How to Survive in
Neuropsychological
Private Practice
Ernest J. Bordini, Ph.D.
February 20, 2004
Presented at U.Florida Dept. of
Clinical and Health Psychology
Clinical Psychology Associates of North Central Florida, P.A
Providing Quality Consultation, Assessment and Psychotherapy to the North Florida Community
2121 NW 40th Terrace, Suite B.
Gainesville, FL 32605
CPANCF.COM 352 336-2888
Our Mission Statement
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Clinical Psychology Associates of North Central
Florida, P.A. (CPANCF ) is dedicated to providing
psychological care at a doctoral level by
individuals trained in Clinical Psychology
programs approved by the American
Psychological Association.
Our goals are to maintain:
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Excellence, service, & leadership in our
field.
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Clinically, ethically, & scientifically sound
evaluation & treatment services.
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A cohesive professional & clerical staff
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Professional and office staff are expected to interact
with patients, referral sources, and third-party
payers in an honest and ethical manner.
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Professional and office staff receive and maintain
training to perform their duties with confidence and
expertise, to remain appraised of ethical and legal
demands of their roles, and to respect the diversity
of the clients and referral sources we serve
The Website
CPANCF Professional Staff –
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Ernest J. Bordini, Ph.D. , Lic. Psychologist
Benjamin Phalin, Ph.D., Lic. Psychologist
Angela Allen-Peck, Ph.D. Psychology Resident
Amanda D. Ross, M.A., Psychology Intern
Independent Practices (located at same office)
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Charles Russell Clifton, Ph.D.
Support Staff
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Office Manager
Receptionist
Assessment Services
Intellectual Abilities
Vocational & Career Interests
Psychological &
Neuropsychological
Independent Medical
Examinations
Learning Disabilities
Attention & Memory Personality & Adjustment
Spanish Language Testing
Personal Injury
Evaluations
Worker's Compensation
Evaluations
Post-Traumatic Stress Disorder
Attention Deficit Hyperactivity Disorder
Assessment of
Malingering &
Dissimulation
Fitness for Duty
Disability Evaluations
Neuropsychological
Functioning Child, Adolescent, & Adult
Competency & Sanity Evaluations
Death Penalty Appeal Evaluations
Personality Assessment
Assessment of
Neurodevelopmental
Disorders
Treatment
Services
Adult, Child, Marital, & Family Issues
Attention-Deficit Hyperactivity Disorder
Adjustment to Career, Family or Life Changes
Childhood Behavior Problems
Individual and Group Psychotherapy
Pediatric Psychology
Depression, Anxiety, & Mood Disorders
Medical & Health Psychology
Post Traumatic Stress Disorder
Adjustment to Major Medical Illness
Stress Reactions
Pre & Post Surgical Evaluation &
Intervention
Panic Disorder & Other Anxiety Disorders
Alcohol & Substance Abuse & Dependence
Adjustment to Child & Adult Pain
Disorders
Victims of Crime
Behavioral Headache Management
ADHD SERVICES
We provide quality consultation,
comprehensive, psychodiagnostic
assessment, and psychotheraputic
services for children, adults &
families who may suffer from
(ADD or ADHD) Attention-DeficitHyperactivity Disorder and other
related disorders.
We offer several types of services.
Assessment
Parent Training
Group Therapy
Individual Therapy
Referrals
Associated Disorders
Proper identification and treatment of these
disorders, when present,
often improves the overall prognosis.
ADHD disorder is common yet, it is complex
and often misunderstood. Proper
diagnosis is the foundation on which
effective treatment and management is
based.
Common Symptoms
Disorganized or messy
Trouble paying attention
Easily distracted
Inconsistent performance
Difficulty completing tasks
Impulsiveness
Distractibility
Frequent fidgeting
Children with the disorder may be described as immature, may tend to
always be on the go “as driven by a motor”, may be impulsive, and
frequently act before thinking. They may suffer frequent reprimands
from parents and teachers. Self-esteem is at risk, and they may
become rejected by peers.
