Meet our Front Office Coordinator

Littleton Foot and Ankle Clinic would like to introduce our Front Office Coordinator, Christy Holt.

Christy joined our team after relocating from her home state of Georgia where she worked as the front desk coordinator and corporate trainer at a podiatry clinic for 13 years.

Christy enjoys working with the Littleton community and takes great joy in forming relationships with our patients. When she is away from work, she enjoys camping, hiking, walking, and biking in the beautiful Colorado mountains.

She is just as commited to providing our patients the best care possible as Dr. Garvin and will always go the extra mile to make sure your experience is as pleasant and easy as possible.

Find more information about our staff at http://www.littletonfootandankleclinic.com/meet-the-doctor.html

High Heeled Winter Boots are Dangerous on the Ice and Snow

High heeled winter boots dangerous on ice and snow
This winter’s fashionable high-heeled boots put women at risk for slips, falls, and injuries on ice and snow.

These popular boots typically feature tall, spiked heels and narrow, pointed toes.

Wearing high-heels makes you more unstable when walking or standing on dry surfaces, let alone slippery ones like ice or snow.A stylish low-heeled winter boot is a lot more fashionable than a cast and crutches. It's also a good idea to scuff-up the soles of new boots, or purchase adhesive rubber soles, to provide greater traction.

Falls from high-heeled winter boots can lead to a number of injuries, depending on how the woman loses her balance. If her ankles roll inward or outward, she can break her ankles. If her ankle twists, ligaments can be stretched or torn, causing an ankle sprain. According to the American College of Foot and Ankle Surgeons consumer Web site, FootHealthFacts.org, broken and sprained ankles can be present at the same time.
This time of year I see a variety of broken bones occurring in patients who have slipped on the ice. These include broken toes, metatarsals, heels and ankles.

Dr. Garvin urges women hurt from slips and falls in high-heeled winter boots to contact her office at 303.933.5048 for prompt evaluation and treatment. In the meantime, immediately use the “R.I.C.E.” method – rest, ice, compression and elevation – to help reduce swelling, pain and further injury.

Delaying treatment can result in long-term complications such as chronic ankle instability and pain, arthritis, or deformity. Even if you’re able to walk on the injured foot, pain, swelling, or bruising indicates a serious injury.

To contact Dr. Garvin, call 303.933.5048 or visit http://www.littletonfootandankleclinic.com

Little Things Make a Huge Impact on Your Business

What Little Things?

When I started my own business, I thought I had a good grasp of what I needed to do to run the business.  I still think I started with a good foundation.  Sure, I learned some things along the way, but for the most part, I knew what I needed to do to run my business well; except for the little things I missed.  You never realize what little things you need, until you run up against them.  I know it sounds trite and self evident, but it's the little things that hurt the experience for the customer (or my case patient).  

I missed some little things to make my patients more comfortable and at ease.  The first thing I missed was music.  I needed something in the waiting room and something on the way to the exam rooms to help the patients relax a little and feel a little more at home.  The second thing I missed was smell.  The waiting room needed to have some other scent than the typical sterile smell you normally smell in hospitals and clinics.  To the last little thing that I needed; it was something for me.  I needed a way to easily do my accounting and file my taxes, without having to have calendar reminders everywhere.  

Little Thing: Music

One of the things that every clinic needs is music.  I find that it calms the patients and it puts people at ease.  It makes them feel like they are more at the mall or shopping somewhere than at the doctors office.  I, luckily, had four speakers already installed into my drop ceiling, I just needed to wire it up.  

That's far more difficult than it sounds.  It turns out that I didn't have the budget to spend a lot of money on this project.  So, we purchased a second hand amplifier and hooked the speakers into that.  The next problem was where were we going to get music?  Our IT guy had a brilliant idea.  He had a Rasberry Pi that would be perfect for this.  There is something called Pi Musicbox and it solved our problems.  We had a number of choices for services and stations and it made an immediate impact.

Our patient population noticed.  We got positive feedback and the best part is that it really did make a difference with our patients feeling more relaxed and at home. 

Little Thing: Smell

A major gripe that we would hear is that clinics, including ours, smelled too sterile.  That is it smelled like a hospital.  Nobody feels comfortable in a clinic to begin with, and making them smell that bland hospital smell just adds stress to the patient.  

