New PAin Clinic from a Scratch Need Expert recommendation Thanks

[IPCS]

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Looking to establish new independent pain clinic from scratch.
Need help and expert advice for
1) EMR/EHR
2)Advertisement of practice
3)Establish referrals
4)equipment like RF / flouroscope ( planning new OEC 9900)
5) hiring nurses and ancillary staff
6)advice for billing and bussiness management software and companies ( payrolls, health plans).

At this stage I have approved bank loan of 175000 for equipment
and decided a space to lease ... working on documents.
Any help or support will be appreciated. Thanks
IPCS 😕

 

[SSdoc33]

😱

 

[facets]

😱

I second that

You have no idea what you are getting into. Are you just out of fellowship? Do you have any cash cushion or other source of income? It will take you a minimum of 1 year to break even. Until then you will bleed red ink every month.

 

[SSdoc33]

who says this is even a doctor?

 

[Tenesma]

somebody who doesn't know how to establish a referral pattern, how to advertise --- has NO business starting a pain business from scratch unless you are going to live in a non-competitive environment (ie: somewhere really rural)...

my recommendation: work for a group for a 1-2 years and learn how something should be run properly - and then go solo... it will save you money, and headaches.

 

[LongSnow]

"planning new OEC 9900"😱


I'd plan on a refurbished pulsera or a refurbished 9800 or 9600; why the heck get something new for so much more $$? You can even lease something.

BTW - I'll send you an PM

Cash is king, hold onto it.

 

[PMR 4 MSK]

I'll bite

1) There are a number of free EMRs and a fe threads on here about them. Don't pay for something that is free if you can help it. For most paid EMRs, the biggest chunk is probably the saleman's commission.

2 Don't advertise. Market. Newspaper ads, radio, billboards, etc - none of those work unless you want every pill-head for 30 miles to come see you. Go meet with potentially referring doctors, shake their hands and tell them what you have to offer them, and why they should send the pts to you instead of your competition.

3) #2 above and word-of-mouth are your biggest sources of new patients. Do well for each patient and they'll send their friends and family.

4) Lots of threads here on fluoro and RF generators. For RF, have each rep bring you their model and let you try it out for a couple weeks.

5) Good luck. Pay for as well-trained people as you can get. Don't hire anyone who has never worked in a medical office. Hire old ladies - they are not as petty/bitchy as younger staff, they don't take Mondays off because they are hung over, they don't get pregnant, and they don't have young kids getting sick causing them to miss work.

6) Get a good accountant who knows they work for you, not Uncle Sam. Many play it too safe. Ask them what 2+2 is. If they answer "What do you want it to be?" you have the right person. Get a good layer to incorporate your business and review all contracts. Check with a local hospital about billing, some do it for local docs to build the relationship. Within a year, start doing it on your own, in your office.

 

[melancholy]

somebody who doesn't know how to establish a referral pattern, how to advertise --- has NO business starting a pain business from scratch unless you are going to live in a non-competitive environment (ie: somewhere really rural)...

my recommendation: work for a group for a 1-2 years and learn how something should be run properly - and then go solo... it will save you money, and headaches.

Based on what I've seen around a competitive job market region, the recommendation to work for a group for 1-2 years to learn the business as much as possible is a wise one. Obviously, working with a known entity off the bat until you get your feet wet is better, but I suppose it depends on your current experience. Getting in touch with local reps who know the lay of the land may be helpful as well.

 

[hyperalgesia]

ask them what 2+2 is. If they answer "what do you want it to be?" you have the right person.

Hehe 😛

 

[mille125]

somebody who doesn't know how to establish a referral pattern, how to advertise --- has NO business starting a pain business from scratch unless you are going to live in a non-competitive environment (ie: somewhere really rural)...

my recommendation: work for a group for a 1-2 years and learn how something should be run properly - and then go solo... it will save you money, and headaches.

Working with a group is no guarantee that you wont get screwed over. Many have regrettably treaded down this road. You can open a practice on your own but you need to surround yourself with good advisors. Start out by getting a good practice manager. He/She will serve as your quarterback. Accountants, lawyers, and other specialists wil follow. Do yourself and shell out your money for good help. I question the need for a brand new OEC 9900 right off the bat. I dont have your financials and maybe you can roll like that but I doubt it at your stage.

