00:00:04:03 – 00:00:54:09
Welcome to Shorr Solutions: The Podcast. I’m your host, Jay Shorr. I’m the CEO and founder of Shorr Solutions, a national and award-winning consulting firm, assisting aesthetic and surgical practices with their operational, administrative and financial success. I have an amazing team of practice management experts and clients across the U.S. and as an industry expert with firsthand experience owning a multi-million-dollar cosmetic dermatology and plastic surgery practice.
Listen in as I lend you my expertise and best tips to successfully manage and grow your aesthetic practice. I will also be bringing in guests along the way, so get ready to be equipped to operate your aesthetic practice strategically and profitably. Welcome to Shorr Solutions: The Podcast.
00:00:54:10 – 00:01:10:09
This podcast episode was originally recorded as a webinar for the American IV Association. However, we thought the content was so important. We wanted you, our loyal podcast listeners to hear it as well. We hope you enjoy.
00:01:10:10 – 00:03:46:14
Employee handbooks, protocols and compensation strategies in your practice. My name is Jay Shorr. I am the founder and CEO of a National Award winning practice management consulting firm, and we specialize in the operational administration and financial help and guidance of your medical practice.
So before we get started, I want to actually share a couple of things about medicine, and we say, what is medicine? First of all, medicine is a science. Naturally, we’re doing about anatomy, physiology, pharmacology, health and medicine as a way to heal the sick and injured in the aesthetic business in the regenerative medicine business. It is a way to keep our patients looking young and beautiful.
It is one of the most respected professions today and most importantly, medicine is truly a business. Now, why do I say that? Well, because we have to treat it like the business that it is. Now, before we begin, I really want to try to share some of the most important parts about AIVA. It is not something new. The conference itself is new.
However, what’s mostly important is regenerative medicine is not new, but it has become so popular and IV therapy is now being integrated into multifaceted types of medical practices. Example: family practice. It’s being led to regenerative medicine in aesthetic and cosmetic medical practices as an additional level of service. So all types of practitioners now are bringing in IV hydration therapy.
But what’s most important is safety. So what are the priorities of medicine? Priorities of medicine. Number one and foremost is safety of our patients and safety of our staff. By far, the most important thing. Secondly is to protect the health and welfare of all of our patients. Number three, have fun. And lastly, make money. And I assure you that if you practice steps, numbers one through three, you will make money.
00:03:47:00 – 00:08:04:06
So let’s get started. So how do you create an employee handbook, implement protocols and create compensation strategies in your medical practice? Well, some people wing it, and that’s really never the way to go because when you wing it, you’re always going to be behind the eight ball. You’re always going to be able chasing your tail, changing it all the time.
And there’s nothing wrong with change because as we progress and as we grow, we always want to change for the better. So what is it that we want to do in creating an employee handbook or a practice handbook? Protocols and compensation packages? We have to really define what is a handbook, what is a protocol, and how do we define and how do we create compensation strategies in the practice.
Well, an employee handbook has to include several things policies, procedures, protocols in your medical practice. It includes benefits, it includes PTO, who does what. How do we do it in each step of the way? And people say to me, Well, what do I put? What kind of a thing do I put into a protocol? And I even say in my former medical practice here in the Fort Lauderdale area.
Now, let me make a disclaimer before I start. I am not a physician. I’m a businessman in the medical industry. So when I referred to my practice, we had a dermatology facial body, plastic practice, aesthetic cosmetic gynecology medical spa, and we did a weight loss and IV hydration therapy. And this was before it all became as big as it is. Before social media, actually.
So I always say a protocol starts from how do you open the door in the morning? And lastly, to how do you clean the coffee pot and lock the door at the end and everything in between. And the reason that you want to have protocols is so that it all goes so seamlessly that if and when you need to hire more people or you discharge others and you bring on other people, you have what’s called a playbook.
And a playbook is something that has the rules and regulations. I call them policies, procedures and protocols. In your medical practice so that each and every person, when they start and while they’re employed, know exactly what the rules and regulations are, each and every step. Now, in the olden days and I say in the olden days because I’m one of those olden days kind of guys.
So in the olden days, we used to have a handbook, we used to print it, and it was 30, 40, 50 pages long, and everybody would get a copy and they had to sign it. And you kept the receipt in their HR File. Well, today you create the handbook and we’ll go over that in a little bit, and you put it in the cloud, and therefore, for when you have a change, you just make the change in that particular handbook that you have.
We create these all the time. Then what you do is then you allow each and every one of your staff members to know at the time that you make the change, whether you have a staff meeting or whether you send an email to each and every one, or you do it through your intranet What’s an intranet? An intranet is that system that you have that’s only within your practice, whether it be Teams or you can send messages and then you give them the link that it was and they’re able to view, but you let them know what the change is.
It’s kind of similar to when you get a notice from some of your vendors like American Express or MasterCard, and they want to have a change of terms and conditions. Well, that actually you can click a button, click the URL, click a link, and it takes you to it. But what they do is they give you the exact change of that particular protocol.
