AHHA SELF-HELP ARTICLES COLLECTION
   


Susan E. Kolb, M.D., F.A.C.S., board certified plastic surgeon and founding diplomat of the American Board of Holistic Medicine, has been in private practice in Atlanta, GA since 1988. She established Plastikos Surgery Center and founded Millennium Healthcare, an integrative medical practice. Dr. Kolb hosts a weekly radio program on holistic and spiritual medicine. She recently published The Naked Truth About Breast Implants discussing treatment protocols she developed to help women with toxicity problems from breast implants. Dr. Kolb also authored a chapter in Goddess Shift, an anthology of 42 women leaders in diverse fields of human endeavor. For information call (770) 457-4677 or visit www.templeofhealth.ws.


The American Holistic Health Association has compiled a collection of self-help articles to support your efforts to enhance your own health and well-being.

This article is part of the
article category
TIPS FOR DEVELOPING INTEGRATED HEALING CENTERS
and the sub-category
CLINIC BUSINESS TIPS

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Introduction
We have all heard that the medical paradigm is shifting. As is happening in many aspects of our society, from cuisine to fashion, there is an integration of international energies. Out of this blend of healthcare approaches is an emerging healthcare model, the integrated medical center. The blueprints of one such center including the elements of its creation follow.

Creation
Creation is the alignment of mind, will, and heart. The vision of what is to be created is given and the enlightened creator realizes this vision comes from the "universal" mind rather than his or her individual separate mind. As the vision comes into sharper focus, the intention to bring the vision into the physical comes from the will. Individuals with addictions and "weak wills" have problems manifesting their visions. This manifestation process proceeds more quickly when the creator's will is razor sharp and focused. The energy of creation also comes from the "heart." Creators who are passionate about their creations fuel the creative process with emotional energy.

Vision
The vision of the integrated center we were to create was given at the Airport Vortex in Sedona, Arizona in 1990. I was told the center would be built for the "disasters." Several years later I hired a video producer who suggested we build a large center integrating surgery and holistic medicine. He had been given the same vision when he was in Virginia and knew he had to come to Atlanta to build this center. This alone indicates that the "vision" is larger than any one individual.

Intent
As individuals with similar "intent" gathered in the creation of the center, the vision manifested into the physical. An academic anesthesiologist who had been taught healing as a child by her father, became the medical director and chief anesthesiologist. Managers and employees who were intrigued with the "vision" came together to focus the group intent. As this process progressed, the energy of the center continued to rise. As energy determines relationships, employees and managers left and new employees and managers with a more developed sense of responsibility and work ethic replaced those with weaker wills and intents. I observed that only those employees and providers who were truly service-based, and not self- or ego-based, would survive in the center's energy. Some weaker individuals became physically or mentally ill. The clairvoyants, who guide the formation of the center, say that this process would only continue as the center's energy continued to rise. The original creators, of course, are still in the center and continue to guide the process. As with the creation of any worthwhile endeavor, there are times of strife and attack, but because of the creative "intent" holds firm, the vision continues to be brought into the physical. Other managers, employees, and healthcare providers with similar vision are now drawn to the center and contribute to the vision. As the group's "intent" comes into sharper focus, the vision expands and grows. Although I do not understand how it will manifest, I now understand a 1986 prediction by a clairvoyant that I would have holistic health centers across the United States. Then I was a military plastic surgeon with virtually no knowledge of holistic medicine. I've been shown that the "vision" exists at a much higher level than my individual mind.

Guidance
An important part of my spiritual training, which began much earlier than my training in holistic medicine, was the development of spiritual guidance. Achieving levels of meditation to access information is an important part of the ongoing creative process. I have also been blessed with several clairvoyants who confirm the information I receive.

Discernment
As the center grew, we were challenged with opportunities to learn spiritual discernment. Our process of written contracts with managers and healthcare providers, our human resource system, our process of precertification, and our financial policy with patients has evolved to take care of previous problems. Our discernment during interviews has greatly increased as we learn how to evaluate potential employees and providers. There is nothing like life experience to teach us about energies we do not wish to bring into the center.

Group Synergy
The center's group synergy works because we gather like-minded people with a common intent.

Faith
Above all, faith that a "higher" plan exists even when you cannot see how the various elements will merge is the most important quality to cultivate. I learned that when the energy flow is "stuck" to work on myself, become centered, and become a better channel for the energy coming through.

Practical Matters

So what else have we learned in the last five years?

Physical Plant/Finances
Creation of the physical plan involves some very important decisions. Location of course, needs to be chosen carefully, especially if healing is to be a prominent activity in the center. Certain geographic areas have higher energy than others and it is wise to check the earth's energy in the area you choose. Feng Shui, along with other dowsing methods may be used to shift energy if needed.