 

[knoxdoc]

I used a 9400 in my practice for a few years. It worked absolutely fine and only cost 50K. Don't bury yourself in debt.

 

[drpainfree]

at this time, banks are pushing out business loan like crazy...unless you're getting these loans with personal collateral, I'd be careful taking out this large amount of loan without establishing your referral base first.

it's very questionable if new solo pain management practice will be survivable in 5-10 years time frame.

Looking to establish new independent pain clinic from scratch.
Need help and expert advice for
1) EMR/EHR
2)Advertisement of practice
3)Establish referrals
4)equipment like RF / flouroscope ( planning new OEC 9900)
5) hiring nurses and ancillary staff
6)advice for billing and bussiness management software and companies ( payrolls, health plans).

At this stage I have approved bank loan of 175000 for equipment
and decided a space to lease ... working on documents.
Any help or support will be appreciated. Thanks
IPCS 😕

 

[Pain Applicant1]

You can do it but it'll take a lot of work. I did it straight out of fellowship and so far I'm surviving okay after a month. Make sure you do your homework.

Hire old ladies - they are not as petty/bitchy as younger staff, they don't take Mondays off because they are hung over, they don't get pregnant, and they don't have young kids getting sick causing them to miss work.

Ask them what 2+2 is. If they answer "What do you want it to be?" you have the right person. .

 

[Tenesma]

mille: of course most of us would get taken advantage of financially for those 2 years of practicing for a group - but it allows the future soloist to learn the ropes.

I consider myself pretty savvy, but starting a practice from scratch straight out of training without an understanding for marketing, and building referral networks, would have been a disaster...

and the OEC 9900 is also a sign of not being prepared... first of all, it sucks compared to Ziehm/Pulsera - 2nd of all it is expensive...

 

[mille125]

mille: of course most of us would get taken advantage of financially for those 2 years of practicing for a group - but it allows the future soloist to learn the ropes.

I consider myself pretty savvy, but starting a practice from scratch straight out of training without an understanding for marketing, and building referral networks, would have been a disaster...

and the OEC 9900 is also a sign of not being prepared... first of all, it sucks compared to Ziehm/Pulsera - 2nd of all it is expensive...

Agree with OEC 9900 statements. I did open up right out of fellowship and have not looked back. It would have been a disaster without the right team in place because as physicians we generally do not know a lot about business. Overall I think that some individuals will excel and some will struggle. Those with good teams usually get an added push towards the finish line.

 

[zipzapzoo]

My scenario is little different...I am joining a physician who already has chronic pain practice with hospital privileges for inpatient ( pain and rehab) patients....I would be joining as his first "interventionalist"....so will this be also considered as "start from scratch"...or this is a safe start....I will be doing my procedures across the street in the surgery center though !!!.....I would like to have some expert opinion from you guyzz regarding what potential complications can arrive and what to be vary of
Thanks and Regards...

 

[PMR 4 MSK]

My scenario is little different...I am joining a physician who already has chronic pain practice with hospital privileges for inpatient ( pain and rehab) patients....I would be joining as his first "interventionalist"....so will this be also considered as "start from scratch"...or this is a safe start....I will be doing my procedures across the street in the surgery center though !!!.....I would like to have some expert opinion from you guyzz regarding what potential complications can arrive and what to be vary of
Thanks and Regards...

What potential complications can arrive? Anything you can think of and thousands of things you can't.

Here's some things that have happened to me:

An ownership change - hospital or ASC admin changes, suddenly you have a completely different contract or none at all. You are out on your own.

A pipe bursts, damaging all your books. Who's gonna pay to replace them? Or a pipe bursts at the ASC, and it is closed for 2 weeks. Where will you do your injections?

You suspect your billing agent is slacking, or worse, embezzeling. What do you do?

You are the first interventionalist for the group. Who's gonna cover for you? Who is going to be your cover on paper, a doc with the same hospital privileges? If your partner doesn't do interventions, he cannot cover for you.

You need 2 docs from the same specialty in your town to vouch for you for credentialing for each hospital, ASC or insurance company. Who do you ask? How do they sign a form stating they know your practice and you are safe and competant to perform the procedures you are asking to do?