We found that oil based plugins provided a nice pleasant scent and removed the clinical smell.  We also purchased expensive air fresheners for the bathroom and waiting room.  We would spray it twice a day.  Once in the morning and once upon closing.

A major fear was that patients wouldn't appreciate the smells or would feel like it was just covering up the clinical smells.  To our surprise, most people really liked the smells and were far more comfortable in our waiting room.

Little Thing: Accounting

Everything we've done up to this point was more for the patients, than for the doctor or staff.  A little thing that could have turned into a big thing was a gap in the way we dealt with finances and accounting.  Sure, our accountant would call us up before the end of the quarter, but it was always a scramble.  Nobody thinks about money, when you have patients coming through your door, insurance issues to deal with, inventory problems, and so on.  

Using Quickbooks solved some of the issues, but we needed a solution where we would be more proactive in our accounting and more automated.  It turns our the EMR we use actually plugs into Quickbooks, but we weren't aware of that.  Once we pluged the EMR into Quickbooks, a large portion of the little thing was solved. 

However, we still had one outstanding issue, how do we know when to end the quarter?  Did the quarter start in August or was it September?  We needed to streamline what happens at the end of the quarter.  Again, the EMR to the rescue!  It turns out you can also set the fiscal year and near the end of the quarter, run the quarterly reports.  It would even give the user a heads up the quarter was ending.

What's the Point of Solving the Little Things?

First of all, patient comfort.  That was key. If a patient is comfortable, they are more likely to return for their follow up appointments and also more likely to recommend your clinic to their friends.  It also stops what could be big things in their tracks.  By being proactive and solving the little things, not only do you save time, but you also save money.  

Did we change the world?  Not at all, but we did manage to streamline the business and make our patients feel less like they were there for a scary medical procedure and more like they were just out at another shop.  

Starting Your Own Medical Practice is Tougher Than You Think

Starting Your Practice

To even think about starting your practice, you need to do TONS of paperwork first. You need your NPI number, your Tax ID number, your Articles of Organization, Insurances (good luck!), hospital privileges, a website, and IT guy, and a place to buy all your stuff.

That isn't including having to figure out the budget for the next 6 months to a year, along with trying to get small business loans, and finding out how much medical equipment really costs. You need all of this for your business plan, which has to be dead on. Back in the day, banks handed out money like candy, now you actually have to prove you aren't going to run your business into the ground.

So what did I learn?

1. Keep a spreadsheet for finances
2. Have a super strong business plan.
3. Defer your student loans for at least 6 months
4. Have plenty of capital. You'll need around 3-4 months of liquid capital to pay the bills.
5. Have an IT guy from the word go.
6. Build your infrastructure for the future, not for now.
7. Buy used for some things, like autoclaves, but buy new for treatment tables and other high dollar equipment. You get tax breaks.
8. Try to find a move in ready space. Building out an office space takes a TON of time, that you don't have.
9. BUDGET EVERYTHING AND STICK TO IT.
10. Have an amazing website.

Getting the practice running

Once you have gotten all the paperwork done, it's time to move in and get things going. You are going to have a break down of three things.

• Medical Equipment Setup and Treatment Rooms

You really need to think this out. Make sure you have everything you need. Also, if you can't afford to setup all your treatment rooms right this second, it's ok. Setup the ones you can and then buy the other equipment as time goes on. Each treatment room is going to need an exam table, a stool, a mayo stand, sundry jars, hand sanitizer, posters, and a place to put your tablet/laptop. Also make sure you have all the consumables for at least the first 2 months. I know that sounds crazy, but you are going to go through them like crazy.

Do not skimp on this. It is critical that you are ready to rock and roll the second the doors open.

• IT

Hire a good IT guy or make friends with one you can pay in beer. You are going to need it. You need to get hooked up to your EMR, have streaming music, have computers installed, have your tablets/laptops setup and maintained, your phone system configured, and the software you need installed and configured. It's far more effort than you would imagine.

You think, oh I installed Office at home, I can do it at work. You are so very wrong. It takes a lot of time and it is time you don't have.

Plus the website, oh god the website. I mean our guy did a pretty bang up job on our http://www.littletonfootandankleclinic.com and that is not something we could have possibly done. Looking back, we probably would have done things a little differently, but all in all it worked out well.

