Last month I wrote about long-term savings in tax deferred/retirement accounts, utilizing low cost/fee mutual funds. Recently, I was reviewing investment materials and the concept was crystallized even more.

Just think:

• If you invest $1,000 per month in a bond fund which returns 3% for the next 40 years, you'll have close to $1,000,000.
• If you invest the same $1,000 per month in a diversified mutual fund which historically has returned 8%, those investments will be worth over $3.5 million.
• If the same fund remained in place for 50 years, it would grow to about $8 million and...
• If the fund returned 10% rather than the 8% calculated, it would have a worth of $16 million.

Obviously, the power of time and compounding is compelling, but management and investment fees are also an important consideration... as a 1% fee would equal almost $2 million of the $8 million calculated return.  A simple and wise method may include the use of indexed mutual funds which are quite cost effective and may ultimately enhance your long-term return and "pot of gold."

So, get started today. Years go by in a flash and... it really is fun watching your investments grow!

A recent article in the Boston Globe health section touts a "new model of welcome care" being developed and implemented in the northeast. 

This model was developed after hearing patient frustration across the country due to lack of access to their doctors.  Many have resorted to drugstore clinics for basic care.  Primary care doctors are so harried that they are abandoning private practice.  Thus, the inception of what is being called "medical home" practice - an attempt to provide an alternative.

Doctors quickly answer patient's questions by email and by phone.  Visits are available from early morning into the evening and on weekends, too!  The team and the practice are designed to offer patient care WHERE and WHEN the patient wants it. 

What distinguishes this medical model from conventional practice is:

• a comprehensive approach to care from prevention through hospitalization
• providing as many services as possible in one location
• coordination of all other care using a personal touch and  electronic medical records. 

In Massachusetts a group of physicians affiliated with Tufts Health Plan opened a medical home aimed at diabetes patients.  The state Senate passed a bill last month that would establish this type of practice in 10 communities to serve low-income patients with chronic and/or severe illnesses and would be funded through the Medicaid program.  The project will be launched in 8 states (yet to be chosen) in 2009. 

The article further stated that "newly graduated doctors who have been trained to work in this setting are seeing benefits.  They are more satisfied working in this setting because they feel they are helping the patient more and spending less time creating records (thanks to the use of the Internet and medical records)."

So, what does this have to do with you? 

Well, you might want to seek out this type of model if you are starting into practice.  It appears to provide an alternative to the more traditional associateship and also moves you, as a doctor, into the future rather than staying in the past. 

If you are starting your own practice, why not seek out the entities who are forming this type of practice model and become a part of it? 

It's funny, I guess I have been around long enough to see things come "full circle"...chiropractors have always practiced this type of care: calling patients, providing a stress-free environment, a caring staff.

Hmmm ... maybe you have more to offer than you think! 

Have any of our readers explored this type of practice?   

Like me, some of you may already know what type of practice you want to have after graduation.  I often wondered if it was too early (or even too late) to start as well as where and to whom I should turn for this information.

Melissa and I knew that our plan was to have her associate while I opened a separate practice. But a unique opportunity presented itself for us both to associate in the same practice.  Ultimately, we decided to stick to our original plan. But it is important to be flexible with your options realizing that it’s not the plan that is important. Rather, it’s the process of creating the plan that is most important.

Everyone’s process will be different.  Your plan and the process of developing your plan will not and should not be the same as your peers.  Some will start early, some will start late.  And by the way, it’s never too late to start.

Many of my classmates didn’t start thinking about their post-graduate plans until 10th trimester and they are doing just fine now.  However, I started early because - as my fiancé would say - I am an over-analyzer by nature.

Although the ink on my diploma is just starting to dry, I still remember how tight finances can be while in school.  Use all the free information and seminars that are available to you as students.  Here are a few that I’d recommend:

• Your school’s career development center - set up an appointment with your career counselor if one is available.  Many schools realize the importance of practice management and offer free seminars and programs for this purpose. 
• Your local branch of SCORE (Service Corps of Retired Executives) -  they will provide you with a retired business professional in your area who can give a general understanding of business.  I first met with a SCORE rep in my 4th trimester and he directed the start of my business plan and also got me to start thinking about cash flow management - something I hadn’t previously considered. This was a valuable jumping off point; however don’t count on getting specifics of running a chiropractic practice. 
• The internet - the Starting Into Practice website (sponsored by NCMIC) is a great resource that I did not have access to, but I wish I had! 
• Instead, I accessed information on the SBA website regarding financial assistance and free online courses. 
• Use your school’s library and tap into your professors’ experiences.  There is wealth of knowledge right in front of you so don’t be afraid to use it.