Adolescents with the disorder may show less overactivity, but may
have difficulty meeting the increased demands of middle school.
Trouble with organization, planning, and meeting increased
productivity requirements are common.
Adults with the disorder may continue to have difficulty tolerating routine
types of work, may shift jobs more frequently, and may have difficulty
attending to details and organizing. There is increased risk for marital
Our Group / Testing Room
Waiting Room
Are You Ready To Fly?
Don’t be afraid to Dream – or you
will not go far.
Creating your own practice or being
part of a practice you identify
with involves knowing where you
want to go.
To enjoy the ride you need great
spirit and a sense of adventure
You’ve done your pre-flight Check
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Train with the Best
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Know your areas of
expertise
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Fluent in your skills
Are you ready for
Practical applications?
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(Go Gators!)
Know your Risk Tolerance
Solo vs. Group
Limited vs. Comprehensive Services
Where will you be if things go wrong?
Owner, Partner, vs. Employee?
Shared Space - Blended Practices
Single vs. Multi-Specialty
Types of Clients/Practice?
City vs. Town
Competition
Can you survive in a hostile
 Pressure from price
environment?
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competition
State Boards
Critical Colleagues
Increasing Standards
Conflicting and confusing
State and Federal
Regulations
HIPAA
Unhappy or Even
Dangerous Clients
Deadlines
Avoiding Agony
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Reduce and Manage Debt
Identify A Practice Attorney
Have a Comprehensive
Patient Agreement Form
Have Adequate Insurance
Have Formal Contracts
Choose your Associates
Seek the Counsel of Peers
Determine your Short Term
and Long Term Needs
Establish a Business Plan to
Meet Those Needs
Do a realistic Assessment of Your Strengths and Weaknesses
Assessing Your Strengths and Weaknesses
Will you at minimum
Always being able to maintain an acceptable Standard?
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Health
Marriage
Perseverance
Responsibility
Ability to Work Independently
Organization and Efficiency
Ability to Perform consistently Under Stress
Ability to Market
Are you user friendly?
What hours are you willing to work?
Can you work extra hours when you must?
Ability to Initiate, Sustain, Complete?
Can you collect for your services
Generalist vs. Specialist
How do you fit in with the practice you are joining
or the community you are entering?
What unique skills and expertise do you have to
offer?
What interests you?
What motivates you?
What won’t you do?
What can’t you do?
What shouldn’t you do?
Avoiding Horror
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Don’t forget to consider your
personal needs
Consider maximizing Board
Complaint insurance
Keep current on State Statutes
as Well as Rules
Treat other Psychologists as
you would like to be Treated
Practice within your
Competency
Limit the number of high-risk
Cases
Keep records up to date
Psychologist Emptor
Avoid the Quacks
Research the Background and History
of your Potential Associates and
Business Partners
You will be judged by the company you
keep.
The good will your group, referral
sources, and associates generate is a
critical asset – Guard it!
You are liable for who you refer to.
Are your potential associates team
players?
Avoid destructive internal competition
What are the expectations of your group
or referral sources? Do they match
your goals and values?
Use the Right Tools
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HIPAA Forms
AUTHORIZATIONS
RELEASES
APPROPRIATE TESTS
RULE 26 Document
CE Documentation
State and Local License
Progress Notes
Discharge Letters
Practice Policy
Keeping Your Practice Secure – Part I
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Malpractice Insurance
Premise Liability Insurance
Workers Compensation
Auto Insurance
Life Insurance
Disability Insurance
Overhead Insurance
Health Insurance
Your National and State
Psychological Associations may
have good rates
Buy Disability and Life Young!
Keeping Your Practice Safe and Secure - Part II
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Record Security
Computer Security
Telephone Systems
After-Hours Contact / Policies
Passwords and Encryption
Ownership, Transferring and Disposing of Records
E-mail
Referral Sources / Trade Secrets
Keeping Practice Secure Part - III
Staff Safety – Who is on premise, late
appointments, Staff Scheduling.
