Our guest host tonight, April 2, 2001 is Richard K. Adler, Ph.D., CCC-SLP. Dr. Adler is an
ASHA Fellow and President of The American Academy of Private Practice in Speech Pathology and Audiology (AAPPSPA).
Dr. Adler's private practice, Communication Improvements of Seattle, P.L.L.C., is
a general practice including therapy and diagnostics for the following disorders: Articulation, voice,
fluency, language disorders, TBI rehabilitation, transgendered voice and speech therapy, business communications improvement, foreign dialect and accent improvement.
He will lead a chat tonight about about private practice in Speech Pathology and Audiology.
<Robin> ok! Well as you know Richard is the president of American Academy of
Private Practice in Speech Pathology and Audiology
<Robin> why don't you tell us about the organization and what it does for the SLPs and
<Adrienne> that would be great
<Richard Adler> The Academy is the only organization that exists solely for the benefit
of SLP's and audiologist in Private practice. We are a Related Professional
Organization of ASHA. We have over 100 members.
<Richard Adler> All members are in private practice mostly full time but some part
timers. We have only a few audiologists-- the rest SLP's. The academy has been
around for over 35 years.
<Erika> do professionals in private practice do 'house calls'?
<Richard Adler> Some of us have home health contracts as part of the practice. Some
folks start their practice solely with home health work and expand from there. If you
have an office for your practice, you would
<Richard Adler> not usually go to someone's home to see their child or adult. They
would come to your office. But if you wanted a practice without a physical office, you
could do that and only go to homes.
<Erika> so it is not common to do housecalls
<Adrienne> Do many slps have their own office or is it more common to see 4 slps in
<Erika> you think there is a market for something like that?
<Richard Adler> Erika: some of my colleagues choose not to have a physical office and
will travel to people's homes. You have to weigh the cost of each. Not that it is
common or not but most SLP's get an office or
<Richard Adler> work out of their home office and have contracts at various places.
<Robin> Richard, do you have other SLPs working for you?
<Richard Adler> Adrienne: Many SLP's have their own office. If they share they share
with a PT, OT or Psych person. Unless the practice is big then there will be a need for
more than one SLP. I had three employees working for me who were all SLP's.
<Richard Adler> Robin: Some of my colleagues have up to 20, 30, or more employees
due to the numerous contracts they have.
<Richard Adler> Many of these employees are part time.
<Robin> big practices!
<Erika> holy mackeral
<Adrienne> how much area do they cover?
<Adrienne> and what population?
<Richard Adler> Don't be alarmed. Not all practices are big. The majority are smaller.
Many practices cover a metro area. One I know of is in three states.
<Erika> a private practice in 3 states?
<Richard Adler> They cover children and adults in schools, hospitals, etc. They
choose to vary. The biggest practice is in multiple states (New England)
<Erika> that kind of redefines my understanding of the concept
<Richard Adler> Erika; You see, many practices have office patients as well as outside
contracts in schools, SNF's, hospitals etc.
<Richard Adler> Hello to the Newcomers
<Adrienne> how do you solicit clients for private practice?
<Anonymous2399> As far as opening a practice, did you take any business classes or
administration seminars to manage the practice? I don't know how that works or what
<Erika> so...you could say that large corporations might be considered private
<Richard Adler> Adrienne: You advertise in various places. Depending upon the area
of the country, the Yellow Pages helps. I advertised very little. I got referrals by word of
<Richard Adler> Emily: I did take business courses from the small business
administration in my city. I also had administration and supervision courses in my
<Richard Adler> Erika; Do you mean like Nova Care? That is not a private practice.
That is a very large for profit corporation owned by investors.
<Erika> oh oh oh...I think I get it now
<Erika> that was exactly my question
<Adrienne> Richard, how does the extra responsibility of running a business factor in?
<Richard Adler> Adrienne: You can either do it yourself or get an office manager and
billing clerk. But many practices fail because the SLP or audiologist knows nothing
about how to run a business.
<Robin> anon 609046, do you have any questions for Richard?
<Richard Adler> You need an attorney, accountant, and a good marketing course or
<Erika> how about reimbursement? Is it a pain to enroll and run that aspect of a
<Adrienne> does malpractice insurance go up?
<Richard Adler> Erika: If one has an office practice, getting on Insurance Provider lists
helps. It is difficult to get on them and you must be persistent.
<Richard Adler> But I had about 12 provider contracts and got referrals from them all.
<Erika> do the participating rates hurt?
<Richard Adler> Adrienne: The malpractice insurance goes up if you have employees
and if you have multiple contracts. You want to be covered at all places.
<Robin> how much time do you spend doing administrative work and marketing,
compared to clinical work?
