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practice for sale
Started by bigpodguy
Just start your own office... not as expensive as you think.
You will be busier a lot quicker than you think.
You can always start on a budget and expand if you want to later.
You get the stuff you want for supplies, staff, system that way.
You don't take on liability and legacy costs of assuming somebody else's either.
My general exp was that it was fun to look, fun to to see offices. Some are even good... but all wanted FAR more than it was actually worth (rougly 1yr net... plus/minus reputation and goodwill that is or isn't transferrable).
If you're intent on looking/buying anyway, try APMA classifieds or others on PODIATRYJOBS.ORG
I think podiatryexchange is defunct, but there are other options.
GL
You will be busier a lot quicker than you think.
You can always start on a budget and expand if you want to later.
You get the stuff you want for supplies, staff, system that way.
You don't take on liability and legacy costs of assuming somebody else's either.
My general exp was that it was fun to look, fun to to see offices. Some are even good... but all wanted FAR more than it was actually worth (rougly 1yr net... plus/minus reputation and goodwill that is or isn't transferrable).
If you're intent on looking/buying anyway, try APMA classifieds or others on PODIATRYJOBS.ORG
I think podiatryexchange is defunct, but there are other options.
GL
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I think in an area that is heavily saturated with PE, there’s some value to marketing yourself as a non-PE guy in a heavy PE area. Patients, such as myself, will seek that out. En****tification of PE practices is catching on with people. In addition, PE and corporate hospital groups are snared by their own bureaucracy and are not very agile in the market.
1. PE sucks, but when you say lots of PE what you are really saying is "saturated".
2. Starting your own thing is probably cheaper than buying someone else's if only because everyone overstates the value of their group. My partner valued our last group at $180K when I bought in. That's not technically a lot. My equipment and purchase costs were less than that (ie. quite a bit less than $100K) though that doesn't account for things like paying staff to man an under-utilized office that is starting up.
3. The question in my mind is - what market do you know? Where have you practiced? I started my own thing, after already being a partner in a different group in the same town I was already practicing in. I kept my hospital credentials. I had contact information for all the local insurances because I had already done the contract negotiations for my last group. It was familiar. Every market may be different. When it came to insurance negotiations I had already fought several companies once so I knew what I got the last time we fought.
4. Part of me wants to tell you that you'll have to do everything from scratch. That said, I think you potentially still have to do everything from scratch regardless. I'm doing ERA/EFT set-up right now. That has to be done everytime a bank account changes.
5. I have a theory and it may be wrong. My theory is that within reason - everything insurance-wise sort of pays the same. Its not 100% - I fully admit that. Someone on here has been comparing rates with me and there's definitely some variation, but its not enormous. A few more dollars here or there. I don't think there's anyone out there being showered with money ie. Medicare is still the anchor around things fall even if adequate insurance is paying ...175% of Medicare. SO- here's my battle for you. If everything sort of pays the same with small-moderate fluctuations then the real battle for a lot of people will be cost of living. The real estate market keeps getting worse but I bought my house for under $300K and my office building for under $400K. If you get trivially more from insurance but pay 2-3X for the above - that might make some of those cooler localities impractical.
*E&M continues to be under reimbursed with everyone I speak to.
6. Cash flow is king is my final comment for you. Personally and professional. I haven't taken a paycheck yet. Now - there's technically $29K in the checking account, but I still want to continue to see the bank account increase and make sure I'm not missing any big surprises.
Yes... essentially this.
PE are usually not hard to out-compete. They do cookie-cutter impersonal medicine. They overbill.
Ergo, your angle is that you are the local office, personal service. Tell MD/DO refer sources that you communicate, you will be here awhile, you are in the community. Same angle for your marketing. Talk with your patients about local stuff. The upside to solo is more money, little/no admin headaches, and ultimate job security; the downside is obviously that you are tethered to that area (but use that in a good way for your marketing and enjoyment).
