After turning down an opportunity for a another set of contract classes that I had run in the past, I thought this would be the perfect time to talk about how important knowing your worth is and how to set fees based on that. It is hard to put a price on the service provided as a Dietitian. I want to help people and almost feel guilty charging too much and losing a client; however, at the same time, I rely on my business for income now. I have changed my fees multiple times in the past few years, so today's blog is going to guide you through my thought process and give you tips for setting your own fees (for individual sessions + classes).
Research Dietitians in Your Area
One of the first things I did when trying to figure out what to charge for counseling sessions was to see what other RDs were charging near me. A few did not list their fees on their website (I will talk about this in other blogs); however, the majority were in the $120-$175 range for an initial 1-hour consultation. I ended up going a bit lower since I had just started my practice and didn't have a masters degree or specialty certification yet.
Factor in Expertise + Education
As I mentioned earlier, I low-balled my initial fees for counseling; however, after getting my masters and having my practice for a year or two, I bumped up my fees to match what others charged in my area. When setting your hourly rate or counseling fees, think about your education, experience, certifications, etc. Your knowledge and level of experience is adding to the value that the client receives in the session (or class).
Base off of Insurance Fee Schedules
If you are a provider for insurance companies, you will have a flat rate that they will reimburse you and that changes slightly from initial to follow-up visit for MNT. You can use the rate that insurance reimburses for self-paying clients or choose to make that a little bit lower since they are paying out-of-pocket. The fee schedule for insurances helped me to alter my pricing a bit.
Triple Your Hourly Employee Rate
Something else I thought about when setting fees for counseling was determining what I was paid hourly when I was an employee and multiplying that by 3. Three seems arbitrary; however, I thought that 1/3 goes to me, 1/3 to taxes, and 1/3 to time spent on prepping. This can just help to give you that baseline rate to build from.
Offer Packages + Add-ins
When I think about my initial counseling fee, I also factor in what other "service" I bring to the session. Will the session include bio-metrics? Will I calculate nutrient needs? Will this be an in-home visit or office-based visit? If your initial session is simpler, you can charge a bit lower for the hour and have add-ins that clients can choose from. Say they want menu planning help, that can be added for an extra $60 (or whatever you will charge). Maybe they want a nutrient analysis done for their current meal plan, that can be an extra $50 or so. I also find it helpful to offer packages to clients.
Note About Charging for Classes
The classes were the hardest for me to determine rates for; however, I found the formula below to help me:
Start with Base Rate - $100/hr (I base this off of my flat counseling rate)
+ Travel Expenses - $.50/mile
+ Parking Fees
+ Prep Time/Lesson Development - $40/hour
+ Cost for Supplies/Handouts
When I determine how I am charging for a class, I alter it on a case-to-case basis. My base rate my be lower or higher depending on if this is an ongoing class or a one-time seminar. If I am driving for more than 30-minutes, I may also add in a fee based on the time spent in my car. Parking may be free for some classes/areas; however, others tend to be $20 just for the hour, so this will change too. If I created lessons on this topic before, I may charge $30 or $40/hour for prep time. If this is a new topic or the client wants it to be more involved, then I may charge $50 or $60 for the hour of prep. Lastly, I factor in a few dollars based off of how many handouts I needed. If I am providing a cooking class, I estimate the amount of food needed and will have another fee added to the pricing.
There are so many ways that you can calculate fees for classes. I have often charged a flat rate (lower than $100) and then added in a cost per person ($20/head) with a minimum number required to run the class. Charging for classes will definitely vary per client/company. For some non-profits, I have accepted a lower rate for a one-time class in exchange for them distributing my business cards or keeping me on a list as a dietitian. It is ultimately up to you to decide what you feel the most comfortable charging.
Final Tips
Setting fees for individual clients and group sessions is often difficult. One of the key things I have learned is really knowing your worth and not being afraid to walk away from something. I have had companies/organizations try and take advantage of my services. I even had one goes as far as guilt tripping me into thinking I was a monster for trying to charge even 1/3 of what I normally do. I am all about giving back to my community and providing free programs/seminars. What I need to be careful of is keeping the balance between free and paid work. I often think about if doing something will open doors for me or create opportunity. If the answer is yes, I will provide a free service (i.e. lunch n' learn for a company I may partner with, teaching in a school for the day, etc). If the answer is absolutely no (or slim), I rethink my decision. After all, one of the reasons I went into private practice, which I am sure may be the reason for many, is having the ability to choose your own destination.
