7 Deadly Mistakes Made By New Practice Startups

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23: Hiring Employees: What You Need to Know

Hiring your first (or 35th) employee is a big deal, and doing things the correctly is important.  In this episode, I run through some of the most important things to consider when hiring your employees.  I recently went through a audit at the State level for all of our employees, so I thought you might enjoy some of this information.

In this episode:

01:29 – + 10289 listeners
02:21 – Only one opportunity available for the “Perfect Student”
03:23 – Work with me
05:30 – More freedom
06:41 – Hard work and dedication
07:41 – Items for employee chart
08:10 – Witholding information
08:38 – A4 and State Taxes
09:38 – CV and Resume
09:43 – Letters of recommendation
11:06 – CPR card First Aid card
11:55 – Medicaid billing number
14:41 – Interested in a private membership community?


I went to visit my boss and she was saying “Hey remember when your last week here and you were just really nervous about breaking away from your job and going into Private Practice, and I told you could always have this job if you wanted” and I said “Yeah, I remember that, now we have 37 employees between 2 businesses, we see over 1600 patients per month and I don’t need that job anymore”. And it felt really good to say that because I think sometimes she would hint at me and said “You know you can always come back” and I would like “Nope I will never come back here again”. Not that it wasn’t a bad facility or anything, it’s just you know, when you make your mind up to do what you got to do.


Well, Hello everyone! You’re listening to the Speech therapy Private practice Startup Podcast; this is episode number 23. My name is Kyle Meades and I’m a speech pathologist since 1993 and these podcasts are designed to help you improve your business and your life one podcast at a time.

Welcome back to the show everyone, today is Sunday February 12th 2017 and as of today we have over 10289 listeners to the show and I’m really blessed to have you guys on-board. Very grateful for all the questions and comments I get. And I am just so happy to know that you guys are out there getting valuable information and you’ve heard me say it before. Now say it again, value is what you get in the absence of money and these podcasts are free for you guys so if wouldn’t mind please do your part and go to iTunes and leave some good five star feedback so other like yourself can find the podcast easier. Again I would really appreciate if you go to iTunes, take some time and leave five star feedbacks for me. And that way that will allow other people to find the podcast easier and get the same valuable information that you’re getting.

Also I wanted to take this opportunity and let you know I still have one opportunity available for the Perfect student. Now the perfect student is where you pay a monthly subscription fee and have direct access to me for a minimum of six months. And that’s where you can come in and fly in and visit me at the clinic and spend at least four or five days hand in hand. It will go through all of the nuts and bolts of either outpatient clinic or a home health agency or both. And I will show you how we obtain our referrals, how we schedule the referrals, how the workflow in the clinic runs, how we do our billing, how we do our collections and our AR. I will show how to setup your phone system, your fax systems, how to increase or improve your referral base, how to bring on new employees, how to get all that paper work done, all the forms, all the systems that we have in place in our Outpatient clinic and in our home health agency. I will show you how to do that.

Now you can come in and work with me hand in hand four or five days but what you also get in the perfect student direct access to me via the online community or via telephone or we can have a GoToMeeting. You will have a weekly call with me and also you’re just going to learn so much. If you want to just really supercharge your learning curve I challenge you to go ahead and contact me kyle@privateslp.com put The Perfect Student in the subject line there and send that email to me, let me know where you are in your Private practice journey. Are you just starting our; do you have employees; about how many patients do you see per month. Give me all that detail information so I can help you better. Because I want this to be a good fit, as all relationship requires got to be a good fit, because if its not I don’t want to take your money or waste your time. I am looking for people who are just really ready to just supercharge their learning experience and just learn how to do this.

Again I will show you everything that I know about Private practice startup, growth and scaling. I am going to show you everything. You’re not going to learn this in a book or an eBook or online. This is something that is one on one. You’re going to have direct access to me and I will help you grow that business that you really want. So if you’re interested reach out to me at kyle@privateslp.com and in the subject line put The Perfect Student.

