Starting a New Practice - ALgos and Todd!

[Tenesma]

Hi guys

I have a question that is open to everyone... If I were planning on opening a practice (either going solo or with another pain doc), what are the big things i should be looking for

1) population size?
2) number of other pain docs in area?
3) medicare to private insurance ratio
4) should i buy or lease equipment
5) should i buy or rent commercial space
6) since more and more insurance companies are pushing for office based procedures , should i stay away from hospitals and ASCs who will make money off me?

any suggestions, or even better - pitfalls to avoid from those who have gone through it?
thanks

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[Doctodd]

1) population size?
i have no idea...i work in Miami and have plenty of patients as well as competition from other pain docs

2) number of other pain docs in area?
well...if he/she is successful, at least you know there are enough patients

3) medicare to private insurance ratio
again, i have no idea. But i can tell you that workmans comp and auto/personal injury pay more. You just might have to wait longer to get paid. But once it starts flowing after about 4-8 months, it will keep doing so. So if there are attorneys in town, there should be enough of a population to have a pain doc in town.

4) should i buy or lease equipment
if just starting, the words to live by are "lean and mean". Lease usually.

5) should i buy or rent commercial space
see #4 and expect to expand to hopefully buy something where you can also have a pharmacy or other facilities. You can even sell Rx out of your own office. There are some companies who can help. WC pays about $200 for Lodine, yet it costs you about $10. For nonWC patients, you can have a steady cash flow from Rx copays which are usually $20 or so. Example .... generic vicodin costs you about $5. Plus it is better for the patient cuz it saves them a trip and you can closely monitor what and when you gave it to them. Check out dispense express i think. I am starting a deal with them.

6) since more and more insurance companies are pushing for office based procedures , should i stay away from hospitals and ASCs who will make money off me?
Dont rule those guys out....maybe you can buy in and make money off your own ASC facility fees. But surgical centers are like pyramids. If you are low man on the pyramid, you might not get your money back. Hospitals are a good source of patients and getting known with other PCP's. Short answer....if you are just starting, do both. Any way to put food on the table is the way to start.

This is a tough situation to answer. Maybe you can be more specific, such as "I want to start an office in Siberia" vs "I want to start an office in rural Arkansas, but there are 3 larger cities within 20 miles." Also, maybe you can supplement your income with another specialty, such as if you are PMR or anesthesia? Either way, a small hospital without someone like you may offer you a contract to start up.

T

 

[Tenesma]

very refreshing - thanks todd

by the way... are you in private practice? isn't south florida saturated with docs? what have you done to stand out? if this is too personal i would love a PM!!!

 

[Aether2000]

I agree with everything Todd said, except the pharmacy in your own office selling narcotics to patients. For me, that would be inviting criminals and hostile pain patients to break into my business, would involve a significant amount of mandatory paperwork and tracking of narcotics, may draw the scrutiny of the DEA (some docs have been jailed for this), and may identify one's office as a drug clinic.
As for everything else, lean and mean, hybrid, don't buy all new equipment (forget a new neurovasc OEC 9800 for your office...you don't need it). I have placed a new section on buying a fluoroscope on the fluoro tutorial at algosreseach.org if you care to peruse. Also there are links to used fluoro resalers on the manufacturers links.

 

[Doctodd]

Yes, it is saturated down here. But there are still plenty of patients to go around. The drug reps and the dinners they sponsor are a great resource. PCP's are eager to get help.

As for the DEA stuff, in my state Dispense Express supplies you with all the documentation. You can choose what meds you want to carry.

T