More About Steve
With over 15 years of experience in the nutrition & wellness field, Steve has specialized in kidney disease, weight management, diabetes, Vitamin D, and heart disease.
He has both master's and bachelor's degrees in Nutrition Science from Brooklyn College and completed his dietetic internship at LIU. Past leadership positions include President of the Long Island Dietetic Association, Chair of the Greater NY Council on Renal Nutrition, and currently Board-president of For Kidney Sake, Inc.
He began Nutrition Practice Management as a service for the registered dietitian nutritionist in private practice who want to save time while growing their business. He is also a dad of 2, happily married and living on Long Island, NY.
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Links From This Episode:
- Google My Business
- Call 4 Nutrition
- Business Networking International
- Simple Practice
- Practice Better (affiliate link)
- Office Ally
- Functional Nutrition Library
- Insurance Credentialing and Billing for Dietitian Nutritionists Facebook Group
- Dietitians in Private Practice Facebook Group
- Dietitians in Group Practice Facebook Group
Read the Transcript
Welcome to The Unconventional RD podcast, where we inspire dietitians to think outside of the traditional employment box and create their own unconventional income streams. We'll talk all things online business to help you start, grow and scale your own digital empire.
What to Expect in This Episode
On today's episode, we have Steve Della Croce. And he is the owner of Nutrition Practice Management, a company that offers admin support to private practice dietitians, which I think is such a fun business idea. So that's what we're going to talk about today on the show.
So, thanks for being here, Steve.
Steve: Thank you so much for having me.
Steve's Background in Dietetics and Entrepreneurship
Erica: So I know you have nearly 15 years of experience in this field, so although I want to talk about your company, Nutrition Practice Management, I'd really love to hear how your career and dietetics started and how that eventually led to you owning a private practice and then founding Nutrition Practice Management. So, could you kind of guide us through that journey?
Steve: Sure, it is not a straight line, so I'll try to make it brief.
I'd actually left college midway through not knowing I wanted to be a dietitian. I had no idea what I wanted to be. But I was lucky enough to play music and actually do that professionally for a few years. I got to grow up a little.
And I knew I wanted to own a business somehow. But no one in my family did, so I didn't know where to start. I figured I'd just go to school and do something that I thought I'd like to get a job. And when I went back to school, I really knew how passionate I was about health and wellness. And I knew food was a big piece, so I went and became a dietitian.
I went to Brooklyn College. I'm from Brooklyn if you can't tell from my accent. And, um so I, you know, again knew I wanted to own a business, and I knew that if I eventually got a private practice, that was a way of owning a business. So I figured that was a good place to start.
Um, ended up having no idea what kidney disease was, but in my second week of my two week renal rotation in my internship, I ended up falling in love with it and got a job right out of internship in renal, so I worked in dialysis. And within a year I understood what a niche was because now, here I am, I have a specialty.
And I decided to go into private practice dealing mostly with all the issues that I was dealing with on a day to day. But I wanted to do more preventative and work with that early stage kidney disease and diabetic populations and prevent them from maybe advancing to dialysis.
So in 2005 I incorporated myself and honestly, I just talked to people that I knew that owned a business. I, you know, hired a lawyer who explained to me what an S Corp was. I had no idea what an LLC was. And it just made sense to go with an S Corp. So there I am. I'm incorporated now, and now I have to learn what the heck to do. Trust me, I made mistakes with my taxes and you name it.
And didn't know how to market myself. I had no business background at all, but over the next few years, I just tried to find ways to learn, so I would read books or I would listen to books or, actually one of the best advice I got was, If you want to own a business, learn how to do sales somehow, because you can get paid to basically run your own little business.
And I actually got some work in pharmaceuticals after being in dialysis for a few years, and they hired me as an expert in vitamin D with kidney disease, so that was right up my alley. But I got to learn the basics of running and promoting yourself and doing some things the right way and got paid for it. So it was pretty cool.
And then I eventually focused back on the private practice and started networking with doctors and getting them to know who I was and just filling a void, which was they had no one to really refer patients to with the conditions that they had to deal with.
So, um, the one thing that I will say is when I started the private practice and started learning, I had a biller and had to learn how to bill from them. I really had the idea of, I want this to be bigger than me. I really want to help as many people through health and nutrition as possible. So there are lots of dietitians who don't want to run the business, but they want to see patients. So I figured if I could structure my practice in a way that I could hire on other dietitians, give them work, everyone's happy.
So, you know, fast forward to about three years ago, I just got good at billing and really knew how to create processes in my practice so that I wasn't doing all the work. And I had so many dietitians with questions and no clarity at all on how to get paid to run their business and even just have the right mindset of being a business owner, that I just started to put these packages together and put it as like a beta test, using my own practice to market it. And then my first client was another dietitian, that I was on the board with at a local dietetic association.
You know, we were somewhat friendly. I approached a few people I knew first. Gave her a good deal, of course, but, um, it started with that. And then the more I started talking to people, the more I saw what the need was, and filling that need. So it was never me just trying to make money or just promote myself. It was always about the end result, which was more people getting healthier through nutrition and helping the dietitian facilitate that. And now it's been three years and we're really growing, and it's exciting.
So that's my long story short.
Erica: No, that was a great summary. I feel like there's a lot of parallels that identify with, even with my own business.
And, you know, I did start seeing clients one-on-one, but then transitioned into more content creation and writing. And then, you know, teaching other dietitians how to get found on the Internet through their writing sort of became my thing.
So, you know, I feel you on, you know, seeing some success yourself and then wanting to pass that on to other people so that they can get more visible and help more people. I think that's really powerful.
More Details on Nutrition Practice Management
Erica: Um, so okay, so at this moment, you have your private practice with, like a team of dietitians. And then you also have Nutrition Practice Management to help dietitians with more of, like, the admin side of stuff?
Steve: Basically anything they need. So, if it’s something that they would hire an assistant for. But usually dietitians, not a full-time practice needing full-time employees. So we offer everything on an as-needed basis, uh, answering phones or doing the billing and following up with the bills that are trouble and so on, and calling and verifying benefits.
