Starting a mobile podiatry service in CA ?

[podiatryresident]

Hi everyone,

I'm a resident about to start working full-time in California. I'm interested in starting a mobile podiatry practice as a side gig, ideally after hours and on weekends.

I'm wondering if anyone here has experience doing this, and I’d love to hear your thoughts on the following:

1. Legal Structure – I understand that California doesn’t allow PLLCs. Do I need to form a Professional Corporation (PC) even for part-time/mobile work?
2. HIPAA Compliance – Any recommendations for mobile-friendly HIPAA-compliant EHRs and how you handle patient records while on the road?
3. Malpractice Insurance – I assume I need a separate policy?
4. Marketing – What's the best way to get started with referrals (e.g., from SNFs, PCPs, or home health agencies)?
5. Do I need to join an IPA to get credential with other commercial PPOs ?
6. Compliance with My Primary Employer – How do you navigate side work when you're employed by a larger HMO?

Any insights or pitfalls to avoid would be greatly appreciated. I'm not looking to compete with anyone or build a huge business — just hoping to provide care to those who can’t make it into the clinic and maybe earn a little extra.

Thanks in advance!

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[DYK343]

@Creflo

 

[Homo sapien]

Hi everyone,

I'm a resident about to start working full-time in California. I'm interested in starting a mobile podiatry practice as a side gig, ideally after hours and on weekends.

I'm wondering if anyone here has experience doing this, and I’d love to hear your thoughts on the following:

1. Legal Structure – I understand that California doesn’t allow PLLCs. Do I need to form a Professional Corporation (PC) even for part-time/mobile work?
2. HIPAA Compliance – Any recommendations for mobile-friendly HIPAA-compliant EHRs and how you handle patient records while on the road?
3. Malpractice Insurance – I assume I need a separate policy?
4. Marketing – What's the best way to get started with referrals (e.g., from SNFs, PCPs, or home health agencies)?
5. Do I need to join an IPA to get credential with other commercial PPOs ?
6. Compliance with My Primary Employer – How do you navigate side work when you're employed by a larger HMO?

Any insights or pitfalls to avoid would be greatly appreciated. I'm not looking to compete with anyone or build a huge business — just hoping to provide care to those who can’t make it into the clinic and maybe earn a little extra.

Thanks in advance!

Don't you want any time off or anything. Other than go go go

 

[heybrother]

California doesn't allow non-competes. I wonder if you'd be better off learning the ropes with a mobile company and then starting your own thing in time.

Here's my weird problem for you. There are start-up costs associated with this. Equipment. Credentialing. Malpractice. Schmoozing. A component of your business model and reason for implementing this is altruism. If you choose to accept insurance - Medicare, Medicaid, etc what you are going to find is there isn't a lot of meat left on the bone reimbursement wise. Medicare does not incentivize physicians to go to patient's homes. They think - "service rendered in the home doesn't have office overhead". In the face of your good intentions is going to fly the cold hard reality that most people who do this are likely trying to efficiently pound out volume for pennies. Even more impractical. This is not your main job. You already have something eating up your time and energy.

Consider that physicians who start side hustles routinely target cash pay ie. ketamine, cosmetics, obesity, etc. They are not trying to increase their interaction with the medicolegalinsurance complex. They are attempting to have limited high dollar encounters. You on the other hand are proposing to devote your free time, nights, and weekends to a bureacratic area of podiatry associated with higher risk of audit in dreary facilities and unclean patients homes (where people can spill urine on you) that is associated with some of the lowest reimbursement per patient encounter that exists.

1. Your lawyer will have been asked this before.
2. Yes, you'll need malpractice.
3. Yes, you'll need your main employers blessings.

 

[DYK343]

I could never knowlingly go into a bed bug infested home.
I currently have at least 5 patients that I actively see bed bugs crawling on them in the office chair.
I could never be a home health provider.

 

[ExperiencedDPM]

Even though Cali does not have a non compete, you have to check the terms of your contract regarding outside work within the specialty. Your lawyer needs to review the contract and any applicable laws.

 

[air bud]

How about everybody's just stops indulging this and says this is a terrible idea.

 

[Creflo]

Hi everyone,

I'm a resident about to start working full-time in California. I'm interested in starting a mobile podiatry practice as a side gig, ideally after hours and on weekends.

