Meet The Expert: Ann Silver

It’s about listening – meet your clients where they are, bring them back, and listen and address what they bring to the session – even though it may not be what they need (nutritionally) at that time.
— Ann Silver, MS, RDN, CDE, CDN

Today we’re featuring Ann Silver, MS, RDN, CDE, CDN. Ann established her own private practice, Ann Silver Nutrition, in NY. She is also the co-author of Making Nutrition Your Business: Private Practice and Beyond – thus an expert in getting a private practice off the ground! 

Why did you get started in nutrition/ become an RDN?

I wanted to explore my options during my time in community college. Interestingly, I took a biology class during that time and fell in love with the process of photosynthesis! One of my advisors suggested that I pursue the sciences, and put me in touch with the nutritional sciences program director at State University of New York College at Buffalo. I didn’t hesitate: I was shuffling off to Buffalo!

I became a Registered Dietitian the October following my graduation. I became a staff RDN and was eventually promoted to Assistant Executive Dietitian at Mt. Sinai Medical Center in Manhattan. I eventually moved to the Hamptons with my husband and with no major medical centers nearby I tried something different – long-term care. It was so unlike the hospital – I really got to spend time with patients and follow through. I got to watch them get better.

Sadly, the long-term care contract was abruptly terminated, but I recall sitting on a beach and saying, “That’s it! I’m starting a private practice!” This was 25 years ago. 

How did you market your practice? How did you pursue insurance reimbursement 25 years ago? 

Back then it was fairly uncommon to be a private practice dietitian. I sent a lot of letters to a lot of doctors to introduce myself. I was pleasantly surprised by the overwhelming positive response.

Insurance reimbursement for nutrition back then was mostly unheard of. There was one regional insurance company that had one participating RDN on the plan more than an hour away. I kept marketing myself to that insurance company, following her lead. Eventually they pulled me on board and from there I leveraged this as a spring board to get other third party payers to recognize me as a provider.

I am still taking insurance in my own private practice but I am particular about it. I pay attention to various reimbursement rates so that I am assured a good return and good revenue. 

What makes your practice special? 

I am a certified diabetes educator, but also specialize in eating disorders and weight management. Given the small community that I live in, I’m able to really connect with my clients. I also take a truly behavioral approach with my clients and address the emotional and psychological aspects of their care.

I always ask my clients, “What do you want to get out of today’s session? How can I help you the most?”  I suggest giving more to clients than they ask for. It’s about listening – meet your clients where they are, bring them back, and listen and address what they bring to the session – even though it may not be what they need (nutritionally) at that time. 

I work on developing relationships with my clients for the short term and even the long term. Years later I will see a client return.  And, in the interim, they are recommending friends and family. 

How did you come to write Making Nutrition Your Business: Private Practice and Beyond? What feedback have you received from RDNs who have read your book? 

I became a co-author of Making Nutrition Your Business after the untimely passing of Ann Selkowitz Litt. I’m proud to say that the Academy of Nutrition and Dietetics reports it is one of their best sellers! I have been fortunate to meet many, many RDNs and dietetic interns who have bought the book and have shared how it has helped them establish and grow their own practices.  

How did you learn about the insurance process? 

I’ve always had an interest in insurance—strange as it may sound. With my parents being self-employed I learned from them about insurance benefits and claims. Aside from that, no one was there to hold my hand when I started out as a participating provider. There weren’t any forms, templates or codes to use. There also weren’t many other colleagues to learn from. I had to figure it out on my own via trial and error. Oh, and I learned!

I currently participate with the following insurance plans: Cigna, Blue Cross Blue Shield, Island Group Administration, Medicare (diabetes and kidney disease only), Oxford Health Plans and United HealthCare. 

I’ve made it a habit to learn all that I can about the insurance process and stay current on updates. Somehow I’ve become recognized for Medicare’s PQRS (Physician Quality Reporting System) program. Last year, I spoke the Academy’s Reimbursement Representative at the annual Food and Nutrition Conference and Expo (FNCE 2015) and, at the beginning of this year, presented a webinar for the Academy on the topic. The webinar is available at eatrightpro.org/pqrs

What is the future of reimbursement?

We will have to see, but we are beginning to experience a transition in payment from one based on volume and time – to client outcome and cost. The focus will be more on whether clients and patients are getting quality care (read as improving health) while decreasing costs. Wait, this does not mean we will necessarily be getting paid less, but how we are paid will change. For example, if we contribute to keeping a patient out of the hospital (and we CAN help), which results in saving money, there can be an incentive payment. There will be changes in the future on third party reimbursement. Stay tuned…  

Why should RDNs consider accepting insurance? 

Insurance equals automatic marketing. If people don’t have to pay out of pocket as much, they will be more likely to use insurance than perhaps not to pay. If it comes to dining out versus a visit to one’s dietitian and paying out of pocket for it, they might head to dinner instead of coming to see us. 

Accepting insurance allows us to build our practices as RDNs. And even if your plan is to have self pay only, you still need to be versed in reimbursement on some level. Because nearly everyone has insurance! 

Lastly, I think accepting insurance is a way to give back to the community – depending on the community you live in and what your patient population is like. Some individuals may not be able to pay out of pocket. I know that accepting insurance and getting started can be overwhelming, but once you understand it, you get into a routine, and you’ll flourish!