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Straight from the consultants' desks: Tips for entering the business

Are you business savvy? Do you have a strong desire to educate others? Does the idea of working with clients to address their specific needs appeal to you?

If you answered yes to any of these questions, chances are, you might have also considered pursuing consulting at some point during your coding/HIM career.

Starting a consulting business from scratch may be easier said than done, though, say Beth Haenke Just, RHIA, MBA, of Just Associates, Inc., Deepa Malhotra, MS, CPC, of Healthcare Education Resource Services (HERS), Inc., Walter Sanderson, CCS, of WDS Coding Services, and Lori S. McGuire, EMT, CCS, of Simply Coding. You'll have to choose a specialty, build a client base, market your services, and get yourself up to speed on how to run an efficient business.

But these challenges didn't stop Just, Malhotra, Sanderson, or McGuire from delving into the consulting profession. Here's a look at the tips they provide for starting your own business, as well as the lessons they learned along the way.

Tip #1: Gain as much experience as possible.
Just-who has been a consultant in many areas of HIM for more than 25 years-says working in different types of settings-both large and small facilities-helped her hone her skills before becoming a consultant. She began consulting in small hospitals and nursing home while maintaining a full-time HIM director position for two Colorado hospitals.

"That gave me a taste of consulting and an easy way to experience the types of behaviors and processes needed to be successful while still having the safety of a full-time job," she says.

Making the most of your current work situation is also important, says McGuire, who worked as an inpatient coder for five years before being hired by a short-term placement firm that placed her in a variety of larger hospitals. She currently offers on-site educational programs specializing in medical terminology and various sessions for physician education.

"I had my choice of assignments and hospitals," McGuire says of the placement firm. "I chose the larger and more challenging facilities so I was exposed to a larger variety of coding."

She says the short-term placements also helped her develop skills to work with different people/environments. "I learned how to become flexible and adapt to a variety of working environments and styles. No two hospitals are the same," she adds.

Malhotra, who has worked in the healthcare industry for more than 15 years, says she gained experience by working in a variety of settings, including for a billing company in which she learned an overview of the entire revenue cycle when working as a data entry clerk.

After working as a medical records clerk for two years, Sanderson, who has now worked in health information management for more than 10 years, decided to pursue coding after his then director approached him with the idea. He says his experience with medical records familiarized him with physician handwriting, lab reports, doctor orders, and progress notes and made the transition to coding much easier.

Throughout his coding career, Sanderson says he gained experience by working for a variety of companies and traveling to many different hospitals. "For me, it was actually getting the chance to meet some of the best consultants in the country. That gave me my start," he says.

Tip #2: Assess the job market/consulting demand in your area.
Make sure that the market in your particular state is not already overwhelmed with consultants, McGuire says. "Check out you area and find out what services are already available. Can you be competitive with pricing in your area? Are the services you can offer something that area facilities are looking for?"

For example, if you determine that your local hospitals perform a large number of outpatient surgeries, outpatient coding might be a great area to focus on, McGuire says.

Sanderson says after assessing the market in his area, he knew he that his smaller business could compete well because he could offer more reasonable prices to institutions that couldn't afford larger companies.

Tip #3: Decide whether you want to work with others or independently.
Just says this is an important decision you should make early on in the process. She adds that having a business with employees or sub-contractors, though, will bring a slew of business-related concerns with it that you should be prepared for, such as marketing/sales issues, cash flow protection considerations, capital outlay requirements, and payroll company affiliations.

If you don't have the business background, Just says to find an accounting firm that can advise you on what you'll need to consider. As your business grows, you'll eventually have to find an accounting resource that can work directly for you, she adds.

Tip #4: Decide whether you want to focus on a particular specialty.
Malhotra, who specializes in radiology coding, says focusing on one specialty has served her well. "There is so much one can learn in that one area," she says.

Sanderson, however, says he keeps his consulting broad so he can appeal to as many facilities as possible and because he enjoys staying well rounded in all areas of the field. "I never want to be turned away from a facility simply because I can't provide the services they need," he says.

If you decide to pursue a specific specialty, simply taking inventory of your own experiences and background might point you in a direction, says Just, who has significant software development experience as well as health information management experience. She said her decision to specialize in consulting for patient identity data integrity was an easy one. "I have a very unique combination of experiences and education that lends itself to this type of niche consulting that I'm in," she says.

Also think about who you already know, she adds. "If you have an inroad to reaching hospital administrators or chief financial officers, then general HIM consulting is probably a good avenue," Just says. "If you have strong connections with hospital HIM directors and have a strong resume in hospital coding, then the inpatient coding avenue is good. It depends on how you think you can drum up business."

Tip #5: Hire top-notch staff.
"In consulting, your business is only as good as the weakest individual on your team," says Just. She says that before hiring someone-including administrative support staff-make sure that individual not only has the exact skill set you're looking for, but also that he or she will fit into the culture of your organization.

Tip #6: Be creative when building your client base.
Gaining your first few clients may be difficult, but those individuals are crucial when it pertains to the bigger picture, Malhotra says. "It's who you know, rather than what you know, that makes the difference. Your first few clients will become your sales people by word of mouth," she says.

Sanderson suggests contacting the hospitals where you've previously been employed to drum up business. "I had already proven to those hospitals that I could code, and they were willing to give me a chance," he says.

McGuire says being flexible also helps attract potential clients. "I had to be willing to work first, second, and third shift, according to when the extra space was available and depending on the staff that needed training," she says. Taking the old fashioned route of posting flyers, sending out direct mailings, and networking through conventions/meetings also helps, she says.

Consider partnering with other companies to obtain an initial client base, says Just.

List-serves might also be a way to get your name out there, says Malhotra.

And although clients are the life of your business, your goal should not be to gain as many clients as you can, Malhotra says. "Don't take on clients just for numbers sake. Make sure you can deliver 100% before you move on to the next client," she says.

Tip #7: Expand your credentials.
In a business where compliance is everything, Malhotra says any consultant needs to have a national certification with either the AAPC or the American Health Information Management Association. "People do pay attention to your credentials. It reassures them of your commitment to your profession," she says.

Sanderson says the area of coding that you'd like to pursue should dictate the credentials you want to be sure to have. For example, if your goal is to pursue acute care coding, then the CCS credentials are important, he says. If you want to pursue outpatient coding, go for the CCS-P or CPC credentials.

But other non-coding credentials come in handy as well. "Whenever I do emergency room (ER) coding education, it's been very helpful for me to also be an emergency medical technician (EMT) because I can offer insight to both coders and physicians about documentation," says McGuire, who has EMT certification as well as CCS credentials.

On the business side, Just says having an MBA has served her well. "I understand the financial reports and can dialogue well with my accountant. I understand the importance of cash flow management and therefore can stay ahead of that dangerous curve," she says.

Tip #8: Have a good attitude.
Optimism and a sincere attitude will get you far, says Malhotra. "Be persuasive and confident and never give up learning," she says.

Just agrees that confidence is important as long as it's not overshadowed by arrogance. "Being able to dialogue with your client, listen to their needs, and ensure that you're not only meeting those needs, but also exceeding them is important if you want to repeat business or obtain a good reference," she says.

Sanderson adds that if you're considering consulting, don't limit yourself. "Be your own motivator and when you feel you are ready to pursue your goals, go for it," he says.