Solo practice questions

[PainApp2021]

Hi all,

I just had a few questions as I think more about my future in pain. I've been thinking more and more about hustling on my own to start a PP rather than joining a large group or hospital. I did have a few questions.

-Would you ever recommend working for a few years prior to trying to start on your own?

-Do any small solo practices also start out with employing a physical therapist/occupational therapist under the same roof to both benefit from collections as well as know that patients are getting good therapy prescriptions (coming from a PMR background)?

-Are there any stats out there that discuss the point with patient load at which building an ASC would be worthwhile?

-What pain conferences are best for networking and learning from others with what has worked and what hasn't worked for starting your own practice?


Thank you for any input!

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[myrandom2003]

you can start solo and try to round on subacutes part time to pay bills.

ASC is tough to determine. you probably need a partner to keep it running while you are in clinic. Also depends on how efficient you are and state requirements which determine cost to see if it makes sense.

most will recommend keeping costs low. if you want to partner with PT and share overhead thats one option. doesnt hurt to start solo and build on from there.

Billing, billing, billing learn as much as you can. ASIPP has some resources and society for pain practice management

 

[RoloTomassi]

Hi all,

I just had a few questions as I think more about my future in pain. I've been thinking more and more about hustling on my own to start a PP rather than joining a large group or hospital. I did have a few questions.

-Would you ever recommend working for a few years prior to trying to start on your own?

-Do any small solo practices also start out with employing a physical therapist/occupational therapist under the same roof to both benefit from collections as well as know that patients are getting good therapy prescriptions (coming from a PMR background)?

-Are there any stats out there that discuss the point with patient load at which building an ASC would be worthwhile?

-What pain conferences are best for networking and learning from others with what has worked and what hasn't worked for starting your own practice?


Thank you for any input!

1. I would work a few years in PP to learn the business side of things, have some capital, reduce debt.

2. PT is generally not a big money maker.

3. Old but good read on establishing ASC.

Establishing an Ambulatory Surgery Center: A Primer From A to Z (Part 1)

This article summarizes several issues that are critical to establishing an ASC. The article focuses on business and planning issues and does not focus on legal and regulatory issues for ASCs. In addition, industry experts offer their advice on some of these areas.

www.beckersasc.com

Establishing an Ambulatory Surgery Center: A Primer From A to Z (Part 2)

Note: Part 1 of “Establishing an Ambulatory Surgery Center — A Primer From A to Z” appeared in the May/June issue of Becker’s ASC Review. You can find the complete article online at www. BeckersASC. com. Equity ownership, physician partner issues and hospitals and management companies as

www.beckersasc.com

4. I would think ASPN has the most business-minded docs.

 

[Pain Applicant1]

Hi all,

I just had a few questions as I think more about my future in pain. I've been thinking more and more about hustling on my own to start a PP rather than joining a large group or hospital. I did have a few questions.

-Would you ever recommend working for a few years prior to trying to start on your own?

-Do any small solo practices also start out with employing a physical therapist/occupational therapist under the same roof to both benefit from collections as well as know that patients are getting good therapy prescriptions (coming from a PMR background)?

-Are there any stats out there that discuss the point with patient load at which building an ASC would be worthwhile?

-What pain conferences are best for networking and learning from others with what has worked and what hasn't worked for starting your own practice?


Thank you for any input!

-Would you ever recommend working for a few years prior to trying to start on your own?
Would I ever? Yes. Is it necessary? No. I started my practice right after fellowship so it's doable.

-Do any small solo practices also start out with employing a physical therapist/occupational therapist under the same roof to both benefit from collections as well as know that patients are getting good therapy prescriptions (coming from a PMR background)?
I wouldn't recommend it but I'm NOT speaking from experience. You have to build up a pt population first as a customer base. Then you have to fill in a PT popluation from that base and/or receive referrals. I imagine it would take time to work up to that and you would probably be in the red for a while. There's a lot to do when you first open a practice. I couldn't imagine having to manage PT at the same time. But still doable if you wanted to.