A note of caution: Be sure to get your information from reputable resources.  There are lots of people and programs out there who want to take your money and guarantee success.

Ultimately, it doesn’t matter when or where you start but force yourself to begin the process.  Do your homework now to gain knowledge and experience to direct you to achieving your future goals.      

We are now in the heat of baseball season and since I am a devout Boston Red Sox fan, it is easy to render an opinion as to why they lead the eastern division of the American League.

The "Bosox", as they are referred to, have won more one run games than any other team in professional baseball.  One run victories generally rest in the hands of the relief pitcher, commonly called "the closer."

Jonathan Papelbon is the closer for the team and if he continues on the track he is on, there is no doubt that he will join the ranks of those players who have been elected to the Hall of Fame.

When he comes on the field, generally in the 9th inning, he becomes the personification of the word FOCUS.  When the TV camera zeroes in on him in a close up one can see that he is singular in his focus on the catcher--every fiber of his body is recruited in the challenge of throwing a strike--one deliberate pitch at a time with the objective of retiring the batter.  He does this time and time again with regularity and consistency. 

Why all this baseball talk in the SIP Blog?  Simple.  It's all about focus and consistency on a daily basis. 

When the patient is the absolute center of your focus and the focus of the staff and all the extraneous factors are set to one side, the ultimate winners will be your patient and the practice. 

Very rarely does something come out of Washington that actually works.  Even more rare is something that works and is a benefit to the population.

I'm referring to Health Savings Accounts (HSAs).  I'm a fan.  Not only are these good for chiropractors, I believe they are good for chiropractic.

If you are not familar with HSA's, here's how they work. 

• You contribute money into the HSA on a pre-tax basis, just as you would an IRA or 401K plan. 
• The HSA is coupled with a high-deductible, catastrophic care health insurance policy. 
• When out of pocket health care expenses arise, you use the money in the HSA to pay them.  T
• he money in the HSA accumulates if not used and can be an additional nestegg during retirement.

Why does this make sense for chiropractors? 

Chiropractors are generally healthy people and do not use the healthcare system like the average consumer.  As a result, most of the time, the deductibles on traditional healthcare policies are not met.  So by buying the high-deductible plan, you save money on the premium and have coverage in place for the big stuff, should they occur.

Meanwhile, money is being saved in the HSA to take care of any out-of-pocket expenses.  Which is why I think this is good for chiropractic. 

HSAs put the healthcare dollar back in the hands of the consumer.  When consumers are paying the out-of-pocket expenses associated with the high-deductible health plans, they will seek out the best value.  And guess what?  Chiropractic is the best healthcare value available.

The benefits of HSAs and high-deductible health plans go on and on....it's a more affordable way to have coverage for your family, you can offer the plans as an employee benefit, etc.

First enacted by Congress in 2003, HSAs work well and I think they are a step in the right direction when we look at healthcare costs.

Hopefully, Congress won't screw it up.

Recently, I was asked if a chiropractor has to be a Medicare provider?

The answer is "yes" - but don't  shoot me, I'm only the messenger!

Since January 2004, the Centers for Medicare and Medicaid Services (CMS) established that it is illegal for a chiropractor to opt out of Medicare.  A medical doctor or doctor of osteopathy can opt out of Medicare. 

What does it mean to opt out of Medicare?  If an M.D. or D.O. opts out of Medicare, it means that, although they are treating a patient with Medicare insurance, they are not accepting Medicare's payment for the services.  As a chiropractor, if you see a Medicare patient, then you must not only abide by all rules, regulations and payment schedules for manipulation of the spine, but you must also file a claim for the patient.

Often I will be told by the new practitioner that they are going to have a cash only practice.  While this seems ideal on the surface, it is not always practical.  Furthermore, if you see a Medicare patient, then you must file the claim for the manipulation of the spine if it is active care.

Can a chiropractor just not see Medicare patients? 

Sure, as long as you do not discriminate based on sex, color, creed or sexual orientation.  BUT WHY?  Consider that there are currently 80 million baby boomers in the United States.  They will soon be Medicare recipients. 

Do you want to eliminate a significant base of patients and future referrals, because you do not want to deal with Medicare? 

Consider also that if National Health Care becomes a reality, what type of health insurance model do you think the U.S. government will choose?  The apple doesn't fall far from the tree - now every man, woman and child has a Medicare-type insurance.