<Richard Adler> The reimbursement rates are sometimes very low-- in the Atlanta area
where I used to live, it was as low as $28 per session
<Robin> for an hour or half hour session?
<Richard Adler> $28 was for 1/2 hour
<Adrienne> what would it have been if you were not private?
<Richard Adler> MY theory is that I will take all referrals until I cannot handle any more.
So I don't worry about the rates as much as others.
<Richard Adler> Robin: I worked about 70 hours a week. I'd say about 40% was admin
and the rest clinical.
<Richard Adler> I did not do marketing per se
<Adrienne> holy cow
<Richard Adler> Adrienne: If you were not private you would not have been on that
provider list. If someone came to pay you the rate depends on the area of the USA.
<Richard Adler> In Atlanta, the 1/2 hour rate was about $65. Here in Seattle it is about
<Robin> was this in Atlanta that you worked those hours, or now in Seattle?
<Richard Adler> I worked all those hours in Atlanta. I sold my practice last April when I
moved to Seattle. I started another practice here.
<Adrienne> once you are on a provider list, can you refuse a pt?
<Richard Adler> Adrienne: If you refuse too many, they will take you off the list.
<Robin> is the cost of living lower is Seattle?
<Richard Adler> The cost of living is much higher in Seattle and I don't know why the
rates are so low here
<Richard Adler> It was a shock to me when I got here.
<Richard Adler> Per Patient I make half what I made in Atlanta
<Richard Adler> Welcome Newcomers
<Adrienne> hi 1483, we are talking about private practice, any questions for Richard
<Robin> Richard, what kind of adjustments are you making as a result of the
significant changes in reimbursement in Seattle?
<Anonymous49> What resourses are on the web for people going into private
<Richard Adler> Robin: I am starting out as a part time practitioner here. My rent is
lower as I got a great office space here; small but adequate. I keep my expenses
low. I am doing more marketing here than I did in atlanta.
<Alex> What kind of marketing are you doing? What's working best?
<Robin> are you doing any accent reduction work?
<Richard Adler> Alex: AAPPSPA has a website. There is also Speech Pathology.com
which has some private practice info. It is easiest to go to www.aappspa.org and ask
questions or seek info.
<Adrienne> Richard is President of AAPPSPA, fyi
<Richard Adler> Alex: I am visiting psychologists, pediatricians, neurologists, etc. and
giving them my spiel. I am also asking friends for leads.
<Richard Adler> Robin: I am doing accent reduction. I am on the list from ASHA
ProServ for people who are looking for an SLP or audiologist and they type in a city. I
will come up as available.
<Richard Adler> Getting yourself known in the medical, education, and psych
communities in our city will help a lot with marketing.
<Adrienne> that sounds like a good list!
<Robin> thats good, Richard. So you are willing to work with the full range of speech
and lang. disorders?
<Richard Adler> Attend PTA meetings, other group meetings, state organization
<Richard Adler> Robin: Yes I work with all areas except Cleft Palate only because I
have only a little experience in that area by choice
<Richard Adler> Adrienne: The ProServ from ASHA is a good way of marketing
nationwide and it is a free service from AHSA if you are a member
<Adrienne> that's good to know!
<Robin> what is the competition like in your area?
<Richard Adler> The competition is more than in Atlanta. I am directly across from a
large speech and language center and about 7 blocks from two different private
practitioners. But I like competition. If you are good you will do well.
<Alex> What about private-practice.com? Do you know them?
<Robin> welcoome 9744, we are talking about Private Practice with Richard Adler
<Richard Adler> Private-Practice.Com is Don Harris and Kellie Hetzel's baby. I know
both of them. They are also members of AAPPSPA.
<Richard Adler> Private-Practice.com is a very good group who are now selling
products to help those in practice.
<Tracy> Do you work with all ages?
<Richard Adler> Tracy: I do work with all ages. But I prefer toddler to adult. I have
worked with geriatrics for so long, I choose not to take those patients.
<Erika2> Richard, What does it take to be competitive in as a private practitioner (i.e.
time of experience...)?
<Richard Adler> To be competitive, you must be willing to stand up for what and who
you are. You know you are good (I hope) and that will help you. To be competitive you
must market at first. Word of mouth will help you as you move on.
<Richard Adler> Giving free inservices to nursing homes, schools, hospitals,
psychology groups helps.
<Richard Adler> Before going into practice, you should make sure you have worked
with the population you want to serve for at least 4-5 years, especially if there are a lot
of Private folks in your area.
<Alex> Do you advertise in the newspaper or on radio?
<Richard Adler> Alex: Advertising on radio and TV and in Newspapers is very costly
and I have found it to give very little return for the money.
<Anonymous9744> I'm a 1st year grad and I am positive that I want to go into private
practice, yet I'm not sure where I should start preparing.
