Hamilton Back Clinic - Practice Building Blog

Dr. Lombardi video-feature for business excellence for large Italian business newspaper.

lombardi — Mon, 02 Apr 2012 22:00:24 +0000

Dr. Lombardi and Hamilton Back Clinic has been featured in a project for Il Sole 24 Ore, an Italian Business Newspaper (written in English) with a readership of 1.2 million people. Language Point targets companies with unique business styles within their respective professions. This video will go live on the Milan, Italy website in the near future.

Business Point – a video profile of successful, world-class entities, their owners, developers and operators – produced exclusively for Language Point, Milan, by a Canadian production team, who seek out business stories of impact and influence and introduce you to the people making their mark on the global business map.

Update on Dr. Lombardi Business Courses

lombardi — Tue, 26 Jul 2011 06:43:09 +0000

Hi everyone,

I want you to know that because I have been recruited to teach in Europe there will not be anymore Practice Building courses until 2012 (last one is Aug 27). I will also be taking a break from the practice building blogs to focus on my future projects.

In the future I will only be accepting selected students, doctors, and therapists into the workshops. I am only interested in those individuals who aspire to be the very best at what they do within their community. So, if you are an average therapist who just wants to be average you will not be accepted into the workshop.

Students: Because my time is valuable I will only entertain those students who take their profession seriously and who want to learn material that will make you wildly successful in business. Students who think they know it all will be left behind.

Dr. Lombardi

Chiropractic Practice Building Advice: The power of incorporation

lombardi — Fri, 17 Jun 2011 22:14:38 +0000

Medical professional corporations:Process and tax benefits

Ontario has allowed regulated practitioners to incorporate and reap the benefits. The Regulated Health Professions Act, 1991 (Ontario) allows a number of health professionals, including but not limited to, Dentists, Surgeons, Audiologists, Dental Technicians, Psychologists, Nurses, Midwives and Massage Therapists to incorporate their practices. Further, the Social Services and Social Service Work Act, 1998 (Ontario) allows the benefits of incorporation to those who are members of that College. We intend to discuss the incorporation process, structure and tax benefits and the affect professional corporations governed by the Acts can have on will drafting.

Incorporating

A practitioner who incorporates creates a separate entity which they can control, but which is independent from the practitioner for income earning purposes. The practitioner then possesses several roles including that of an employee shareholder and director of the Corporation. They are able to collect payment through several avenues, each taxed in its own manner. As the practitioner carries on as an employee, the Professional Corporation must have the ability to remit all employee deductions, including CPP, EI and certain instances, the Ontario Health Tax, insurances, and employee allowances for automobile use and leases and use of he home for employment related uses.

Generally, practitioners who wish to incorporate must meet the general requirements for incorporations under the Ontario Business Corporations Act and then obtain a Certificate of Authorization must be obtained from the regulating organization. All Professional Corporations must be named and not numbered, so a Names search must be submitted. Similar names to those already incorporated cannot be used. The name of the Professional Corporation must contain at least one surname of a shareholder who is a member of the regulating organization and may contain any given names or initials of that shareholder. The name must contain the words “Professional Corporation” and finally, in the case of Regulated Health Professionals, it must contain the area of practice as well.

The organization of the Professional Corporation is also outlined. All Directors must be members of the regulating organization and all shares must be legally and beneficially owned by members of the Regulating organization, except in the case of physicians, surgeons and dentists, whose spouses, children (through trusts) and parents are able to hold non-voting shares of the Professional Corporation. A restriction of the business activities is also required in the Articles. Application forms, fees, statutory declarations and in some instances undertakings are also required by the various regulating organizations. The Professional Corporation should also apply for a Business Number and GST number from the Canada Revenue Agency. A minute book should be prepared.

The Minute Book will need updating on a yearly basis. A Corporate Information Act Form 1 must be submitted to the Ministry of Small Business and Consumer Affairs and a Certificate of Renewal must be obtained annually from the regulating organization.