You just pay for what you use, basically. We don't have minimums and all that, and you know I have a diet tech who has been working with me for years. So she really understands what the dietitians are trying to do. So, yeah, it's just, um, we've also launched some web services and other things. Just anything incorporating private practice ownership.
What It's Like to Run Two Businesses
Erica: That's cool. Is it overwhelming to run two businesses? Like, how do you manage that time-wise?
Steve: Uh,I delegate as much as I can. My goal every week is to find a way to fire myself.
So basically, getting somebody else to do the day-to-day so I could focus on growing and really having a wider reach. So, yeah, it's not eight hours a day. It's not five days a week.
Um, and I have a family, and I have lots of other things going on. But you know, when you're passionate about it, you just make time for it. It's not really work. But it's a lot, and some weeks are harder than others, and every day there's a problem. But you know, if I didn't love doing it, I wouldn't do it. If I didn't really have a passion for our end result of helping more people, it wouldn't get done.
Erica: Yeah, and I think that's a cool perspective that you have, to even be aware that you're trying to build systems that you could slot other people into, and then you're just kind of rising up and being the overseer and the bigger picture thinker. Because I think that's not super common as dietitians.
A lot of times, like you said, we're in the trenches with the one-on-one client work. Um, so that's a good perspective, I think, for people to be reminded of, that you can create a business like that where it's not all centered around your one-on-one time.
Steve: But not everyone wants that, and that's okay.
But I think not enough dietitians realize, and I always make the comparison to like, an electrician. My brother's an electrician. So he is as good of an electrician as you could find. But he's a terrible business owner because he wants to do all the work a certain way, and he doesn't understand that some people have to do some of the work for him.
And some dietitians just get stuck in that. They're the practitioner. They’re the mechanic. They’re the person doing the work. And they don't really want to do anything else, but they want to control everything because it’s their business. But they also think they have to be the person that does all that, and you just can't.
And it could start with just hiring a good CPA. Right? And just not doing your own taxes, like having somebody else to look at your business from an outside point of view, and you could get comfortable with that and go on from there. But it's a very different mindset.
Erica: Yeah, well, thanks for bringing it up and shining a light on it.
Were People Supportive of Starting a Second Business?
Erica: Just in terms of starting this business, the second business, was that, you know, when you told people about it, what was kind of like the reaction that you would get from people? Was it generally supportive or were people like, “What are you doing? You already have a business”?
Steve: I think the general consensus, and I hope people weren’t just being nice to me, what they were saying was, like this is a really good idea, there’s a need for it. To this day, it's still the same theme over and over again. There's a need for it.
And if anyone is trying to figure out a business, so, let's talk about a private practice. Trying to get started or having trouble growing, you know, who are you serving? You know, are you trying to create something that no one knows exists? There’s a couple of different focuses of dietitians using terminology that people just don't know.
And who's in your area? You know, who's in your geography? Who are the doctors who could refer to you? And if you want to focus on one area. And let's say you're a GI specialist, and there's no real big practices around, and everyone else is in endocrinology and internal medicine. That's tough, and maybe you have to find a way to serve those people.
But if people aren't finding you, then either you're not giving them what they're looking for or you're not, you know, getting your name out enough. So I think it's important to know that you have to serve a certain need. And then it becomes very easy at that point. Really, the business comes in very easily.
Erica: Yeah, I feel, I agree with that. I kind of have found that with at least my SEO stuff that I've been talking about more recently. There is a need and it's fun, and I don't have to do that much work because people come to me. Whereas maybe in the past, I didn't have clarity on my messaging or who I was helping. Nobody came to me because nobody knew what I did.
Steve: It makes you feel like you're doing something wrong, and it's not. It just, it wasn't a straight line like you thought it would be.
Erica: Yeah, it definitely took me, like, four or five years to figure out my niche just in life, in business, in general, I would say. But it worked out.
Steve: You're going the right direction. You're doing good things.
Taking Action and Being Okay with Mistakes
Erica: Yeah, I think. Well, I don't know how you feel about this, but I think just, like, taking action was the most helpful. And then evaluating how it went and pivoting if I needed to, and just continuing to track.
Steve: Well, do you, do you feel like making a mistake was okay? Like if it didn't work out, you learn something from it, right? There's no real failure, there’s no real mistake. As long as you learn from that mistake.
And by the way, these are not my first businesses. I’ve tried to do other things. And I am one of those people who’s failed more than they've succeeded. But I learned every time. And there's a lot of mistakes I did not make this time around, so it looks good. But you have to, you have to take action. Absolutely.
And you know, you’ve gotta hedge your bet a little bit and keep making sure you have some income coming in If you're trying something new and not just close shop and go and do something else or leave your job and start a private practice or whatever you're looking to do. Just make sure you're taking things one step at a time because you will make mistakes and you will “fail.” Just learn from it and keep pushing forward and things seem to work out. And I think you're a great example of that.
Erica: Yeah, 1000%.
Mistakes That Steve Made When Starting Nutrition Practice Management
Erica: When you were starting this Nutrition Practice Management company. Do you have any mistakes that you think that you made in the beginning that you reflect back on and you're like, oh, I really learned from that?
Steve: Oh, yeah, and they add up to the thousands of dollars.
So, um, you know, part of it was what I thought, and because we have so many different services, part of it was offering something that actually nobody either wanted or was willing to pay for. And it was costing me money to kind of produce the service. So I had to cut that down or cut it out and learn through my clients and losing some clients and also talking to people who were looking for services of what really they needed.
So, changing our business and changing what we did based on that, only, what they needed. And then stop wasting time and money on the things that really nobody was looking for, so kind of pointless.
So it's been a huge difference. It's literally changed us to becoming profitable by getting rid of the things that we were spending time and money on that we shouldn't have.
Erica: That's such a good insight. How often do you look kinda at the data? Or ask your clients to reflect back on that stuff?