Attend medical staff meetings. Drop some cards and shake hands at ER, pedicure shops, urgent cares, PT places, whatever (for early on... later, you just want basically just the MD/DO primary care refers and not so much the ER/UC ones). The pts referred from PCPs are the ones that are gold; they will have been told your'e good, and they have fair/good insurance. The online ad refers and most other place refers can be too random in terms of payers and mental health and drama... usually want the PE group or someplace else to get those ones once you are full and can pick n choose. 🙂
I have a PE podiatry supergroup office, biggest in the state, under same roof as me... they have been stuck at 2-3 days/wk since I left (I was 5d/wk when I worked there). They essentially just get the leftovers: pts who they get with paid social media ads or pts who were referred to me but want to be seen asap for minor routine complaints... and I can't accommodate that. I am full consistently, on a multi month wait list (yeah, from a biz $tandpoint, I should start another nearby office and get a biz partner to cut into that backlog, but I've won the game already). The PE supergroup will likely go back to 5d/wk when I retire (assuming no other DPM comes in or hospital doesn't hire), but that's simply not my concern. There are way too many podiatrists, and we all know it. Even if PE in my area strenghens again due to lack of other options, it's easy for another DPM (solo or hospital) to disrupt them years later also... even most pts/refers don't like the supergroup - they just go/send there as it's the nearby foot care option in a lot of areas now. They're McDonalds; you're a unique local restaurant.
...But yeah, don't be at all afraid to compete with PE podiatry supergroups; they generally get average or below average podiatrists (the big one here has maybe one DPM out of their dozen who's ABFAS cert). They have a revolving door of docs also (so, even if they hire a doc pts or refer sources like, that person will probably will leave fairly quick). You can even work for the PE group yourself if there are no non-competes in the state for physicians (this works for me in NM or works for Cali... def not in TX and prob not in Fla, but check the laws and consult employ attorney). I wouldn't do that as a top choice, but if you are unsure of the area or need a foothold in the area and/or to build up some $$ for startup, that can work.
No, your NPI can only be on Medicare and the payers once.
You basically have to lock out present one (they will know soon after).
I'm skeptical this is true.
I present to you the following - I haven't cancelled my enrollments yet through my old office. Everything is still listed. My old PTANs still show up under my individual enrollment and my old group enrollment still shows up.
Yes - I need to cancel these, but if what you are saying is true no one could be a contractor and work at multiple places.
Well, you can make whatever places you like associated with NPI (to finish of collections at prior job, etc). But the doc NPI is linked to one set of contact info.
I don't think your situation with old office was covert? (old office knew you were leaving, right?)
...For this guy "don't want my employer to know" (like pretty much any associate), then any logging in, overriding passwords, changing info, etc will send emails or lock out billers / credentialers at his current employer. He probably doesn't even know the passwords right now. They'll need reset and primary info changed, new office added. At that point, the jig is up very fast.
So, it pretty much just has to be planned, then done all at once... and the current workplace will know within days - if they are paying any attention whatsoever. You can lie and say "tried updating it" or "got an email I had to correct stuff" or whatever, but it doesn't really fool anyone. They've seen it before at any multi-doc office. 🙂
Holy crap. Now that you mention all of that. My practice/biller/credentialer (which is all the same couple people here that do all that for our practice) have all of that information for me. When I joined this group, they set up all my credentialing, all my insurance, all my CAQH profile, etc. I have no idea what the logins even are.
Honestly, I don't even know if I have a login or if a login was ever made for anything. They never asked me to do anything when I started, but I keep getting emails saying, "You are now credentialed with blah, blah, blah," or, "You are now approved with blah, blah."
Guess I won't be able to rage quit and walk out of here, and will have to let the contract expire and stay on good terms so I can gain access to all my accounts (if I even have any) lol.
You can override it for MCR / MCA and CAQH and others (will tip them off fast as their email is set as contact info), but honestly, unless you really enjoy that credentialing stuff (nobody does), pay your billing service or a cred service or just let next employer/hospital credentialing person do it. It is good to keep a list of your numbers, usernames, license numbers, etc etc etc to help them out.
"There are two ways to learn: your mistakes, or someone else's.
One's cheaper, and one's faster. And they're the same one."
I think we need to acknowledge that there is a difference between being unable to create new/have multiple accounts and triggering your current/old practice to know you are creating an account.
1. BCBS is interacted with through Availity. No one else has your Availity login because everyone's Availity login is their own. If a practice tries to share an Availity login it will likely be deleted ie. multiple people using one login. I know this because my old office did it and BCBS came down on them. We also had people keep leaving and by creating my own Availity login I was able to verify all the future staff. When I started my new office, I already had an Availity login and when I added my new practice it simply showed up with my old one. I was absolutely still with my old group when this happened.