00:08:04:08 – 00:12:48:11
So in an employee handbook, tip number one, you should always include a staff social media policy. What do I mean by that? A staff, social media policy. And today everyone wants to be a quasi-influencer either personally or within your practice. So each and every one of you should have a social media policy. Now, what is that and what does it do and how does it help you?
Well, it’s a document that tells you the do’s, the don’ts, the shoulds, the shouldn’ts and everything in between. And what happens. The most important part about that is they can post, but not on their own feed about anything within your practice, nothing about patients, nothing like before and afters. Because when a consent is signed and we’re going to get into that in a little bit, when it consent is signed, it’s usually, if not always between the actual patient and the practice and not necessarily an individual provider unless you as a provider are the practice.
Now, it does not give you unilateral consent as a provider to take those photos and put them on your cell phone, for example. That leaves the office because now we’re speaking about potential HIPAA violations and that’s another animal in and of itself. But I always say that social media policy tells what you can post, what you can’t post, what you should and shouldn’t post, and the legality behind it.
Because the last thing that we want to do is put the medical practice in any kind of legal danger. All right. So with that, we always say, how do you post or have a staff member post anything about the business on the business page and then you can repost it on your personal page and not have it become part of the initial part of the social media standard.
As far as the employee’s social media handbook, Instagram, Facebook, because a patient may withdraw a consent at any time. All right. So I really want to be sure that we understand that. So everything from your state compliant benefit to your social media policy goes in your employee handbook, your PTO plans, personal time off, whether it is accrued or earned PTO, the separation difference between your vacation and your personal time off, sick days, whatever other benefits you give them.
The technology policy, for example, the device that you physically take any pictures on, should never leave the office. And you say why? But for those of you who are in other modes of medicine, for example, if you’re in the aesthetic cosmetic, but you’re providing IV hydration therapy within your integrative medicine portion, whether it’s your medspa or separate division of your business, you really want to ensure because of HIPAA, that those devices that you take the pictures on, don’t leave.
Why? What happens if you lose the cell phone? What happens if it’s stolen? And people say, well, but I have double encrypted and password protection, I can tell you there are glitches sometimes where you push specific buttons and there are people that are hackers and they know how to get into it. And if they see pictures of patients that were taken, the commonly known PHI, protected health information, that gets out to the general public without their consent.
I’ll repeat without their consent, because you remember the patient gave that consent to the practice unless otherwise delineated inside that consent. But most of the time it’s within the practice. And for those of you who are practice owners, I strictly urge you against giving employees the unilateral consent to have those pictures, because who owns photos in that practice?
So it’s that technology practice about social media as well.
00:12:48:12 – 00:18:54:02
Tip number two before and after protocols for everything from taking the photos and storing them, including a written policy about who owns the photos. Now, remember, just because somebody is a provider, it’s not like they own the photography. Totally different than you hire a photographer to do a wedding ceremony or to do a photo shoot.
Believe it or not, the photographer owns the photos and gives you the right to have them. So in the event that a staff member were to leave your practice, they cannot, I repeat, they cannot take those photos with them unless you already have a legal binding agreement because it’s taken for educational purposes, it’s taken for board certification when you have to present, but always make sure that you have a very specific policy on who owns those photos.
All right. Very important. And which forms of media, the patient is signing off on? Number one, is it educational purposes? Is it for conferences that you can show? Is it for the academia? I teach at Florida Atlantic University here in South Florida, in the medical business management. And there are occasions where I might show something, but it’s for educational purposes.
When we’re speaking at the different conferences, we urge people in the attendance not to take pictures because they were given the concerns were given for educational purposes Only Now is it for radio. Is it for TV? Is it for any type of a newspaper magazine? Please believe people still do newspapers and It’s not that there’s anything wrong with it.
But website they have to check off on all of those. That’s a typical protocol. And now where are all of these photos stored? Are they stored on, here’s my age coming out, are they stored on a server or are they stored on separate external drives or are they stored in the cloud?
HIPAA compliance is the number one criteria here, and don’t think that you have a personal Gmail and that’s okay. You have to have specific types of programs that have HIPAA compliance. And also many of these vendors such as myself, as a consultant, if I have access to any of the protected health information or any vendors, EMR or website vendors that I may have access to this. Ensure that they sign a proper, and I mean, proper business associate agreement. That goes for each and every person outside of your employee staff because you should have NDAs in every one of your documents for your hiring process.
But in the event that there is any external third party source that has access to protected health information (PHI), then they have to sign and execute a business associate agreement. And you need to store that because a business associate agreement defines what happens in the event of a breach. Example, if you recall, Target had this big breach, if you recall, some of these credit card and credit companies have a breach and they let you know that there was a breach potentially of your protected health information or your credit information, and that they’re willing to give you some type of an offer.
And more importantly, what is the remediation process to prevent it from happening again if in the event that it happens. So calling a patient always changes their mind. If you do something wrong in your protocol, don’t let it slide. If you call a patient and you share with them that there was an error, most of the time they’re going to be very forgiving, but some of them are very litigious.
And in the state of Florida and in the Republic of California and sorry, but any of you listening from California, you’ll understand what I mean. Extremely litigious and we have to protect ourselves. So our goal as AIVA one, they have these wonderful webinars and they have these educational sessions. The one example in Fort Lauderdale for those of you will be attending, I’ll be doing a couple of lectures.