Steve: Um, well, I definitely look at everything monthly, but, and I'm not the most analytical person, but I am very, uh, I guess intuitive, and I try to feel the way things are going. But black and white is a good thing, right? The bank account tells you a little bit of the story, so I definitely don't let too long ago before evaluate. And if I see things going the wrong direction now, I can catch them a little earlier, after having made those mistakes in the past.
Services Offered by Nutrition Practice Management
Erica: Well just so that people listening know, I kind of looked at your website and made a note of all the different things that your company offers. So I'm just gonna say them out loud so people know what we're even talking about, and maybe we can dive deeper into some of them.
Erica: Um, so, like, I noticed you have insurance verification, billing, credentialing, answering services, which sounds super cool, like, picking up the phone when your potential clients call, scheduling, accounting, and bookkeeping, and then some website stuff and Google My Business help, which I think is awesome.
So which one of those did you start with? And then, did you gradually expand? Or did you always have all these offers and you honed them? Maybe you had more to begin with?
Steve: Right. We did take a few things away, but it started from my practice. Right? That was the beta test. What did I have?
I had somebody answering my phones, because I was losing clients who would leave a voicemail. Then when I called them back, they didn't answer or they called another dietitian. You know, eventually it got to the point that when I had somebody answering my phones professionally, I was the 5th, 6th, 7th, 8th dietitian that they called. But that person scheduled an appointment with us because we answered the phone.
So I said, wait a second, that means eight other dietitians didn't answer the phone and lost business? This is a problem. Let me fix it. All right, so it kind of started with that.
And the billing piece came very soon after that, because it was something that I did on my own and something that I was good at. But it was something that everyone really struggled with significantly.
So, those are the first ones that really came about. And then all the other ones were really connected in some way or another. I mean, we have a website called “call4nutrition.com” with the number 4 in it, and the goal of it was to be kind of a directory so people could find you. Um, and there's a few of those out there, and I used my own practice as a test and had a webmaster build it and really have people find us through the site. And once I started seeing that it worked, we offered that out as well.
And that's one of the things that I was talking about before that nobody's really willing to pay for, and I get it. And so it’s not as much of a focus on what we do, but from that piece, we realized that people's websites really weren't working and it's a very expensive thing to build and maintain a website.
So I work with people, and it's not me building the website, so I should be clear, right? It's not me answering the phones. It's not me calling you, verifying your benefits. But you know, I have people who are good at what they do, who just really wanted more business. And it's a kind of mutual relationship that we work together.
So building a website is part of it, right? That's gonna be key, and we try to make it affordable, because we're dietitians. We’re not going to, maybe, make the income a doctor would or, you know, a blue chip business would with a fancy website. So, try to do things reasonable but effective.
Acting Like the CEO of a Business, Rather Than an Employee
Erica: That was actually gonna be my next question. Like, did you hire employees right off the bat? Contractors? Like, how did you even find those people?
Because I'm thinking as someone who is, like, thinking about even starting a business in the structure that you describe, that seems super overwhelming, like the hiring part seems like it would be a roadblock. So can you give us some insight on how that goes?
Steve: Yeah, I think there's options, right? And this all came from just, you know, talking to people who built their own business, working, being in masterminds with other business owners, not nutrition business, right?
So, getting other points of view. Knowing what the options are, having a good CPA, an attorney to talk to and ask these questions, too. And I know the laws have changed recently. Used to be able to just hire everybody as a contractor and 1099 them, but it's not quite that simple. But there are some rules around where you can do that.
So if somebody wants to just work part-time or a few hours a week, as long as you don't give them a schedule, that's a good start for them to be a contractor, and maybe that's appropriate, ready to go.
But I do also have some third-party vendors, so people who do what they do that I needed that we just kind of partnered up with without being business partners. There's a way of having a relationship, there’s things called joint ventures, and there's just third party vendors agreements that you could use their services,
Erica: Kind of like white labeled stuff?
Steve: White label’s the term, yeah. Not everyone knows what white labels are. So I’ll peel back the veil a little bit. So white label means that, and I think it comes from wine, actually, so,
Erica: Oh, I didn't know that.
Steve: A lot of wine that you buy with a name on it wasn't produced by that winemaker. There's, you know, farms out there, and what they do is they’re good at farming grapes and making wine. And then companies come in and they put their own label on the bottle, another person's wine. By the way, supplements are famous for that, right? There's supplement companies that you can buy and basically just put your own label on it. That's called a white label. So that's the approach I've taken with a couple of services, and then on the services that I need somebody more in house, then they become more part of the team, under the umbrella.
Erica: Yeah, even in SEO you can do that. Like, you can hire people to do the audits for you, and then you can use their report and put your business on it, if you want it.
Steve: Yep. Just make sure you trust them, right? And make sure they do good work.
Erica: Yeah. Yeah, I've never done that. But I just know it exists out there. So that sounds, you know, totally outside, I think, of the wheelhouse of skill set that we have as a dietitian. So I mean, it sounds like you've had mentors and you've learned, you’re in masterminds.
Resources for Getting Better at Business
Erica: Do you have any tips for dietitians who maybe wanna get better at the business side of things? Suggested resources?
Steve: You know, there's a lot out there and part of where this came from too, was that I got out and started networking.
And for those people who don't know me, I'm as introspective and shy as they come. But you know when I'm passionate about something I'll get out and talk. So being out and networking with people who are not only not in the health field, but I mean, had every business imaginable.
So I joined a BNI group. If you haven't heard of Business Networking International, just look it up. There’s a chapter, I guarantee, within a mile of your house. Um, and you go out and you meet people, and you have to start talking to people about what you do, and within 30 or 60 seconds you have to tell them who you are, what you do, and what you offer. And you find a lot of resources there. People are willing to really share those resources and everyone starts talking about their business structure and how they're set up and whatnot.