Now, I was talking to one of my X Bosses the other day, I stop by the cinic where I use to work, it was a long term care facility it was actually my last job, and today I was cleaning out my home office and I was going through some old paper work and bring a lot of stuff to the shredder and I was just kind of going through my old pay stubs – and it’s like WOW! I can’t believe how much I have changed financially, all the independent and all the freedom that I’ve had in the past eight or nine years, after running this Speech therapy private practice. It’s just amazing how much freedom I have now, again not just financial freedom but freedom of time, freedom to go pick up my son from school or volunteer at his school and just really be a part of his life as well. To me, that’s worth more than money being there for my child, and having that relationship with him. So I was just thinking about that and I went to visit my boss and she was saying “Hey remember when your last week here and you were just really nervous about breaking away from your job and going into Private Practice, and I told you could always have this job if you wanted” and I said “Yeah, I remember that, now we have 37 employees between 2 businesses, we see over 1600 patients per month and I don’t need that job anymore”. And it felt really good to say that because I think sometimes she would hint at me and said “You know you can always come back” and I would like “Nope I will never come back here again”.

Not that it wasn’t a bad facility or anything, it’s just you know, when you make your mind up to do what you got to do, you just do it and I did it and I’m happy to say it’s not all easy, again I’ve said it before on other Podcast if this was easy, everybody and their mom would be doing it. But this is hard work and it takes dedication but it was really nice to go back and talk to my old boss and see where I use to work – it was kind of interesting, and feeling of gratitude came over me. As I was walking down the hall pass the trach and vent unit and I remember going into those rooms and working with all those families on those trachs and vents and helping them regain their swallowing and regain their communication or cognitive ability. I mean it was a great job, but it was tough. Not like, you know Speech Therapy Private practice is like super easy but you know I’m just glad it’s on my terms now, so I’m really grateful for that.

Now, I got an email recently about employee, so, I’m going to take this time to go over the aspect of hiring your first employee. So there are some things that you have to do in terms of law when you have a new employee. So, when you are bringing on a new employee you need to do these things. So, first of all, you need to make sure you have a copy of that new employee’s driver’s license or a copy of their passport, so you can login. Here is the first thing, login to I-9central. I-9 central is on the web you can just search it under e-verified and that’s going to let you know if the person you are hiring is actually indeed able to work in the United States, because you have to have a copy of that report in that employee’s file.

The next thing you want to do is you want to make sure you have their Federal Tax information, so you can indeed withhold the taxes from their pay cheques. So you want to give that employee – there is the second thing a W4. Now if you want to know where to get that I’ll put this in the show notes as well, you want to get a copy of the W4 and have the employee fill that out so you know what to put in your payroll system in order to withhold taxes.

The third thing you want to do is on the State side of that what’s called an A4, that’s where you want to withhold the State Taxes from that employee pay cheque. Some other things that you want to think about again, I’ve mentioned it in the past on other Podcast, payroll service I use Intuit Payroll. I have a Costco membership so I get a discount and it’s really affordable, and it allow you to have multiple pay types and track sick leave and vacation and benefits and deductions, all that stuff. So, again think about a payroll system so you can track all this stuff. And again if you have questions about whether to make someone a 1099, which is where you don’t hold that tax out or W2 employee where you do withhold that employee tax. You want to talk to your CPA or your Attorney and make sure you get that solid advice, so you can move forward when you do hire. Because it’s a system folk, and when you get the system down it’s pretty easy you just duplicate it.

Another thing you want to have for your first or any employee is to have a copy of their CV or their Resume, you’ve got to have that in the chart. Another thing you want is at least 3 letters of recommendation or reference letters, so you can get some information on past employment history. Another thing you want to really look into, let’s say you have a contract in your State to service certain client or certain populations, that contract may require you to have what’s is called a Criminal History Self-Disclosure Affidavit. You might want to look into that, that’s where the employee goes down through a list of disqualifying events and either they check yes or no and if they check no, they are disqualified from being employed to service that contract. So again this might be contact specific for you all it might not apply, so you might want to look into that; but read the contracts that you have with insurance company or third party payers or other contract with the States that you operate in and service those contracts, they have their own requirements and I guarantee you every year with the State of Arizona, we have a contract with the Division of Developmental Disabilities and we always get audited annually. And they want the things that I’m talking about right now; they want copies of that so they can see the employees are up to date on all these things. So that is why I’m sharing it with you, so you can kind of be a step ahead so you can be ready when you get audited – you will have that paperwork for your employees ready.
Another thing you want to make sure is, you have a copy of that employee CPR card or their First Aid card. Another thing you might need a TB test, something that is required in the file – maybe not. Another thing here in Arizona we have a fingerprint clearance card, and that’s where you go down to the local police station, they finger print you, then you fill out a piece of paper, you send it to the State and you get a card back. They run it through their computer system and you get a fingerprint card that’s valid for 3 to 4 years, that needs to be up to date. Also, like in the State of Arizona, we have what’s called an Article 9 Review Certificate; it’s good for 3 years. That’s where you take a test on the phone or in person and you go through a class about restraints and thing like, how to not treat consumers basically.