Our role and our goal is to protect you from you in spite of you. Because although we all want to be very efficient and we all want to take as many shortcuts as humanly possible, we don’t want to do anything illegal, unethical or knowingly immoral. All right. So once we pass that portion, we’re often running to ensure that we do not intentionally disparage a patient, give away any of their protected health information, and we store photos properly. We have proper consents, and we’re going to get into that as well.
00:18:54:02 – 00:32:49:06
So tip number three: consents, consents and more consents. So, you have to have a consent for every single procedure that you perform in your practice. Here’s the caveat and you have to have it in the language that your patient speaks and or have somebody with them that can translate to them what it is that they’re signing.
Now, look, I know having run and owned a practice that you are running at 100 plus miles an hour and in order to be compliant, what do you do? You give them a consent and you ask them to sign it. And most of the time a patient will pencil with it, whether it is for IV drip therapy, whether it is for neuromodulators and dermal fillers, or whether it’s for any other nonsurgical and or surgical treatment.
But what is the purpose of a consent? The purpose of the consent is two things, to be an informed consent to give the patient the information so that they are properly informed about all the adverse reactions and contraindications associated with each and every procedure you’re going to perform. Now, just because we’re going to go, let’s just say IV hydration therapy and somebody is going to do it once every two weeks, once a month, hopefully more often.
But let’s just say you’re going to give them that and they’re going to come in and you ask them to sign a consent. Just because they signed the consent then doesn’t mean that the next treatment that you’ve figure, but they’ve already signed the consent. Now, here’s the game that I have done. I had the major consent. And then on a separate page that refers back to the actual consent, regardless of how long your consent was, was a signature and witness consent for treatment number one, two, three, four, five.
But what you’re doing is you’re signing with the patient is acknowledging and signing that they have read and understand once again all the contraindications, adverse reactions to each and any and every treatment that you’re going to perform for them. And why is it have to be in a language that they understand? Because if it is ever argued in a court of competent jurisdiction, you want to make sure that you can share with the court that they were explained in the language that they understand either by you or by somebody that came with them.
Now, here we’re in South Florida and we have a lot of clients in Texas, California and South Florida. The number one sometimes primary language here is Spanish. It’s a very heavy Latin American community. So I know that in Texas and I know that in California, and of course, there’s a lot of others. So we always and I mean always had staff in our office that were bilingual.
So depending upon where you are, I urge you to have bilingual staff members that can explain it and or have dual types of consents. We had consents that were written in English, in Spanish, in French, Creole and things like that, and there was a very heavy Russian community in parts of South Florida. So wherever it is, and we have clients in the Southern California that is very heavy Chinese and we have Chinese staff people.
But don’t do Google translate. It doesn’t fare well. You want to make sure that you have it properly translated. All right. That was tip number three.
So can multiple procedures be combined into one consent? Yes, they can. I prefer to have individual procedures so that it doesn’t get muddied up. But if you are a surgeon, for example, and you’re doing a tummy tuck with lipo, then yes, you can do that.
And it’s preferred that you have individual consents, but if that is a combo procedure, as long as you have the proper adverse reactions and indications that will share what happens, that’s fine. But it is very important. Even with IV hydration therapy and people say, Jay what problems can happen with IV hydration therapy? Anything can happen. And there are new rules and regulations every day in certain states that have the mandates of what has to be done.
I’m not going to get into that right now. That might be for an attorney, that might be for a doctor. And let me reverse for a second. When I said I owned a medical practice and my disclaimer was, is that I am not a physician, here in the state of Florida, a non physician may own a medical practice.
There’s other caveats with that. But the corporate practice of medicine, you know, is different in Florida than it is in many other states. For example, in Texas, for example, it has to strictly be owned by a doctor. And then there could be MSOs and management service organizations. I’m not going to get into that. Whereas in California, 51% has to be owned by a doctor and 49 by other licensed medical professionals.
All right. So multiple procedures can be combined into a consent. I’m not sharing that it is the best way to do it, but it can be. So how often should a consent be signed? each and every time a procedure is performed? Why? Because things can change in a patient’s health. A female from the first time that they had a procedure till now can be either on any additional types of bioidentical hormone therapy.
They can be pregnant, a patient can be undergoing cancer treatment and other medications, and you want to make sure that what you’re putting in, even though it might be innocuous, you want to make sure that there is nothing that can, you know, have an adverse event. What you want to do, bruising on the eye, the swelling on the infiltration, many of these things are perfectly normal things that can happen.
But I always say you want to advise and have a consent, because if you’re going to be providing a treatment, let’s just say it’s on the face. Of course, we don’t do the IV on the face, but let’s just say that you’re having a treatment on the face and you want to let the patient know that you can bruise black and blue, you can swell.
And then all of a sudden the patient comes back to you and says, well, I had a wedding, I had a christening, I had a bar mitzvah, and I looked terrible. And now they want their money back or they want to sue you. Not that the case is going to hold up. I’m not the lawyer. One of my very professional colleagues, Jeff Cohen, is from the Florida health care law firm.