And that's different than a mastermind which would be actually having regular scheduled meetings with a group. Hopefully no more than 6, 7 maybe 8 people, uh, to be effective. But if you're going to join a mastermind, make sure that everyone there has something you could learn from, and the best scenario will be that they're a little more advanced than you are in just about everything so that you can gain a lot. But you have to bring value to that group as well. So you have your specialty and something you can offer.
But there's a ton of resources out there. Some of it’s free, some of it’s paid. And so, if it's worth the money…
How to Find a Mastermind
Erica: How do you find masterminds in particular?
Steve: Um, you know, there's a few websites out there. I'm actually struggling finding my next one. To be honest with you, because I want to break out of, you know, just my niche. Um, do a lot of searches. But again, if you go to some of these other groups, like the networking groups or Toastmasters or even Kiwanis groups, things that are part of your community, you will find a lot of business owners and a lot who, you know, they want to grow their business, too. So they're looking for meeting with people who are like minded.
Erica: Are they typically paid, or are they just set up by peers?
Steve: If there's a facilitator, there might be a fee. But a lot of people just meet, you know, over coffee, or if somebody offers up the conference room and, you just meet there for an hour once a month.
Now there's a lot of online resources, and I know plenty of dietitians who are part of the dietitian mastermind groups. And maybe it's as simple as putting out a post on your Facebook and saying, “Hey, I'm looking for like-minded people to be in a mastermind group with” and you'd be surprised where it leads because somebody knows somebody who knows somebody. So it's just part of that network piece. That's why I brought that up first. Cause it does start there. And there's just so many resources.
But, um, there's also a lot of great books that you could learn some of the basics from. I mean my favorite thing in the world is my Audible account. You know, I’d just constantly listen to new books. Um, I used to read at least 10 books a year when I commuted, and just learn what I wanted to learn, which was to get better at being a business owner, not a dietitian business owner, but really understanding what's necessary from running a true business and not just being self-employed and being my own boss, but beyond that, So read, listen, meet people, you know, kind of do things that you didn't think you would have to in the past. But take that action first and it will lead you to the next step. Definitely.
Erica: Thanks, that was really helpful advice. I've dabbled in the thought of joining a mastermind but I haven't pulled the trigger on it yet. So I'm always curious, like to hear other people's perspectives.
Steve's Long Term Vision
Erica: Where do you see yourself going with your career and your two businesses? What's your long-term vision? Do you plan to continue to run both of them, or lean harder into one or the other? What do you think?
Steve: Yes, so, I mean, the private practice, we’re based in New York, in Long Island, and we're pretty much the only renal private practice, so people come to us from over an hour away. I have a call with somebody in India on Friday. I mean, it's just, you know, when you have a niche, there's a need for it, so it's hard to stop doing that.
But because so many dietitians want nothing to do with any of the admin work, they just want to see patients, but they're great at it. That's who I bring into my practice. So we're not huge. But being in that niche, we’re a little bit smaller, but you know that I don't see stopping.
Although I could say, oh I can't focus on it anymore. I'm just gonna go on to the next thing. But I put pieces in place of, you know, phones are being answered, the clients are being scheduled, the billing is being done, and the patients are being taken care of. There's a lot of value that we're offering to that community, so there's no reason to stop it. But from a large point of view and really kind of taking care of my family long-term and that I see through business ownership, that's for me, personally.
So Nutrition Practice Management is where I'm mostly focused, and I think there's a lot more we haven't done. And most people don't know we exist. You know, we have over 30 private practices as clients probably gonna cross 40 this month. Just for different services, and most people don't know we exist. So again, if I didn't think there was a need, I wouldn't be going forward.
But we're excited to do some advertising in a lot of the state meetings coming up in the next few months. So hopefully people will hear our name. Here’s some people sharing stories about us being good at what we do, hopefully, and, um, I think there's just thousands of dietitians who need help, and
I'm actually starting to look into build a course for billing and insurance and all that fun stuff that nobody wants to do and really get, just cut those errors down and speed up the time where a dietitian can go from starting private practice to actually being successful in it and not stressing out over something that we don't learn in school.
I think that I've spoken to a few interns who have learned about business ownership and insurance because they had a couple of good professors, but I didn't learn it, and most of us did not learn it, and they need help. So that's just that's what keeps us going.
Erica: Yeah, I definitely didn't learn, I mean, I learned a little bit about business. We had people come in and speak about whatever they did and a lot of them were entrepreneurs, but I don't recall specifically learning anything about insurance for sure.
Um, and I think it's super powerful that you are a dietitian. So people, I think, just inherently maybe feel a little bit more trusting because they're like, oh, you get it. You do this, and it's not like some other person just seeing the business opportunity and trying to fill the need without really understanding the nuts and bolts of everything. So I think that's a huge plus for your company.
Steve: I hope that comes through when I talk to people. That really, it's the truth, I get where they’re coming from.
How Does a Business Owner Know When They're Ready to Outsource?
Erica: How does the dietitian or business owner know when they're ready to start outsourcing admin work? Like is there an ideal time or stage of their business that you typically recommend they start thinking about it?
Steve: Yeah, you know, I think it depends on time. Right? Time available to do all this. We all probably know some great dietitians who just set aside time and do their own billing and answer their phones and get it all done. And that's great. Delegating is not for them. They handle it. They, you know, they have exactly how much business they want, and they're very happy. So not talking about that.
So the dietitian, who, this is typically who calls. Right? It's the dietitian who has either a full-time job and/or a part-time job and has a couple little kids at home. And they want more than anything to have a private practice. They want the flexibility and the extra income, but now they've run out of time. Every minute is filled with helping somebody else and maybe seeing some patients, usually crossing over about five patients per week, five hours of billable patient time per week.
Then you have some revenue coming in. Your rent's paid. A couple of your basic costs are paid. And now time is a real factor, because if you want to go from 5 to 10 then that's time taken away from doing the admin work. So that's the time that it makes sense to reach out to somebody and find out who, you know, who could help you. And definitely over 10 hours a week it becomes a little more challenging.
