Sept. 4, 2025

The Complete Turnaround Strategies for a Private Practice in Crisis

The Complete Turnaround Strategies for a Private Practice in Crisis

Send us a text Are you a private practice physician feeling crushed by high overhead and low revenue? You’re not alone—and you don’t have to stay stuck. In this episode of the EntreMD Podcast, I’ll show you the proven steps to rescue your practice, lower costs, boost revenue, and finally build the thriving business you envisioned when you started. You’ll discover the mindset shifts, practical strategies, and systems that will help you go from survival mode to profitability and peace. Whether ...

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Send us a text

Are you a private practice physician feeling crushed by high overhead and low revenue? You’re not alone—and you don’t have to stay stuck. In this episode of the EntreMD Podcast, I’ll show you the proven steps to rescue your practice, lower costs, boost revenue, and finally build the thriving business you envisioned when you started.

You’ll discover the mindset shifts, practical strategies, and systems that will help you go from survival mode to profitability and peace. Whether you’re just starting out or you’ve been in practice for years, these principles will help you turn things around—fast.

Additional Resources:


When you are ready to work with us, here are three ways:

  • EntreMD Business School Accelerator - If you are looking to make a 180 turnaround in your business in 90 days, this is the program for you.
  • EntreMD Business School Grow - This is our year-long program with a track record of producing physician entrepreneurs who are building 6, 7 and 7+ figure businesses. They do this while building their dream lives!
  • EntreMD Business School Scale - This is our high-level mastermind for physicians who have crossed the seven figure milestone and want to build their businesses to be well oiled machines that can run without them.

To get on a call with my team to determine your next best step, go here ...

00:00 - Introduction to the Practice Crisis

04:15 - Low Reimbursement Challenges and Solutions

18:35 - Tackling Out-of-Control Accounts Receivable

25:26 - Addressing High Overhead Issues

32:38 - Team Issues and Leadership Solutions

40:18 - Personal Finance Pressures and Mental Health

45:35 - Building Support Systems and Final Encouragement

WEBVTT

00:00:01.564 --> 00:00:14.066
Hi docs, Welcome to the EntreMD podcast, where it's all about helping amazing physicians just like you embrace entrepreneurship so you can have the freedom to live life and practice medicine on your terms.

00:00:14.066 --> 00:00:15.891
I'm your host, Dr Imna.

00:00:15.891 --> 00:00:30.692
We have a doctor in private practice who has a practice where her overhead is so high, her revenue is a lot less and she thinks that her private practice is at risk of failing.

00:00:31.120 --> 00:00:47.866
And so today, what we're going to do is take a look at this practice, come up with a diagnosis, fix the practice and give this doctor a strategy she can start working with and, right away, start seeing wins in her practice and, over time, bring it from a place where it goes from almost failing to completely thriving.

00:00:47.866 --> 00:00:50.642
Okay, so we're going to look at this private practice.

00:00:50.642 --> 00:00:53.348
This is going to be a lot of fun If we haven't met before.

00:00:53.348 --> 00:00:54.351
My name is Dr Una.

00:00:54.351 --> 00:00:55.884
I'm a pediatrician by training.

00:00:55.884 --> 00:01:02.987
I have been in private practice for the last 15 years and at this point I've technically exited my practice, if you will.

00:01:02.987 --> 00:01:06.293
My practice is team-led and it's been that way for the last five years.

00:01:06.293 --> 00:01:08.647
And then I'm the founder of EntreeMD.

00:01:08.647 --> 00:01:14.188
I help doctors build profitable businesses so they have the freedom to live life and practice medicine on their terms.

00:01:14.188 --> 00:01:17.308
I am a huge advocate for private practice.

00:01:17.308 --> 00:01:18.906
Private practice is not dead.

00:01:18.906 --> 00:01:23.725
The old playbooks are and, yes, we have a lot of systemic problems in the healthcare space.

00:01:23.725 --> 00:01:29.197
But until we have enough empowered physicians who can then stand up to the system, we are going nowhere.

00:01:29.197 --> 00:01:37.474
Okay, so I fully understand there's a lot of things to fix, but you know, when you get on a plane, they tell you, if the pressure goes low, oxygen masks are going to come down.

00:01:37.474 --> 00:01:45.572
You're going to put it on yourself first and then you're going to put it on others, okay, so this is us putting the oxygen mask on ourselves, okay, all right.

00:01:51.120 --> 00:01:56.953
So when this doctor told me this, I said okay, I want you to think about the top five things that are creating this financial pressure and financial challenge you have in your private practice.

00:01:56.953 --> 00:02:01.108
And she sent me these five things, so we're going to troubleshoot these five things, okay.

00:02:01.108 --> 00:02:08.066
So the first thing was you know my reimbursement right from the insurance company.

00:02:08.066 --> 00:02:08.627
So this is insurance-based.

00:02:08.627 --> 00:02:11.116
Private practice is low and slow.

00:02:11.116 --> 00:02:12.561
Okay, so it's low and slow.

00:02:12.561 --> 00:02:14.926
Money coming in, and we know money coming in.

00:02:14.926 --> 00:02:18.844
That's like the blood, if you will, of the private practice and all of those things.

00:02:18.844 --> 00:02:22.161
So this is something that we absolutely need to fix, okay.

00:02:22.161 --> 00:02:23.903
So she gave me some context.

00:02:23.903 --> 00:02:29.111
She said there's a large discrepancy between insurance carriers, and so you know.

00:02:29.111 --> 00:02:32.263
So some pay you know well and some pay very poorly.

00:02:32.263 --> 00:02:34.570
She said I've already stopped taking Medicaid.

00:02:34.570 --> 00:02:42.551
There are thousands of outstanding dollars after the first year with Medicaid, and then it's considered letting go of TRICARE.

00:02:42.551 --> 00:02:50.360
Okay, and again, because of low reimbursements and all of those things, and so this is something that absolutely needs to be fixed.

00:02:50.360 --> 00:03:01.692
When you think about the practice revenue, anything touching it is like something touching your aorta, like once you bleed from there you're bleeding out, right.

00:03:01.692 --> 00:03:03.126
So this is something very serious.

00:03:03.126 --> 00:03:05.508
We want to look into it and we want to fix it.

00:03:06.599 --> 00:03:08.407
So I came up with some recommendations for her.

00:03:08.407 --> 00:03:10.546
Okay, these are things that she can consider.

00:03:10.546 --> 00:03:11.846
These are things that she can do.

00:03:11.846 --> 00:03:13.766
Some of them will work fairly quickly.

00:03:13.766 --> 00:03:15.225
Some of them will work over time.

00:03:15.225 --> 00:03:18.368
I don't think that any of these strategies really that she shouldn't employ.

00:03:19.781 --> 00:03:25.938
Okay, so the first one I said is looking into joining a network that manages contracting.

00:03:25.938 --> 00:03:37.169
Okay, so, like an IPA, an independent physician association, or PHO, a physician hospital organization, you know, like one of these, and this is if she's not already a part of it.

00:03:37.169 --> 00:03:38.092
And why is that?

00:03:38.092 --> 00:03:42.675
Well, because these organizations have a pool of physicians within them.

00:03:42.675 --> 00:03:45.968
They're usually able to negotiate for better rates.

00:03:45.968 --> 00:03:56.491
Okay, so there's so many people who have had significant bumps in their revenue just because they went from contracting directly to contracting with an IPA right Now.

00:03:56.491 --> 00:03:59.885
So if she hasn't done this, this will be a really great thing to consider.

00:03:59.885 --> 00:04:11.105
Chances are that it's not going to bring an immediate turnaround, because it's going to be a process to go through them and all of those kinds of things, but it's something that, yes, it will bring a lot of transformation.

00:04:11.606 --> 00:04:21.545
Now I will say with this, because it has to do with your money and the entire revenue of your practice, you do want to choose carefully, right, everybody's going to sell you a good game.

00:04:21.545 --> 00:04:24.069
They're going to say, when you come on, we'll do this, we'll do that, blah, blah, blah.

00:04:24.069 --> 00:04:35.178
They'll make all the promises in the world and I'm going to challenge you to find three to five people who are using that IP or using that PHO and go find out from them what the real deal is.

00:04:35.178 --> 00:04:36.505
Right, so you want to get references.

00:04:36.505 --> 00:04:38.786
It doesn't have to be from the company.

00:04:38.786 --> 00:04:44.870
It can be from the company or the organization, or you can get them directly like who's part of this network, who's part of this network?

00:04:44.870 --> 00:04:47.473
And you go interview and have real conversations.

00:04:47.552 --> 00:04:50.355
Okay, do not take anything at face value.

00:04:50.355 --> 00:04:54.858
This is something that we do as physicians and something we want to walk away from doing.