The decision to lease or buy property is often financially based, but buying the property, especially if major renovations are planned, is wise. A holding corporation can be created to own the property and the space to lease to other corporations at market rate. You are your own landlord and this is a wonderful relationship. If a large build-out is needed, as it was for our surgery center, financing such as through a local bank or the SBA is necessary. You will need to chose advisors carefully and get several bids on all aspects of the business deals. I chose to have a single project manager for the project and (as I was busy in my surgical practice), who acted as a general contractor as well as a financial manager. I remember him on the phone to potential sub-contractors. "Just think of this as a restaurant, and give us your bid." He was convinced the contractors would add 30% if it was medical. After reviewing our options, we decided to renovate an existing building. Of course, it was important to learn about building permits, certificate of needs for the surgical facilities and other requirements of government agencies. State licensure is required to accept facility insurance. JCAHO or AAAASF certification is important as well and specifications outlined in certification programs need to be known before the build-out so they can be incorporated in the building plans.

As the build-out project (which took about three months) progressed, we continued to pay attention to energy. The center's energy was grounded at one point by placing crystals in the walls during their construction. Large amethyst crystals were placed throughout the center once it was completed.

The center's design emphasized flow and efficient use of space. The colors used in the design were given through spiritual sight. The walls are white with accent colors of dark blue, mauve, and purple. A waterfall and pond with a seating area outside the front door gives patients and families a meditation area.

Computer/Information Systems
Along with the physical plant, planning of the business infrastructure should begin early. An adequate computer and network system should be put in as part of the build-out.  If more than one office exists, plans for communication of information systems between offices needs to be addressed. Professional advice will prevent choosing a system that cannot expand as the practice grows or accommodate new technology such as the Internet, the electronic medical record, and even the virtual medical office.

Management
As your practice grows and shifts in focus from traditional to holistic medicine know that often your managers and employees will shift. It is important not to hold on to old relationships emotionally as these energetic shifts occur. Several managers were unable to make the transition into the new center. Fortunately, I had been warned of this in meditation so it was of no surprise when they left. Allowances for these energy shifts is suggested as it allows the process flow to occur. Of course, faith is the key to this allowance.

Managers are crucial to your practice. As you should spend most of your time providing patient care and outlining the "big picture," it is crucial to have managers that can implement the plan. I have had managers that are very competent and proactive and others who mostly produce excuses. Learn early to double-check your manager's ability to get their work done and their ability to manage their employees. Check overtime with accounting as this is frequently overused when poor management exists. Give your managers guidelines for which practice parameters to follow and review their work regularly. Profit and loss reports, cash reports, accounts receivable, and referral source tracking forms need to be reviewed by yourself and management monthly.

Insurance
Attention to proper levels of insurance is important. Speaking with an insurance professional who can assure an adequate level of business insurance is a first step. As my business grew from three to forty employees, my insurance agent handed my account over to a larger insurance company, as her company could no longer meet my needs. Remember to review your insurance coverage and as you grow in the number of employees and number of locations, expand your coverage appropriately. You may wish to have employee dishonesty, credit card fraud insurance, and other specialized business insurance that smaller companies do not offer. As the number of corporations grew from one to thirteen, it was important to find a business insurance company to cover all the corporations under an umbrella. When you have equipment that can easily switch locations and/or corporations, this is especially important.

Review of your medical malpractice is necessary to decrease exposure and risk, especially in the holistic/alternative medical field with it‚s emerging technologies and modalities. We have representatives from our malpractice insurance company visit regularly to review systems, and make suggestions. It is important for your corporations to be listed as an "additional insured" on your policy. It is also necessary to have written statements from independent contractor providers indicating responsibility for their own insurance and liability. You should check if your providers who are also employees are covered under your malpractice insurance. Malpractice does not usually cover product liability insurance so this should be addressed separately if you sell products or supplements. We chose to have a separate corporation, The Natural Apothecary, to handle these products.

Providers
As your center grows, you may bring in additional providers to cover the wide range of modalities that make up holistic medicine. We have hypnotherapists, chiropractors, homeopaths, nutritional counselors, psychotherapists, energy and spiritual healers, and Traditional Chinese medical doctors along with our holistic physicians. You need to consider if you want these providers to be employees or independent contractors. There are legal requirements for independent contractors that must be met to avoid liability for back taxes to the IRS. In general, employment contracts outlining both parties' legal responsibilities is wise. These contracts should be updated by your attorneys every few years in order to incorporate changes in the law or legal precedent. In general, independent contractors should have more than one practice location and not be employed full time by your corporations. They are responsible for their insurance, liability, and taxes and should sign an agreement. As an owner, you assume more liability for an employee than for an independent contractor, so this may be important as you decide how to employ certain providers.

Billing/Managed Care/Precertification
As you gather your providers you need to make sure your billing system will accommodate the growth. I leave the decision to participate in managed care programs to my providers individually, but some centers have policies regarding managed care for all providers. Decisions must be made in regards to self-pay policies, Medicare, Medicaid, HMO, POS, PPO, liability insurance cases, auto insurance cases, and managed care companies who bring together alternative providers but expect discounts from normal fees. For some providers, such as plastic surgeons, medical credit card programs are also a consideration. We have an employee in the business office and managers who evaluate managed care contracts and plans and make recommendations based on the provider's available time and the proposed fee schedules or payment plans. It is recommended you know your practice overhead expenses before accepting large managed care contracts. You need to assure that you can make enough profit to cover your expenses and pay yourself. Working for below Medicare rates can be risky for practice survival.