So again, the dietitian who, maybe it’s a second career or their kids are now out of the house, they’ve grown up, and now they have some more free time, maybe they can do it all on their own. But just like I used the example of answering phones before, if you're not answering your phone because you're busy seeing clients, how much business are you losing?
So that might be one of those examples where you didn't realize that you could have been growing, but you weren't because you were doing it all yourself. So that pain point that once you start feeling that's a problem, that's a good place to find some help, right?
Um, billing, being specific, if you’re just completely lost, and I'm not laughing because of just how often I hear it, and it's sad that it's not. It's such an important part of a private practice, but it's not something that everyone knows how to do. That point, again, reach out for resources, take a course, you know, there’s some great online resources out there. Learn what you have to do from a basic level, because then it's repetitive. And if it becomes a point where, well, for what it would cost me to hire a biller.
I could see three extra patients a month and make that money up and I'm a lot happier seeing patients, that's a part of the conversation, too, right? It's not just giving money away that you could have kind of swapped out for your time. It's actually you'd prefer doing something else with your time.
Or maybe you want to create an online group, create an online course, write a book, do some presentations. But now you need time. That's when you have to delegate out. And it hurts in the beginning because you're out paying money for a service until you've, you know, you’ve gotten a return on that new venture of yours.
But yeah, that's where planning comes into place, and that’s why you have to look a little bit long term and understand things don't happen overnight, and maybe you're looking six months or a year later of you actually, um, collecting on this, this new opportunity and in the meantime, you had to pay someone to take that task off your plate, but it was worth it in the long run.
So there's a couple of pieces to the conversation. And if any dietitian ever calls me, we go through that. We talk about it, really, what makes sense for them. A lot of times they know it at that point. Um, so I just don't want anyone to wait until it's so bad that they're losing money and they're stressed out. And I mean, I’ve had dietitians in tears on the phone. I never want to hear that. I mean, it's supposed to be happy doing what you do!
So don't wait. Really have a plan to say okay, well, now I have 10 clients a week. Well, once I get to 15 I'm gonna need help there. So let me find out what's out there. And then I could pull the trigger without losing anything, losing any momentum and definitely losing sleep.
Erica: That was really good advice.
How Do the Business Owner and Admin Assistant Coordinate?
Erica: Since I've never run an in-person or insurance-based private practice, really. And I've never had an admin assistant in that context. I'm curious. Like, how do the business owner and the admin help person stay organized and coordinated? Do they, like, meet on a regular basis? Or, you know, how does that all work?
Steve: Yeah, that's a good question, because most of what we do is virtual. So it's not like we have meetings and we kind of see each other in the office every day.
Um, and same thing with our clients that look at us as their admin. So we're virtual in one spot and our clients are all over the country, literally. So, you know, obviously there's email and the occasional text. I'm actually looking into Slack, which is becoming more popular, and it might be an option because it's HIPAA-compliant. We can talk to clients. So maybe by the time, everyone hears this I’ll be using Slack even with my staff.
But I think technology's going to be a lot more helpful. We use a lot of Google, you know, Google Drive tasks like Docs and Sheets and all that, and we can see what each other is doing and communicate when something needs to be done.
We do a lot of encrypted email with HIPAA and so on, but, um, it's a challenge because you're not face-to-face, but at the same time there's an expectation that everyone has to do what they have to do, and there’s gotta be accountability.
So, little check in here and there. Um yeah, you know clients can check in with us as often as they need to. We set up meetings. With some of our larger practices, every two weeks we have a call and go through everything, make sure they have what they need, and we're doing what we have to do.
So you don't want to let too long go between an accountability check. So I'm hoping that, um, that Slack or some other technology is going help just kind of smooth that out a little bit.
Erica: Cool. Do you work with, so I'm just imagining, maybe someone's hiring a person to help with answering the phone and scheduling, for example. Do you guys, like, share logins if they use a certain scheduling service, or you have your own system? How does that normally work?
Steve: Yeah, well, first particularly, we try to use whatever the dietitian has. Like we don't want to recreate the wheel. We don't want to make it more complicated. We want them to own everything.
So it's their accounts, their login. Some portals, obviously we’re dealing with EMRs all the time. the EMRs might or might not have an admin access so we can use our own email or login. But we can log into their portal and see what needs to be done.
And some portals don't have that, and it just boggles my mind sometimes because it just complicates things. So we tried to work as if we were personally in the office of the dietitian, as if we were right next to them and there are at the front desk, and you would have access to everything there.
That's kind of how we work. And it's been working really well. Nobody's had any security issues, and we’re very conscious of HIPAA. We have a business associate agreement between every client.
If you don't know what that is, it's basically saying that you're responsible for everything that happens with HIPAA, and whoever’s seeing what you're doing and involved in working with those patients and that information, that they're also responsible. So we want to take that as serious as we can and again, it's a challenge being at a distance. But at the same time, it really should work as if we were in the office together.
Erica: That’s awesome.
The Most Popular EHRs for Dietitians
Erica: Do you have like an EMR or EHR or whatever people like to call it that you prefer? Not to put you on the spot.
Steve: No, you know, we try to learn all of them.
The popular ones are Kalix. Simple Practice is becoming more popular. Practice better, and they only just recently started a billing feature, so there’s some, you know, hitches there. Um, a lot of people were using Office Ally, but they've gotten away from that as far as an EHR. And Healthie. I would say those 4 especially.
And we've been using Kalix in my practice for probably six years now. And the majority of our clients happen to have that. Um, I think it’s just popular because it’s dietitian-created and so on.
But again, Healthie is very popular, and I find that some people just have a preference, and we tell him to use what you like. Just make sure it's effective and does what it has to do and it doesn't slow you down, and they're all a little different in some ways, and that creates problems here and there.
But they should be affordable. That's another thing, you know. So it's like whatever service you're gonna use, don't pay for something you're not going to use. And make sure it does what it has, and it's, you know, kept up and it's up-to-date and so on. So, yeah, I don't want to promote anyone, but we definitely work with all of them.