• Hiring Staff

You are going to need an accountant, which I outsourced, a front office person, and at least one med tech. You can do more, but many times, you won't have the budget until your insurances actually start paying you. So hang tight. With that being said, be careful with how you hire. It is easy to get bogged down in everything else and not pay as much attention here. If you don't pick the right staff from day one, you are going to have to fire and hire; which is terrible. Doing background checks, reference checks, and basically getting to know the person really does help.

Also make sure you outsource what makes sense. In our case, we outsourced coding and billing because that gave us a break on the cost of the EMR, our accountant, and IT. We couldn't really afford to have in house personnel for either of those and it didn't really make sense as it was generally a few hours a quarter for IT and accounting. For the coding and billing, it would have been fairly expensive to hire a full time head count or possibly even two, when we could give up a very small percentage of our accounts receivable and have it all done for us. Plus, the bonus is that we have legal protection there as well. If anything goes wrong, we shouldn't need to hire a lawyer and it should be less effort on our part.

Make sure your staff is the right fit for you. We are a little more laid back, we play practical jokes, and have fun in the office, but when it comes to crunch time, it is no time to sit around and it's all hands on deck.

• Plan for the Future

By 2020, all medical records need to be available to patients via a portal and paper records are gone, they all have to be digital. So, plan ahead. You also need to know what is happening over the next decade or so. Make sure that you pay attention to what the EMR sales people are saying. Sure, most of it is hot air, but if you hear the same phrases over and over, pay attention.

Also, pick the right EMR for you. Don't just pick the EMR that the clinic down the street uses or the EMR the Urgent Care around the corner picked. Find the right fit and find something that will grow with your practice. Remember, your patients don't care what you use, by you have to live with it every day for the next...well...forever. It is super hard to leave an EMR once you have started with one.

Also make sure you buy equipment that will last the test of time. Sure the blood pressure cuff was cheap today, but if you have to replace it in 6 months, it's not such a good deal is it?

Profit and Loss for Year 1

Where we failed

We failed on a couple of counts. We didn't quite understand how much SEO would cost, consumables were extremely expensive and used at a far greater rate than anticipated, and the the fact we didn't factor in how long it would take insurances to actually pony up meant we under budgeted and were in trouble at the end of month two.

As you can see from the chart above, we were bleeding money. We had a fair amount in the bank, but it was getting pretty unpleasant around month 3. Liquid capital is far more important than you think. and what you are lead to believe.

Keep in mind, even if you are established with insurances, your new clinic is not. This can be a huge drag on actually being able to charge. You'll find that it can take anywhere from a few weeks to a few months for insurances to move things forward. Of course, as you know, claims can take some serious time as well.

Had we known these things, we probably could have been a little smarted out of the gate. We didn't do our homework and we got burned. Sure, that's our fault, but don't fall into our trap. Make sure you know that things are expensive and you are going to be bleeding money for at least the first month, if not the first two or three months.

Finally, do not get suckered into a huge contract with anybody. It doesn't matter what they are selling. We made a mistake out of the gate with our original medical provider. They talked the talk, but couldn't walk the walk. Make very sure you know everything about who you are dealing with.

Budget Breakdown

Item	Estimated	Actual	Delta
Exam Tables	$5000	$5000	0
Waiting Room Furniture	$500	$650	$150
Consumables	$1500	$2500	$1000
IT Equipment with Installation	$4000	$2500	-$1500

Why start you own practice?

It boils down to one simple concept; you are your own boss. It is rewarding, challenging, heart breaking, stressful, and fun. Sure there are days that you wish you were still under the nice safe net of a hospital or that you were just a worker bee at a practice somewhere, but the reality is there is nothing like saying "this is mine."

Your ownership of your practice means you can treat your patients how you have always wanted to. You can work your butt off or take a month off, it's up to you. The day to day challenges can be amazingly frustrating, but they are yours. You get to decide and you get to drive how things will work.

It also comes down to patient care. Treating patients like people and treating them like you would treat your family is great. No longer are the patients just a number in the system, they are somebody with a name and you are much closer to them.

Would I go back to anything else? I don't see it happening any time soon.