October 2001

Entrepreneurial Spirit

By Nancy J. Beckley, MS, MBA

I hear from several readers each month who want to chat about the column, ask my opinion about the state of affairs in rehab with managed care as well as Medicare regulations, and what it is like to be a “consultant.” I have recently fielded a number of calls from folks who are curious about consulting, looking for consulting positions with an established firm (they always want to know “are you hiring?”), or looking to be entrepreneurial and considering consulting as a career move. Someone even suggested that I write a column on how to catch the entrepreneurial spirit and start a consulting practice.

So how do you start an entrepreneurial consulting practice? One of the first things to consider is whether you like the idea of being a consultant, being an entrepreneur, or being both! It is possible to enter the world of rehab consulting in a variety of fashions, each carrying its own degree of risk. Most often I am asked what it takes to be a consultant. From my perspective, it takes enthusiasm, fortitude, marketing ability, and technical expertise. Peter Block’s Flawless Consulting: A Guide to Getting Your Expertise Used (Jossey-Bass; 2000) is considered the bible for consultants.

Let’s look at some of the types of consulting venues:
Positions with a professional organization—Think of your own professional organizations that you belong to such as the American Physical Therapy Association (APTA) or the American Medical Rehabilitation Providers Association (AMRPA). Both are headquartered in the nation’s capital, and their main purpose is to represent the interests of their constituents to other parties as well as to act as advisors and consultants to their members. If you are a member of the APTA Private Practice Section, you may have called them to get advice and counsel on how to best implement a program or how to interpret the complexity of the Medicare rehab outpatient prospective payment system (PPS).

Positions with a national rehab or health care firm—These positions are internal consultants dealing with various facilities and personnel located throughout the region or country. Position titles can include “clinical consultant,” “human resources,” or “marketing consultant.” In fact, most people in staff positions in large organizations are really consultants even if they are not officially called consultants or think of themselves as consultants. They do traditional consulting functions of planning, recommending, and advising.

With either of the above-mentioned positions, the financial risk is somewhat minimal as they tend to be more aligned like traditional jobs with salary and benefits. The positions discussed below, however, call for the consultant to take on more job and financial risk.

Consulting within an established rehab consulting firm—Numerous rehab consulting firms have consultants and analysts serving all aspects of the rehab industry from outpatient to skilled to inpatient rehab. In these firms a traditional consulting hierarchy may be employed (partners, principals, directors, managers, analysts). Depending on your position, your financial risk may vary: analysts may have secure salary and benefits, but the compensation of partners and principals may directly depend on their ability to bring clients to the firm through their marketing savvy. Directors and managers may have their compensation tied to not only billable hours but marketing as well. While this arrangement may employ a traditional consulting hierarchy, don’t mistake the need for a true entrepreneurial spirit that is critical to the success of working in this type of firm. Without new business continually coming in, it may be impossible to stay employed.

Positions in a traditional consulting firm with a rehab clientele, or for the express purpose of developing a rehab clientele—All of the large consulting firms have health care practices, and many of the health care divisions have individuals with rehab expertise that is utilized to either market to potential rehab clients or provide consulting services during the engagement. There is the need to keep the pipeline full, so, in addition to consulting, billable hours may be emphasized as well as marketing and selling to existing clients or potential new clients.

In either the established rehab firm or traditional consulting firm, salary may be a mixture of base pay with commission and may be paid out as a draw against commission.

Independent consultant—There are hundreds of small entrepreneurial rehab consultants throughout the country primarily operating as solo practitioners. Many of these independents have a friendly group that they share referrals with, or a key list of other consultants that they bring to projects as the need dictates. These folks (myself included) are truly entrepreneurs. They must have technical expertise that clients need.

Sometimes you may have to demonstrate to potential clients that they need your services. For example, you may consult on coding and billing for rehab. A potential client may not understand that they need your services because they are getting reimbursed on all their Medicare billings until you point out the complexities of the Medicare rehab outpatient PPS and risk factors for fraud and abuse. You then describe potential problems or give examples from the latest confusing Medicare Program Memorandum, and the client may hire you to do a compliance/coding review and staff training to ensure their past and continued compliance. The client is so happy with your services that you are asked to take a look at the marketing plan, assist with managed care contracting, or help value the practice. A good independent rehab consultant should have a network of resources and be able to bring in someone with the correct expertise.

The nice aspect of being an independent rehab consultant is that you are truly an entrepreneur. You do not have to take clients you would prefer not to work with, and you do not have to take projects that are not appealing. The downside is that you can starve to death. The independent rehab consultant is challenged to constantly keep potential clients and projects coming while simultaneously working on current consulting engagements.

According to Block, the five phases of consulting include: entry and contracting; discovery and dialogue; feedback and the decision to act; engagement and implementation; and extension, recycle, or termination. Contracting is negotiating clients’ wants, coping with mixed motivations, and dealing with concerns about exposure and loss of control. Feedback is funneling data, identifying and working with different forms of resistance, and presenting personal and organizational data. Decision includes running group meetings, focusing on “here and now” choices, and not taking things personally. You may begin to discover that you really are already a consultant, but not quite an entrepreneur.

So, is your interest in entrepreneurial consulting piqued? If so, I recommend that you begin to explore not only the technical expertise that you bring to consulting, but in which venue you would like to practice. You can also contact the American Association of Healthcare Consultants. If you are really serious, get Peter Block’s book as well as its companion: The Flawless Consulting Fieldbook & Companion (Jossey-Bass; 2001). Good luck, and let me hear from you!

Nancy J. Beckley, MS, MBA, is a rehabilitation consultant, entrepreneur, and professional coach. She can be reached at (888) 999-0275 or via email bcgbeckley@aol.com.

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