Leave a comment and let me know if this blog was helpful to you in determining how you will set fees for your practice. Was there something else you thought about that I didn't mention?
Stay tuned for my next blog that will break down billable hours + setting income goals.
Sunday, March 19, 2017
Sunday, March 12, 2017
First 10 Steps to Starting Your Private Practice
A few weeks ago, I wrote a blog post about preparing yourself for full-time private practice. I realized afterwards that I hadn't included a post about getting started with your private practice! So, while this is just slightly out of order, I have included a lot of links and resources for getting yourself set-up for private practice. Some of these resources I used when I was first starting out and others I found out about afterwards. I actually ended up doing some of the steps out of the order mentioned below; however, this is what seems to make the most sense for me now.
1. Get an NPI --> LINK
Even if you decide not to accept insurance, it is still something you want to get. It doesn't even take long to register for one. Excerpt from the website: "The Administrative Simplification provisions of HIPAA of 1996 mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information."
2. Get a Tax ID Number or EIN --> LINK
Your EIN is your federal tax ID number that is used to ID your business entity; generally businesses need this. This was a pretty simple process as well. You will need to choose a business name. Here is a LINK for information on registering your fictitious name. For my business I am Felicia Porrazza doing business as PorrazzaNutrition. If you are doing business under your full and proper name, you are not required to register your personal name as a fictitious name. I think I spent maybe 2 hours initially trying to figure out if I needed to further register my name in PA. This may vary state-to-state so be sure to check your individual Department of the State website to see what regulations are in place. You will also need to choose your business entity or business structure in this form. Here is a great LINK explaining the types of business structures by the US Small Business Administration, a great resource!
3. Get Professional Liability Insurance --> LINK
I am a member of the Academy of Nutrition & Dietetics and the one they recommended is Proliability by Mercer. I am pretty sure they still offer a discount for AND members. It is reasonably priced and covered the basics for what I needed as a Dietitian.
4. Insurance Vs. Self Pay Acceptance
I am not going to go into too much detail here because this will be featured in another post; however, one thing to think about is if you will be accepting insurance or only self-paying clients (or both). If you will only accept self-paying clients, you can move to step 5. If you will accept insurance, I would highly suggest getting yourself set-up with CAQH ProView. This is a free resource that allows you to decrease paperwork for becoming a provider with insurance companies. It will ask for your professional and practice information, credentialing info, directory services, etc. When you go to apply to become a provider for a particular insurance company, they will ask for your CAQH number. It has really helped me to streamline the process and avoid entering the same information 10 times. The application takes a bit of time; however, it was very much worth it! I started working on this step while I was still working a full-time job since it took a few months to get credentialed anyways.
5. Deciding Pricing
This is again going to be another blog post; however, setting your fees is often the hardest step. I find it difficult to put a number on the valuable service I provide. Needless to say, it has to be done. One way to get started on this is by checking out what other Dietitians or health professionals are charging in your area. Factor in your expertise, years of being a dietitian, etc. If you choose to accept insurance, they will have a contracted amount that you will be paid per unit (15-minutes per one unit and you can have multiple units per appointment). You could also use this as a guideline for how you charge self-paying individuals. I found it to be helpful to include counseling packages for savings with self-paying clients.
6. Payment Acceptance
Along with deciding your pricing, you will need to figure out how you will accept payment. Will you set-up an account with PayPal? Get a merchant account through your local bank? There are a lot of different options out there. You can choose to do only checks or cash; however, I would suggest getting a separate business banking account regardless of the route you choose.