I'm wondering if anyone here has experience doing this, and I’d love to hear your thoughts on the following:

1. Legal Structure – I understand that California doesn’t allow PLLCs. Do I need to form a Professional Corporation (PC) even for part-time/mobile work?
2. HIPAA Compliance – Any recommendations for mobile-friendly HIPAA-compliant EHRs and how you handle patient records while on the road?
3. Malpractice Insurance – I assume I need a separate policy?
4. Marketing – What's the best way to get started with referrals (e.g., from SNFs, PCPs, or home health agencies)?
5. Do I need to join an IPA to get credential with other commercial PPOs ?
6. Compliance with My Primary Employer – How do you navigate side work when you're employed by a larger HMO?

Any insights or pitfalls to avoid would be greatly appreciated. I'm not looking to compete with anyone or build a huge business — just hoping to provide care to those who can’t make it into the clinic and maybe earn a little extra.

Thanks in advance!

1. Your liability will be primarily professional which your personal malpractice will cover, and automobile liability while driving, which your auto policy will cover. I don't see a big incentive to form a corporate veil for liability purposes.
2. Low cost is the way to go, don't spend on an expensive EHR for this side gig. Maybe even just do handwritten notes, as long as you are under the mips/macra threshold.
3. Your malpractice policy should cover you for all of your podiatry work no matter if it's done under your name or your employer's name, but verify.
4. Look for local house call primary care providers, they may be MD, DO, or NPs. Take some brochures/cards to them. Ditto with hospice and home health nurses.
5. You may want to stick with original medicare at first to get your feet wet, don't overcomplicate things starting out.
6. I don't know, but I would let them know what your'e doing. Be sure they don't prohibit it, they may eventually find out if you don't tell them.

Tips: There is a big need for this service. Occasionally, house call patients may have unrealistic expectations (asking for a firm arrival time, asking for pre arrival phone calls to update arrival time, being in the shower when you arrive and expecting you to wait, etc). Remember you are providing a very valuable service and they need to work with you regarding scheduling demands and accomodating you in their home. Also, if you bill ethically, financially it's a very tough go these days due to low reimbursements. I would say it's basically not financially feasible today if you do it through insurance. If you do it, learn how to bill nail and callus care. It's not simple, and it's misundestood and abused. Some house call pods just bill e&m's when doing nail care and get away with it, but it's not ethical. Dr. Michael Warshaw is the guy you want to listen to to learn this stuff, he has books, does seminars, and will help you directly. His fees are reasonable and he's a good guy.

 

[Hybrocure]

I could never knowlingly go into a bed bug infested home.
I currently have at least 5 patients that I actively see bed bugs crawling on them in the office chair.
I could never be a home health provider.

Free protein

 

[Homo sapien]

How about everybody's just stops indulging this and says this is a terrible idea.

Yes it is

 

[heybrother]

I'm sure the OP has their own reasons / something they've looked into that they are hoping will pan out. Awhile back I was at a conference and met a young woman who believed she was being paid the same rates for nails/calluses done in a nursing home as done in an office. She was a partner in a group and literally received no feedback on her collections or rates. I don't do any nursing home work, but nursing homes are POS 31-32 - something like that - and I'm pretty confident that's a facility for Medicare's purposes.

 

[Feli]

...if you bill ethically, financially it's a very tough go these days due to low reimbursements. I would say it's basically not financially feasible today if you do it through insurance. ....

Not totally unlike office podiatry... or medicine in general. 🙂

If I had to practice quite awhile longer, I'd probably have to transition to mostly/exclusively a cash pay fee schedule.
The tricky point for me would be surgery, but with house calls, that's a non-issue.

If you play the insurance game, the only other ways to make a reasonable income/ROI are usually by farming associates, super high pt volume, quasi-fraud like wound "grafts" or other weird services, refer-for-profits, or straight up fraud... or some/all of those.

When labor or utility or materials costs go up on most industries or professionals, they simply raise their prices of their goods or service.
Our increasing podiatry overhead, increased student debt, insurance, inflation, etc costs are frustrating...
...but our inability to set our own prices is a backbreaker. It's a huge challenge.

 

[Adam Smasher]

I don't think it's a terrible idea per se. If you keep your overhead down and use this as a stepping stone towards establishing your own practice, and if you jettison any of your surgical aspirations since you'll be focused on conservative care for years, it can be a good short term move.

The problem is what Feli alluded to before about price setting. I've told this story before, but I was once asked by a non-podiatrist acquaintance who is connected with a lot of wealthy eccentrics if I did housecalls. I politely told her I'm office-focused and I would need to do it as a cash service. Didn't specify how much. But that was the last I heard about it. Yes it's a valuable service, but the minute patients expect you to put a dollar amount on that value, they lose all interest.