Erica: Cool. Yeah, that's helpful. I think there's probably people listening who might not even be familiar with any of those. So now they have some leads and some things to check out.
How Does Outsourcing Work?
Erica: So if someone is ready or they think they're ready to reach out and get some support, should they be calling you already knowing exactly what they need help with and, like, have a system in place that they're just ready to kind of hand off? Or would your company help them get organized if they're feeling like they're just barely holding all the balls in the air?
Steve: Sure, it depends. Sometimes, I do a lot of mentoring, so I'm happy to steer people in the right direction. Sometimes that's enough. They have an idea what they need.
But sometimes we have to figure out what it is that hurts the most. Like that pain point. Um, So they come to the website. They just, you know, put in a note about what they're doing and I get a message, and I'll reach out to them soon to just say, OK, this is where you're at. This is what you need. Or this what you thought you need. But have you thought of this?
And the most important thing to me whether they're a client or not is that they get a process in place because it just takes a lot of the mental stress off. You have to have things done a certain way at a certain time. Otherwise, you're just pulling your hair out of your head. So, um, if nothing else, I just steer them in the right direction and make some suggestions.
And if they can't do it, or if they're ready at that point and they know what they need, then that's what we're there for. And we're only going to offer, you know, what they need. But we also offer, you know, extra discounts if they’re using multiple services and so on. Um so I've gotten dietitians who literally have not incorporated yet and don't even have an NPI number, to, you know, dietitians with four dietitians in their practice. So it's really through the gamut.
And, by the way, dietitians have outgrown us, and I'm more than happy for them, because they've gotten so big that they actually had to hire in-house an assistant and a biller. And we're like, “Congratulations!” Nothing excites me more than seeing dietitians succeed. So that's great.
We know where we're at. We're not for the very beginner, but we’re maybe not for the biggest practice, but there's a whole lot in between who need our help, and that's fine. So really, my goal is to get them steered in the right direction. That's number one.
Erica: I like that. That’s been a common thread, I feel like, throughout this interview. Being very clear that, like, do what's right for you. You know? I agree. There is no, like, one way or one thing you have to be doing. And, um so I appreciate that you're continuing to drive that point home, you know?
Steve: I’m trying.
How Much Does It Cost to Outsource Admin Work?
Erica: Yeah. Um, so is there, like, a ballpark, like, estimate of what people should expect to spend on these types of things? Like insurance, billing, credentialing, or phone services, that type of stuff.
Steve: Well, they're definitely all different, and again, it’s as-needed service. So you know, the busier practice needing the phone answered, it could be several hundred dollars a month.
For somebody just starting out who just is working all day and sees patients at night and can't answer the phone, but only has the phone ring once a day. You know, it might be under $100 a month, but meanwhile, all they need is one or two new clients to pay for that. Right? So it's worth it.
Uh, billing. And not to push ourselves, but for billing, usually billing companies charge a percentage. And I want everyone to kind of be careful out there because number one, you know, the work isn't very different from one biller to another, so that to collect more on one insurance, you know, paying more, the biller, really, why should they get paid more? So we do a flat rate.
But the other piece is that there's about 12 or 13 states in the country that it's illegal to charge a professional a percentage of what they make. And we're based in New York and it's illegal there. Every billing company does it anyway. They charge a percentage. So we just came up with a flat rate.
It's $1.50 for every unit that you bill and you know we're going to do just the same amount of work as we would if we were getting paid more. But I'd rather you kept the upside on an insurance company paying you more, than paying it to us. That's really a benefit to you there. So watch out for, you know, billing companies charging 7, 8, 9 percent. Six percent is definitely the average.
And there's been an unfortunate situation lately of a company that kind of decided not to work with dietitians going forward. And they also raised their rates for the current customers, and I've heard as much as 9% plus a base fee and all these other things that just aren’t really adding more value to the service.
So dietitians should know what that ballpark is. You know run the number of okay, well, if I have this amount of hours per month, and I’m gonna pay a biller at this amount for that work, how much does that cost me? And how much am I getting in return? In other words, how much time am I getting back? Can I see an extra couple of patients a week and not just pay for the service but make money on it? That should be what they're looking for when they're trying to find a biller.
Erica: That's super helpful. I don't know anything about billing or how much it usually costs for people to do that. So that is really enlightening.
Steve: Well, I don't wanna bore the non-insurance taking dietitians out there. You know this. It's still important for them to know how they're getting paid too.
And what a lot of the dietitians that don't take insurance don't know is they can bill out-of-network for insurance, which is what their patients would prefer they do. So maybe it's worth looking into having that process instead of just giving a superbill and wiping your hands of it, maybe saying, “Hey, I'm gonna take care of submitting the bill for you. It's worth, you know, you paying up front for my service. But maybe I could get you reimbursed.”
And it's really not more complicated than clicking a couple of buttons on any EMR and submitting the bill sometimes. So I don't want to exclude the dietitians who don't take insurance when they’re listening to this. I think I'm gonna bring them some value too.
Erica: That's cool. I didn't really know that. I didn't see clients for that long, but I was just private pay, and sometimes I would give people superbills. But I didn't even know that there was another thing I should be thinking about or consider doing.
Steve: You didn’t learn that in school?
Alright, well, I think that's super helpful. And people listening, even if they don't have a private practice, I think they're probably just learning a lot about systems and business and staying organized and really taking the time to, like you said several times, like, what is my time worth? And what am I getting back by outsourcing some of these things? Um, I think that applies to a lot of different types of businesses as well.
Advice for New Entrepreneurs
Erica: So, switching gears a little bit just talking about entrepreneurship in general. Since you have so much experience and wisdom to share, do you have any advice for the budding entrepreneur now? Like anything maybe you really wish that you knew when you were first starting out?
Steve: Um, I think, well, maybe it was just me, but marketing is not something that comes natural to a lot of us, right? I mean, a lot of us, really. We know what we have to offer, and we want to help people, but we can't get the word out.