00:04:54.858 --> 00:04:59.980
Okay, something we want to walk away from doing, which is, whatever they said, we just believe them, don't.

00:04:59.980 --> 00:05:00.982
You're an entrepreneur now.

00:05:00.982 --> 00:05:01.843
That's not what we do.

00:05:01.843 --> 00:05:03.404
Trust, but verify, right.

00:05:03.404 --> 00:05:03.745
Okay.

00:05:04.166 --> 00:05:08.052
So that's the first recommendation for reimbursement being low and slow.

00:05:08.052 --> 00:05:14.230
The second one is to audit the distribution of patients and insurance in the practice.

00:05:14.230 --> 00:05:20.706
Data is a very beautiful thing because data will show you like data preaches to you.

00:05:20.706 --> 00:05:25.555
You see, the data automatically becomes obvious what needs to happen, right.

00:05:25.555 --> 00:05:33.213
And so you want to think like what are the top three insurances my patients use?

00:05:33.213 --> 00:05:35.264
You want to know what that number is.

00:05:35.264 --> 00:05:37.831
You want to know what those insurance companies are.

00:05:37.831 --> 00:05:39.302
You want to have a feel for it.

00:05:39.302 --> 00:05:46.701
But, more importantly, you want to know, like, based on the fee scale, you want to organize them from best paying to lowest paying, right.

00:05:47.081 --> 00:05:52.507
And then you ask yourself a question for the lowest paying ones Am I even making money on them, or is every?

00:05:52.507 --> 00:05:58.947
Do I lose money with every visit Because we've had to drop some insurances because they would pay us lower?

00:05:58.947 --> 00:06:02.173
Or the exact amounts that the vaccines cost?

00:06:02.173 --> 00:06:19.629
And I'm like, if you pay me the exact amount that the vaccines cost, I am losing money with each vaccine I give because I have to buy the vaccine, I have to store the vaccine, I have to pay staff to process the vaccine, I have to do all of these things and so, yeah, and we have vaccine wastage.

00:06:19.629 --> 00:06:21.494
I'm losing money on that.

00:06:21.494 --> 00:06:29.410
And so you are an insurance company that is too expensive for me to be in network with, like you're too expensive because you cost me money, right.

00:06:29.410 --> 00:06:31.624
And so you have to look like, am I losing money?

00:06:31.624 --> 00:06:33.108
Or I'm just not getting as much?

00:06:33.108 --> 00:06:34.732
Like, what is it right?

00:06:34.732 --> 00:06:38.927
If you know like, and then you want to consider dropping some.

00:06:38.927 --> 00:06:45.370
If you need to drop them, right, if you need to drop them because it's a business decision.

00:06:45.370 --> 00:06:58.281
But you want to look and then you find out that most of your patients are with a very poor paying insurance company, then the question then becomes do I close the panel and market really hard and change the distribution?

00:06:58.802 --> 00:07:01.771
Now, this doesn't mean change the philosophy of your practice.

00:07:01.771 --> 00:07:07.889
For instance, my private practice is 60%, is about 60% Medicaid, and at a point it was even higher.

00:07:07.889 --> 00:07:10.201
And I'm okay with it because that's what I wanted.

00:07:10.201 --> 00:07:19.641
I, you know, I wanted a practice where I could people who had really good insurance and people who had Medicaid they, you know, they could come, they get treated really well, they have a great experience.

00:07:19.641 --> 00:07:20.742
They have access to a doctor.

00:07:20.742 --> 00:07:23.887
We had same day appointments, we had like all kinds of fun stuff.

00:07:23.887 --> 00:07:25.208
I wanted them to have that.

00:07:25.548 --> 00:07:29.975
Now, what it means is I was also aware that I was playing a volume game.

00:07:29.975 --> 00:07:32.062
I, you know, like I didn't lie to myself.

00:07:32.062 --> 00:07:35.761
You can't say I want to take Medicaid and I want to see one patient an hour.

00:07:35.761 --> 00:07:37.624
Those two things cannot coexist.

00:07:37.624 --> 00:07:39.346
The business will die.

00:07:39.346 --> 00:07:42.211
It will die a sure death, right.

00:07:42.211 --> 00:07:44.353
And so I'm like okay, I want to do that.

00:07:44.353 --> 00:07:53.809
So the question then becomes how can I go through the volume and do it in such a way that it's still a very personalized experience where they felt like they were heard and all of that?

00:07:53.848 --> 00:08:00.399
Then I had to come up with the strategies for people to have a great experience, even though then I'm not sitting with them for an hour.

00:08:00.399 --> 00:08:02.043
Do you see what I'm saying Like?

00:08:02.043 --> 00:08:04.846
So it doesn't mean find the people, drop everybody.

00:08:04.846 --> 00:08:05.767
That's not what it means.

00:08:05.767 --> 00:08:07.930
But if you don't have the data, you don't know.

00:08:07.930 --> 00:08:15.430
So I have 10,000 patients, wonderful Top three insurance companies used by those 10,000 patients.

00:08:15.430 --> 00:08:16.540
You want to know what that is.

00:08:16.540 --> 00:08:26.329
Then you want to have the insurance companies top to bottom, from best paying to lowest paying and lowest paying is it lowest paying, like I'm making a little profit, or is it lowest pain, like I'm losing money?

00:08:26.329 --> 00:08:27.952
If you're losing money, you got to drop them.

00:08:27.952 --> 00:08:29.641
You got to drop them.

00:08:29.641 --> 00:08:31.084
Okay, all right.

00:08:31.084 --> 00:08:34.520
So that's the second thing we want to do, this audit of the distribution.

00:08:35.081 --> 00:08:53.926
The third thing for this person, because her specialty lends to it, is I'm like, but you want to consider some cash-based services and chances are, this doctor has either been thinking of it or maybe has some cash-based services, but they haven't necessarily been promoted and stuff like that.

00:08:53.926 --> 00:09:10.808
And the reason why I brought this up because, with what this practice is going through, it does seem like having an immediate cash injection would be really good for the practice, and so if they're cash-based verticals that already exist, we want to go hard on those.

00:09:10.808 --> 00:09:16.369
If they don't exist I mean for this person's specialty there are many that can just exist.

00:09:16.369 --> 00:09:19.984
They can start today because this person is equipped to do them.

00:09:19.984 --> 00:09:23.091
They're hot topics, all of those things, so they can do them.

00:09:23.172 --> 00:09:25.822
Why Immediate cash flow and higher margins?

00:09:25.822 --> 00:09:27.748
Right, because you don't need the bill or you don't need this.

00:09:27.748 --> 00:09:37.503
There are a lot of things that you don't need, so I would do that because and someone may say, oh, but this is so businessy, we're just going to bring these services because of the cash.

00:09:37.503 --> 00:09:41.428
No, we're going to bring the services because it'd be high value to her people and it will bring cash.

00:09:41.428 --> 00:09:50.432
And if you're in private practice, I don't want you to continue to be thrown off by the need to make money, because for your practice to stay open, you need to make money.

00:09:50.432 --> 00:09:54.051
We need to stop pretending, we need to stop acting like this is not an important thing.

00:09:54.051 --> 00:10:01.304
I am fully aware that one of the best ways I serve my patients is by staying profitable, because if I'm not profitable, I have to go away.

00:10:01.304 --> 00:10:03.629
Okay, okay, so that's that's.

00:10:03.649 --> 00:10:06.822
The third recommendation is to lean into some cash-based services.

00:10:06.822 --> 00:10:11.033
Okay, again, cash injection, because this practice, we need to get cash in.

00:10:11.033 --> 00:10:19.761
The fourth thing is I would prioritize services that increase the cashflow, and I'll explain what I mean by that.

00:10:19.761 --> 00:10:37.168
Okay, so let's say, for instance, in my private practice, if we say, oh, it looks like the next two weeks that we have open spots and stuff and we need to do something to fill our schedule, so we need to be proactive as opposed to reactive.

00:10:37.168 --> 00:10:38.933
Okay, and I have.

00:10:39.274 --> 00:10:43.745
Let's say, I have 300 patients who are overdue for well checks.

00:10:43.745 --> 00:10:47.932
Okay, now I know that I can't see all 300.

00:10:47.932 --> 00:10:49.581
So what are we going to do?

00:10:49.581 --> 00:10:55.284
We are going to call the people with the better paying insurance and we're going to get them in.

00:10:55.284 --> 00:10:57.028
What is that going to do?

00:10:57.028 --> 00:10:58.613
It's going to give me a better cash flow.

00:10:59.379 --> 00:11:01.446
Now, you might say, but what of all the other people?

00:11:01.446 --> 00:11:07.586
Well, in my practice, we happen to have a routine schedule for sending out reminders to make appointments.

