Help with starting up a pain practice

[Anapa]

Hi all,
New to the forums. I've been practicing pain mgmt for a couple of years for a large group but interested in starting my own practice for a lot of reasons(less red tape, more control of the direction of my practice etc..). As I'm sure most of us can relate to, I have no knowledge of the "business" aspects of medicine and its a bit overwhelming.

Does anyone who has experience starting up their own pain practice have advice on where/how to start? Lots of questions as you can see:

1. Incorporation(S corp or LLC etc..) and need for healthcare attorney?
2. Did you use a practice management consultant or is this a waste of money?
3. Licenses(for business) required by the state(CA) to start a business?
4. Equipment(c-arm, table, office supplies, computers) vendors you'd recommend(I saw the sticky about vendors in the forum but its pretty old)? did you purchase your c-arm/monitors or lease?
5. The issues that can arise when looking for office space suitable for fluoroscopy?
6. Financial--did you obtain a line of credit/loan from a bank? How much did you receive vs. did you think it was enough?
7. employees-did you hire any right off the bat? MA? NP?
8. How did you contract with insurers and how did you decide which?
9. Did you decide to stick with paper charts or buy an electronic health record system? If so, which one?
10. How did you advertise your practice to the public/other doctors?
11. Did you implement a urine drug screen(in office dipsticks and/or urine labs for send out)? Do you use the saliva drug screens? Are these reimbursed by insurers?
12. How do you charge patients for initial visits? follow-up visits? Do you implement the "patient is responsible for all charges that are not covered by your insurance" (ala dentists)?
13. Was it worth it?

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[PMR 4 MSK]

Get a lawyer who knows medical business and have them set everything up. Get an accountant the same.

Need to contract with someone to do your billing, unless you know someone who can do it, like family.

Consultants are mostly overpaid opinion-givers, and we all know what opinions are like...

Most states don't require a license for a business, but some cities require a permit.

Talk to above lawyer and acountant before taking out any loans.

Personnel you need -
1) Front desk check in/out, takes co-pays, deductables and other amounts owed. Answers telephone, makes appts.
2) Back office assistant - room pts, some charting, set up for injections

Insurance contracts are tricky. As a solo guy, you have no negotiating power - take it or leave it. Find out which are the big insureres in the area and start with them. Often BCBS, Aetna, Cigna, Humana.

Go with EMR if you can. The government is still giving money toward this, but at the cost of giving them a lot more info.

Only advertising to public you should do is an add in the paper when you first open announcing you are taking new patients. Then watch the drug addicts come crawling outta the sewers. Screen them all thoroughly - demand records, UDS before even giving them Tylenol.

Market to physicians in the lunch rooms of local hospitals, or by setting appts to visit them - breakfast, at the end of the morning, lunch or end of day.

UDS if you'll be prescribing opioids. Set up with a company to send out - AIT, QUest, others. Too much of a PITA to get paid in office.

Charge for everything you do, do everything you charge for. If you don't know it, learn the ICD-9 and CPT codes. Contract with someone to teach you if neccesary.

 

[101N]

Get a lawyer who knows medical business and have them set everything up. Get an accountant the same.

Need to contract with someone to do your billing, unless you know someone who can do it, like family.

Consultants are mostly overpaid opinion-givers, and we all know what opinions are like...

Most states don't require a license for a business, but some cities require a permit.

Talk to above lawyer and acountant before taking out any loans.

Personnel you need -
1) Front desk check in/out, takes co-pays, deductables and other amounts owed. Answers telephone, makes appts.
2) Back office assistant - room pts, some charting, set up for injections

Insurance contracts are tricky. As a solo guy, you have no negotiating power - take it or leave it. Find out which are the big insureres in the area and start with them. Often BCBS, Aetna, Cigna, Humana.

Go with EMR if you can. The government is still giving money toward this, but at the cost of giving them a lot more info.

Only advertising to public you should do is an add in the paper when you first open announcing you are taking new patients. Then watch the drug addicts come crawling outta the sewers. Screen them all thoroughly - demand records, UDS before even giving them Tylenol.

Market to physicians in the lunch rooms of local hospitals, or by setting appts to visit them - breakfast, at the end of the morning, lunch or end of day.

UDS if you'll be prescribing opioids. Set up with a company to send out - AIT, QUest, others. Too much of a PITA to get paid in office.

Charge for everything you do, do everything you charge for. If you don't know it, learn the ICD-9 and CPT codes. Contract with someone to teach you if neccesary.

Like he said.

And if that doesn't float your boat, come to your senses and joint a PHYSICAN run group. Drink from the fountain.

 

[Anapa]

PMR 4 MSK--thanks for the information!

101N--thanks as well. I've already tasted the kool-aid from a physician run group.