I think just finding something that you're comfortable with, and you know, when you're comfortable and at ease, you can talk about anything. And if you're really passionate about what you do, make it simple. Find a way to explain to people what you do in 30 seconds.
If you can do that, and they understand who it is that you're helping, how you help them, and what you bring to the table, then you could promote yourself to anybody, right? So that conversation might go to, you know, making a relationship with a couple of doctors in your area.
And how do you do that? Well, it's literally as simple as just having a conversation. Marketing is something that I still read books on, still learn about, because it does not come naturally to me at all. I'm not a natural salesman. I'm not a promoter. I slack on email marketing and you name it. And you haven't seen a post from me in weeks because I've been so busy. So, but, you know, when I can talk to somebody, I can explain what I could do that I've gotten good at. So definitely get clear on what you do.
And that's why I really promote a niche when you're doing any business. I think it makes you laser-focused, and that means your target audience is laser-focused. You know who you're going after, rather than casting a wide net, and getting very little. So I think getting really clear on that. That's something that I didn't know I had to do in the beginning.
Erica: Hey, I went through that as well. Like my very first year straight out of the gate, I was working a farmer's market booth and somebody asked me, like, what I did. And I was like, I'm a dietitian and like, end of sentence. I don't think that person understood at all how I could help them.
Steve: Okay, let's not get the audience started on why people don't know what a dietitian is. Did they ask you if you work out? Because that's one I get all the time.
Erica: Yeah, it’s so bad. But, um, yeah, I think I don't even know if I would have realized the things I was doing wrong, inherently. But I agree just reading marketing stuff and starting to get into that world. It's like so many light bulbs! Just like, whoa, I was not approaching this the right way at the beginning!
Steve: It's a whole new world.
Erica: Yeah, but I agree. A lot of us are not natural salespeople. I think this profession attracts a lot of helping souls, and, you know, and that's not always the same person who's maybe really great at marketing. So it's definitely a learned skill, but I don't think we should be afraid of it. Which is why I'm glad we're talking about that.
Advice for People Thinking About Starting a Second Business
Erica: And do you have any advice? Maybe for other people who are hearing your story. And they're like, wow, okay, he has a practice, and then he has this other passion, and he started another business. And maybe they have been having an idea circle in their brain about a second side business, maybe, that they could create to help dietitians, or maybe something totally unrelated. Um, do you have advice for people who are thinking about starting possibly a second business?
Steve: Uh, I think two things. One is you have to find where the need is, right? So if you're filling a need, it's going to happen very organically and maybe quicker than you think.
Maybe not quick, like, you know, cashing in quick. But at the same time, you'll see, all the sudden, referrals come in and people talking about what you're doing. And you know it's not hard, you're not spending money on marketing, and all of a sudden people are asking you to do that thing. Um, that’s one thing, you have to explore the market if you will. Really figure it out.
So, I mean, if you're thinking of starting an online group, or a course, I think you have to see who's looking for it, so go on Google and find, you know, what people are looking for. Like type in the topic that you're talking about and see what the common questions are that come up and the common things that people need.
See what else is being offered. If somebody else is selling what you have, it might make sense for you to go into that business because it already exists, right? You don't have to own the market. So whether it's an online course or a niche in private practice or finding out do I start a private practice? Are there other dietitians in my area? Maybe that's something you have to find out before you just go and start paying rent somewhere. That's not what you should do.
But the other thing is, and I had a conversation with another dietitian friend of mine a while ago, she had this new thing she wanted to offer that she was so afraid of charging for because she didn't know if she was going to be good at it, right? She didn't know if she was gonna bring value to that patient.
So I said, Well, offer it at a discount or maybe do it for free the first time and just see what the response is. If the woman would have said, in this case the client was a woman, who would have said “yeah, I would have paid for this” or “I would have paid X amount for this. You should charge more” then you didn't lose anything just because you gave that service away for that one person. You gained a lot of insight, and it saved you a lot of time and money.
So don't be afraid to kind of do a little, you know, discount or free trial and just do a very small beta test in the beginning of whatever it is that you're trying to do without sinking a lot of time and money into it. Because, and maybe we should talk about this, Erica.
Stop worrying about being perfect. I know you've talked about it on your podcast. It's, like, it's okay. You're going to evolve and change even if you think you know what your business should look like, identical to somebody else's, there’s going to be something that will change, whether it's technology and how people find you or how you bill for them or whatever it is.
So you just have to just explore a little bit and be ready to be a little flexible. But, um, you know, don't think it's gonna look exactly how it is in your brain a year or two from now, if at all. So just go out there and try to offer some value and you'll see what the response is.
Erica: That's really good advice. There's a few things that popped in my head while you were talking. Number one, a few episodes ago, I interviewed Samantha Scruggs, who also has a private practice, but ended up starting a second business on, like, Facebook marketing because she got really good at that.
Steve: And she's really good.
Erica: Yeah, it's, like, exactly the same type of thing where it sort of just comes to you, and there is a need for it. I feel like that was something that she was talking about.
And then your point about giving stuff away or offering a discount, sort of like beta testing and verifying, that's been a game-changer in my own business as well. And that was even how I had my very first online business success, my membership site, the Functional Nutrition Library, where I just like, amassed all my notes and put them behind a paywall.
Basically, that was born from sharing my notes for free. And then people being like, oh my gosh, I would pay for this. So, you know, it's those organic things that maybe you even overlook because it seems so easy to you. You're like people would pay for this? I agree. You know, like listening to those moments.
Steve: Was that the first paid site you had?
Erica: Yeah, my first actual win online after trying to food blog for a few years. Um, yeah. So, great advice. Great advice all around.
Steve's Special Offer
Erica: And for people listening… I know you're like, I don't want to self-promote too much, but totally fine. I know, you have, um, you have an offer for people who are listening if they wanna check you out, and, um, you know, look more into your services. Can you tell us more about what you have to offer for listeners and how they can access it?