All right. That would be a much better resource to tell you what you can and can’t do on that. So I should say that a consent should be signed each and every one. And where do I get these procedural consents? Very interesting. Procedural consents can be gotten from your medical society example from the American Board of Plastic Surgery or AIVA will be having different types of things that you can subscribe to.
And I urge you all to become members of AIVA because you want to ensure that if you’re doing something, you’re doing it right and you’re doing it right by a professional organization like AIVA that has great legal advice and they’re not putting anything out that isn’t properly vetted by legal counsel, and that when you give these to the patient, that you’re going to make sure that if it ever has to be argued in court, that they’ve been vetted ahead of time.
If you have a consultant, this is not a sales pitch, but a consultant like us, we have a toolkit of over 300 procedural consents and policies and procedures and protocols. And if you have a good attorney or if you have a good consultant that specializes in the industry that you are doing, it makes it very easy because you may subscribe to or it may be part of your consulting package.
And we can also customize them for you because although consent can be alike, for example, the American Board of Plastic Surgery, the American Board of Facial plastic surgery, if you belong to those organizations, they have books that you can purchase that have all of these, right. Or have one that’s made up by a company that specializes just in that, along with the operational, administrative, financial, health and guidance of your practice.
So any other areas of concerns is what you should put in your process book, your handbook, whether it’s employee or practice, and have a checklist so the patients know all of the options that are available when they come into your location. Let me give you another example. We had a leading dermatology, facial body, plastics and cosmetic plastic gynecology practice here in South Florida that encompasses three counties.
We were in Broward County, which is right in the middle of North Pole Beach County and to the South Dade County. There was nothing on either side except the ocean. On one side to the east. So really what has to happen is that you want to know what options are available, because when a patient comes in, if they’re coming in for IV hydration therapy, for example, but you are not just an IV clinic.
You have other things that you do. How do they know that? So I believe in having a checklist. Now the checklist is what are the services that you perform? Now, what is the most hateful time that a patient has to spend in the office? when they first come in, you know that hateful forms and paperwork or checklist, whether you do it on paper, on a clipboard or whether you do it on there was a company called Freesia that would hand you a pad.
Now, there’s other companies out there and you fill it all out on line. I’m thinking about inventing a microchip like your dog has, and you insert it right under the skin. I’m only kidding, but kind of serious. And each time that you go to a doctor, they just scan the chip right back into, so anytime you go into a doctor, it has everything you do.
All right. Kind of like a joke, but I think it would be a great idea. Now, what’s the best part? I became embarrassed in my derm and plastic surgery practice, and I knew I was doing something wrong. When a dermatology patient would ask, Do you know a good plastic surgeon? and when a plastic surgeon or medspa patient would ask, do you know, a good dermatologist?
I knew I was doing something wrong. Why? Because why shouldn’t the patient come to me? I don’t want a patient going to another doctor to have an IV, for example. They may go to one of these storefront clinics. Nothing wrong with those. But, you know, the franchise or chain models that I’m speaking about. And what happens is if they go there for their IV and they also might do neural modulators, neurotoxins and dermal fillers, microderms, and things like that, they may leave my practice and never come back because they’re able to do it in a one stop shop.
So I always share, let the patient know. And any time you introduce another procedure into your medical practice, let the patient know. Either put it on your music on hold, or if you have a video TV in the reception area, not the waiting room. Nicks that word “waiting room”. All right. That’s not what we want to hear. It’s a reception area, relaxation area.
It’s that time that we don’t want to keep the patient waiting where they have to stay there for hopefully not too long. But if you have a video board or you have a TV in each exam room while they’re waiting, it scrolls instead of allowing them to be on their iPad, iPhone. Let them know everything that you do.
There’s a reason why retail stores where they used to wear or sometimes still do “ask me about.” There’s nothing wrong with that. Even having buttons made up. If you have a new procedure, ask me about IV hydration therapy. So if you are not just an IV business and you’re introducing that new into your practice, it’s a wonderful way for the patient to say, Oh, I see that you do IV hydration.
Can you… oh, then you get all excited about it and it can kill that time that the patient has to wait. But you must dedicate good resources and employee staff to positively and I say positively, explain it to the patient so that you can keep having them back for more. I call it the upsell of the upsell. So let them know all of the wonderful services that you do in your location and don’t assume that they know it.
00:32:49:07 – 00:34:30:06
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00:34:31:08 – 00:39:31:02
So what you want to be sure to include are symptoms in your consents, not treatment names. A patient doesn’t understand legal jargon. Patients don’t understand medical terminology. All right. You might say, yes, they do. But it’s easier, for example, to say to a patient that we’re going to give you and call it what they want. You know, a patient looks up nose job instead of rhinoplasty.
All right. So you want to make sure that they totally understand what it is that you’re trying to explain to them. And how often should a patient fill it out? Like I said, each and every time that they’re in the office and make notations, either in the EMR that you’ve given it to them. And when if you are still on paper charts, put a little code that they filled it out.