00:11:07.586 --> 00:11:10.721
So they have all had reminders, every last one of them.

00:11:10.721 --> 00:11:14.291
Okay, we also do not let people leave the office without scheduling appointments.

00:11:14.291 --> 00:11:20.024
So for them not to have an appointment, it means that they canceled the appointment or they no-showed for an appointment and we have not been able to reach them.

00:11:20.024 --> 00:11:22.347
Okay, so are we reaching out to everybody?

00:11:22.347 --> 00:11:32.207
We are, but if I want to go hard and put staff time behind bringing people in, I am going to leverage what will be a bigger win-win situation for all of us.

00:11:32.207 --> 00:11:33.793
Okay, all right.

00:11:34.201 --> 00:11:37.610
So for this doctor, you have to be aware.

00:11:37.610 --> 00:11:39.186
You have to be aware.

00:11:39.186 --> 00:11:55.388
The services that I offer, top to bottom, from biggest revenue generator to least revenue generator, do you do all of them, sure, but in a situation like this, where we're like, oh, my goodness, something needs to give, you want to prioritize those.

00:11:55.388 --> 00:12:04.970
You're available for everything, but you prioritize those, okay, all right Again, if this makes you feel like, but it's about the patient, of course it's about the patient.

00:12:04.970 --> 00:12:07.567
That means you're treating people differently.

00:12:07.567 --> 00:12:10.389
No, no, no, no, we're not, we're not.

00:12:10.389 --> 00:12:19.691
But seeing patients is the responsible thing for a doctor to do, and keeping the practice profitable is a responsible thing for a doctor to do.

00:12:19.691 --> 00:12:21.908
They're both responsible things.

00:12:21.908 --> 00:12:22.653
So we're doing both.

00:12:22.653 --> 00:12:23.580
Okay, all right.

00:12:23.580 --> 00:12:29.287
The fifth recommendation there I have is maximize daily productivity.

00:12:29.287 --> 00:12:33.354
Now, this is so, so, so, so important.

00:12:33.354 --> 00:12:35.482
Okay, I will give an example.

00:12:35.503 --> 00:12:41.982
I was talking to a doctor, someone that I really have a lot of respect for, and all of that stuff.

00:12:41.982 --> 00:12:45.567
She's running a practice, she built it from scratch, she's doing an amazing job.

00:12:45.567 --> 00:12:50.500
And then, while we were talking, she says you know, I don't want to get burned out.

00:12:50.500 --> 00:12:57.980
I want to see a certain number of patients every day, you know, because that's what I want to see.

00:12:57.980 --> 00:13:00.607
Okay, and then I said so.

00:13:00.607 --> 00:13:02.961
And then she went on and I said wait, wait, what is that number?

00:13:02.961 --> 00:13:14.436
How many patients do you want to see and I asked this question because I know she's an insurance based model and so she says I want to see 14 patients a day.

00:13:25.919 --> 00:13:28.227
No, your reimbursement is probably not more than $150 per visit.

00:13:28.227 --> 00:13:29.230
So I'm like, okay, we're going to do some math here.

00:13:29.230 --> 00:13:32.081
Okay, so 150, I didn't use 150, I used 100 on that day because the math was easier.

00:13:32.081 --> 00:13:32.961
But let's do the real math.

00:13:32.961 --> 00:13:36.409
Okay, 150 times 14 is 2100.

00:13:36.409 --> 00:13:41.264
So I mean that your cap with you as the doc there, your cap is 2100 a day.

00:13:41.264 --> 00:13:47.033
Okay, and you multiply that by 260, you're at $546,000.

00:13:47.033 --> 00:13:51.322
Now when I did the math with 100, it was $364,000,.

00:13:51.322 --> 00:13:56.025
Okay, so you're at $546,000 before overhead.

00:13:56.025 --> 00:14:01.210
That's the cap.

00:14:01.210 --> 00:14:13.102
If your practice is like 60% overhead, which is not unusual, your 60% overhead puts you at 327,600.

00:14:13.182 --> 00:14:16.109
So the question is then becomes what's left?

00:14:16.109 --> 00:14:18.192
Right, what's left?

00:14:18.192 --> 00:14:21.783
So this is what we need to look at.

00:14:21.783 --> 00:14:23.628
You have to know what the numbers say.

00:14:23.628 --> 00:14:26.134
You have to know what the numbers say.

00:14:26.134 --> 00:14:31.115
So when I did it with her and did the math at a hundred, I said you're at $364,000.

00:14:31.115 --> 00:14:31.957
That's the cap.

00:14:31.957 --> 00:14:35.193
That's the most your practice can bring in before overhead.

00:14:35.193 --> 00:14:39.532
Before paying you before any profit, you have to be sure that you're okay with that number.

00:14:40.333 --> 00:14:40.995
You see what I'm saying.

00:14:40.995 --> 00:14:46.756
So for this doctor, I would actually have her look like look back on the last two weeks on the last month.

00:14:46.756 --> 00:14:48.701
How many patients are you seeing every day?

00:14:48.701 --> 00:14:51.086
Look back on the last two weeks on the last month.

00:14:51.086 --> 00:14:52.350
How many patients are you seeing every day?

00:14:52.350 --> 00:14:56.316
What is the maximum amount of revenue you can create with that?

00:14:56.316 --> 00:14:57.360
Are you having more no-shows than you thought?

00:14:57.360 --> 00:14:58.323
Are you seeing less volume than you thought?

00:14:58.323 --> 00:15:01.613
With the volume that you are seeing, what is the max per day?

00:15:01.613 --> 00:15:07.693
Because if that max per day is a number that you don't want, something needs to give.

00:15:07.693 --> 00:15:09.500
Do you see what I'm saying?

00:15:09.500 --> 00:15:13.378
If we don't do the math, bad things happen, okay.

00:15:13.378 --> 00:15:19.159
So this is part of the reason why we use in my private practice, we use Practice Pilot, okay.

00:15:19.181 --> 00:15:34.717
So Practice Pilot is a financial tracking software for private practices and when you create, when you go in there, one of the things you would do is it will have you put your average reimbursement per patient, okay, and then you create, when you go in there, one of the things it would do is it will have you put your average reimbursement per patient, okay, and then you will set what your goal is.

00:15:34.717 --> 00:15:44.663
So if you say my revenue goal for this year is I want to bring in 2 million, now, based on your average reimbursement per patient, it will tell you how many patients you need to see.

00:15:44.663 --> 00:15:54.712
And if you say, no, I don't want to see that number, I want to see this number, it will show you how much revenue you can generate.

00:15:54.712 --> 00:15:58.039
And once you see those, there's just something about seeing the data that lets you know like, wait, I don't like that number.

00:15:58.039 --> 00:16:05.672
And then, if you don't like the number, the average reimbursement needs to change or the volume of patients needs to something, something needs to give.

00:16:05.672 --> 00:16:13.904
Okay, so I would have this doctor do the math with the way you're functioning, what is the potential amount of revenue your practice can bring in every day?

00:16:13.904 --> 00:16:15.533
This is a number you want to know.

00:16:15.533 --> 00:16:16.816
Okay, all right.

00:16:17.879 --> 00:16:19.182
So that was the first thing.

00:16:19.182 --> 00:16:20.091
That was the first thing.

00:16:20.091 --> 00:16:23.538
My reimbursements were low and slow, okay.

00:16:23.538 --> 00:16:26.803
Second thing my AR is out of control.

00:16:26.803 --> 00:16:28.875
Okay, my AR is out of control.

00:16:28.875 --> 00:16:34.697
So when we looked at this, okay, this was the number, this is the number that she gave me.

00:16:34.697 --> 00:16:40.312
Okay, she said over over 90 days.

00:16:40.312 --> 00:16:47.182
So from from over 60 days was almost 80% of her revenue.

00:16:47.182 --> 00:16:51.128
90 to 120 days was 38% of her revenue.

00:16:51.128 --> 00:17:03.758
She has a lot of revenue sitting in her AR, a lot of it and for older practices you may have that because maybe you have bad debt from years and years and years.

00:17:03.758 --> 00:17:06.103
So you're over 120 is bloated.

00:17:06.103 --> 00:17:08.473
She's in her second year.

00:17:08.473 --> 00:17:18.093
She's in her second year of practice, right, and so to have that number, I would definitely make the assumption that my biller is not doing a good job.

00:17:18.093 --> 00:17:24.376
You can even make the assumption that maybe your fund desk people are not doing a good job, maybe the insurance eligibility, I don't know.

00:17:24.376 --> 00:17:25.721
But there are things that you're going to.

00:17:25.721 --> 00:17:27.673
Okay, we need to look here Now.