Tax Benefits Available

If the practitioner is already in practice, they will need to transfer the assets of their practice to the Professional Corporation. They will require an Asset Purchase Agreement which clearly indicates the value assigned to the assets, including goodwill, works in process and chattels. The Practitioner can obtain a promissory note equivalent to the tax basis of the assets, which can be considered a shareholders’ loan, if the practitioner is taking ownership of shares. (Does this help in the creditor proofing process???) If the practitioner has liabilities, these should be taken on by the Professional Corporation which will obtain a promissory note from the practitioner or the liabilities can be retained by the practitioner. The Professional Corporation cannot take on additional liabilities or the ability to defer taxes will be negated.

If the practitioner is part of a partnership which decides to incorporate into a Professional Corporation has two options. Each individual practitioner can choose to incorporate a Professional Corporation which can then create the partnership or the individual practitioners can directly become shareholders in the Professional Corporation. Employed practitioners should not include their employment income in the Professional Corporation or they will be considered a “personal services business” and will be taxed at the highest income bracket.

A Professional Corporation can claim the Small Business Deduction as indicated in the Income Tax Act. This Deduction is allowed to Canadian Controlled Private Corporations on the first $400,000.00 of active business income. (This amount is subject to change according to changes in the Income Tax Rules). This amount is taxed at a lower rate, currently 18.67%. Each individual incorporated partner of the Professional Corporation can claim the deduction as an employee, although it may need to be shared if the Professional Corporation and the Claimant are considered associated parties according to the Income Tax Rules.

Income that is necessary to the maintenance of the practitioner’s personal lifestyle can be disbursed as income to the practitioner while all other funds can be maintained in the Corporation and invested. By using the additional share structure, physicians, surgeons and dentists can income split resulting in a further reduction in tax payable.

In addition to the methods of paying money out of the Corporation, there are a few other methods of doing the same. First, the Corporation can issue promissory notes to the practitioner for funds. Second, the practitioner can obtain a salary from the Corporation. Salaries can also be disbursed to family members in reasonable amounts and for work performed. Funds in the Corporation can be withdrawn as a taxable dividend, making the tax payable deferred until the dividend is paid.

The Small Business Capital Gains Deduction is triggered when shares of a “qualified small business corporation” are sold. The first $500,000.00 of the sale proceeds are not taxed where non active business assets do not substantially exist. Prior to initiating a sale of shares, this asset holding test should be canvassed.

A tax deferral is also available through the use of pension plan initiation.

In Dr. Lombardi’s Practice Building One Day Workshop he will show you examples of how to incorporate yourself and give you the paperwork you need to make this transition easy and to save you thousands of dollars.

Next Workshop is August 27, 2011 in Hamilton. Register at www.hamiltonbackclinic.com as soon as you can. Space is limited.

FREE Introduction to Practice Building Presentation

lombardi — Wed, 11 May 2011 02:45:46 +0000

Dr. Anthony Lombardi will be hosting a 30 minute presentation featuring an Introduction to Practice Building for Chiropractic Students. The presentation will focus on the motivation and”mindset” of success that all prosperous business people own.

This event will take place Sunday July 17, 2011 at 11:30 am at the Hotel Clarence located on Fall St in Seneca Falls, NY. Appetizers, wine and beer will be included for guests. Those interested must confirm their attendance by emailing my staff at info@hamiltonbackclinic.com

Who is Dr. Lombardi?

I practice in the economically depressed city of Hamilton, Ontario (population 505,000). I am a graduate of New York Chiropractic College and have been in practice for 8 years.

While in student clinic, I researched locations and 6 months before graduation I signed a lease for a 1400 sq ft office space. I hired a registered massage therapist and in November 2002 Hamilton Back Clinic opened seeing massage patients only. I graduated in December 2002, incorporated my clinic name and I started practicing in mid January 2003. In July 2004, I hired a part-time physiotherapist to help treat patients who could benefit from rehab and then in 2005 a kinesiologist came on board to assist the physiotherapist and I. Later that year, a second registered massage therapist joined our team.

In January 2006, I purchased a piece of land (3 km from my practice) w a house on the property with the long term aspiration of moving my practice into it. Renovations were done to convert the house to an office and zoning laws were changed to allow me to run a business. In September 2006 I opened the practice. I practiced 3 part days/week out of that location and the rest out of my original location. I also hired an associate chiropractor to help me with the increasing patient load (as many weeks in 2007 I had been seeing over 180 patients visits per week) and another massage therapist. In 2009, I made plans to build an expansion onto the new location. A 4th RMT and a 3rd chiropractor joined our team. In October 2009, Makeup Worx, an aesthetics and makeup studio moved into the lower level of Hamilton Back Clinic. In August 2010 both clinics amalgamated into the new 2500 square foot complex.

