Methodology 1. Design

of Your Clinic. Obviously, if you have a computer and a printer, and a phone and credit card machine, you are going to need a desk and a work table or counter area. If you have a desk or two, then a chair or two is also probably a good idea.

Get a comfortable chair with good back support and

cushioning. If you don’t have a receptionist, then you will be sitting here thinking, planning, and checking patients out yourself. So invest in a nice place to sit.

Lamps and lighting to go on or around your desk as well as lighting in your treatment rooms and waiting area will make the day’s tasks easier than operating in the dark. For more

information on lighting and ambience, see Section 2, Chapter 6.

Another office requirement for the HIPAA generation is a locking file cabinet for your patient charts. As we discuss in the chapters listed below, the question is not really if you store your patient charts. It is how you store them and how you keep them secure. To learn more about HIPAA

compliance, please see Section 2, Chapter 9, on HIPAA and Section 1, Chapter 4, on Legal Stuff.

5. Treatment tables: A good, sturdy table in each treatment room is a must and a no-brainer. Therefore, we recommend that, aside from the table you may or may not already have, a good idea for finding inexpensive tables is to call the

companies that make them and try to buy any of the trade show tables they may have lying around. They are almost always in perfect condition. They’re just worn-in a bit from traveling around the country and having scores of people sit and lie down on them.

You may also scour your local paper or eBay for practitioners who are selling off old or unwanted equipment.

Whatever you do, make sure the tables you purchase have a

decent working weight that will stand the test of time. A colleague of ours and recent graduate from a local massage school thought she got a great deal by getting her massage table at Costco. The price was great, but the patient who was on the table when the leg snapped off did not return for another treatment! Always use equipment tailored for professional and not home use.

Paperwork

To run your ultra-efficient acupuncture clinic, you will need specific forms. From patient intake and charting, to HIPAA privacy requirements, we’ve got the forms for you. Included on the companion CD is an example of each of the forms listed below that you will need to operate your clinic. Feel free to use the forms as they are or modify them to suit your liking and style. More about forms and their legal ramifications is listed in Section 2, Chapter 8.

Forms on our CD:

– intake forms

– patient health history

– liability waiver or permission to treat form – insurance Assignment of Benefits form – notice of privacy policy (HIPAA)

– acknowledgment of receipt of privacy policy (HIPAA) – individual rights for authorization (HIPAA)

– disclosure form (HIPAA) – informed consent (HIPAA) – fax log (HIPAA)

– sign-in sheet

– patient private information form

– clinic financial and cancellation policy form – follow-up care (Report of Findings)

– herb instructions (bulk internal and external, patent) – referral information sheet

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Office Supplies

The day-to-day operation of your clinic will place certain, unavoidable demands on your stock-pile of office supplies.

Whether you are just opening or starting a stash of office supplies in advance of opening, this list of essentials and bonus items will get you started.

Stapler and staples: Get a good one. The cheap ones break easily.

Paperclips: You may or may not need these depending on how you take care of your billing notes to the front desk staff.

Regardless, when it comes to paperclips, do get the cheapest you can find.

Paper: Buy it by the box to save money. Office Depot always has a deal on theirs. You can buy a box of five reams for the same price as four individual reams. You can find them at www.officedepot.com.

Tape: You never know when you will need tape. So keep some handy or you’ll miss it when you need it. We don’t use it that often in our clinics, but there are occasions.

CMS forms: The old HCFA 1500. Check online for the best current pricing. We once got 2,500 for $30! If you can wait for or find a sale, that’s your best bet. Buy as many as you can stand. HIPAA regulations have made that form the standard and, despite the talk about ABC codes, we don’t foresee it changing any time soon. Lots of companies carry these forms.

Do a search on www.dogpile.com for “hcfa 1500 price” and you’ll be amazed at the results you get.

Ink and toner: Keep at least two black and one color toner/ink cartridge on hand as back-up. Nice, sharp forms and super bills say nothing but “professional.”

Pens: Don’t forget to get a good amount of ink pens. Chart noting must be done in ink (blue or black), and you will be amazed at how quickly they disappear from the front counter. If

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you want to use that fact as a marketing technique, there are lots of companies that will laser engrave your business name and information onto a decent tube pen for very low prices. Again, do some looking around before you buy.

Stamps and envelopes: You’ll be surprised at how much mail even a small office can produce. Buy envelopes (#10 security envelopes are best) in bulk and you’ll save in the long run. If you have just signed a five-year lease, you might consider getting some printed with your address, logo, etc. Once in a while, you will get offers for 1,000 envelopes with your return address printed in black for very inexpensive pricing. However, if you are going to stick with plain ones, Office Depot sells them in boxes of 500. As for postage, you can do that one of two ways:

1) Get a postage machine and pay the monthly fee plus postage, or 2) go down to the post office and order 100 stamps at a time.