00:17:27.673 --> 00:17:30.740
So these are the recommendations I have based on that.

00:17:31.801 --> 00:17:39.570
First of all, I'm like you have to treat this as a matter of urgency and I would think of it like somebody's bleeding out.

00:17:39.570 --> 00:17:44.102
You're a surgeon, you have somebody on the operating table and this person is bleeding out.

00:17:44.102 --> 00:17:46.713
Nobody's like calm and collected and whatever.

00:17:46.713 --> 00:17:48.297
Like we have something to fix.

00:17:48.297 --> 00:17:52.143
Okay, so we're not frazzled, but there's urgency.

00:17:52.143 --> 00:17:52.845
Okay.

00:17:52.845 --> 00:17:58.115
When you have AR like this this early in the game, there's urgency.

00:17:58.115 --> 00:17:59.390
This needs to be fixed.

00:17:59.390 --> 00:18:01.377
It means the practice is bleeding out.

00:18:01.377 --> 00:18:09.951
What that means is you know we have this thing of if we're seeing a lot of patients, that means you know if we're really busy, it means the practice is working.

00:18:09.951 --> 00:18:10.471
No, no, no.

00:18:10.471 --> 00:18:17.018
The evidence of the practice working is in the bank account, because the fact that you saw a patient doesn't mean you got paid for seeing the patient.

00:18:17.018 --> 00:18:18.651
It doesn't mean that at all.

00:18:18.651 --> 00:18:23.061
After seeing the patient, there are processes that need to happen before you get paid.

00:18:23.061 --> 00:18:25.835
So this is what I have for her Treat this as a matter of urgency.

00:18:25.914 --> 00:18:28.621
Treat it like there's somebody in the OR on the table bleeding out.

00:18:28.621 --> 00:18:32.911
If you know the level of urgency you have with that, you're still calm because you have the strategy.

00:18:32.911 --> 00:18:36.882
You know the algorithms and all of those things, but it's urgent, it's urgent.

00:18:36.882 --> 00:18:39.117
So one is treat it as a matter of urgency.

00:18:39.117 --> 00:18:44.071
Two is meet with the billers to diagnose the issue and create a strategic path forward.

00:18:44.071 --> 00:18:48.396
What that means is you're not even offering all the things when you have a vendor.

00:18:48.396 --> 00:18:50.199
Please understand that the vendor works for you.

00:18:50.199 --> 00:18:53.563
Okay, they may not be your W-2 employee, but they work for you.

00:18:53.563 --> 00:18:55.986
And so you sit with them and you're like okay, we have an issue.

00:18:55.986 --> 00:18:58.917
Okay, this is what our billing looks like.

00:18:58.917 --> 00:19:00.309
This is what the national standard benchmarks are.

00:19:00.309 --> 00:19:05.576
So somebody walk me through what exactly is going on Like, what is the core issue here?

00:19:05.576 --> 00:19:10.451
Okay, the core issue here?

00:19:10.451 --> 00:19:11.093
Okay, it can be more than three.

00:19:11.093 --> 00:19:11.595
What are the top three?

00:19:11.595 --> 00:19:12.557
What are the three core issues here?

00:19:12.557 --> 00:19:14.443
Or the one core issue here is usually not one, so let's say three.

00:19:14.443 --> 00:19:16.976
And what is the strategic path to move forward?

00:19:16.976 --> 00:19:21.432
How do we make this AR look like this AR, like this national benchmark?

00:19:21.913 --> 00:19:31.474
Okay, now, billers have been known to blow hot air because they know physicians don't care about this stuff, physicians don't want to look at this stuff, physicians will not ask questions.

00:19:31.474 --> 00:19:40.171
I literally had a client who talked to her biller like I want us to meet and do all this, and she's like no physician's ever asked to meet with me.

00:19:40.171 --> 00:19:42.996
I was like, ooh, we're in the on-term deal world.

00:19:42.996 --> 00:19:43.297
Of course.

00:19:43.297 --> 00:19:45.942
We ask this is the era of the practice, right?

00:19:45.942 --> 00:19:48.707
Okay, so what is the issue?

00:19:48.707 --> 00:19:51.974
And when they tell you highfalutin things, you're like, break it down, break it down.

00:19:51.974 --> 00:19:58.001
Like I'm a doctor, like I'm a third grader, like make it make sense, but don't just accept anything, right, don't just accept anything.

00:19:58.001 --> 00:20:02.376
The diagnosis needs to make sense to you.

00:20:02.376 --> 00:20:07.695
The strategic path forward needs to make sense to you, okay, so have them come up with it.

00:20:07.695 --> 00:20:09.180
Create a strategic path forward.

00:20:09.180 --> 00:20:10.442
You want to lean into it?

00:20:10.442 --> 00:20:15.455
So I've taught about this in the profitable private practice movement, like you know how to look at these things at all.

00:20:15.455 --> 00:20:16.337
You want to look at it?

00:20:16.337 --> 00:20:17.602
Okay, all right.

00:20:18.069 --> 00:20:22.441
Then the third thing is after you're done with that meeting, things will change.

00:20:22.441 --> 00:20:27.137
If you do this thing, which is to meet with them weekly, give them the gift of accountability.

00:20:27.137 --> 00:20:28.921
This is where we were last week.

00:20:28.921 --> 00:20:30.683
This is where we are this week.

00:20:30.683 --> 00:20:32.488
These are the plans that we made.

00:20:32.488 --> 00:20:34.413
These are the problems we identified.

00:20:34.413 --> 00:20:35.436
What is the update?

00:20:35.436 --> 00:20:37.423
What is the update?

00:20:37.423 --> 00:20:43.029
This does not need to take more than 30 minutes, but that 30 minutes will be at the equivalent of thousands and thousands of dollars.

00:20:43.029 --> 00:20:46.619
If you do it, and if you don't, everybody will forget it and go to the status quo.

00:20:46.619 --> 00:20:57.036
Everybody, including champions, need the gift of accountability, right, and so you meet with them weekly to at least you slow down the bleeding, right?

00:20:57.036 --> 00:21:00.222
Okay, so that's the thing I would do, absolutely Okay.

00:21:00.482 --> 00:21:02.833
Number four I would hold the biller.

00:21:02.833 --> 00:21:10.157
So she has a biller, like her EHR company does the billing and then she has another person to assist with the billing.

00:21:10.157 --> 00:21:12.977
Okay, I would hold both accountable.

00:21:12.977 --> 00:21:17.913
Okay, I will hold both of them accountable, to whatever metrics and all of those things.

00:21:17.913 --> 00:21:20.200
I would even hold the front desk accountable.

00:21:20.200 --> 00:21:29.881
If they're not verifying insurance eligibility, collecting co-pays Like if your personal AR as opposed to your insurance AR is also really high, I will hold them accountable.

00:21:29.881 --> 00:21:32.038
Like, all co-pays need to be collected.

00:21:32.038 --> 00:21:33.787
All co-insurance needs to be collected.

00:21:33.787 --> 00:21:37.523
All deductibles need to be collected, all balances need to be collected.

00:21:37.523 --> 00:21:41.138
I want you to start thinking about your front desk person as your director of finance.

00:21:41.138 --> 00:21:50.443
Their job is to collect money, because your practice is in a place where you need like, everybody needs to collect money, but for this practice in particular, they need to collect money.

00:21:50.443 --> 00:21:52.236
They can leave no money on the table none.

00:21:53.058 --> 00:21:57.137
Okay, then number five is long-term.

00:21:57.137 --> 00:21:58.161
You have to look.

00:21:58.161 --> 00:22:00.238
Do I need to start looking for a new billing partner?

00:22:00.238 --> 00:22:02.055
Do I need to look for new billers?

00:22:02.055 --> 00:22:12.461
Okay, because if you're working with billers and they're not making the changes, they're gaslighting you.

00:22:12.461 --> 00:22:13.364
It's the same thing over and over again.

00:22:13.364 --> 00:22:14.509
They're not getting any sense of urgency or whatever.

00:22:14.509 --> 00:22:22.480
You probably need to work with them to do what you need to do in the moment, but if you know you're going to look, then you want to start looking, because that's a whole process on its own.

00:22:22.820 --> 00:22:24.573
And again, I would tread carefully.

00:22:24.573 --> 00:22:34.096
I would not roll over my billing to a new company without interviewing people who are using that new biller and want to go with hearing their real experience, especially if they're people who know what their numbers are.

00:22:34.096 --> 00:22:35.625
Sometimes people are like, oh, that biller is great.

00:22:35.625 --> 00:22:37.994
They've never met with them, they don't know what the AR is and all that.

00:22:37.994 --> 00:22:39.719
It doesn't matter.