And when you’re in the exam room with that patient before the physician or the nurse practitioner, aesthetician physician, associate physician, assistant, whatever they’re called in your particular practice that they reintroduce and say that, you know, we’ve added a new procedure because what the patient had filled out from the last visit until now can be much, much different. You may have introduced a new form of technology.
I’m not going to name any of them. All right. Because You may not have seen them six months to a year and they’re coming back into you if you’re family practice for semiannual or an annual. And then lastly, what each team member should be doing with this wonderful worksheet, and that’s explaining it to the patient, Go over it, go over it again and go over it again.
Why do I say that? I have a term called compelling events. And let me explain what a compelling event is. How many times do you walk into a supermarket and you might pass by the gum, the mints, the candy at the checkout and you don’t buy it? I’m not even going to get into those crazy story newspapers about all the garbage that’s going on in the world about celebrities.
But let’s just let’s just do gum candy mints and you’re in a hurry in the checkout and you leave. But one day you’re in there and you’ve got this horrible taste in your mouth. And all of a sudden that one $2 Altoids gum, candy, whatever it was, looks very appealing to you and you buy it. Well, it’s the same thing with our business.
You come in and a patient says, I’ve been feeling tired. I’ve been feeling run down. Oh, well, are you aware that this wonderful hydration therapy we could offer you and it gives you all this supplementation and nutrients, and I’m not going to get into what they are. That’s up to you. As the medical professionals. And it could make you feel wonderful.
It’ll give you a feeling of a lot more strength. You’re not going to feel tired. I remember IV hydration therapy when I was working in the OR in my trauma days. I was a trauma medic. And it’s not because I’m a physician, but we used to get in the ER. It was a Saturday morning, Friday night, Saturday morning, Saturday night, Sunday morning.
The rally packs. All the drunks would come in and they needed to have an infusion of IV Now it’s for health purposes and not just because it’s a drunken stupor. So what each team member should be doing, this worksheet is explaining it to you and sharing with the patient the benefits, the wonderful benefits, and have memberships and have great introductory processes.
I know that when I had to go to a surgery, I needed a medical clearance. My doctor, my primary care, my internal medicine doctor was on a vacation, so I went to an urgent care center. And in the urgent care center, they’re now doing I.V. hydration therapy at the urgent care. And it was in the back of the door, in every room.
And they told about the different vitamins that were in it and it told how much it was. And the person who took my blood pressure and my heartbeat and the pulse oximeter and everything like that, they explained what this was. And it was wonderful because people don’t know that you’re offering it and you give the features and the benefits of it each and every time.
00:39:31:02 – 00:42:48:11
So number five, a pre treatment checklist for every patient to make sure that nothing gets missed along the way. The pre treatment checklist and the consent. As you can see in this particular graphic, the doctor or practitioner is going over this with the patient versus what I said before, just throwing it in front of the patient and asking them to sign it.
And at the very, very end, you have to say to the patient, is there anything that you have questions about in addition to what I’ve explained? in summary, I call it, never leave the room without asking the patient if there’s any other questions. It’s similar to the standard consent form. All risks and complications have been explained and the patient has elected to proceed.
That’s part of the OP notes. In general notes. But I would also share and have the patient initial that as well, because it is acknowledging that they’ve had the opportunity to ask questions and that they are comfortable and ready to move forward. Why? It’s another means of your argument in the event that you ever have to proceed in any type of litigation.
So what are the two terms contraindications, adverse reactions, medications to medical clearances every step of the way that you want to include when you’re ordering supplies for this, a procedure, should this be included as well as who in the practice is in charge of that? This is a protocol now, not necessarily from the patient’s point of view. So when you have a protocol, the protocol for who orders medications and supplies, well, from the medication to medical clearance, who is responsible for the medical clearance?
There’s a checklist each and every step of the way. For whom does what, where, when, how. All right. So when you order supplies for the procedure, should it be included in the protocol? Absolutely! as well as who in the practice is in charge of that specific task. Don’t let any stone go unturned. And then they should be one person who oversees the entire process to make sure that nothing gets missed.
Now, who could that be? That could be an administrative person, your practice administrator, your practice manager, or it could be the lead provider, whether it’s the doctor, usually the doctors may be too busy for that. However, whether it is your head nurse or whether it is a physician assistant, physician associate or nurse practitioner, I always want to know that there is a check checking the checker
00:42:49:11 – 00:50:45:06
Now, tip number six post procedure follow-up protocols are amazing because it includes when and how to schedule the next appointment. Both surgical and non-surgical appointments. All right.
Follow-ups. It’s very important that you follow up. Now, most of the time in heavy procedures, surgical, there’s always somebody that should call the patient that night to see if everything is okay. I’ve had, you know, in our practice, I even had the provider who did the procedure, whether it was medspa procedures or any type of procedure, including, let’s say, an IV hydration therapy.
Now, how many are you going to do in a specific day? Eight. Ten. All right. Well, maybe you assigned specific staff members and it’s always nice to even have that practitioner who provided that procedure to call the patient just to say hi, this is Jay, this is Dr. So-and-so. How are you doing? How do you feel?