I personally find it very rewarding to treat elderly patients.  They frequently will break down crying in thanks for the pain relief they have gained through chiropractic.

Frequent readers of my blog know I consistently preach that you can't go it alone.  You need an attorney, a CPA, an insurance advisor....the list goes on.  These professionals will help you make informed decisions and hopefully help you avoid mistakes.

I have these relationships in place to help with my real estate business.  But just because an advisor was right for me several years ago, doesn't mean they are the best fit now.

Business needs change as the business changes, grows, shrinks, etc.  I am in the process of changing CPAs.  The guy I have used for years, just isn't up to speed on issues where I need his help.  Nice guy, I've enjoyed working with him.  But he's not meeting my needs so I need to make a change.

It was hard for me to come to this decision.  Will his feelings be hurt?  Will he wonder what he did wrong?  Or will he recognize this is a business decision and I just needed to move on?  The latter is the most likely...he's a business person too.

As your practice changes, your needs will change too.  Keep your options open and if an advisor isn't doing what you need, it's time to switch to a horse that will help you win the race!

Inevitably, most new D.C.'s find themselves asking ... "Now what?"  Maybe you've decided exactly how, what, where, and when. 

Maybe not. 

Either way, it's OK!  For those of you looking for some quick tips on what to do those first few weeks out of school, this list will help get you started. 

1. Relax. This is the time to get your thinking cap on and avoid running around like a decapitated chicken!  Boards, graduation, moving, start-up loans, and interviews.  Yea, I get it ...it's chaos ... but get organized and stay focused. 
2. Make sure your student loans are in order.  Your university's financial aid department can provide exit interview information to make sure your most important financial commitment is accounted for.  Note: in some states, your license can be revoked for defaulting on student loans!
3. Finish your boards and apply for a state license.  Unfortunately, your diploma is just an expensive piece of paper without it!
4. Call the major insurance companies (Medicare, Blue Cross, etc.) and ask for a credentialing packet to be mailed to you.  You won't be able to fill it out yet, but it's good to have it available when it's time. 
5. Once you have a license number and are waiting for your credentialing packets, start the application process for an NPI number.  And YES...you'll even need one as an associate or independent contractor.
6. Make a list of how you're going to get patients!  Brainstorm ideas and borrow some from others.  Don't be afraid to look at other professions for creative ideas that can be modified for chiropractic.
7. Make a list of stuff you're going to do during your down time.  A "to do" list that exists for the sole purpose of filling the void when you're not seeing patients is a great way to stay motivated and control the mind-numbing silence that occurs while waiting for the phone to ring.   

Please take advantage of all the resources within the Starting Into Practice Checklist for further details!

Good luck! 

P.S.  Don't forget to celebrate your accomplishment!  Congratulations and welcome to the profession!

When I am doing the Starting Into Practice seminars, I always preach that new practitioners should take advantage of opportunities and speak whenever asked. 

Well, I was asked last month and I did it. 

It was a high school career day and although I am not new in practice and may not need the exposure, I was honored that they asked me.  After I did the presentation, a few things occurred to me.

• We need to constantly educate the public...no matter what age they are in terms of what a chiropractor is and does.  I enjoy getting their idea or definition of what a chiropractor does and go from there.
• Make a PowerPoint presentation with all kinds of slides that can be used for any occasion.  Kids love technology!
• Make it fun and interactive.

Even if I do not get a single patient from that career day presentation, it is a wonderful opportunity to EDUCATE the public at a young age.  For those of you intimidated to speak in public, high school students can be a great way to start. 

As I have always said...speak whenever asked!

Maybe you're interviewing for an associateship. Or maybe you've decided to start your own practice. But what if you can't decide? Maybe you just need some good, solid advice.

Whatever you're doing - do it with some well thought-out questions. Here are some interviewing tips that might work well in any of those situations I just mentioned. Hopefully, they'll open up some great conversation to help steer you in the right direction.

Understand the "Big Picture"

It may be easy to worry about yourself, the job you want and all the things you need to get done. But take a step back to look at the big picture and where you want to be in the long-term. That discussion may open up some new doors and new ideas.

Find Out What Keeps the Boss Up at Night

Think about this from the boss' perspective ... understand what that person is thinking or worrying about. What worries the hiring DC? What did he worry about when he was starting out?

Look for Answers

No one expects you to have all the answers. It may actually be better to demonstrate your willingness to consider options and find solutions. It seems like everyone likes to give advice - so stop and listen.

For more great tips, read 7 Things You Must Do in an Interview. It makes a lot of sense!