7. Decide Your Online Presence
When developing your online presence, you can choose from a number of sites and hosting services. For your website, you can choose to go with companies like Wix, Squarespace, GoDaddy, etc. You could also use WordPress and update your account to have a .com address. I am not going to get too far into website design and such; however, I am going to just touch on what you may want to include on your site --> information page about yourself and your business, location, services offered (you may or may not include pricing too), contact information, pictures, blogs (or link to blog), testimonials (may come later), newsletter opt-in, etc. I created my website about a year before registering my business and accepting insurance. I didn't have much on the site and I basically just linked it to my blogs where I was much more active. This is a step you can do at basically do at any time in creating your practice.
8. Decide on Office Space/Set-up
This is definitely a step that you can do earlier in the ballgame. There are a few options for how you choose to see clients. You can do in-home counseling appointments, where you basically go to the client's home. You will need to make sure insurance will cover this if you are a provider. You can rent office space for yourself or sublet from another provider (doctor, chiropractor, etc), which is usually cheaper. Other options for renting office space can include using a shared office where you schedule times to come in and pay either monthly or on a single-use basis. You can see clients in your own home; however, you will need to need to check to see if there are stipulations or zoning laws. Here is a LINK for some more information on that. You can also provide virtual counseling services, which again have stipulations especially in the insurance provider realm. Here is a great article from Today's Dietitian on the TOPIC. If you are a member with the AND, you can also check out this LINK.
9. Create Office Forms
One of the last things you will need to do before seeing clients is to get your office paperwork in order. You will need an initial client form, privacy notices, privacy consents, HIPAA forms, release of information form (for you to speak to family members or doctors), and a policy form relating to your business (for information on cancellation fees, rescheduling, non-payment, etc). I would also suggest thinking about how you will log business income and expenses too. EatRightPro has a great section on HIPAA with education and forms --> LINK.
10. Additional Tips
There are a lot of free resources out there for starting your business. Some may not be related to the Dietitian realm; however, they can still prove to be quite useful. Check out your local Small Business Administration for tips on building your business. Network with other Dietitians or health professionals in your area to see how you can help one another. I purchased this AND book and found it to be really helpful when I first started out. The AND published another book on credentialing and billing that is free for members; however, I didn't find it useful at my stage of practice (it may be for those just starting though). I also discovered that the Free Library of Philadelphia had a lot of free online and in-person resources for business owners, so I suggest checking out your local library too.
This is by no means intended to be an all encompassing list. I am sure there are additional steps that you may have heard of or wish to include in starting your own private practice. This was simply from my point-of-view and how I thought might be helpful for others. You can jump around with the steps I have included and even eliminate those that may not apply to your business. Regardless of how the information today was presented, I hope that this helped you in some aspect of starting your business!
Leave me a comment to let me know what I missed, what you found helpful, or where you are in your private practice :)
1. Get an NPI --> LINK
Even if you decide not to accept insurance, it is still something you want to get. It doesn't even take long to register for one. Excerpt from the website: "The Administrative Simplification provisions of HIPAA of 1996 mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information."
2. Get a Tax ID Number or EIN --> LINK
Your EIN is your federal tax ID number that is used to ID your business entity; generally businesses need this. This was a pretty simple process as well. You will need to choose a business name. Here is a LINK for information on registering your fictitious name. For my business I am Felicia Porrazza doing business as PorrazzaNutrition. If you are doing business under your full and proper name, you are not required to register your personal name as a fictitious name. I think I spent maybe 2 hours initially trying to figure out if I needed to further register my name in PA. This may vary state-to-state so be sure to check your individual Department of the State website to see what regulations are in place. You will also need to choose your business entity or business structure in this form. Here is a great LINK explaining the types of business structures by the US Small Business Administration, a great resource!
3. Get Professional Liability Insurance --> LINK
I am a member of the Academy of Nutrition & Dietetics and the one they recommended is Proliability by Mercer. I am pretty sure they still offer a discount for AND members. It is reasonably priced and covered the basics for what I needed as a Dietitian.