And you document that in the patient record. Believe me, it goes a long way versus doing the procedure, getting them up to pay and quote unquote, kicking them out the front door until the next time you see them. I know we don’t do that. Hopefully we escort the patient out instead of letting them walk out the door themselves.
Do you what I just said? We escort the patient out of the door no differently than wonderful restaurants and wonderful hotels do. There should be a protocol who reads the patient when the patient walks in the door? And I don’t mean the director of First Impressions, commonly known as your receptionist is sitting down when a patient walks in the door and they’re still sitting down when the patient comes up to the front desk.
To me, that is totally unacceptable. That person should stand up, greet the patient, shake their hand. It’s something to allow that patient to know. And we should always greet that patient and thank them for being a part of our family today. And when they’re done, thank you for taking the time to be part of our (the name of your practice) family.
We appreciate you as being part of our family because now you’ve already scheduled their follow up and their next treatment and it should never change. Example when there are brand new patient, when the patient walks in the door and who knows the patient’s best? Your director of first impressions. It’s uncanny. But I never understand why that director of First Impressions is usually the least paid in your practice.
It wasn’t in my practice. They were paid equal to that of a medical assistant. Why? They are the director of First Impressions. They may be the first and the last person that a patient sees when they’re leaving and when they’re coming in. And we want that to be an experience, a positive experience, and not an interruption of your day.
I know if it wasn’t for the patient, you’d get a lot of work done, right? The patient is your business. So including the how to the post procedure follow-ups means if you’re going to sell them anything at that time, you share with them why what they’re purchasing, whether it’s over the counter medications or over-the-counter garments or over-the-counter skin care products, you make sure to credential the person who recommended it and the wonderful experience they’re going to have by using the product that they’re purchasing.
And now you’re rescheduling it. Is it any different that when you go to an OBGYN, they schedule if you’re going for a papsmear, They scheduled that next appointment before you leave. Any time I go to my dentist for my teeth cleaning, they schedule my three or my six month follow up appointment as I’m checking out. I love it because I’m very busy and I will forget that little card that they give you that two by three, whatever it is, it gets lost.
And so what I do, I put it right into my iPhone or whatever mobile device you have, and I put it in with reminders. And then, of course, another one of your protocols is whether or not in your EMR or practice management software, you have patient reminders that may be a week, whether it is on text, whether it’s on email a week.
Reminder ahead of time, three days, two days, one day. It is never an interruption of my time. Let me explain again. It is never an interruption of my time when somebody reminds me of an upcoming appointment. Why is it important? Because I can even forget the day before and I want to ensure. Plus, it allows you to know whether or not the patient is going to have to reschedule.
It is what if you do it by text or if you do it by a phone call that the patient picks up, then it’s click one to accept, confirm two to cancel, three to reschedule. And then of course, that goes into your practice management software. And that should be part of your protocol of who is the person in your practice that’s going to contact the patient again.
And when you’re doing this for your IV hydration therapy business, you always want to make sure why? Because you’ve already booked out that time or your provider. And when the patient doesn’t show when they didn’t give you the courtesy of rescheduling in due time, that seat on that airplane that just took off is gone, never to be recaptured as far as the revenue.
So we always want to make sure. So when and how scheduled your next appointment or your treatments, what to look out for. I’m summarizing what’s normal and when they’re due back. You know, if a patient has infiltration, if they have a bruise, a black and blue mark, if they swell, if they have any type of an adverse reaction that would otherwise be normal, if it’s explained to them and it happens.
The patient’s going to say, Oh, of course I was expecting that. Then if it doesn’t happen, it’s a bonus. But when it’s not explained to them and it does happen, it’s a little alarming, especially if it’s the first time that it’s happened, similar to that of a brand new parent. Every time the brand new baby hiccups, coughs, burps, passes gas, cries, the parents are frantic.
But the second child, not as frantic, and by the third child, eh, all right. Not that they don’t care, but they’re used to it because of self experience. But when the patient is due back, have a protocol in your manual. It’s very, very important. All right. So that they know that they’re due back in one week, two weeks, a month.
00:50:45:07 – 01:00:12:06
Now, let’s get to the financial part, your protocols, your policies in your manual, your practice, manual. Budgeting your spreadsheets. This can be your profit and loss, which is your P&L or a pro forma analysis and review of your business plan. Now Why am I stating this? Because if you remember in the first couple minutes of our presentation, we said that operational, administrative, financial or marketing, once again, operational, administrative, financial marketing.
Why? Because medicine is a business and we have to treat it like the business that it is. Now, look, we’re here to help patients along the way safely and efficacious, but we’re here to make money. Otherwise we wouldn’t have a business. We would go work for somebody and let them take all the problems and the hassles of running a business.
So you want to have some way to have your P&L analyzed and have a pro forma analysis in your business plan. Folks, if you don’t have a business plan, you are missing the eight ball. Why have a business plan? We write business plans every day for clients because you want to know what do I have to do?
When am I going to have to do it. How am I going to do it? And what financial gain am I going to get out of it? And at what rate? So a business plan is designed. Now, look, we are in the second quarter of 2023. My help time has flown April, May, June, second quarter. You should have already written your third and fourth quarter plan months ago because what your business plan is for whatever you’re doing today, whether it’s marketing or whatever, isn’t going to affect your business until the next quarter because the generation of revenue and money that you’re doing today is from the efforts that you did months ago.