00:22:39.719 --> 00:22:43.134
So you want to talk to somebody who, like you, is looking into their numbers.

00:22:43.134 --> 00:22:46.558
They know what it is, they know their billers, are good at this and all of that kind of stuff.

00:22:46.558 --> 00:22:50.384
Okay, I would say, long-term, start looking for new billing partners if you need to, okay.

00:22:50.384 --> 00:23:01.073
And again, a financial tracking system like you know, practice pilot is probably a good system for you to keep your numbers in front of you.

00:23:01.073 --> 00:23:03.121
You can see it as a simple system.

00:23:03.121 --> 00:23:10.643
You can log in every day, see what we're doing with money, let's see what our potential revenue is, look at what our AR is looking like and all of those things, okay, okay.

00:23:11.471 --> 00:23:12.497
So that was the second problem.

00:23:12.497 --> 00:23:14.176
First problem reimbursement is low and slow.

00:23:14.176 --> 00:23:15.957
Second problem AR is out of control.

00:23:15.957 --> 00:23:17.736
Third problem high overhead.

00:23:17.736 --> 00:23:23.461
Okay, now, I didn't get all the details of the overhead, but, for instance, her rent is $9,500 a month.

00:23:23.461 --> 00:23:33.575
Right, that's $120,000 a year, almost, Okay, all right.

00:23:33.575 --> 00:23:36.765
So we have high overhead in the midst of our low and slow reimbursements, okay, and our AR being out of control.

00:23:36.765 --> 00:23:40.053
So we have inflow problems and we have outflow problems, okay.

00:23:40.053 --> 00:23:42.377
So what would I recommend?

00:23:42.377 --> 00:23:52.392
She does Right, so this is a high rent, it's a high lease and, by extrapolation, our overhead is just high, okay.

00:23:52.873 --> 00:24:04.616
So one is consider subleasing, and one of the things that happens when we have really big things that we need to work through is that our mind offers up this thought of it's not possible, you can't, it's not possible, nobody does all of that stuff.

00:24:04.616 --> 00:24:12.481
You're an entrepreneur now, right, so everyone watching this, and so what that means is there are very few things that are, we don't start with, impossible.

00:24:12.481 --> 00:24:14.010
So we don't say I can't do that.

00:24:14.010 --> 00:24:15.193
We say how can I do that?

00:24:15.193 --> 00:24:17.479
This is such an empowerment question.

00:24:17.479 --> 00:24:18.342
How can I do that?

00:24:18.342 --> 00:24:19.510
How can I pull that off?

00:24:19.510 --> 00:24:20.792
How can that be possible?

00:24:20.792 --> 00:24:21.493
How can?

00:24:22.255 --> 00:24:24.538
Okay, so, have human beings subleased?

00:24:24.538 --> 00:24:26.701
Yes, yes, millions of people have subleased.

00:24:26.701 --> 00:24:27.923
So, okay, how can I?

00:24:27.923 --> 00:24:34.751
Right, oh, but the landlord said I can't sublease.

00:24:34.751 --> 00:24:35.354
Okay, does he want that?

00:24:35.354 --> 00:24:36.277
Or does he want a private practice?

00:24:36.277 --> 00:24:37.540
That's not there at all and can't pay him money anyway?

00:24:37.540 --> 00:24:38.202
I'm paying you 10 grand a month.

00:24:38.202 --> 00:24:39.670
Man, help me figure out how to help you.

00:24:39.670 --> 00:24:43.295
Okay, and so, yes, so can it be negotiated?

00:24:43.295 --> 00:24:44.836
Yes, can we find a tenant?

00:24:44.836 --> 00:24:45.698
Yes, we can.

00:24:45.698 --> 00:24:46.720
We simply can.

00:24:46.720 --> 00:24:47.661
Okay, all right.

00:24:47.661 --> 00:24:55.953
So, especially if you're not using all this space, oh, my goodness, because you can reduce your rent by $2,000 a month if you can find somebody who sublease for $2,000 a month.

00:24:55.953 --> 00:24:58.199
Okay, so that's a thing, and I would work it.

00:24:58.199 --> 00:24:59.942
I would work it.

00:24:59.942 --> 00:25:05.497
Okay, I would tell the people in my network, I would have my team talk to people, I do all kinds of stuff, okay.

00:25:05.938 --> 00:25:20.790
Second thing is reduce non-essential, non-revenue generating expenses, and so what that means is you're going to pull, for instance, your bank statement, your credit card statement, all of those things for the practice, and you're going to go line by line.

00:25:20.790 --> 00:25:24.298
Okay, is this essential to the running of this practice?

00:25:24.298 --> 00:25:26.241
Does this create revenue?

00:25:26.241 --> 00:25:27.896
Is this essential to the running of the practice?

00:25:27.896 --> 00:25:28.460
Does this create revenue?

00:25:28.460 --> 00:25:29.446
Is this essential to the running of the practice?

00:25:29.446 --> 00:25:29.970
Does this create revenue?

00:25:29.970 --> 00:25:32.116
Is this essential to the running of the practice?

00:25:32.116 --> 00:25:32.898
Does this create revenue?

00:25:32.898 --> 00:25:37.378
And if it doesn't just chop it off, chop it off, okay, and it's a way of thinking.

00:25:37.378 --> 00:25:40.637
I recommend this for people when their practices are booming.

00:25:40.637 --> 00:25:42.182
It's like you want to go through.

00:25:42.182 --> 00:25:44.357
Does this essential?

00:25:44.357 --> 00:25:45.912
Does this generate revenue?

00:25:45.912 --> 00:25:50.258
Okay, now I want to tell you three things to never cut off.

00:25:50.258 --> 00:25:54.324
Okay, these are three things we don't cut off because we need them.

00:26:01.930 --> 00:26:02.955
Number one advertising with a return on investment.

00:26:02.955 --> 00:26:03.740
Okay, so let's say you were running ads.

00:26:03.740 --> 00:26:04.905
You were running Google ads or Facebook ads and whatever.

00:26:04.905 --> 00:26:12.582
So let's say you're doing Google ads and from Google ads, you get 40 new patients every single month and you're spending a thousand dollars on it.

00:26:12.582 --> 00:26:14.711
Okay, now let's just make up numbers.

00:26:14.711 --> 00:26:22.811
Let's say you know, for their first visit their first visit is just for the sake of math let's say it's $150.

00:26:22.811 --> 00:26:28.838
Okay, so you have $150 times 40, right, that's $6,000.

00:26:28.838 --> 00:26:35.346
So you are making an ROI return investment of $6,000 for every $1,000 you spend.

00:26:35.346 --> 00:26:45.160
Okay, so how much do you spend on that, all the money you can spend, because it's paying for itself Every time you spend one, you get six, which is a net of five.

00:26:45.160 --> 00:26:46.262
You see what I'm saying.

00:26:46.262 --> 00:26:50.326
So, when we're reducing expenses, we don't cut that.

00:26:52.134 --> 00:26:56.913
Now, if you have the marketing team, you're paying 12 grand a month and they're not doing anything, by all means cut them Right.

00:26:56.913 --> 00:27:03.715
Well, when you have an established, documented I can see in the bank ROI you don't cut it off.

00:27:03.715 --> 00:27:05.680
You don't cut it off, okay.

00:27:05.680 --> 00:27:11.715
The second thing you don't cut off is coaching and consulting with an ROI, okay.

00:27:11.715 --> 00:27:35.982
So, for instance, in this conversation that I'm having, like, where we're troubleshooting this private practice, you will find that these strategies, if you execute them, the minimum you'll be able to get from this one conversation is a hundred thousand dollars, and this can extend to multiple seven figures depending on how aggressively you execute on these strategies.

00:27:35.982 --> 00:27:39.816
Seven figures depending on how aggressively you execute on these strategies, okay.

00:27:39.836 --> 00:27:50.061
Now if you are paying somebody right for this and you are getting the strategies that are keeping you in motion, you're getting the strategies that are helping you build, you don't cut that off.

00:27:50.061 --> 00:27:54.557
You don't cut that off right.

00:27:54.557 --> 00:28:08.074
You don't why the ROI is huge If you can go from a failing practice to a thriving practice, like a failing practice to a profitable practice, to a thriving practice through a coaching program.

00:28:08.074 --> 00:28:14.631
You don't cut it off, right, because the ROI is ginormous, okay.

00:28:14.631 --> 00:28:20.163
The third thing you're not going to cut off is you're not going to cut off your team with an ROI.

00:28:20.730 --> 00:28:22.233
So, let's say, your front desk person.

00:28:22.233 --> 00:28:38.976
You talk with them about this new strategy we're going to engage and this person takes her role as the director of finance like super seriously and she's collecting all the dollars and every day she's collecting between $500 and $1,000 in co-pays, old balances, all of these things.