It is crucial to have a definitive financial policy that each patient signs before treatment indicating how the office handles insurance, collections and attorney's fees. Precertification process needs to be thoroughly accomplished with approval in writing so that the patient and the insurance company cannot find a loophole to avoid payment. I suggest hiring people with previous precertification experience to avoid expensive mistakes, especially if procedures are precerted.

Many services and procedures in holistic and alternative medicine may not be covered by insurance. We utilize our experienced precertification department to precert procedures so the patient knows costs up front. Many practices have a policy of not accepting insurance and letting the patients deal directly with their insurance company. We feel that our policy is more service based and allows the patient to more fully take advantage of services we know their insurance company will cover.

Receptionists/Call Center
We chose to separate reception and call center functions but they can be combined. Our reception area serves more than one practice and it is in reception that the patients are greeted and guided to the area of their appointment and their medical record given to the provider. If a provider is running late, it is up to reception to communicate this and to suggest alternative activities such as viewing the T.V. for our recent T.V. show, "Your Health Today," a visit to skin care or perhaps a trip out to eat lunch if a prolonged wait is anticipated. We keep a fair amount of educational material in our waiting room as well.

The call center functions as a referral service for the Atlanta Holistic Doctor's Group as well as a resource center from the community. We have a database of over 400 providers listed by specialty and geographic area. We are listed as a referral service in the yellow pages and our providers and staff are happy to provide information over the telephone or refer patients to the Real Talk section of the Yellow Pages for audio information on 40 topics in holistic medicine.

Education
The call center is only one branch of our community educational services. We have weekly T.V. and radio shows on holistic and spiritual medicine. We interview authors and other holistic healthcare providers from all over the country. The center sponsors the Atlanta Holistic Doctor‚s Group monthly, as well as the Atlanta Community Group for Noetic Science. We also sponsor a number of weekly events such as Power of Prayer and Tai Chi Qi Gong instructional classes and several monthly events such as Develop Your Clairvoyance.

We partner with local Unity churches, The Wellness Community, and other organizations to sponsor national speakers and events. Health fairs and expos can be a good forums for your providers to speak to the community and for your center to market itself to the community.

We consider education is an important priority, especially as the public as well as other healthcare providers develop an active interest in integrative medicine. We sponsor regional symposia for the American Holistic Medical Association in order to educate holistic practitioners in our area.

Advertising/Public Relations
A business manager should explore public relations and educational opportunities with local business, community groups, churches, and hospitals. We have many providers who are comfortable educating via lectures, seminars, T.V., and radio. We provide a large number of educational articles on many topics in our reception area as well as on our three web sites. Promotion of the web sites is done monthly by our web master as well as through our print media. We are linked to many other informational web sites that help draw visitors to our site. Patients can communicate to our office via the web sites and someday may communicate with our providers via web cam. Our providers are frequently interviewed by local and national magazines and T.V. and radio shows. The Real Talk section of the Yellow Pages also has an audio description of 40 topics in holistic and spiritual medicine. We use a monthly referral source tracking program to track our referrals in order to evaluate our public relation and advertising activity.

Local Environment
Know your local political environment. Georgia has a "Right to Treat" law which allows M.D.'s and D.O.'s latitude in using alternative methods to treat patients with life-threatening illnesses. The climate of your medical board toward alternative medicine and alternative providers is important to understand. Who can perform acupuncture? Are homeopaths and naturopaths allowed to practice independently or only under an M.D. or D.O.'s supervision? There may be local groups who can provide current information on legislative issues so you can stay informed.

Teamwork
The final area to emphasize is encouraging your providers to work together and refer to each other when appropriate. This can be challenging, as many alternative providers have a "solo" mentality and believe they should do it all. The patient is best served when they are educated regarding all the holistic modalities and - along with their primary provider choose the modalities that will benefit them the most. The patient is an important, active member of the process. Again, the group synergy is important and we encourage our providers to experience what the other providers have to offer. As I formed and ran the Craniofacial Board in the military, I saw the opportunity for group conferences for patients with difficult diseases to take advantage of the group‚s wisdom. Twenty-first Century medicine will be integrated medicine with a shift away from the solo practitioner and towards the group. We must learn to work together for the good of the patient, especially the patient with complex or life-threatening illness. As we incorporate spiritual healing, psychotherapy, hypnotherapy, Traditional Chinese Medicine, chiropractic, detoxification, homeopathic, holistic, and traditional medicine for the benefit of our patients, so shall we learn to put aside our differences and work together.

As Plato said thousands of years ago:
"The cure of many diseases is unknown to physicians. They are ignorant of the whole which ought to be studied also, for the part can never be well unless the whole is well. This is the great error of our day in the treatment of the human body, that the physician separates the soul from the body."

At Millennium Healthcare we strive to take Plato's advice to heart and treat the whole patient.

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