All right. In your marketing. Now the actual procedures that you’re doing today are going to generate that revenue. But how else do you know if you’re on par if you don’t have a plan? It’s kind of like going somewhere. It used to be MapQuest. Now it’s your GPS on your phone. If I said to you folks, I’m inviting you over for dinner to my house on Saturday to watch the Florida Panthers or tomorrow night to watch the Florida Panthers play in the Eastern Conference Finals, you’d say.
I’d love to thank you for inviting me, Jay, but how am I going to get there? Well, that’s a plan. You type in the address and that’s your plan. But in your business plan, you want to know staffing, you want to know revenue, you want to know all your expenses and you want to know is it profitable and what marketing ideas, what advertising, what am I going to do on my website?
How am I going to analyze the results of my efforts? Example Conversion cascade. I do a certain amount of marketing. What’s the purpose of my marketing purpose of my marketing? Well, this is going to be cylindrical. The purpose of my marketing is to make the phone ring, right? Whether it’s social media, whether it’s my website, whatever it is, it’s to make my phone ring.
Once my phone rings, I have to get that call to schedule the consult, and when I schedule that consult, what’s the purpose of the consult? To perform a treatment. Market to call, call to consult, consult to treatment. Treatment generates revenue and then the re-treatment. So remember, it’s a cylindrical conversion cascade. All right. So it’s very important. That’s part of your business plan.
And you review the numbers because you want to know what am I paying for a product and supplies. Have a spreadsheet for something that you’re comparing each and every gauze and needle and syringe and IV tubing and all the medicines and the medications and the saline. Of all the procedures that you’re performing and you’re able to compare, What am I paying?
Let me share something. It’s very important that you do market analysis financially in your business. And why? Because each and every dollar of revenue that you generate in your practice may generate 30%, 35%, 40% margin. If you’re lucky. GROSS dollars is defined in dollars, margin is defined in percentages. However, every revenue dollar is a percentage. $0.35 of every dollar might be your profit.
But when you reduce expenses and I can reduce this item from $0.25 to $0.20, may not seem like a lot, a nickel, but everything you do for every amount of treatment, every dollar that you save in your business is a 100% margin dollar, profit dollar. Repeat every dollar you generate 30%, 35%, if you’re lucky. Every dollar that you reduce in your expenses is a dollar profit.
So why not go through the painstaking agony of reducing your expenses? Because it takes a lot to generate revenue, time and money. So make sure that you’ve got a great business plan to do that. You should need to have a chart of accounts on your spreadsheet. Your P&L should have a chart of accounts to show every line item, every line item.
And you, you know, I’ll offer a 30-minute free consult with every one of you as courtesy to the AIVA members and what I would like to show you is you want to know what you’re spending on each one of your line items, even generally in your revenue, even though your gross revenue minus your cost of goods sold, let me repeat, cost of goods sold equals your gross profit. And then everything underneath that, fixed and variable expenses will give you your net profit.
Net profit is what you take to the bank. So you want to have a chart of accounts so that you can compare month over month, quarter over quarter, year over year is my expense in proportion to my revenue increasing? If it is, we need to talk because it should be equal or less than. All right. What is my procedure actually costing me to perform?
Because here is your gross revenue and then what it cost for that procedure. It’s staffing plus supplies plus additional expenses that you’re aware of it, but it doesn’t come front mind. And then you evaluate those P&Ls with a proper spreadsheet. Now, if you have somebody that is astute enough in your practice, then you should review them.
Jay, how often should I review my P&L? At least, at least quarterly, preferably monthly, maybe by the fifth, the 10th of the following month. You should be analyzing your PNL. I do this with all of my clients. Why? Because I want to know, is there a trend up or is there a trend down? And I need to know it’s too late for and five and six months from now to correct what happened two or three months ago.
But if I’m doing it every month, I can certainly prevent what’s going to happen in the next couple of months If you don’t know how to do it, folks, please hire a professional, whether it’s your accountant that does it. Your attorney. Usually, attorneys don’t do that or a good bonafide consultant that specializes in that. That’s the market you should be doing.
And if you ever say that, I don’t know that I can afford a third party, the extra accounting work or a consultant, my answer to is you can’t afford not to because you’re probably going to end up saving more in your practice and being more profitable than the actual cost of what it cost you to do this. So, you know, you have a procedural cost spreadsheet so that you know what every procedure costs you to the penny.
And I don’t mean just the gross revenue minus your supplies. There’s so much more that goes into that. And then P&L evaluation spreadsheets
01:00:12:06 – 01:03:11:05
Number eight, hold regular team meetings. This is a protocol that you have to have in your staff handbook, in your practice handbook. Now, who creates the agenda? Whoever’s holding the team meeting. Now, if you’re going to have a staff associate holding the team meeting, then let them create the agenda.