-Are there any stats out there that discuss the point with patient load at which building an ASC would be worthwhile?
I chose not to go in that direction and refused ownership in the local ASC. Right decision on my part. Be sure you calculate the billing out and your investment in the ASC. Also, understand if your state requires a CON or not. If it does, prepare for a fight.

-What pain conferences are best for networking and learning from others with what has worked and what hasn't worked for starting your own practice?
From my experience, fewer and fewer providers have opened their own practices.

PS: Give me my username back, LOL!!!

 

[sunny117]

Build an immunoassay lab to bill 80307 for your urine tests.

And do NOT build an ASC. It'll be more hassle than you know what to do with. Do your stim trials local and send the perms to the big institutions.

 

[gazzer]

Build an immunoassay lab to bill 80307 for your urine tests.

And do NOT build an ASC. It'll be more hassle than you know what to do with. Do your stim trials local and send the perms to the big institutions.

What are some of the pitfalls of an asc? ROI not worth it?

 

[TIVAndy]

is immunoassay considered quant or qualitative test ( i'm assuming qualitative).
do you have guide to how you can set up immunoassay lab? we have CLIA waiver and just using cup 80305

 

[Ducttape]

for drug testing that i believe is appropriate for patients on chronic opioid therapy, you should be relying on liquid chromatography gas spectroscopy testing, not immunoassays.

also, i would be worried about "building" an immunoassay lab and Stark violations with regards to sending your patients there for testing.

 

[pmrmd]

Starting independently is market dependent for obvious reasons. Much more expensive to open PP now than 20 years ago. You need in-house fluoro and RF machine to make it.

Don’t hire a PT/OT. It won’t help at all.

Solo ASC won’t help early. Too expensive and too little revenue. Do a few cases at some different places and network.

If you want a lab make it part of your practice. You aren’t “referring” to it. It’s in the practice. You can make anything a part of your practice—MRI, behavioral therapy, whatever.

 

[swamprat]

Any resources you guys have for getting on insurance panels? I assume you get on medicare first and go from there. Are there companies you can hire to do this ?

 

[Pain Applicant1]

I have a moderate complexity lab, mostly to monitor my suboxone pts. High complexity is quite the investment and not worth it to me but can be worth it if you're busy using it. Calculate the numbers out. You can hire a consultant to help you get it set up. For a high complexity lab, when I looked into it, I think the consultant wanted $50,000 to just set it up. Too risky for me. If you read up enough on it, you can figure out how to set it up yourself.

You can hire companies to get you credentialed with the different payers or do it yourself. It's quite the pain. When I started I belonged to a PHO so they did everything for me, except for Medicare which I did through PECOS. The PHO has since dissolved once the big university hospital system moved into town and took over nearly everyone, except for the few remaining independent practices like mine.

 

[GoBeers]

for ASC owners, how do you decide on what cases to take to ASC vs. keeping it in-office? time? efficiency? reimbursement?

 

[RoloTomassi]

for ASC owners, how do you decide on what cases to take to ASC vs. keeping it in-office? time? efficiency? reimbursement?

Take everything except those that pay more in-office, kypho being the only one for me, and those where the facility fee won't be paid, like hips and SIJ with some insurers. But it doesn't really make sense to have office fluoro if you have an ASC. Just lease your ASC out to your office on specified days/times for office procedures.

 

[Pain Applicant1]

for ASC owners, how do you decide on what cases to take to ASC vs. keeping it in-office? time? efficiency? reimbursement?

time = strike 1
efficiency = strike 2
reimbursement = strike 3 (pro fee)

ASCs are of very little benefit for nearly all pain procedures and they are definitely not efficient. Some procedures must be done in the ASC or you won't get reimbursed for them. Most procedures can be done on an outpt basis and the sole purpose for doing them in the ASC is for reimbursement of the facility fee. Your pro-fee drops but if you're part-owner of the ASC you might make it up from the facility fee depending on your setup.