00:28:38.976 --> 00:28:43.772
And you're like, oh, my payroll is so high, I'm going to slash my team.

00:28:43.772 --> 00:28:48.903
You don't slash that person because their ROI is ginormous.

00:28:48.903 --> 00:28:50.431
Do you see what I'm saying?

00:28:50.431 --> 00:28:51.711
Now notice for each of them.

00:28:51.711 --> 00:28:58.701
I said, with an ROI, if it doesn't have a return on investment, throw it away, but if it does, we don't cut that.

00:28:58.701 --> 00:29:00.503
Okay, all right.

00:29:00.824 --> 00:29:07.276
So your non-essential, non-revenue generating expenses, you can get rid of those.

00:29:07.276 --> 00:29:08.378
Okay, all right.

00:29:08.378 --> 00:29:11.997
So the next thing we're going to do for this really high overhead is to increase revenue.

00:29:11.997 --> 00:29:13.842
So we go back to what we had with number one.

00:29:13.842 --> 00:29:20.673
I'm going to talk about more.

00:29:20.673 --> 00:29:21.214
Right, we increase revenue.

00:29:21.214 --> 00:29:22.480
Right, because there's some expenses that just can't be cut.

00:29:22.480 --> 00:29:24.146
So we go after making revenue so that our expense to the ratio becomes a lot less.

00:29:24.146 --> 00:29:25.511
Okay, and this is my favorite strategy.

00:29:25.511 --> 00:29:27.538
My favorite strategy is let's create that.

00:29:27.538 --> 00:29:29.592
Of course, we want to shed fat and get rid of waste.

00:29:29.592 --> 00:29:30.453
We don't want to be wasteful.

00:29:30.453 --> 00:29:42.759
We want to be good stewards but at the same time, good stewards but at the same time, your revenue, this is your big strategy.

00:29:42.759 --> 00:29:43.461
Okay, all right.

00:29:43.481 --> 00:29:44.743
So then the doctor had team issues.

00:29:44.743 --> 00:29:50.432
So she said I have three team members no office manager, not there yet.

00:29:50.432 --> 00:29:51.054
Two are rock stars, one is not.

00:29:51.054 --> 00:29:53.901
Okay, I've had multiple conversations with this one with her productivity, but she doesn't know how to pivot.

00:29:53.901 --> 00:29:56.051
Okay, so she might be what we call a steady Eddie.

00:29:56.051 --> 00:30:01.700
Steady Eddies are people who will come, they will do the same thing every single day, forever.

00:30:01.700 --> 00:30:10.751
They're not going to be proactive, they're not going to come up with some big, daring, great plan and all those things, but they are steady Eddies.

00:30:10.751 --> 00:30:15.441
And so, right off the back, I will say, like, if this person is a steady Eddie, they do well in the confines of this one thing.

00:30:15.441 --> 00:30:23.634
When I say one thing, I don't mean one task, but I mean if you tell them what to do, they'll do it, but they're just not going to be creative and they're not going to do that.

00:30:23.634 --> 00:30:26.390
Then you want to ask yourself is this one I can repurpose?

00:30:26.390 --> 00:30:29.054
I'll talk about that in a second, so let me not get ahead of myself.

00:30:29.054 --> 00:30:32.778
Okay, so the team issues what's my recommendation?

00:30:32.778 --> 00:30:41.479
Okay, now I will start with my observations, and this is my observation after studying thousands of private practices over the years.

00:30:41.700 --> 00:30:47.980
Okay, the number one problem with most of the teams in private practices is the team leader.

00:30:47.980 --> 00:30:51.496
Is the physician owner, like we are the problem of our team.

00:30:51.496 --> 00:30:55.699
Right, and a lot of times that problem is because we don't define what their role is.

00:30:55.699 --> 00:30:58.955
We don't define what their role is, we don't define how this role makes money.

00:30:58.955 --> 00:31:01.261
We don't have clarity on what they're supposed to do.

00:31:01.261 --> 00:31:09.219
We have not communicated with them how to win, so they don't even know they're in a basketball game and they don't know where the basket is and, like we're the issue.

00:31:09.219 --> 00:31:10.521
Okay For the most part.

00:31:10.521 --> 00:31:13.051
So that's an observation I made.

00:31:13.051 --> 00:31:15.834
Another observation I made is that you know.

00:31:15.834 --> 00:31:16.674
So that's an observation I made.

00:31:16.674 --> 00:31:35.109
Another observation I made is that you know improperly led teams are where practice profits go to die Because you're seeing the patients, you're generating the revenue, but you haven't empowered your team, so your team becomes dead weight, your team becomes a liability, and so they're not creating revenue, so you are the only revenue generator, okay.

00:31:35.109 --> 00:31:45.342
So once you stop everything stopped, once you stop like you have no support, you feel like you're carrying everything yourself is too much, and I'm going to show you how to how to fix that and so.

00:31:45.342 --> 00:31:49.040
So that's where profits go to die, and we just didn't set up our teams to help us.

00:31:49.040 --> 00:31:59.593
To help us with the burden of ownership, with the burden of creating revenue, right, okay, burden of ownership with the burden of creating revenue, right, okay.

00:31:59.593 --> 00:32:00.734
So what are my recommendations as how to fix this?

00:32:00.734 --> 00:32:07.835
Number one define KRAs, key result areas for each role, and I didn't say key tasks, I said key result areas.

00:32:07.835 --> 00:32:15.737
So, for instance, for a front desk person, we're not saying well, greet the patients, check them in all of that stuff.

00:32:15.737 --> 00:32:18.823
Those are activities, those are tasks and those do nothing.

00:32:18.823 --> 00:32:34.134
Right, like, of course they're very important, but oh, my goodness, those are tasks as opposed to right, as opposed to, for instance, 100% collection on all co-pays, deductibles, co-insurance and old balances.

00:32:34.134 --> 00:32:42.493
Right, pays, deductibles, co-insurance and old balances, right.

00:32:42.493 --> 00:32:47.022
We say 100% insurance verification on all appointments, right.

00:32:47.022 --> 00:32:52.434
We say five Google reviews a day, which means they have to greet the patients in a certain way, do things in a certain way.

00:32:52.434 --> 00:32:55.333
So when the patient is leaving, it's like I hope you had a great experience.

00:32:55.333 --> 00:32:59.060
It would be so much to me if you could leave me a five-star review.

00:32:59.060 --> 00:33:01.192
That's how I keep my job.

00:33:01.192 --> 00:33:03.538
I'm not saying that's how she keeps her job, I'm just being funny.

00:33:03.538 --> 00:33:13.884
But when you have these outcomes, now their creativity is unlocked to go, make it possible and you can show them like.

00:33:13.884 --> 00:33:14.644
This is the outcome.

00:33:14.644 --> 00:33:16.246
These are the activities you do to get there.

00:33:16.246 --> 00:33:27.336
But when you do that, can you imagine you don't have to bear the weight of, oh, things were collected upfront, or we're getting reviews, or like, you're sharing, you're sharing it right, okay.

00:33:27.336 --> 00:33:34.114
So, and every role in the KRAs, every role, needs to include serving and earning.

00:33:34.114 --> 00:33:35.256
It has to include both.

00:33:35.256 --> 00:33:36.739
Okay, all right.

00:33:36.739 --> 00:33:44.346
So the second thing I would do is now distribute the outcomes linked with turning the ship around.

00:33:44.346 --> 00:33:46.251
So we've talked about a lot of things.

00:33:46.251 --> 00:33:48.596
We've talked about the billers.

00:33:48.596 --> 00:33:54.895
We've talked about collecting our old balances, maximizing daily production.

00:33:54.895 --> 00:33:57.080
We've talked about auditing.

00:33:57.080 --> 00:33:59.214
We've talked about all of these things.

00:33:59.214 --> 00:34:00.578
You want to do it with your team.

00:34:00.578 --> 00:34:01.461
Don't do it alone.

00:34:01.461 --> 00:34:03.314
Don't do it alone.

00:34:03.314 --> 00:34:06.151
So, for instance, we need to make sure we're collecting all the money for what we do.

00:34:06.151 --> 00:34:11.503
So the front desk person could have collected all the upfront money, right?

00:34:11.503 --> 00:34:17.719
You can have another person that's in charge of creating three appointments with this cash-based vertical that you want to do.

00:34:17.719 --> 00:34:23.376
Right, you have your biller with the metrics, so they're in charge of that.

00:34:23.376 --> 00:34:25.784
Like, share the burden for this stuff.

00:34:25.784 --> 00:34:32.300
Maybe you looked at your daily productivity and you're like, oh my goodness, like we're seeing four patients less than I actually want to see.

