Starting a new practice

[rollercoaster]

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I would like to set up my own practice. Prefer autonomy over being employed.

Questions :

1) I am already employed in the same city - would I need to reestablish insurance credentialing to be "in network" ? if yes how to go about it (no compete clause is no issue) ?
2) Currently extremely busy in the employed position and booked about 2 months ahead - would it be ethical to contact my current patients updating about my new practice after I quit ? What is the best way to do it ?
3) Is it better to start off renting two offices 40 minutes apart for more referrals than start with one office ?
4) Staff - should hire from day one with unclear number of patients to start or rather wait till have 4-5 patients /day ?
5)Where to buy malpractice insurance from and which kind ?

 

[Hello.]

1. You might- you should call up the insurance companies to find out.
2. Maybe your current clinic manager will have some ideas about this.
3. ?!
4. Would you want one staff per office?
5. Google it or see what one is currently APA endorsed- it can't be that bad..

Good-luck private practice can be a very satisfying way of practicing psychiatry

 

[Indodo]

I would like to set up my own practice. Prefer autonomy over being employed.

Questions :

1) I am already employed in the same city - would I need to reestablish insurance credentialing to be "in network" ? if yes how to go about it (no compete clause is no issue) ?
2) Currently extremely busy in the employed position and booked about 2 months ahead - would it be ethical to contact my current patients updating about my new practice after I quit ? What is the best way to do it ?
3) Is it better to start off renting two offices 40 minutes apart for more referrals than start with one office ?
4) Staff - should hire from day one with unclear number of patients to start or rather wait till have 4-5 patients /day ?
5)Where to buy malpractice insurance from and which kind ?

1) Credentialing no, contracting yes. These are 2 different things.
2) Probably not. Its a state to state law. Generally though restrictive covenants are not allowed. Also depends on your contract if you are in a "bad" state.
3) I have no idea. Depends on so many factors bruh.
4) If you are already filled 2 months out, get staff. Even if you can't take them all with you, it means there is demand. You may not make the same in the short but the long is in your favor.
5) Region dependent. The apa insurance is usually pretty good.

 

[notdeadyet]

Out of curiosity, have you ever worked full time in a private practice?

I'm hoping yes, but Psychiatry is one of the last hold outs where people think it makes sense to start a business they've never worked in. If someones goal is the autonomy of a private practice, getting experience in watching a successful one from the inside makes sense.


Sent from my iPhone using Tapatalk

 

[rollercoaster]

1) Credentialing no, contracting yes. These are 2 different things.
2) Probably not. Its a state to state law. Generally though restrictive covenants are not allowed. Also depends on your contract if you are in a "bad" state.
3) I have no idea. Depends on so many factors bruh.
4) If you are already filled 2 months out, get staff. Even if you can't take them all with you, it means there is demand. You may not make the same in the short but the long is in your favor.
5) Region dependent. The apa insurance is usually pretty good.

thanks -

1) Credentialing no, contracting yes. These are 2 different things.
2) Probably not. Its a state to state law. Generally though restrictive covenants are not allowed. Also depends on your contract if you are in a "bad" state.
3) I have no idea. Depends on so many factors bruh.
4) If you are already filled 2 months out, get staff. Even if you can't take them all with you, it means there is demand. You may not make the same in the short but the long is in your favor.
5) Region dependent. The apa insurance is usually pretty good.

Thanks for your encouraging reply. What is the difference between credentialing and contracting ?
Agree -would hire staff day one. I am looking for a good attorney to fight no compete clause/ labor laws - suggestions ?. Hopefully can get a major chunk of my patients with me.

 

[Indodo]

Credentialing is the initial process where they verify who you are etc, similar to getting a license in a state. Contracting is figuring out what they are going to pay you and for what codes/diagnoses, how many visits etc. If you are already seeing insurance patients, you are already credentialed but contracted under someone else's tax ID. If you left you would have to contract on your own, probably lower rates.

RE: Non compete, it really depends on your situation.
What does your contract say? Is your RC geographical, temporal or both? Is it reasonable? That may be the most important part, courts will throw out unreasonable RCs as void completely or can be blue penciled (partially void). Also who do you work for? Is it a small group, large group or a system?
Are you urban, suburban or rural and if you left, how many other psychiatrists would be near you in a 5,10,25 mile radius? If you can show you would be serving a shortage, it is greatly in your favor. Geographical RC has to be lower for more common specialty, shortage notwithstanding and psychiatry is the most common non primary specialty. A 5 mile RC has been called excessive in an urban environment for a PCP.
Are you a member of the Medical Association in your state? Sometimes the state APA chapter can be helpful but I have found them to be somewhat useless in the couple of states that I have worked.

 

[rollercoaster]

thanks for your very helpful answers -

Are there any better ways of negotiating the contracts with insurance ? what rates do they base it on, and if there is way to find out how much they are short changing a solo practitioner versus a bigger group - Does medicare rates also change (get lower) with new contracts?

RC: 30 miles, 24 months, should we contestable based on fewer docs left/under served.

 

[Indodo]

30 miles: depends where you are. May be excessive, may not be.
24 months seems excessive for a physician, there is probably precedent in your state though.

As a solo guy, you wont have much (most likely zero) leverage in getting rates, at least initially. Medicare doesn't change rates.