 

[GoBeers]

time = strike 1
efficiency = strike 2
reimbursement = strike 3 (pro fee)

ASCs are of very little benefit for nearly all pain procedures and they are definitely not efficient. Some procedures must be done in the ASC or you won't get reimbursed for them. Most procedures can be done on an outpt basis and the sole purpose for doing them in the ASC is for reimbursement of the facility fee. Your pro-fee drops but if you're part-owner of the ASC you might make it up from the facility fee depending on your setup.

ya i'im looking at ASIPP facility fees and pro fees. sometimes the math doesn't add up that much more compared to in office pro fee. especially taking into account efficiency and turnover and maybe cost? I prefer to do most procedures in office for convenience alone, but we will see what we move into the new ASC.

 

[RoloTomassi]

ya i'im looking at ASIPP facility fees and pro fees. sometimes the math doesn't add up that much more compared to in office pro fee. especially taking into account efficiency and turnover and maybe cost? I prefer to do most procedures in office for convenience alone, but we will see what we move into the new ASC.

Efficiency and turnover should be as fast or faster in a well-run ASC, as they usually have more staff. That's the trade-off: you can crank out cases in an ASC but the overhead is higher. The volume + SOS differential surpass the extra overhead.

 

[GoBeers]

Efficiency and turnover should be as fast or faster in a well-run ASC, as they usually have more staff. That's the trade-off: you can crank out cases in an ASC but the overhead is higher. The volume + SOS differential surpass the extra overhead.

so what I'm hearing is... if you were the owner, then in general you would essentially want all procedures in ASC (except kypho) ?

 

[nvrsumr]

Alot of this is location, practice, payor and patient dependent. If you have NPs writing narcotic scripts all day while you and your 3 partners are busy being "pain surgeons" at the ASC in a practice that has infinite volume, great contracts, auto cases, lots of OON as well patients with little out of pocket expense then the ASC facility fees and your employed CRNA anesthesia fees will get you 2 million/yr.

If plain old pain doc with office fluoro a million/yr can be a reach.

 

[RoloTomassi]

Keep in mind also that ASCs don't have to be extravagant. You can follow your state's minimum guidelines, make a 1 procedure suite ASC next door to your office with tiny entrance, staff it with your office suite staff. After upfront costs, running it shouldn't be much more than running your office suite. If you plan on having partners in the future, their buy-in at FMV once its It's profitable will be much higher than start-up costs, so you can recoup your investment. It should be said that the ease and complexity is very state dependent.

 

[nvrsumr]

I interviewed for a job in NH years ago and they had their office suite and asc across the hall from each other. For compliance with some state regulation they had a piece of tape running down the middle of the hallway and patients were supposed to stay on one side or the other.

Very state dependent and don’t forget about certificate of need states

 

[Pain Applicant1]

Efficiency and turnover should be as fast or faster in a well-run ASC, as they usually have more staff. That's the trade-off: you can crank out cases in an ASC but the overhead is higher. The volume + SOS differential surpass the extra overhead.

I can see this. When I was interviewing I was invited to a hedge fund run clinic. There were several carms in their asc. All the pts were set up and sedated. The doctor just went from carm to carm knocking out procedures, no more than minutes with each pt.

I'm my situation, it wouldn't be efficient. I don't think my catchment area could produce that volume of pts to make it worthwhile. I'm my set up, I bounce back and forth between pts but those include everyone, procedures, new pts, and f/u.

 

[pmrmd]

I have a “don’t be a dikc” rule when it comes to the ASC. I could do have every block there or every ESI and hit my patients with a facility fee for what I can do for a copay. But I’m not a dikc and wouldn’t dream of doing that. Some wiser patients get that and have left practices like that and established with me. Sedation cases are ASC cases as are cases that require a facility for payment. Use your own judgement on others.

 

[Analgesia108]

Can a midlevel see patients and bill under 'physician supervision' in the office while the pain physician is doing procedures in the ASC in the same physical building ?