Policies for payment of one or more of your procedures changes, and suddenly your collections drop 20%. With 50% overhead, thats a 40% drop in take-home pay.

Others I can think of:

You partner is sued. You, as co-owner of the business get sued vicariously. Your malpractice doesn't cover that, because it's the business being sued, not you for any medical mistake. How do you pay for that lawyer at $500/hour?

Your partner loses the suit and is hit with a $5M verdict, with $1M in coverage. They come after the practice and notice you, the partner have assets. Are they protected?

V.v. You lose a lawsuit. How is your practice and partner protected?

Your partner suddenly decides one day to leave the state. You are left holding all the bills. How are you protected?


Your partner turns out to be a lying, tax-cheating backstabber. You signed for a 50-mile non-compete clause. You have a $3K/mo mortgage in a city with a 16 month supply of houses.

You partner is getting divorced. His wife wants half of everything. Being cash-poor, he is forced to either take out a loan against the practice or sell. Whattayado? V.v. again, and it's you getting divorced...

A weather disaster hits. Hurricane, tornado, flood, whatever. Your clinic gone with the windl. You have nowhere to practice, records are lost, including billing and collections. Now what?

Obama wins a second term, democrats win the House back and keep the Senate. Health Care reform goes full-tilt forward. Medicare payments drop 40% (as they will if they SGR does not get fixed) and many people join the new government-sponsered exchanges and expansion of Medicaid. What will happen to your practice and partnership?

Partnership is a marriage. A marriage of convienence, but a legal marriage. Sometimes a polygamous one. People get sued, divorced, move and die.

 

[mille125]

My scenario is little different...I am joining a physician who already has chronic pain practice with hospital privileges for inpatient ( pain and rehab) patients....I would be joining as his first "interventionalist"....so will this be also considered as "start from scratch"...or this is a safe start....I will be doing my procedures across the street in the surgery center though !!!.....I would like to have some expert opinion from you guyzz regarding what potential complications can arrive and what to be vary of
Thanks and Regards...

This is not a start from scratch because your partner, even though he is not an interventionalist, has referrals. He also has infrastructure set up that can handle billing, coding,marketing, payroll, etc. This is far from a new startup.

Before discusssing complications, I would need to see your contract. PM me if you want me to look.

 

[inspire004]

I am planning to join an established solo pain practice of pain anesthesia doc. He has no idea about contracts , his past docs were part time, do you guys know of any good lawyers around Charlotte area. How much to pay for the whole process. Review it correct it and possible change in future with changing climate.

Basics with contract with a negotiable partner which I could think of

1. Non compete, 5, 10 mile
2. Partnership, from get go or fixed salary for a year and % after that
3. Exit strategy, what do we do if thinks don't work well
4. Collections, what % goes to him and how much do I get from my work
5. Expansion, asc or hospital
6. Insurance malpractice and health
7. Expenses sharing
8 coverage, locations
9. Please PM me if you have any contracts with ur practice just to get rough draft of the essentials to include in mine. Privacy will me appreciated both ways and u can hide your private info.


Thanks

 

[IPCS]

Thank you every one for this detailed discussion.
few Points to share:

1) New OEC 9900 super C is approx 130,000 and old refurbished 9800 is some where between 90,000-105000.
Leasing for 3 yrs is expensive then financing for 5 yrs. For approx 20000 more from leasing price OEC will be mine if I keep financing payments equal to leasing payment for first 3 yrs.
2) Agree with RF machines, Will call multiple reps , use it then decide.
3)I have cash of approximately 100,000.
4 ) I had pain practice experience in a group for few years now moved to a different city for family reasons and don't want to work as junior partner or slave from the scratch, neither I was offered a good package from local hospitals.
5) Didn't have to worry about billing, nursing or other issues in previous practice. I have an idea of ancillary staff issues but just wanted to get other physicians personal & professional opinions.
6)The City, I plan to work in is very competitive for pain jobs.
6)Don't want to ba an hospital employee because compete is 2 yrs and then I wouldn't be able to establish myself independently.
7) I had an excellent reputation at previous practice but obviously its going to be start from a scratch at new location