Another thing you want to have is a copy of that new employee’s Medicaid billing number, their provider number. Also, you want to copy of their NPI number so you can bill – let’s say you are billing Blue Cross or Blue Shield of Arizona or any other State for that matter, you are going to have to use that NPI to bill that person out. You are going to need, let’s see maybe some sort of rules of conduct, like a signature page at the end. Let’s say you are just starting out, you want to make sure that you have clear defined rules for your employees, like work hour, appropriate dress for work or disciplinary action – just things like that. You want to have a simple job description and a conduct page or something to set some boundaries and some framework for your employees.

Now I do have a place on Privateslp.com where it is a closed forum for people to have access to all these forms, I have tons of forms on there; I have some training on there. If that’s something you’d be interested in being a member of my online community, shoot me an email kyle@privateslp.com and express that interest in me and we can talk about letting you into that private membership or you can have direct access to me on a daily basis for any questions that you have. And I get sometimes that people can’t come to Tucson and be the ‘Perfect Student’ and just give up a week of their current job situation, so this might be another angle for you. So if you want to maybe learn from me but just don’t have the time to come down, the online membership is affordable it’s actually more affordable than being a Perfect Student but you’d have direct access to me online in the community. And we also have monthly masterminds and if there is something that’s not on there, let’s say if you are asking questions about a particular topic in Private Practice, I will make that training for you, so if that’s something you are interested in shoot me an email kyle@privateslp.com and again all these things I’ve talked about as far as a new hire packet it’s all in there too. And the service are lightning fast we host this thing on the AWS which is Amazon.com; even if you log into another part of the United States you are going to get linked up with that area, so if you are on the West Coast you are going to be linked up to the West Coast server, so you won’t have any problems with the video quality or video delivery. Even I’ve checked it out when I went to Australia last year for a conference, I logged into the membership community and it was lightning fast because we got redirected to the Asia servers over that way, over in Australia. So it was really nice and I kind of checked it when I go around the world. So that is something if it does interest you, send me an email and we can talk about getting you access to that closed Private membership community.

So that’s it for New Hires, that some really solid information, things you need to know when bringing on a new employee. Also, you want to save your money because you may not see the payments from these new employees – let’s say if you have this new person seeing some speech patients for you; You may not see that money for another 30 or 60 or 90 days, from the time of service so another reason you want to save and be frugal with your money and not go spend and buy all these things that you really don’t have to have in your clinic right now. But you want to save because again you are going to be kind of like fronting that money; that pay check for that new employee and you may not see the rewards from that employee for another 60 or 90 days. So just keep that in mind too, you’ve got to save you money in order to pay that employee. And again you may not see that money from that new employee for the work that they are doing from the contract hat they are seeing patients for. Sometimes even 1/2 a year I’ve seen it because again insurances love to delay, they love to play games and they hold payment and sometimes you have to write the Attorney General’s Office and file grievances. I mean that’s my job now, I really don’t see too many people in the clinic, I have a few clients that I work with one on one, but most of my time is now spent filing grievances, going up to Phoenix, meeting with the Attorney General’s Office – you know, shaking the trees so that I can get paid.

And again when you bring in employees you are not going to see that money the next day so keep that in mind when you grow, you don’t want to bring on too many people. You got to be able to support the people you bring on so just keep that in mind, you’ve got to have a little bit of cash a little bit of buffer there too, so that’s something else to keep in mind. As always if you have any questions at all of anything that I’m talking about on any of these Podcasts, please reach out to me kyle@privateslp.com and as always, thank you for listening.

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