Although its easy to look back and write about it now… The transitions and experiences I went through from 2002 until today were many and not without headaches – but very rewarding. I learned so much from those experiences and it is knowledge I can pass on to someone like yourself. Join me.

Chiropractic Workshop gura Dr. Anthony Lombardi re-visits the de-listing of OHIP and proves his prediction.

lombardi — Sun, 24 Apr 2011 14:54:38 +0000

This is an article I wrote 2 weeks after the Ontario government de-listed OHIP from paying for our services. I predicted all would be well, in fact I predicted things would be better because of it. Many chiropractors were screaming “this is the end of chiropractic!”. I was saying: “this is the beginning!” Enjoy:

Chiropractic care still the most economical
[Final Edition]



Stoney Creek News – Stoney Creek, Ont.
Author:	Dr.Anthony J.Lombardi
Date:	Dec 17, 2004
Start Page:	9
Section:	Community Voices
Text Word Count:	496



Document Text



As of Dec. 1,the Ontario Health Insurance Plan (OHIP) will no longer cover chiropractic benefits. There has been some confusion as to what this will mean to the patient. The Ontario government gives chiropractors $11.75 for an initial visit and $9.65 for followup visits up to a maximum of $150. This means that the patient will likely have to pay $9.65 more per visit to have chiropractic care after Nov. 31. Some say that this reduction of benefits by the government will cause medical doctors offices to become even busier than they already are while making emergency-room waits even longer. I do not believe that is the case. Rather, I believe very little will change in terms of utilization of chiropractic care. As it stands, the majority of extended health-care plans cover chiropractic care after the OHIP is used up. For this to happen the patient would have to frequent the chiropractor in excess of 15 times over the course of the year. Although there are many instances when patients receive care on a regular basis, the majority of people do not use up there OHIP and thus never dip into their extended health benefits. Therefore, eliminating OHIP will help those with extended health- care plans because they will be able to use their benefits immediately. Those who cannot afford chiropractic care are more likely to visit their family doctor or the emergency room but they would have probably done so anyway, even if chiropractic was still covered by OHIP. However, if someone is in need of care but legitimately financially strapped, there are many doctors of chiropractic who will show leniency and allow patients a reduced rate or a flexible payment plan, since the first priority is our patients’ welfare. OHIP is not only eliminating chiropractic coverage; as of April 1, OHIP is cutting physiotherapy services entirely, with the exception of home visits. Thus, those who require physiotherapy for their muscle and joint pain will be paying out of their own pocket if they do not have extended health insurance. Even with the increased chiropractic fees, a chiropractic visit costs about 1/3 less than a physiotherapy visit. With the advent of new techniques like active release technique and medical acupuncture, chiropractors can treat conditions like neck pain, carpal tunnel symptoms, shoulder problems, and knee pain with much greater success than in the past. This makes chiropractic the most economical form of manual medicine. Those who can afford care but are unwilling to shell out the extra fee will likely find themselves waiting hours in pain at the emergency room or waiting days for a doctor appointment. What patients come to realize is that the care they receive there is very limited for muscle and joint injuries and the only solace conventional methods can offer is medication to ease the pain; while doing nothing for the structural problem. Contact your local chiropractor, physiotherapist or provincial MPP to provide more clarity for you. Dr.Anthony J.Lombardi Stoney Creek Reproduced with permission of the copyright owner.



Abstract (Document Summary)



Eliminating OHIP will help those with extended health- care plans because they will be able to use their benefits immediately. Those who cannot afford chiropractic care are more likely to visit their family doctor or the emergency room but they would have probably done so anyway, even if chiropractic was still covered by OHIP. However, if someone is in need of care but legitimately financially strapped, there are many doctors of chiropractic who will show leniency and allow patients a reduced rate or a flexible payment plan, since the first priority is our patients’ welfare.