 

[inspire004]

I have Pain doc who will give me 1 yr contract, 35 % of collections from my 2 days in a week work he initially wants to offer. He wants to build up slowly and wants to take a good chunk from what i make. Has non compete for 8 zipcodes around me virtually does not want me any where near for 2 yrs.

is this any good or what

comments appreciated

 

[Pain Applicant1]

Hi all,
New to the forums. I've been practicing pain mgmt for a couple of years for a large group but interested in starting my own practice for a lot of reasons(less red tape, more control of the direction of my practice etc..). As I'm sure most of us can relate to, I have no knowledge of the "business" aspects of medicine and its a bit overwhelming.

Does anyone who has experience starting up their own pain practice have advice on where/how to start? Lots of questions as you can see:

1. Incorporation(S corp or LLC etc..) and need for healthcare attorney?
2. Did you use a practice management consultant or is this a waste of money?
3. Licenses(for business) required by the state(CA) to start a business?
4. Equipment(c-arm, table, office supplies, computers) vendors you'd recommend(I saw the sticky about vendors in the forum but its pretty old)? did you purchase your c-arm/monitors or lease?
5. The issues that can arise when looking for office space suitable for fluoroscopy?
6. Financial--did you obtain a line of credit/loan from a bank? How much did you receive vs. did you think it was enough?
7. employees-did you hire any right off the bat? MA? NP?
8. How did you contract with insurers and how did you decide which?
9. Did you decide to stick with paper charts or buy an electronic health record system? If so, which one?
10. How did you advertise your practice to the public/other doctors?
11. Did you implement a urine drug screen(in office dipsticks and/or urine labs for send out)? Do you use the saliva drug screens? Are these reimbursed by insurers?
12. How do you charge patients for initial visits? follow-up visits? Do you implement the "patient is responsible for all charges that are not covered by your insurance" (ala dentists)?
13. Was it worth it?

I'm currently in the process of starting my own practice and have gone through all of these things. I'm starting up straight out of fellowship and am pretty much doing everything on my own, with my doors scheduled to open late August. You can get all of your answers from consultants, attorneys, and CPAs but it will cost you. Also, I've learned that no one will look after you as much as you look after yourself so anytime I've received answers from specialists I've double checked it. I've also learned that the library is a great place to start and after a little of reading you can learn more about subjects that what some of the specialists know. For instance, after extensive research, I ended up starting a PLLC with S corp status and a CPA told me I needed to send two forms to the IRS to do this when all I needed to do was send one. I verified that I was correct from a couple of books I read on the matter. My two cents, do most of the reading yourself and use specialists sparingly. Also, if you're in California, I believe you'll be limited to which type of business entity you can form as a professional.

 

[mille125]

I'm currently in the process of starting my own practice and have gone through all of these things. I'm starting up straight out of fellowship and am pretty much doing everything on my own, with my doors scheduled to open late August. You can get all of your answers from consultants, attorneys, and CPAs but it will cost you. Also, I've learned that no one will look after you as much as you look after yourself so anytime I've received answers from specialists I've double checked it. I've also learned that the library is a great place to start and after a little of reading you can learn more about subjects that what some of the specialists know. For instance, after extensive research, I ended up starting a PLLC with S corp status and a CPA told me I needed to send two forms to the IRS to do this when all I needed to do was send one. I verified that I was correct from a couple of books I read on the matter. My two cents, do most of the reading yourself and use specialists sparingly. Also, if you're in California, I believe you'll be limited to which type of business entity you can form as a professional.

yes but that takes a lot of time that most of us do not have.....if it takes me 50 hours to find what it takes a lawyer 3 hours to find, then it is worth it to pay to lawyer...you need to put a price on your time as well...there is no substitute for good consultants when starting out..

 

[mille125]

You have made the right choice and have learned that from experience. I will answer your questions in bold and caps

1. Incorporation(S corp or LLC etc..) and need for healthcare attorney? EASIEST THING IS S-CORP. I SUGGEST THAT YOU KEEP IT SIMPLE WHEN STARTING. MULTICORP ARRANGEMENTS DO MAKE MORE SENSE BUT NOT WHEN JUST STARTING OUT
2. Did you use a practice management consultant or is this a waste of money? YOU ABSOLUTELY NEED THIS. DO NOT THINK THAT YOU KNOW ALL OF THIS JUST BECAUSE YOU HAVE AN MD. FIND SOME EXPERTS[/B]
3. Licenses(for business) required by the state(CA) to start a business? CHECK LOCAL ORDINANCES[/B]
4. Equipment(c-arm, table, office supplies, computers) vendors you'd recommend(I saw the sticky about vendors in the forum but its pretty old)? did you purchase your c-arm/monitors or lease? PRACTICE MANAGEMENT WILL HELP YOU HERE
5. The issues that can arise when looking for office space suitable for fluoroscopy? AGAIN PRACTICE MANAGEMENT
6. Financial--did you obtain a line of credit/loan from a bank? How much did you receive vs. did you think it was enough? GET A LINE OF CREDIT. MOST BANKS ARE STILL WILLING TO HELP IF YOU HAVE GOOD CREDIT. IF YOU DO NOT THERE ARE STILL OPTIONS. I WOULD GET AT LEAST 100K TO START
7. employees-did you hire any right off the bat? MA? NP? YOU MUST HIRE THEM RIGHT OFF THE BAT. PLACE AN ADD ABOUT ONE MONTH BEFORE YOU OPEN SO THAT YOU ARE NOT PAYING EMPLOYEES FOR NOTHING. YOU PROBABLY ONLY NEED TWO STARTING OUT. AN MA AND A RECEPTIONIST SHOULD SUFFICE. IF YOU ARE DOING PROCEDURES IN OFFICE YOU WILL NEED MORE.