<Richard Adler> You won't have a competitive edge if you have not worked for a while
even if it is in a school. A former student of mine in Atlanta worked in the public
schools for three years and then opened a practice with a friend. She is doing
<Adrienne> 9744, where do you go to school?
<Anonymous9744> I'm at school at George Washington, Washington, DC
<Richard Adler> To prepare for private practice, I would take some marketing seminars,
a business accounting class and a business management class from say a local
community college. You can prepare for those while you are working elsewhere.
<Richard Adler> Then you will have more confidence to go
<Erika2> Interesting, I thought you needed at least ten years of experience to begin
considering private practicing.
<Richard Adler> I don't think you need 10 years. If you work in the schools for 10 years
then want to see Neuro adults, where will you get your experience to market youself?
4-5 years is a good amount
<Erika2> Very good information! thank you.
<Richard Adler> Erika2: You are quite welcome
<Robin> welcome 1067, we are talking with Richard Adler about Private Practice
<Robin> Richard, how are your prices compared with your competition?
<Richard Adler> My prices: I am within $15 of my competition. I charge per hour less
than another practitioner but she has very few patients.
<Adrienne> any questions about private practice? We are talking with Richard Adler,
president of the AAPPSPA
<Anonymous1067> I have heard that the billing is the biggest headache of PP
<Richard Adler> 1067: it doesn't have to be. There are computer programs for that
and many billing services
<Anonymous1067> do you work with a specific population?
<Richard Adler> 1067: I work with children and adults. I like the areas of voice,
language, learning disabilities, TBI and Transgendered Voice
<Anonymous9744> Do you have a partner or do you work alone? Do you recommend
finding a partner?
<Richard Adler> I work alone. I prefer it that way. Many of my colleagues prefer a
partner. It depends on your personality.
<Tracy> What is the biggest expense when opening a private practice?
<Richard Adler> Tracy: The biggest expense is start up money. If you have an office
you are opening, that is very costly at first until you see your revenue coming in. Many
people start off with contracts
<Anonymous600> Any web sites out there you would recommend for private practice
<Richard Adler> 600: Try private-practice.com and www.aappspa.org
<Erika> do you contract with federal programs or just commercial insurances?
<Richard Adler> Erika: I don't have any fed programs. I stay away from them
<Erika> one could really get in over their heads when dealing with fed programs
<Richard Adler> Erika:Because feds pay very slowly and the paperwork is horrible
<Erika> the company I worked for (Emergency Physician billing) got sued by the federal
government regarding billing...
<Erika> it was a precedent setting case...
<Erika> made me see what the gov can do
<Richard Adler> The only gov't thing I did was medicaid and that was state run
<Sue> Isn't Medicaid a money loser?
<Richard Adler> Sue: It doesn't have to be if you bill correctly and keep costs down.
<Tracy> Do you have SLPs that work for you?
<Richard Adler> In seattle I am the only one. In Atlanta I had three slp's working for
me. I just started again here about 7 months ago
<Anonymous1067> r u in atlanta now?
<Richard Adler> 1067: I sold my practice in Atlanta last April and now I am in Seattle
<Erika> so do you do sole proprietership or LLC?
<Richard Adler> In Seattle I am a PLLC Professional Limited LIability corp. In Atlanta I
was a P.C. professional corp.
<Erika> I see
<Anonymous91> How long did it take you to get re-established in Seatle?
<Richard Adler> 91: I started in November and now I have 6 patients for a part time
practice. I made connections asap when I got here
<Erika> which do you think is better? PC or LLC?
<Richard Adler> They don't have a P.C. designation here. Only LLC. I had no choice.
It works the same way.
<Anonymous9744> Do you know if Don Harris from private-practive.com will have a
seminar at ASHA's convention this year?
<Richard Adler> 9744: I don't know. AAPPSPA will have one if they accept our paper.
<Richard Adler> AAPPSPA submitted a short course through ASHA. We do it every year
<Robin> 9744, Don Harris had a seminar the day before the last ASHA convention and
he also had a booth there in the exhibit hall
<Anonymous9744> He came to a meeting I was attending last year. I was extremely
<Richard Adler> Don is a good guy and a charmer. His website is for profit and he is
serious about it. So he will make money but he absolutely wants to help all of us.
<Adrienne> welcome 1074! We are talking about private practice
<Sue> I just checked and private-practice.com site does list a workshop pre-asha
<Richard Adler> Hello 1074
<Adrienne> good investigating Sue!
<Adrienne> Thank you so much Richard! I did not realize many of the things you spoke
<Richard Adler> Thanks. For those students who are leaving, it was good to chat with
you. My email is firstname.lastname@example.org Feel free to write