4. Insurance Vs. Self Pay Acceptance
I am not going to go into too much detail here because this will be featured in another post; however, one thing to think about is if you will be accepting insurance or only self-paying clients (or both). If you will only accept self-paying clients, you can move to step 5. If you will accept insurance, I would highly suggest getting yourself set-up with CAQH ProView. This is a free resource that allows you to decrease paperwork for becoming a provider with insurance companies. It will ask for your professional and practice information, credentialing info, directory services, etc. When you go to apply to become a provider for a particular insurance company, they will ask for your CAQH number. It has really helped me to streamline the process and avoid entering the same information 10 times. The application takes a bit of time; however, it was very much worth it! I started working on this step while I was still working a full-time job since it took a few months to get credentialed anyways.
5. Deciding Pricing
This is again going to be another blog post; however, setting your fees is often the hardest step. I find it difficult to put a number on the valuable service I provide. Needless to say, it has to be done. One way to get started on this is by checking out what other Dietitians or health professionals are charging in your area. Factor in your expertise, years of being a dietitian, etc. If you choose to accept insurance, they will have a contracted amount that you will be paid per unit (15-minutes per one unit and you can have multiple units per appointment). You could also use this as a guideline for how you charge self-paying individuals. I found it to be helpful to include counseling packages for savings with self-paying clients.
6. Payment Acceptance
Along with deciding your pricing, you will need to figure out how you will accept payment. Will you set-up an account with PayPal? Get a merchant account through your local bank? There are a lot of different options out there. You can choose to do only checks or cash; however, I would suggest getting a separate business banking account regardless of the route you choose.
7. Decide Your Online Presence
When developing your online presence, you can choose from a number of sites and hosting services. For your website, you can choose to go with companies like Wix, Squarespace, GoDaddy, etc. You could also use WordPress and update your account to have a .com address. I am not going to get too far into website design and such; however, I am going to just touch on what you may want to include on your site --> information page about yourself and your business, location, services offered (you may or may not include pricing too), contact information, pictures, blogs (or link to blog), testimonials (may come later), newsletter opt-in, etc. I created my website about a year before registering my business and accepting insurance. I didn't have much on the site and I basically just linked it to my blogs where I was much more active. This is a step you can do at basically do at any time in creating your practice.
8. Decide on Office Space/Set-up
This is definitely a step that you can do earlier in the ballgame. There are a few options for how you choose to see clients. You can do in-home counseling appointments, where you basically go to the client's home. You will need to make sure insurance will cover this if you are a provider. You can rent office space for yourself or sublet from another provider (doctor, chiropractor, etc), which is usually cheaper. Other options for renting office space can include using a shared office where you schedule times to come in and pay either monthly or on a single-use basis. You can see clients in your own home; however, you will need to need to check to see if there are stipulations or zoning laws. Here is a LINK for some more information on that. You can also provide virtual counseling services, which again have stipulations especially in the insurance provider realm. Here is a great article from Today's Dietitian on the TOPIC. If you are a member with the AND, you can also check out this LINK.
9. Create Office Forms
One of the last things you will need to do before seeing clients is to get your office paperwork in order. You will need an initial client form, privacy notices, privacy consents, HIPAA forms, release of information form (for you to speak to family members or doctors), and a policy form relating to your business (for information on cancellation fees, rescheduling, non-payment, etc). I would also suggest thinking about how you will log business income and expenses too. EatRightPro has a great section on HIPAA with education and forms --> LINK.
10. Additional Tips
There are a lot of free resources out there for starting your business. Some may not be related to the Dietitian realm; however, they can still prove to be quite useful. Check out your local Small Business Administration for tips on building your business. Network with other Dietitians or health professionals in your area to see how you can help one another. I purchased this AND book and found it to be really helpful when I first started out. The AND published another book on credentialing and billing that is free for members; however, I didn't find it useful at my stage of practice (it may be for those just starting though). I also discovered that the Free Library of Philadelphia had a lot of free online and in-person resources for business owners, so I suggest checking out your local library too.
This is by no means intended to be an all encompassing list. I am sure there are additional steps that you may have heard of or wish to include in starting your own private practice. This was simply from my point-of-view and how I thought might be helpful for others. You can jump around with the steps I have included and even eliminate those that may not apply to your business. Regardless of how the information today was presented, I hope that this helped you in some aspect of starting your business!
Leave me a comment to let me know what I missed, what you found helpful, or where you are in your private practice :)
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