8. How did you contract with insurers and how did you decide which? YOU NEED TO START ON THIS EARLY ON. IT SHOULD BE ONE OF THE FIRST THINGS THAT YOU DO BECAUSE YOU CANNOT DO ANYTHING ELSE UNTIL THIS IS COMPLETE. IF THERE IS A LOCAL PHO GROUP, I WOULD CONSIDER CALLING THEM AS THEY CAN HELP YOU WITH NEGOTIATIONS.
9. Did you decide to stick with paper charts or buy an electronic health record system? If so, which one? DEFINITELY EMR. DO NOT DO PAPER. YOU WILL ONLY END UP CONVERTING LATER AND WILL THEN NEED TO SCAN ALL OF YOUR PAPER CHARTS INTO AN EMR. JUST DO IT FROM THE START

10. How did you advertise your practice to the public/other doctors? YOU BEST ADVERTISING IS TOO GIVE LOCAL TALKS TO DOCTORS. YOU CAN ALSO TELL THEM WHO YOU LIKE TO SEE AND WHO YOU DO NOT LIKE TO SEE. A NEWSPAPER ADD IS OKAY BUT REMEMBER YOU GET REFERRAL FROM DOCS NOT PATIENTS.
11. Did you implement a urine drug screen(in office dipsticks and/or urine labs for send out)? Do you use the saliva drug screens? Are these reimbursed by insurers? IT IS REIMBURSED. YOU MUST DO IT. FORGET SALIVA
12. How do you charge patients for initial visits? follow-up visits? Do you implement the "patient is responsible for all charges that are not covered by your insurance" (ala dentists)? YOUR PRACTICE MANAGEMENT GROUP CAN GET DATA ABOUT CHARGES OF OTHER DOCS IN YOUR AREA AND YOU CAN BUILD YOURS BASED ON THIS. PATIENT IS RESPONSIBLE FOR CHARGES.13. Was it worth it?[/QUOTE] A RESOUNDING YES HERE

 

[PMR 4 MSK]

I have Pain doc who will give me 1 yr contract, 35 % of collections from my 2 days in a week work he initially wants to offer. He wants to build up slowly and wants to take a good chunk from what i make. Has non compete for 8 zipcodes around me virtually does not want me any where near for 2 yrs.

is this any good or what

comments appreciated

Run Forest, run!

 

[Pain Applicant1]

yes but that takes a lot of time that most of us do not have.....if it takes me 50 hours to find what it takes a lawyer 3 hours to find, then it is worth it to pay to lawyer...you need to put a price on your time as well...there is no substitute for good consultants when starting out..

That is true. It does take a lot of time to figure the stuff out on your own and you will have to determine what your time is worth compared to what the specialists will charge. I'm doing most of the stuff on my own because:

#1 I'm still officially in fellowship and am salaried
#2 I don't have a busy schedule at this time
#3 I don't have kids just yet

If my situation was different I would most probably use the specialists more frequently.

 

[mille125]

That is true. It does take a lot of time to figure the stuff out on your own and you will have to determine what your time is worth compared to what the specialists will charge. I'm doing most of the stuff on my own because:

#1 I'm still officially in fellowship and am salaried
#2 I don't have a busy schedule at this time
#3 I don't have kids just yet

If my situation was different I would most probably use the specialists more frequently.

just make sure that you have enough time to learn in fellowship and study for your boards....that is impt too

 

[Anapa]

Thanks for all the replies.
I agree that saving the time (and aggravation) needed to do all of these things is well worth paying the right people to do it for you. I work full-time in my current job right now and I have children so my free time is limited. I'm planning to open the clinic in about 1 year or later so I don't have to rush.

I'll be hiring the following:
1. healthcare attorney to assist with S-corporation, negotiations and other legal matters. (Apparently here in California, you can't form an LLC, LLP or C-corporation if you're a physician).
2. Accountant
3. Practice management consultant to help me with everything else

 

[mille125]

Thanks for all the replies.
I agree that saving the time (and aggravation) needed to do all of these things is well worth paying the right people to do it for you. I work full-time in my current job right now and I have children so my free time is limited. I'm planning to open the clinic in about 1 year or later so I don't have to rush.

I'll be hiring the following:
1. healthcare attorney to assist with S-corporation, negotiations and other legal matters. (Apparently here in California, you can't form an LLC, LLP or C-corporation if you're a physician).
2. Accountant
3. Practice management consultant to help me with everything else

smart approach