But I always think that the agenda should be approved ahead of time, either by your practice administrator, slash, practice manager, whatever you want to call it, and or the doctor to make sure you’re not wasting time. You’re not just having a meeting because a vendor rep bought lunch, all right? You’re having a meeting to go over and review the good, the bad and I don’t want to say the ugly, but the good, the bad and the opportunities that exist in your practice.
And believe me, ladies and gentlemen, it is well worth it. Because I remember years ago we always used to have a team huddle that we would speak about who are the patients for the day. And I don’t want any ugliness like, Oh my God, Jay’s coming in to have a treatment today, you know? Jay that pain in the… No. You want to say, okay, these are the patients that are coming in today way ahead of time. Are my rooms stocked? a protocol.
Who’s stocking the rooms? All right, I’m going to have a cart. Big mayo stand that’s going to do it. Or am I going to do one room at a time? We can get into that at another time. All right. So who attends the meetings? In my former practice, we had one meeting every…We had a meeting every week for a month.
One week only my front desk personnel and management. The next week would be my MAs, my nurses. My Pas, alright, and my physicians, providers. All right, that would be. And then one week it would be everybody. Now, this would also be inclusive of team huddles of what’s going on for the day. We would speak about issues and concerns that already happened in the practice.
We ran out of tubing. How do you run out of tubing? All right. You should never you should have par levels. And that’s a protocol that you should have in your staff handbook. A par level is means that when we get down to one dozen, two dozen, whatever that is, we have to order more. I would always say I want two, three cases of IV boxes, IV bags.
Now, whether it’s the small bags, the large bags, whatever it is. All right. The needles, syringes, what goes into the I.V., the medications that go into the I.V., Who attends these meetings now and how often they’re held? These should be standard operating procedure. Don’t leave anything to the imagination. All right.
01:03:11:06 – 01:04:30:04
Now, tip number nine, business associate agreements I spoke about before.
This is for every single vendor that you work with who comes across individual, patient data protected health information or PHI. Protected health information. You are making a big mistake if you don’t have one. And as a special gift to each and every one of you attending and to all the AIVA members, we will give you a copy of a business associate agreement just to make sure if you already have one, fine.
But if you don’t, to give you one to allow you to know what goes into it. All right. And I’ll give it to you in a Word document so that you can create it, all right, to fit yours. You should have one for every vendor. You should have one for your EMR. If they don’t provide one themselves, you should have one for anybody that comes into your practice that comes in to see and take care of whether it’s liquid nitrogen or your drug reps, they have to sign it. All right. This is what protects you from you in spite of you.
01:04:30:04 – 01:07:54:00
Tip number ten, We’re here. And what’s a business associate agreement for? We already explained that. Tip number ten, The process for evaluating and creating incentive programs for your team members should always be based on numbers in your practice, not what you think they deserve without the data. I don’t give raises just because you’ve been there another year.
You keep your job because you show up on time. Now, you know during the year and there might be cost of living increases. Yeah, we might give cost of living increases, but I don’t really want employees in my business that are satisfactory. Everybody has to go above and beyond to help me make more money. That’s really what this is all about.
So know your numbers go over them with solid professionals that know what they’re doing. And if you want to incentivize people, there’s two ways. One is production incentification, whether it is X percent. And we have all kinds of formulas that we help on, whether it is percentages based on gross revenues, not individual treatments, but criteria of the old United Way thermometer.
When you hit this much and that much and this much, you can get a bonus predicated on the amount of revenues individually or as a team. And then the other type of a bonus is a discretionary bonus at the discretion of the practice owner, because they feel that you’re worthy of a bonus, whether it’s a collective team bonus predicated on profitability or anything that you’ve done an outstanding job that’s discretionary outside of your normal raise, be sure to include KPIs, which are key performance indicators that you have to hit this For each team member, the difference is between a bonus and a commission.
The bonus is earned on generations of revenue and the commission can be the same. But the bonus can be based on discretion. What I believe you should receive, because you’re an amazing employee and you’ve gone above and beyond it, is really a way to motivate each team member. Everybody loves money. Ladies and gentlemen, you can connect with us if you choose on this slide the QR code.
You can connect with us to schedule a free 30 minute consult. And lastly, you can join our e-newsletter, which is educational content that allows you to know what’s going on in the industry. Our e-newsletters are not sales processes. We do not have specials of the day or whatever. It is strictly educational. So ladies and gentlemen, thank you for allowing me to be part of your day.
I hope that this time spent on figuring it out. Employee Handbook protocols and compensation strategies in your practice was worth the time that you took out of your real important day. I thank you. Good luck and God bless.
01:07:54:00 – 01:09:29:09
So that wraps up today’s episode of Shorr Solutions: The podcast. If we mentioned any website links, you can find them in our show notes to work directly with me and our award winning team of consultants to increase efficiency, increase revenue and decrease costs in your aesthetic practice, schedule a free consult with us today.
We will help you establish and refine your aesthetic practice’s protocols for maximum efficiency and productivity, decrease your expenses and increase your profitability with an expert financial analysis of your business. Attract more patients, convert calls to consults, convert consults to treatments and keep patients coming back for more. With our sales training, coaching and complimentary access to our conversion cascade online course.
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