Chiropractic Business: Do you know how much you can afford to spend to run a new practice? What’s the magic number?

lombardi — Fri, 22 Apr 2011 23:10:13 +0000

On day one of any business class you should learn the answer to this question. Before you talk about business plans, or incorporation, or how to advertise etc – you need to learn your ‘magic” number. What is the minimum number of patients I have to see per week (at an average cost)to cover all of my bills?

My students are forced learn this formula before going any further. This is because if you cannot establish this then everything else is fantasyland. This is the paramount reason why businesses (not just chiropractic) fail. They fail because they do not know how to select their clinic or business location. You may want to lease that space beside a busy mall, or on a busy street, or in a busy plaza…. but the cost of leasing (which is your biggest expense) is usually so high that you have to see an unreasonable amount of patients to cover just your expenses. If you need to see too many patients per week at first just to cover your costs then you fall further and further behind every month until you go bankrupt.

I use what I call the “Lombardi Formula” (how original..). It is actually a very accurate system for predicting the success of chiropractic practices. Every chiropractor and medical doctor, and physiotherapist who has followed my formula ( we are up to 26 now) has continually grown their practice and posted increasing numbers for the last 3 years since starting from zero.

What do you think the ideal magic number is?

Chiropractic Workshop: Hey Doc! You need to learn the 80/20 principle before you go any further in business or else you won’t go anywhere.

lombardi — Mon, 18 Apr 2011 04:33:14 +0000

The Pareto principle (also known as the 80-20 rule, the law of the vital few, and the principle of factor sparsity) states that, for many events, roughly 80% of the effects come from 20% of the causes.

Business-management consultant Joseph M. Juran suggested the principle and named it after Italian economist Vilfredo Pareto, who observed in 1906 that 80% of the land in Italy was owned by 20% of the population; he developed the principle by observing that 20% of the pea pods in his garden contained 80% of the peas.

It is a common rule of thumb in business; e.g., “80% of your sales come from 20% of your clients”. In your chiropractic business this is no different. 80% of our top referrals come from 20% of our patients. 80% of our headaches come from 20% of our patients too. 80% of our time is spent on 20% of what needs to be done – often because we do not have a system in place to deal with the issues taking up all of our time.

If you take the time to learn the principle you will be successful. Unfortunately you will need help. So if you do consult me and I will help you.

Hey Doc! Are you a Rolex or a Timex? Isnt it time you decided?

lombardi — Wed, 13 Apr 2011 03:21:42 +0000

Do you recognize these shoes?

If you recall I speak endlessly on the concept of self-value. As of late there have been internet coupon companies that have been growing in popularity WagJag, Groupon, and RedHot are only a few of the many companies that will market your product or service at a heavily reduced rate to people who are looking for a deal. Businesses employ these companies with the idea that if they sell their product or service for a very reduced rate then the people may like the product so much that they will come again and pay full price next time. As I will tell you, getting your business involved with these coupon companies can tarnish your image.

As chiropractors, massage therapists, physiotherapists and business owners we make a decision to be the best in our community or we make the choice to be average. Some of us don’t make a decision to be anything (does that mean you decide to be nothing?)

Who are these people searching for deals?

Everybody likes to get a deal and there’s nothing wrong with that. However, people will usually buy coupons at a huge reduction in price simple because it is such a good deal – not because they require your service or product. They say “I might as well for 81% off, why not? I can’t go wrong”

To illustrate my point I would like you to carefully read over the names on these two lists:

1. Cadillac, BMW, Corvette, the original Ford Shelby, Ferrari, Lamborghini, Versace, Prada, Tom Ford, Christian Louboutin, Rolex, The Four Seasons, The W hotel, Ritz Carelton, Cognac, Kobe Steak, Starbucks.

2. Pontiac Sunfire, Ford Focus, Chevy Geo, The Suit Factory, Moore’s Clothing, Aldo, Payless, Timex, Motel 8, Holiday Inn Express, Seagrams, McDonalds, Burger King, Dunkin Donuts.

What did you notice?

Naturally, if you study both lists you can see they both provide similar products of different levels of quality within their own rite. In general, the companies and products in list #1 use better quality material, take more time to make, and have higher manufacturing standards than the companies/products in list #2.

