Some free advice:
Start small.
Smile, breathe and go slowly.
This is suppose to be fun, remember that!
If you've worked with someone in the past that you want, then take them with you.
Utilize social media! Holy shit, I never contacted a single doctor, organization, or website to spread the word that I opened. I relied on facebook and word of mouth. 3 months before moving into my building, I have 35 people on my waitlist, including 5 from my previous employer. I made a job post on facebook and received 27 applications in 2 days. I posted that I was hosting an open house and 8 families showed up, along with 40 colleagues.
Questions
What was the hardest part?
Waiting. Like I said, I made the dumb decision not to start credentialing while being employed so I literally did not work for 4 months while waiting. Waiting for insurance. Waiting for authorizations. Waiting for payments.
What did you wish you had known before starting?
How long I might go without getting paid. I hired my first employee in January, with the expectation that we would have our first client by February 1. That did not happen. Understand this, everything takes WAY MORE TIME than you could ever have expected. We started intake for a potential client the 3rd week of January. We submitted his documents to our billing company. Approximately 7 days later, we received approval for assessment authorization, but only received 4 hours (which is criminal, but seems to be the direction insurances are taking, despite the code changes, more on that in a minute..) I appealed for more hours, and they scheduled a phone call 2 days later. I spoke with that individual about the issue and she agreed with me, but said that it was a Department of Health issue (I was dealing with Medicaid) and there was nothing she could do. I assessed the child a day later for 2 hours, then again the next 2 week for 2 hours. I did not come anywhere near completing the assessment, and ethically, I did not feel comfortable stopping there. So I schedule a 3rd assessment date for another 2 hours, I ate 6 hours of analysis and report writing, and I turned in the assessment with a request for hours based on the comprehensive report. I received an approval 3 weeks later, at the end of February. So as you can see, the process of getting a child in can take 1-2 months. So, I didn't get paid for January, and I didn't get paid for February, but I had to pay my technician (and all the bills!).
How did you determine which clients you would work with?
First, I made sure that they were in my scope of practice (and on a side note, I do recommend writing a Declaration of Practices for parents to sign). Second, were they in network and did they have an autism diagnosis? If they checked these boxes off, I would schedule a meeting with the child and the guardians. I had a series of questions for an interview with the family to make sure that they were prepared to be involved and follow my parent involvement policies (i.e. weekly hourly parent training, strict attendance rules, reliable transportation, support system, etc.). If the parents seemed like they were dedicated to improving their child's life, then we started the engines.
How much money did you spend to get started and can you give a breakdown?
First off, I saved about $15,000 before starting. I knew this would not be enough, so I applied for a home equity line of credit for $100,000. I spent about $10,000 on furniture, toys and general supplies (mostly through amazon so that I could use my amazon card for 5% back, $500!). I spent about $5000 on my billing/credentialing company well before receiving my first client. Website, domain name, logo, google suite, payroll company, and all of the other media involved - I spent about $1000. Phone and internet installation and equipment, roughly $850. To turn the utilities on cost $1000 (by the way), and then my monthly bill started around $500. I spent about $500 advertising on facebook and instagram. My lease cost $3500 per month (for about 4000 square feet, I didn't use 1500ft during the first 6 months). My sign cost $3000, and yeah, that's why I said nix that shit. Here's the kicker, my CPA and accountant were free and done by a family friend - so be prepared for that cost. I also financed all that furniture that I mentioned before. All in all, I spent about $20,000 to start. What's not included in that is all the money that I spent on living without a paycheck. I used the $15,000 in 3 months. Food, bills, (COBRA insurance!), rent, life - it adds up fast without income.
What was your experience with negotiating rates?
You lose. Here's a fun thing that I observed and experienced that I know you will too. We're not allowed to discuss rates, correct? But Tricare and Medicaid have to publicly post their rates. Tricare is competitive and very reasonable. Medicaid is pretty much bottom of the barrel. When you try to contract with private companies and begin negotiating, they will give you rates that are identical to Medicaid in your area - and there is 0 wiggle room. You will not get anything better, because you have no leverage.
Was it hard to get clients?
No, not at all, actually. I'm located in the suburbs of a major metropolitan city (400k population) in the southeast portion of the United States. By the time I submitted my first authorization, I have 60 children on my waitlist (some for school services, some for after school services, but the majority for clinical services). The majority of these children were not enrolled at other centers and were between the ages of 2-6.
How did you get clients?
Facebook and word of mouth. During my 4 months of not working, I networked with other centers fairly well - I reached out and told them my plans, I went to the local ABA conference and spread the word, and I told every BCBA that I knew where my center was and how people could get in touch with me. I spent about $500 advertising on facebook, and I gathered 400 followers in less than 6 months. Organically, I met with 2 different social workers who worked in the local school district, and they began sharing my cards with parents. My center was conveniently located across the street from two large elementary schools, with a daycare located behind it. Don't underestimate location or social media.
What is your typical client demographic?
Aged 2-6, autism diagnosis, non-verbal, with mild-moderate behavior concerns. Health mix of white, African American, and Hispanic families.