2. All of your Medicare logins are controlled through your Medicare I&A account. Obviously my situation is different than an associate as I was an owner - I had control of mine because an office administrator wanted to speak to Medicare and needed to be designated as an administrator through my account. Controlling your I&A account allows you to access your PECOS and your NPPES accounts and create an NPI2 and Medicare application. It is also where you set yourself as your authorized official for your new practice which is a stupid process. I'm strongly under the impression that authorized officials and what not are meant to have their own accounts and you designate authority to them, but I'm willing to admit I don't think I am the person who initially created my I&A account. When I ask AI - is a doctor meant to control the login and password of their own I&A account it definitively says - the doctor must hold their own username and password. Your I&A account links to your social security number and address. Your practice is not supposed to control this. Someone could defraud you if they had control of this. You are supposed to control this and delegate surrogate authority for the reassignment of benefits to your authorized officials. Are there possibly podiatry practices where the group fraudulently controls the individual doctors' I&A accounts? Probably. Should they - definitely not. And if you can take back this control there is nothing stopping you from making a new NPI2 or Medicare 855i application.
3. I did have to steal back my DEA account and I did it during a time where I was still attempting to be covert. I could have called and had the DEA override it, but my office manager had changed the email on my DEA account to the office management email which I had access to. So I simply went to the office at 7am - logged into the email, took the token that the DEA sent, changed my account email, and then deleted the chain. I wanted control of this, but DEA access is honestly I think one of the later things in the process. You can definitely include it in your Medicare application, but I don't know that you have to. Again - when I ask AI it says you only have to include it if its applicable.
4. You only have one CAQH profile - so you do have to take this back. But I don't believe you actually have to control this to apply to Medicare or to BCBS. There are insurances that ask for it, but they aren't necessarily the first ones you might think to apply to if you were still trying to be covert.
1. BCBS is interacted with through Availity. No one else has your Availity login because everyone's Availity login is their own. If a practice tries to share an Availity login it will likely be deleted ie. multiple people using one login. I know this because my old office did it and BCBS came down on them. We also had people keep leaving and by creating my own Availity login I was able to verify all the future staff. When I started my new office, I already had an Availity login and when I added my new practice it simply showed up with my old one. I was absolutely still with my old group when this happened.
2. All of your Medicare logins are controlled through your Medicare I&A account. Obviously my situation is different than an associate as I was an owner - I had control of mine because an office administrator wanted to speak to Medicare and needed to be designated as an administrator through my account. Controlling your I&A account allows you to access your PECOS and your NPPES accounts and create an NPI2 and Medicare application. It is also where you set yourself as your authorized official for your new practice which is a stupid process. I'm strongly under the impression that authorized officials and what not are meant to have their own accounts and you designate authority to them, but I'm willing to admit I don't think I am the person who initially created my I&A account. When I ask AI - is a doctor meant to control the login and password of their own I&A account it definitively says - the doctor must hold their own username and password. Your I&A account links to your social security number and address. Your practice is not supposed to control this. Someone could defraud you if they had control of this. You are supposed to control this and delegate surrogate authority for the reassignment of benefits to your authorized officials. Are there possibly podiatry practices where the group fraudulently controls the individual doctors' I&A accounts? Probably. Should they - definitely not. And if you can take back this control there is nothing stopping you from making a new NPI2 or Medicare 855i application.
3. I did have to steal back my DEA account and I did it during a time where I was still attempting to be covert. I could have called and had the DEA override it, but my office manager had changed the email on my DEA account to the office management email which I had access to. So I simply went to the office at 7am - logged into the email, took the token that the DEA sent, changed my account email, and then deleted the chain. I wanted control of this, but DEA access is honestly I think one of the later things in the process. You can definitely include it in your Medicare application, but I don't know that you have to. Again - when I ask AI it says you only have to include it if its applicable.
4. You only have one CAQH profile - so you do have to take this back. But I don't believe you actually have to control this to apply to Medicare or to BCBS. There are insurances that ask for it, but they aren't necessarily the first ones you might think to apply to if you were still trying to be covert.
Personal NPI may be linked to group NPI so they can bill medicare.
If that's the case you may have to terminate this link.
All done through NPPES
If that's the case you may have to terminate this link.
All done through NPPES
I'm semi-sure its done through PECOS - that's where you can see your individual enrollments, your group enrollments, and where you can control reassignment. NPPES is where you modify your personal NPI information and where you can create an NPI2/modify it.
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Yeah one of the two.
Sick right now so everything is fuzzy
Sick right now so everything is fuzzy
Its all alphabet soup that no one teaches us.
I agree. around 40-50K is more than sufficient to start a practice