The only problem there is that, if you want to send something that is larger or heavier than a regular piece of mail from your office, you won’t know how much it costs without a postage meter, and that means more trips to the post office. Then again, you might do some good one-on-one marketing to your fellow citizens while you are waiting in line. You could probably give away several business cards during a 10-minute wait. If you want to order stamps by mail, the post office will deliver them to your mailbox. Go to http://shop.usps.com.

Tissue and TP: Especially around cold and flu season, but anytime someone puts their head on the face rest for a

treatment, it can make them congested. If you are in a building where the bathrooms are not inside your clinic, toilet paper is already included in the cost of your rent. However, if you have bathrooms inside your clinic, then the TP, paper towels, tissues, and anything else you need for a bathroom such as cleaning supplies, will be your responsibility. Costco is a great source of this type of product. However, if you are into completely

recycled paper products with no chlorine bleaching and cleaning

products that do not harm our nation’s water supply, search online or search your local Yellow Pages for sources of supply.

Ordering Needles

Needles to an acupuncturist are like a wand to a wizard. Some feel good in your hands and others don’t. Some practitioners resonate with copper handles, some stainless, and others like the plastic, color-coded handles. No doubt by this time, you are very comfortable with some varieties of needles. Therefore, we are not going to talk about the style of needles. Instead, we will look at inventory, ordering, and ways to get better prices.

Prices: No matter which company you deal with for your acupuncture supplies, there is one common thread to be found:

buy more boxes and pay less per box. This is a good incentive to order enough for several months at a time rather than 10 boxes per week.

Most companies, for example, will give you a price break per box if you buy 10 or more boxes. If you buy more than 100 boxes, then your price break is even greater. On the other hand, some companies won’t give you any price break until you hit 50 boxes. Typically, this is only on needles that are less than $6 per box. We have found needles out there for $2.50 per box when ordering 50 or more boxes. Email me [ES] if you want to know which ones and from whom.

Another way to get a price break on needles is to become a distributor. Distributorship is not impossible to arrange,

although the initial orders required to do so are quite substantial (around 10,000 boxes in some cases). If you have enough money to do that, then you don’t need a price break! Plus, once you get into distributing needles, you may find it difficult to maintain an acupuncture practice as well as a needle-shipping business.

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Your first order: When you first start out, there’s almost no way to know how many boxes of needles you’ll go through unless you are buying a pre-existing practice. You can take a stab at it, though, by guesstimating how many patients you will see per week in the first month and then multiplying that by the average number of needles you typically use. If you are just coming out of school, then you should have a good impression of what that number is. Just because you are out on your own doesn’t mean that your treatment style is going to change, at least not yet.

The companies out there are pretty good at getting your order to you in a week’s time and possibly faster if you are willing to pay for upgraded service. Also, if you tell them you just

graduated and are looking for a needle company to do business with, you may get an initial order discount. If you can get a new customer discount, it may be wise to order what you think you will need for a few months just for the sake of the omen.

Our suggestion is to start out ordering a few different lengths of whatever gauge needle you feel most comfortable with. (If you like using 32 gauge needles on every patient, we would

recommend getting a few smaller ones for the children, elderly, and MS patients or other very sensitive patients you will undoubtedly be seeing.) Whichever length of needle you use most often should make up the bulk of your order. Then, if you can order enough needles to get a discount, go for that. For instance, an initial needle order might look like this:

34 gage (0.22) x 1” (25mm) – 16 boxes 34 gage (0.22) x 2” (50mm) – 9 boxes 34 gage (0.22) x 3” (75mm) – 5 boxes 34 gage (0.22) x .5” (13mm) – 4 boxes 36 gage (0.20) x 1” (25mm) – 6 boxes

The total order is for 50 boxes. Getting a $0.50 price discount per box (from $3 each) this order total is $125, plus shipping and handling.

Some needle companies and most herb companies require you to register with them or send in a copy of your license. We’ve found this to be more often the case with ordering supplements and sharps containers from medical companies, however, than in the needle-selling business.

Just know that you may run into it.

Inventory: The first thing you want to do when your needle order comes in is to match up what’s inside the box with what’s on the invoice, and match that up with what you think you ordered. (This is easy if you sent the order in by fax or email.) This is

something you do with everything you order, be it herbs, acupuncture supplies, or even books and educational materials.

A word to the wise, the one time you don’t check is the one time you’ll end up shorted or with something completely different from what you wanted.

So you’ve checked in your order and, since this is the first order you’ve ever done, you’ll use this to start your inventory sheet with. If you have Excel, this will be an easy task. Otherwise, get out a pen, a ruler, and some graph paper. What you are going to do is create a basic inventory sheet. “Basic” because you are only doing this to make sure you have enough of whatever the commodity is on hand at all times.