00:34:32.300 --> 00:34:38.072
They have another person who's in charge of making sure you see X number of patients a day.

00:34:38.072 --> 00:34:41.983
They're hitting the recaller, they're doing all the things.

00:34:41.983 --> 00:34:44.413
But do you see what I'm saying?

00:34:44.413 --> 00:34:45.597
Don't just bury it all.

00:34:45.597 --> 00:34:46.438
Bury it with the team.

00:34:46.438 --> 00:34:49.032
Cast vision with them.

00:34:49.032 --> 00:34:51.559
Tell them this is the kind of practice we're in.

00:34:51.559 --> 00:35:02.110
Tell them about all the private practices shutting down and we've decided we're not going to be a statistic but because we can do the things right, share it in such an inspiring way and tell them let's go.

00:35:02.110 --> 00:35:05.036
They will go with you, okay.

00:35:05.036 --> 00:35:09.836
Third recommendation repurpose or de-hire team members as needed, okay.

00:35:09.836 --> 00:35:20.715
So, like the study, eddie, if you need to repurpose them where they're doing something, where they're kind of doing the same thing, and it's a thing that needs to be done, doesn't need to be automated, and stuff like that, you know, like you kind of put them in that position.

00:35:20.715 --> 00:35:24.032
If they just can't work like they, hire them, and the sooner the better, okay.

00:35:24.032 --> 00:35:27.342
And again, this is one of the reasons why I like Practice Pilot.

00:35:27.342 --> 00:35:29.893
I think I'm going to keep mentioning it and you can check it out.

00:35:29.893 --> 00:35:31.597
It's practicepilotio.

00:35:31.597 --> 00:35:38.755
But this is one of the reasons I like Practice Pilot, because it's self-reporting and you don't want to enter the data.

00:35:38.755 --> 00:35:41.242
You want your team to enter the data, so they will see.

00:35:41.242 --> 00:35:46.041
Our goal was to see this number of patients, but today, oopsie, this is what we saw, right.

00:35:46.041 --> 00:35:51.096
And they're like, oh wait, we need to fix that.

00:35:51.096 --> 00:35:52.438
They're the ones who put in the AR.

00:35:52.438 --> 00:35:56.224
They're like, oh, my goodness, and they see that right, and the person and the insurance and all of those things.

00:35:56.224 --> 00:36:06.407
So you want that, because what it does is it helps your team see what you see and it helps them come to the conclusions you came to right.

00:36:06.407 --> 00:36:06.929
Okay, all right.

00:36:06.929 --> 00:36:09.659
So that was the fourth problem.

00:36:09.659 --> 00:36:11.317
That was the fourth problem she talked about.

00:36:11.317 --> 00:36:14.235
The fifth problem she talked about was her personal finances.

00:36:14.235 --> 00:36:27.356
Okay, so there's financial pressure there because she took out a HELOC, she took out from her 401k, she got a bank loan and she used this for renovations, equipment, furniture, personal bills, and she has personal bills still and stuff like that.

00:36:27.356 --> 00:36:28.699
Okay, so what is the recommendation here?

00:36:28.699 --> 00:36:36.083
Okay, now, first of all, I will say this If I was talking to this person face-to-face, I would say you want to be careful.

00:36:36.083 --> 00:36:39.016
If I was talking to this person face to face, I would say you want to be careful?

00:36:39.016 --> 00:36:39.980
Okay, because financial pressure is real.

00:36:39.980 --> 00:36:45.416
Financial pressure is hard and it is sometimes really, really hard to make smart financial decisions when the pressure shows up.

00:36:45.416 --> 00:36:47.121
Sometimes it's really hard.

00:36:47.121 --> 00:36:56.480
Money led decisions like I'm making this because of financial pressure are rarely ever the right ones, and I say this like I'm almost sending I'm sending virtual hugs first.

00:36:56.480 --> 00:37:02.219
I know this is hard and all of that stuff, but let's walk through some things to do.

00:37:02.219 --> 00:37:10.913
Okay, all right Now, and part of being careful is probably if you feel under so much pressure, you feel I must make a decision now.

00:37:10.913 --> 00:37:16.376
Now, I must do this now, now, now, now, now, probably decide to sleep over it when you're in that state.

00:37:16.376 --> 00:37:17.438
Don't make any decisions.

00:37:17.438 --> 00:37:21.355
Don't make any decisions, okay, so, so that's the first thing.

00:37:21.355 --> 00:37:22.137
Just be careful.

00:37:22.137 --> 00:37:25.050
Second thing aggregate all your debt, okay.

00:37:25.050 --> 00:37:26.456
So, these are all the things I owe.

00:37:26.456 --> 00:37:27.574
This is how much it is.

00:37:27.574 --> 00:37:30.480
This is what all the monthly payments come up to.

00:37:30.480 --> 00:37:38.231
This is what the total monthly payment comes up to.

00:37:38.231 --> 00:37:38.833
And talk to all your lenders.

00:37:38.833 --> 00:37:39.914
Everything is negotiable.

00:37:39.914 --> 00:37:40.675
Everything is negotiable.

00:37:40.675 --> 00:37:46.916
So if there could be a pause of something without increasing your interest rate, that would be awesome.

00:37:46.916 --> 00:37:52.833
If there could be a decreased interest rate, if they're willing to do that, that would be awesome.

00:37:52.833 --> 00:37:54.938
Talk with them.

00:37:54.938 --> 00:38:04.717
If they would do lower payments for X amount of period, again without changing the interest and changing the terms we don't want to go from one issue to another then that would be awesome.

00:38:04.717 --> 00:38:07.010
But don't make the assumption that it's not negotiable.

00:38:07.010 --> 00:38:08.655
Everything is negotiable.

00:38:08.655 --> 00:38:10.478
Everything is negotiable, okay.

00:38:10.478 --> 00:38:17.181
Number three I said this before, but I'm going to say it again prioritize services that increase cash flow.

00:38:17.181 --> 00:38:22.360
Okay, prioritize services that increase cash flow, because we want cash flow coming in.

00:38:22.360 --> 00:38:29.543
The thing that will give you the greatest peace, right with this, is bringing in revenue that makes up for that.

00:38:29.543 --> 00:38:30.644
Okay, all right.

00:38:30.644 --> 00:38:35.521
And one of the things was you know, do I sell my house or do I not sell my house?

00:38:35.521 --> 00:38:38.271
I would say it depends on you really want to think about that.

00:38:38.271 --> 00:38:58.711
For instance, if you're like I was looking to sell in the next one to two years anyway, and you had a home that has so much equity in it, it had a low interest rate, all of that stuff, and you'll be able to sell this, buy what it is you want now, and then you have profits off of that that you can put into whatever you want to.

00:38:58.711 --> 00:38:59.996
You can do that.

00:38:59.996 --> 00:39:09.097
If you're not thinking about selling it at all, and maybe you got a house in the last two years and all of that stuff and it's just going to be a lose, lose, lose, then you want to think maybe of not doing that.

00:39:09.097 --> 00:39:14.996
But what I will tell you is there are multiple loans here and you don't have multiple houses to sell, right?

00:39:14.996 --> 00:39:26.565
And so you kind of want to think of what would I do to get myself out of this, outside of the house, and then say, okay, do I want to go all in on doing that and then keep my house.

00:39:26.565 --> 00:39:27.650
You see what I'm saying.

00:39:27.650 --> 00:39:31.400
So there's a lot of thinking that needs to go into that.

00:39:31.400 --> 00:39:40.632
But I would say no hurry to do something that is fairly permanent off of something that is temporary.

00:39:40.632 --> 00:39:41.536
Does that make sense?

00:39:41.536 --> 00:39:43.164
So that's the way.

00:39:43.164 --> 00:39:45.411
But there's more, there's a lot more conversation.

00:39:45.411 --> 00:39:49.101
So I would say you want to be strategic with what you do here?

00:39:49.101 --> 00:39:54.277
Okay, but definitely talk to your lenders for sure, for sure and for sure.

00:39:54.277 --> 00:39:58.711
Get that cashflow engine going, bringing revenue in and all of those things.

00:39:58.711 --> 00:39:59.333
Okay.

00:39:59.333 --> 00:40:01.077
So lots of stuff.

00:40:01.077 --> 00:40:05.193
And so this is the last one and it's mental exhaustion from all of this.

00:40:05.193 --> 00:40:07.721
Okay, and I'm going to read what this doctor said.

00:40:07.721 --> 00:40:12.173
I think it's important because this is what she says.

00:40:12.173 --> 00:40:13.335
I'm a solo doc.

00:40:13.335 --> 00:40:14.717
I've always done it alone.