If you received a coupon from Wagjag for 72% off a stay at the Motel 8 you would say that is a good deal. But, what if you received the same coupon for 72% off a stay at the Ritz-Carelton? Or 72% off Christian Louboutin shoes? That just wouldn’t look right. You might think something was wrong with the room or think the shoes must be knockoffs. When is the last time you saw a coupon advertising 50% off Ferraris? That is because Ferrari and Lamborgini cars, Versace, Prada and Tom Ford suits, Christian Louboutin shoes, Rolex watches, The Four Seasons, The W hotel, and Ritz Carelton hotel rooms – carry an unchanging VALUE associated with them. Drastically reducing the cost of these products would cause them to lose their value. As I pointed out in previous entries, there is a distinct difference between not being able to afford something and not being able to value it. I may not be able to afford to buy a new Ferrari but I can certainly value and appreciate the fine Italian engineering, the hand-made parts, the hand assembly of the engine, and the world class performance which makes Ferrari a work of art. But some people look at $9,000 Rolex and say: “what a waste of money, I bought a watch for $11 at Walmart and it works great”. To say a Rolex is “a waste of money” is a comment which under appreciates and de-values Rolex. That person obviously does not value the fact that the watch was hand-made and assembled by the best watchmakers in the world with the utmost precision and the finest of materials. It too is a work of art. Rolex does not care about those people that do not value and appreciate their work. And neither should you.

If you decide to be average or mediocre then by all means look into coupons as a way of promoting your practice. There is a market full of people looking for services and products at a reduced rate – regardless of how good the service is. Workers Compensation is a form of Wagjag since they pay approximately $20 for a visit that usually costs $50. “Get injured at work and receive 60% off your chiropractic or physiotherapy treatment”.

If you decide to be the best in your community, you must stay clear of coupons. If you aspire to be a Ferrari you wouldn’t spend your time studying how to be a Chevy Geo. If you aspire to be Versace you wouldn’t take courses from Fruit of the Loom.

I pride myself from trying to learn from the best and I aspire to only teach those who want the same.

How to get MD’s to refer you patients -revisited.

lombardi — Thu, 07 Apr 2011 01:25:27 +0000

http://www.thehealthprofessional.ca/CustomContentRetrieve.aspx?ID=3800991

Words of advice to significant others of those starting a practice

lombardi — Tue, 05 Apr 2011 04:35:21 +0000

This can be a very sensitive topic for a doc starting a new practice to address – but it is a vital topic. No one really talks about this but I will. Many docs and therapists call me about this topic when starting their practice so I am going to draw on my experiences and the experiences of successful docs to help everyone understand.

When you start a new practice there are a series of things the doc has to do on a continual basis. There is constant number crunching, planning and enteprenuering, and visioneering going on inside the docs head for a period of several months. You see, the doc or therapist starting a practice is not only the doctor/therapist, but they are the manager, promoter, payroll, billing, human resources and public relations – all at once. They need to be extremely focused for a period of time if they expect to be successful. They not only need to learn how to run a business well, they need to do it consistently while at the same time learn to provide top quality care to their patients.

My advice to the significant other of a doc/therapist starting their own practice is this: for a period of time you need to understand and accept that after your relationship (and family) the practice needs to take top priority. You need to support your significant other by understanding the many nights of staying up late brainstorming office ideas or their tireless efforts to attract valuable patients and the absolute need for continuing education. Because by supporting this you are ensuring financial freedom down the road.

I was extremely lucky to have found someone who wholeheartedly supported this. I am writing this because many docs and therapists struggle with the needs and aspirations of their significant others while trying to successfully start and run a practice. I am not a relationship counsellor but I know what it takes to run a very successful practice. Like anything new, it takes time to grow – patience is needed. A business is like an airplane: the majority of the fuel is burned during the takeoff, but once it levels off it uses minimal fuel to successfully reach its destination.

Wives, husbands, fiance(e)s, girlfriends, and boyfriends – you can play a vital role in cultivating a prosperous practice. There will be sacrifices at first but it will be well worth it. And Doc, its vital that you have someone there to help you create a positive environment while supporting you. Know the difference.

See you in August. http://www.hamiltonbackclinic.com/pb_workshop.php

Best, Anthony.