P O W E R P O I N T

Make a few photocopies of both your license and diploma before you have them matted and framed. Keep a clean copy of each in a file. Then, when you apply to an HMO to be certified or when you need to show an herb company that you are who you say you are, you don’t have to take them down off the wall and struggle to get another copy made.

There are five parts to maintaining a basic inventory: 1) date, 2) on-hand, 3) par, 4) balance, and 5) order. The date is only important in so much as you perform an inventory on the same day each week or each month. For this exercise, let’s say you decide that every other Friday morning you will do inventory and place an order if necessary. So, Friday morning you grab your clipboard and start going through each room to count the unopened boxes of each size and gauge of needle. Only count the unopened boxes because you are only dealing with full boxes here.

Then, if you have a storage closet or cabinet where you keep all of your acupuncture supplies, go there and do the same thing.

Count each size and gauge of needle and write those numbers down in the appropriate column. Now, add the numbers across the page for each specific needle. The end result is your total on-hand.

Next we come to par. Your par is the number of boxes of each variety of needle that you would like to have on hand. For instance, if you think that keeping 20 boxes of 32 gauge, 1”

needles on hand is necessary, then that is your par. This number can be changed as you go through your career. So just start somewhere in the middle of where you think you should be.

Adjust it down if you don’t go through that category of needle very quickly or up if you almost run out.

Now, using some basic math, you subtract what you have on-hand from your par and the end result is our balance. This is what you need to order to bring your inventory back up to par.

Unfortunately, with needles taking almost a week to get to your office, you will probably never maintain your par levels. That doesn’t matter. As long as you don’t run out, you’re fine.

So, your basic inventory sheet could look like this:

After you’ve completed the inventory, send in your order to the appropriate company. Then staple your inventory sheet to the back of your copy of the order. If you have a yearly orders book, punch your order sheet and file it in the pending section. Once the order comes in, check the inventory and contents of the box against your order, staple the inventory sheet to the other two, and re-file that in the completed orders section. Keeping track of things like this isn’t a requirement, but the information can be useful in the long run.

One year or five years down the road, you may start to notice certain trends in patient visits. Maybe your needle orders always go up in March. By keeping track of your ordering, you will be able to better forecast these changes in your spending and can budget accordingly. It can also be helpful to include cotton balls, alcohol pads, moxa sticks, or any other acupuncture supplies you keep on hand in excess supply.

Hazardous Waste Disposal

Lest we forget, once a needle is inserted into the body of a patient, we need to dispose of it properly. That means we need to make sure we’ve got appropriate receptacles. Any of the acupuncture supply companies carry “sharps” containers. What

Date of inventory: FFrriiddaayy,, NNoovveemmbbeerr 2211sstt,, 22000033

Item Rm 1 Rm 2 Rm 3 Rm 4 Other On-hand Par Balance Order

32 x 1 22 33 11 00 1122 1188 2200 22 22

32 x 2 11 22 11 11 55 1100 1100 22 00

32 x 3 32 x 1/2 28 x 6 34 x 1

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style you like and what kind of space you have in your

treatment rooms will dictate the size and shape of the containers you order.

It is best to get the style of container that somehow mounts into a holder on the wall. These will not get knocked over by

patient’s swinging their coat on or by tiny tots tossing their shoes. A spilled sharps container is not a fun thing. Second best are the large base containers that you can set on a countertop, perhaps in a corner again to protect against accidental spills.

Some of the acupuncture supply companies also offer a service to dispose of your full containers. This is a nice system if you have no alternative. I’ve found that by checking local

pharmacies, you may be able to have them dispose of your containers for you. A quick call around town may save you all sorts of money. Another nice option is a mail-in receptacle program. Large waste management/disposal companies have these programs and can be really inexpensive. Again, this is worth a phone call or two. Regardless of the system you choose for sharps disposal, make sure to keep some sort of record of how much you spend in disposal and how often you dispose.

There are some managed care networks that like to make sure you do, in fact, use disposable needles and these records are the proof that you are compliant.

Herbs and Your Dispensary

Herbs are a great asset to any Oriental medicine clinic, if not a complete necessity for good patient care. The downside of an herbal dispensary is the initial cash outlay for the herbs, storage space and cost of building that space, inventory systems, and the fact that you will always come up against a specific herb or prepared medicine that you don’t have when you want it but which would be great for this patient. So, what to do, and how to do it?

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First of all, I would not recommend purchasing any herbs (bulk or otherwise) until you are ready to begin dispensing them to actual patients. Although properly packaged dried herbs have a decent shelf-life, you will spend more in the long run buying herbs in dribs and drabs over time. Storing boxes of herbs in your home,

First of all, I would not recommend purchasing any herbs (bulk or otherwise) until you are ready to begin dispensing them to actual patients. Although properly packaged dried herbs have a decent shelf-life, you will spend more in the long run buying herbs in dribs and drabs over time. Storing boxes of herbs in your home,