Steve: Sure, yes. So if you come to nutritionmgnt.com or you just search us. Like, please like us on Facebook and all that fun stuff, obviously. But if you come to the website, we are offering some free services.
So, like, if you are going to be credentialing yourself with an insurance company, we can give you a cheat sheet. Or, if you’re making some insurance verification calls, just send us a note if it's not up there, we'll send you a little bit of a kind of template to follow so you don't forget anything on that phone call to the insurance company that you waited 25 minutes to speak to one rep for one patient for.
But one thing is, there was, maybe I won't mention the company, but there was a company recently who just I was talking about before, just totally dropped the ball on dietitians, and I've had them call me literally in tears, saying they were doing my billing, now they're not. I don't know how I'm going to get paid and I need to do X, Y and Z. So we took them on. We really just set them up correctly.
So clients coming over who don't have a portal to input their insurance billing to and need to set up an Office Ally account, which we recommend to everybody, the setup could take a little while. So we're going to do that for free. If you become a billing client we’ll set you up with Office Ally. We’ll take care of all the forms that have to get filled out. You might just have to sign a few things, but it'll be one less thing for you to worry about.
Um, and we'll try to get you paid on some of the claims that have been left in limbo. Unfortunately, you did what you had to do, and somebody else decided not to follow through. So we want to pull that through as much as possible. And if anybody else just needs help setting up, you know, Office Ally, just mention that you heard us on the unconventional dietitian podcast and we'll make sure we help you out in some way or another and get you going in the right direction.
What Is Office Ally?
Erica: Cool. And this is totally going on a side tangent again. But can you just, like, really quick recap what Office Ally is?
Steve: Oh, sure. Uh, um, it's called a clearinghouse.
Office Ally does offer an EMR and a platform where you could enter your patients and you can put your bills in, but basically it's almost like, maybe you send bills to 10 different insurance companies. You put all your bills into one place, maybe through what's called a batch of all your claims, and you click a button and they send it out to all 10 insurance companies so you don't have to log into each portal for each company, or back in the day, you’d have to fax or mail to each and every single company in the track. This hubs it all in one place, and you can track your claims.
You could also find, most dietitians get an EOB or an explanation of benefits, which tells you how much the claim is paid for what services. In the electronic world it’s called an ERA, or an Electronic Remittance Advice, and in Office Ally all the ERA’s will come in there.
So every time you get paid and hopefully get that money deposited right into your bank account, you could go there and see which patient that linked up to and just houses it in one place.
And we as a billing company will go in there and collect those bills and update your bills for you and keep you up to date. But it's also a place to find out if you've been denied and you need to do some more work there, So it could be a really valuable thing. It used to be free. Now they have a flat rate of $35/month, sometimes. We'll get into the details, but it's worth it because it just keeps it all in one place, so that little extra cost is annoying for some people, but it's worth it in the long run.
Can People Who Run Virtual Practices Still Benefit From This?
Erica: It makes a lot of sense, and it seems like, this could be wrong, but is this mostly applicable, your services and stuff, for people with brick and mortar businesses? Since one of the main services you offer is insurance stuff. Or would people who run virtual practices have a benefit for contacting you as well?
Steve: If they’re virtual and they need to bill in or out of network, we could definitely help them. One thing we do when we make insurance verification calls is sometimes we have to ask, is telehealth part of what the patient's benefits offer? Sometimes it's not.
And there’s a lot of gray area with telehealth and what's covered. And for the most part, insurance companies have told us, just bill it as an office visit because you should be in your office when you’re providing this service anyway. So maybe we could help with that.
And maybe they just need some help with their website because they're all virtual and they haven't found a good webmaster. So come talk to Melissa. She does great work, really affordable, but she will make sure you are searchable on Google. That is number one.
Erica: Totally agree. Google My Business is, like so important, especially for well, obviously only for, local businesses. But yeah, um cool. So, um, before we sign off, can you just like let people know maybe your website again and maybe your preferred social media platform that they can connect with you on. And I'll put all this in the show notes for anyone listening. But just say it aloud as well for people who may be on the go.
How to Connect with Steve
Steve: Sure, and before I do that, I just want to thank you for having me on. You're doing great, great work. I really love your podcasts. And I know a lot of people are following it to, and they're getting a lot from it. So, very cool to see you succeed.
Erica: Thank you.
Steve: So our website is www.nutritionmgnt.com. Again, Nutrition Management on Facebook and Twitter and LinkedIn. Please connect with me on LinkedIn. Steve Della Croce.
Um, yeah. I mean, I'm probably on Facebook the most. If you don't know, there's a lot of great Facebook groups, private groups. There’s credentialing and insurance for dietitians. There's private practice dietitians, there’s even group dietitians. If you have multiple dietitians in practice, there’s a couple of really good groups and lots of free resources there, so take advantage of them.
Erica: I will put the links to all those in the show notes. I know I'm in some of them, but it's not super applicable to me because I’m not like running that type of business but so, so, so helpful. People are so generous, and I've found a lot of value in Facebook groups for sure.
Erica: Well, thanks again for being here today. It was really good to connect and meet you “virtually.” It was great. Thanks.
Steve: Thanks for having me.
Erica: I hope you guys enjoyed that conversation as much as I did.
As I mentioned, I didn't know much at all about insurance, credentialing or even working with somebody to kind of take the admin load off your plate as a private practice owner. So I'm really grateful for Steve for giving us an hour of his time and imparting all the wisdom that he did during this episode.
If you want to check out more information about Steve and his businesses, or any of the links to the resources that we mentioned, just go to theunconventionalrd.com/episode011. Episode 11, That's where you can find all the extra information.
Thanks again for spending an hour of your time with us today. And as always, if you have not yet connected with us in the unconventional rd community on Facebook, please come check it out. There's over 7800 awesome people in there. The conversations are engaging, generous, enlightening, and focused on business. So come check it out, The Unconventional RD community on Facebook, if you're not already in it.
Have a great Monday!
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