Building Security – Lighting, Alarms
Training Staff to Deal with Paranoid
and Agitated Patients
Dealing with direct and veiled threats
from patients:
- Board Complaints
-Fitness for Duty and Disability
Evaluations
-Custody Evaluations
-Armed Patients
Patients who Stalk
Part IV?
•"Criminals are afraid of only two things: Big dogs and guns. They stay away
from cops because cops have both." - Mossad Ayoob
•“Grrrrrr….” - Rocky
Participate and Benefit from your State and National
Professional Organization FPA and APA
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Lobbying for fair trade practices and our
livelihood – member participation vs. (who
spends the most money?)
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Defending Psychological and
Neuropsychological Assessment
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CE on State and National Ethics and
Regulations
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Business oriented training
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Establishing and Maintaining Networks
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Marketing Opportunities
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Support
Bill for your time: It is your product
and most precious commodity.
Look out OVERHEAD!!!
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Overhead costs can range from 35-50%
Office Space
Furnishings
Office Help
Utilities
Computer and Communications Equipment
Test Equipment and Supplies
Office Equipment and Supplies
Advertising
Postage
Insurance
Attorneys
Professional Dues
Subscriptions
Education and Training
Cleaning and Repair
Security
Billing Software
Answering Service
Financing your Practice… Do as I say, not as I do.
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Pay off high interest unsecured loans first
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Banks are not really interested in your future unless you have some
collateral
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Commercial Property usually requires at least a 20% down payment
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Utilize leases to avoid excess unsecured debt
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Take advantage of no interest 6 month financing for furniture and office
equipment if you can pay it off
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Consider SBA financing if you have some collateral and a good business
plan
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Keep Personal and Business finances separate
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Consider tax and interest rate implications
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Set up retirement plans early and contribute to them even if it means living
modestly
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Things can change rapidly, aim to have three months of operating expenses
in cash reserves
Billing and Collections – I
Medicare fees and allowable hours
 BCBS fees and allowable hours’
 Managed Care
 Worker’s Compensation
 Auto Insurance
 Indemnity
 Private Pay
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Billing and Collections - II
Billing Programs and Equipment
 Paper vs. Electronic Claims
 In House vs. Outsourcing Claims
 HIPAA Considerations
 Billing and Collections Staff
 Credit Bureau
 Attorney Based Collections
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Collection Agencies
If you are not afraid to Crash and Burn…
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Most people who succeed
in business have had
failures
4 out 5 small businesses
fail
Most within the first 2
years
Usually due to limited
capital and difficulties
with cash flow.
Have the Proper Attitude
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As psychologists people look to us as leaders in how to
handle tough situations.
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We need to demonstrate good leadership attitudes with
our staff, patients and in our community.
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People also look to us to be idealistic caring and
empathic individuals. Volunteering time to our
community and organizations vs. the Me Generation.
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We need to have the attitude of a winner…..
So, quit complaining about your job
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Always Strive To Excel
Take the Moral High Ground
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“We are accountable to a higher power.”
Alan Gessner, referring to APA Ethical
Standards.
And don’t get too grandiose….
Keep your bearings and awareness of your
surroundings……………. Check your perceptions.
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Business Plan
Personal Plan
Does it fit your
Environment?
Periodic Assessment
Corrections
Reassessment
Exit Plans
Avoid Burnout – Stop and Smell the Roses
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Commit to scheduling time and
budgeting for recreation, exercise,
family.
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Schedule time for attending
conferences and seminars
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Make this a habit ASAP
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You must not only cover your
expenses …. You have to earn a
salary, care for yourself, pay your
school debts, practice debts, and
provide for you security as well as
respite.
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Go back and review the slide about
billing for your time and study it
carefully. Figure how much you
have to charge to make it all
happen.
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You have to live.
I hope you will find smooth sailing and
fulfillment in your practice ventures