery slope.” Beyond the emotional choice, too many doctors do not have enough tools to make an informed choice. This document is dedicated to giving doctors additional tools to guide and protect themselves.
:dropcap_open:I:dropcap_close: am trusting, eager, believe in my “gut,” and hungry to take my practice to the next level. Therefore, I will seek counsel from many who are smarter than I and I am willing to pay for their knowledge. That was my mantra for many years and I paid handsomely for answers from consultants whom I trusted to bring me to the “promised land” of practice. At one point, I paid 7 years in a row and many, many $1000s to be guided.
My disillusionment and subsequent enlightenment came when I was assigned a consultant who constantly called me for advice on issues he had difficulties with. It was at that time I realized it was time to find a formula to make better decisions. This was a learning experience that I ignored 10 years later and, again, I spent countless $1000s based upon blind faith that brought me close to total financial ruin because the scheme created did not stand the test of time and I willingly became their guinea pig. They made money and I ended up writing checks to lawyers and carriers.Most consultants in our profession have either stumbled upon or developed formulas in their private practices and feel they can profit from the profession by putting together a similar program in a “canned” package where the message remains constant. That in itself is not a bad thing…for today. The one constant is that everything changes, and, in today’s healthcare marketplace, those changes are occurring more rapidly than ever. Therefore, consultants need to be able to change and alter their messages to keep up with those changes. In cash practices, states are passing legislation and updating regulations on how you can bill.
Workers’ compensation practices face even bigger challenges as the rules are changing so rapidly that even the carriers can’t keep up with the changes. Many states have adopted evidenced-based outcomes as criteria for care. Others are strictly using ICD as criteria and yet others have a formula that is completely arbitrary. Then there are court rulings regarding labor issues that also have to be dealt with.
Personal injury is even more intricate. Doctors have to deal with internal insurance company rules, which are arbitrary, but have to be dealt with nonetheless. There are the state regulations and laws which do not change rapidly (except in Florida) and then there are court rulings which literally change on a daily basis, redefining how we need to conduct ourselves in our triage and paperwork. After all of those issues, lawyers representing the patients have issues that must be dealt with on a constant basis.
Managed care is usually more straightforward, yet highly secretive at the same time. The rules are clearly laid out, but they hide their fee structure formula behind a metric based upon their actuarial tables and will not divulge them. It usually requires a court order or subpoena to obtain them. On top of that, they have so many ways not to pay you, a fact you often only discover following the completion of a voluminous amount of paperwork. If you are lucky enough to get paid, you get a fee so low that if every patient was a managed care patient you’d close your doors in financial ruin.
If you have a consultant for any of the above financial classes, how well versed are they in the process they are consulting you for? I didn’t ask if they are good at getting you business because it is relatively EASY to get business and make money. The real issue is: Do you get to keep the money that you make?
A few years ago, one consultant created a scheme for cash practices and then exposed all of his clients to lawsuits for acting as insurance companies without the proper licenses.
Another consultant’s advice resulted in almost every client being sued by the carriers for improper corporate structures, costing some doctors millions in legal defense, and in the end many lost their practices. Another consultant strongly recommended the use of certain documentation to overcome the carriers’ objections in payment. One doctor he consulted with did get paid, but 5 years later the doctor was sued by the carriers, retrospectively costing the doctor close to a million dollars. He lost his practice. The consultant, who was not a doctor, walked away to spend the doctor’s hard earned money, never to be heard from during the lawsuit or any time thereafter.
How do you choose the best consultant for your practice?
Here are strong suggestions:
1. What are the qualifications of the consultant?
This is the most important issue; more so than the subject matter of the consulting program. Your consultant will eventually drive your practice. The only verifiable, valid vetting process is through the consultant’s curriculum vitae if he/she is a professional or a résumé for a non-professional. A professional CV is preferable for 2 reasons. First, you want someone who has been where you are and understands the issues from the inside out vs. a spectator who is commenting on a game he/she has no “skin” in. Second, a professional CV is a legal document that cannot be falsified, as that is a felony in most states and can be the cause for loss of license.
2. What is the experience of the consultant?
:dropcap_open:One doctor he consulted with did get paid, but 5 years later the doctor was sued by the carriers, retrospectively costing the doctor close to a million dollars.:quoteleft_close:
Is your potential consultant experienced in the specific field he/she is consulting for and for how long has he/she been one? Too many consultants are only experienced in their personal offices or ancillary fields and that is problematic. Many consultants have figured out a “scheme” to get more patients or extract money from carriers and/or patients without knowing whether or not 5 to 10 years downstream that scheme will stand the test of time and not trigger a lawsuit later in practice or retrospective audits as many schemes do. Remember, your consultant is not responsible for your actions. You have the sole responsibility and, in the end, you alone will be writing that big check for a lawyer to defend you or a refund to the carriers if the consultant is wrong.
3. Is the subject matter being taught in line with your practice goals?
Simply put, are the teaching materials offered sufficient for you to make the changes you need to positively affect your practice?
4. Has the method stood the test of time and done so in your state?
How long has this method been employed and by how many? Is it important that the consulting method be deemed successful in my state? Some programs are universal and not state-specific while others have been altered state-by-state. Time is critical to determine the success of a program, and although some “start-ups” will thrive over time, do you want to be the “guinea pig?” In some cases, the answer is yes, but be very discerning. Remember the adage of “a fool and his money..”
5. Scour the credentials of the consultants and all that work for them.
It always goes back to credentials and not just those of the primary consultant, but everyone in a consulting capacity within their organization. Be alert for telltale signs, such as improper grammar in a signature line. Does he/she sign his/her name Dr. Joe Smith DC? You can’t have a “Dr.” in front and a “DC” at the end. Does he/she consult on workers’ compensation despite having run a cash practice for an entire career? Does he/she consult on personal injury with vast experience in “on the job injuries?” Credentials do not lie. You also might end up with an employee of the main consultant working with you. What are his/her credentials?
6. Schemes
Does the consultant build an entire program around a scheme designed to confuse the carriers or alter usual and customary practice standards for you to make money? Unless the program is based upon accepted clinical and practice standards, which include documentation standards, you leave yourself exposed to huge issues downstream. Creating a scheme of “smoke and mirrors” is big in the “get rich quick” programs, and in the end they rarely stand the test of time, instead resulting in a necessity for lawyers to defend you.
If a program is centered around “busting” something vs. learning how to succeed at a higher level of clinical and business excellence, look at other professions and realize they do not have any of these programs, confirming this is just another “get rich quick scheme.”
7. Testimonials
Testimonials drive business. However, be careful as any business owner can get his/her friends to write testimonials. The key is how many testimonials are offered and is there diversity in the messages? Getting an individual referral to talk to is important, but, again, you will be handed the “cream of the crop” for that person’s business. Certifying success in this instance is more a function of sheer volume from a diverse geographical location.