00:40:14.717 --> 00:40:18.802
I haven't had mentors or physician colleagues to bounce ideas off.

00:40:18.802 --> 00:40:20.282
I feel isolated.

00:40:20.282 --> 00:40:33.112
I'm a black female physician in town with only two to four other black females in private practice, but there are 30 to 40 doctors in my specialty in this town and all that stuff.

00:40:33.112 --> 00:40:33.673
I'm losing hope.

00:40:33.673 --> 00:40:33.793
Okay.

00:40:33.793 --> 00:40:35.436
So again, first of all, specialty in this town and all that stuff.

00:40:35.436 --> 00:40:35.956
I'm losing hope, okay.

00:40:35.956 --> 00:40:36.137
So again.

00:40:36.137 --> 00:40:36.677
First of all, long.

00:40:36.677 --> 00:40:43.686
You know the long squishy hug like long, squishy, big, understanding hug and all of that.

00:40:43.686 --> 00:40:51.436
And I do want to say, you know, thank you so much for what you do, because you've chosen to serve people for this long.

00:40:51.436 --> 00:41:01.994
You've chosen to build your own healthcare system, which is really what we do as private practice owners, and think of what thousands of people who would not have access to great care if you didn't say yes to doing what you do.

00:41:01.994 --> 00:41:03.717
So big, big, big hug.

00:41:03.717 --> 00:41:08.914
And I want to say the principles of rest.

00:41:08.914 --> 00:41:24.483
Sometimes it's really hard with what you're going through, but there's rest, there's meditation, but there's also a support system and I want you to understand that, no matter what it's out there, you can have a support system.

00:41:24.483 --> 00:41:28.619
It may look different, you may need to get a little creative right.

00:41:28.619 --> 00:41:34.320
Some of them may be outside of your area and some of them may not even be close to you.

00:41:34.320 --> 00:41:35.242
They may be online.

00:41:35.242 --> 00:41:44.664
I have such great relationships with some doctors who've poured into me so much and who I've been able to bounce ideas off and all of that, and I haven't even met them in person.

00:41:44.664 --> 00:41:46.871
Some of them I met them in person after three years.

00:41:46.871 --> 00:41:52.474
You know what I'm saying and so I don't want you to accept this, the fact that you can't have a great support system.

00:41:52.474 --> 00:41:57.351
I want you to know that you deserve a great support system and then build it.

00:41:57.351 --> 00:42:05.016
They may not all be in your area, they may not all be like you, they may be online and all of that stuff Just refuse to walk alone, right?

00:42:05.016 --> 00:42:07.041
And so what is a good starting point?

00:42:07.041 --> 00:42:23.443
In the communities where you do find yourself, show up, ask questions, talk to people, schedule lunch dates, schedule Zoom meets, zoom meet and greets, have conversations, start networking and you find your people, or people who know your people, and all of that stuff.

00:42:23.443 --> 00:42:31.117
Right, I will start, but I will start from this thing that of course my support system is out there and of course I deserve a great support system.

00:42:31.117 --> 00:42:33.362
And no, I am no longer going to walk alone.

00:42:33.362 --> 00:42:40.427
I'm just not going to do it right and know I am no longer going to walk alone, like I'm just not going to do it right.

00:42:40.427 --> 00:42:53.014
And so, whether there's spaces online, you know, if we have a number of communities, we have the Profitable Private Practice Movement, like if you're part of that, like when you come in there, show up, show up in the comments, connect with people and then take those relationships offline and stuff like that.

00:42:53.014 --> 00:42:53.655
Like, do that.

00:42:53.655 --> 00:42:56.737
The Entre Ambi Business School is another one, huge relationships offline and stuff like that.

00:42:56.737 --> 00:42:56.898
Do that.

00:42:56.898 --> 00:42:58.239
The EntreMD Business School is another one, huge, huge, huge one.

00:42:58.239 --> 00:42:59.860
Right, and build your own community.

00:42:59.860 --> 00:43:07.277
And in a time where most people talk about private practice being dead and you can survive and woe is us and all of those things find people who are saying the opposite.

00:43:07.277 --> 00:43:14.077
Find people who, like you, want to take their practices from not doing really well to really really profitable, to thriving.

00:43:14.077 --> 00:43:14.697
Right.

00:43:14.697 --> 00:43:17.983
So do that, right.

00:43:17.983 --> 00:43:21.715
So show up in those spaces and start building those relationships.

00:43:21.715 --> 00:43:28.277
Okay, set a target for yourself three, then six, then 12, then whatever and build that for yourself, okay.

00:43:28.277 --> 00:43:33.635
And then you know so good, well, it always comes back.

00:43:33.635 --> 00:43:34.579
You know what I mean.

00:43:34.579 --> 00:43:41.338
And so when you have an opportunity to help somebody and when I say help, I don't want to mean like you shut down your office for a day and go do stuff.

00:43:41.338 --> 00:43:42.695
I'm not even talking about that.

00:43:42.695 --> 00:43:48.920
I'm talking about simple things like somebody opened a new practice and you're mailing them a card and saying, oh my goodness, congratulations, welcome to the area.

00:43:48.920 --> 00:43:50.414
Somebody gets an award.

00:43:50.414 --> 00:43:59.110
You like, congratulate them Somebody.

00:43:59.110 --> 00:44:00.355
It seems like they're struggling, you encourage them and stuff.

00:44:00.355 --> 00:44:01.981
It's goodwill, and the thing about goodwill is it's going to come back to you.

00:44:01.981 --> 00:44:04.250
It may not come back from the person you showed goodwill towards, but it will come back from somebody, right?

00:44:04.250 --> 00:44:06.054
And so do that.

00:44:06.054 --> 00:44:11.012
Do it knowing that I'm just sowing these seeds and they're going to come back to me, but refuse to walk alone.

00:44:11.012 --> 00:44:26.139
And if you look in your circle, your network, your area, you'll find that there are people I can show goodwill into and there are people that I can start having conversations with and start building that support system, right, whether they're online or they're in person and stuff like that.

00:44:26.139 --> 00:44:39.170
And so I know we went through a lot of stuff, but I hope out of this you can build out like this is where I'm going to start from and revenue you really want to to start, you want to really want to start with fixing the revenue and all of those things.

00:44:39.170 --> 00:44:47.358
But you have things that you can say okay, these are the seven strategic things I'm going to do over the next 30 days with my team.

00:44:47.358 --> 00:44:57.344
So, with your team, you can do seven right, like I'm going to do over the next 30 days to put my practice in a position where we can start the process of thriving right.

00:44:57.344 --> 00:45:00.659
And these are the things you can map out.

00:45:00.659 --> 00:45:06.436
And if you have questions, you know for everyone who's watching the comments and all of those things like post them in the comments.

00:45:06.436 --> 00:45:07.380
I will come back.

00:45:07.380 --> 00:45:13.338
I may make a whole video on all of those things, but for this doctor, I want you to know that I am rooting for you.

00:45:13.338 --> 00:45:14.661
I believe in you.

00:45:14.661 --> 00:45:15.677
Obviously I support you.

00:45:15.677 --> 00:45:15.771
I that I am rooting for you.

00:45:15.771 --> 00:45:15.878
I believe in you.

00:45:15.878 --> 00:45:16.369
Obviously I support you.

00:45:16.369 --> 00:45:17.956
I guess I'm one of your supporters, right?

00:45:17.956 --> 00:45:23.320
I support you and I really cannot wait to hear about you turning this around.

00:45:23.320 --> 00:45:25.458
I know that, yes, it's going to be challenging.

00:45:25.458 --> 00:45:33.855
It may even get a little harder before it gets easier, but I know you can do it and I know you have the strategy and I'm rooting for you.

00:45:33.855 --> 00:45:42.317
Stay connected to us, whether you're in PPPM or you're reading the Profitable Private Practice Playbook, and we have so many resources.

00:45:42.317 --> 00:45:44.356
If you have questions, just post them in the comments.

00:45:44.356 --> 00:45:45.414
I'll come back for it.

00:45:45.414 --> 00:45:50.181
Okay, now I want to challenge everyone to take the link of this video watcher.

00:45:50.181 --> 00:46:05.378
If you're listening on the podcast, I want you to take the link and share it with every private practice owner you need, because these are strategies that work, whether your practice is struggling, or your practice is profitable, or your practice is thriving right Like these are the things we want to stay on top of.

00:46:05.378 --> 00:46:18.717
So we continue to thrive, because the more we thrive, the better it is for our patients, the more empowered physicians we have, and then we now have a group of people who can go into the healthcare system and turn everything right side up.

00:46:18.717 --> 00:46:19.710
Okay, all right.

00:46:19.710 --> 00:46:23.577
So absolutely rooting for you and I'll see you on the next episode.