Author: Mark Terry : Officite Medical Market Blog
If opening your own practice seems sometimes like taking a leap off a cliff, consider that you will not only have to take care of a long to-do list, but you will have to do many things in a certain order because they are the foundation for other activities. This can make opening your own podiatric practice seem like leaping off a cliff and being expected to turn over rocks, touch specific trees, and perform a graceful back-flip with a half-twist somewhere between the shrub on the third ledge from the top and the second condor nest from the bottom.
“This is a complicated business,” says Paul Angotti of Management Design, LLC (Monument, CO). “What I do for my clients is I have a five-page checklist that I go through, and it has four columns. It has all the things you need to do in the first column, and it has a start and due date in the next two columns, then who’s going to do it. It very much is dependent on a sequence of events, some of which are not dependent on other things, and some are dependent on other things.”
We’ll only provide a general outline and touch on some of the most important issues in this article.
12 Months Out
Approximately a year before opening day, the primary consideration is the real estate mantra: location, location, location. If you’re planning on staying where you are currently, it’s possible you can postpone most of this planning for a few months. “Twelve months,” says Angotti, “if you’re changing cities is about right. If you’re not, then I would say three and a half to four months is more the norm.”
If you’re changing cities or states, it’s time to get moving. First, how are you deciding where to move? Dr. John Guiliana, DPM, of SOS Healthcare Management Solutions, (Hackettstown, NJ), says, “Your choice of location is certainly the most important, and that needs to be based first and foremost on where you want to live.” This can be a complicated decision. Choosing Arizona because it has an older population, but despising the desert, or choosing Colorado because it has a good medical malpractice environment, but hating cold weather, is only likely to lead to an unhappy podiatrist.
Aside from that, there are statistical considerations. “With practice location,” says Guiliana, “I always tell clients to evaluate the demographics of the area, and there’s a whole subset of things in that category that they need to look at; for example, they need to look at the podiatrists in the area, what those podiatrists do, even the age of those podiatrists to see if there’s a possible attrition that’s going to occur very shortly. Generally we like to see one podiatrist to every 25,000 population, but that doesn’t necessarily hold true.”
This start-out period is time to hire your practice management consultant, accountant, attorney and more importantly, develop your business plan and start-up budget. Angotti says, “I typically start to talk to the doctors about the style of their practice. Are they going to be focusing on surgery or are they going to be focusing on office procedures? Do they expect to do a lot of elective stuff where they get paid cash, or where they’re going to be focusing on medical, or are they going to be taking Medicare and Medicaid? Sometimes this begins to influence the location in terms of a specific area of town because of competition. That generally leads to: How many rooms per doctor do you want? How extensive do you want the x-ray to be? Do you want to start with electronic medical records?”
By asking a series of basic, elemental questions about how you like to work and what you expect your practice to encompass, you can then develop an intelligent business plan. “You start off with a bigger picture of how you want it,” says Angotti. “How you want the office to operate then leads you to the number of rooms, whether you want the procedure rooms or a full-blown surgery, X-ray, and how you want to handle all those little details. That’s how you get to the financial projections.”
It’s also the time to deal with your medical license. The medical license is the rocky outcrop that can snag a lot of forward momentum before opening your practice.
Angotti says, “One of the first things you need to do is get your state license and that you can do in advance. Depending on the state it’s roughly $350, so why not do that right off because that’s going to be the first thing to start many things. At least if there are any barriers, then the whole issue of going out of state goes away. Assuming you can get your state license, get that right away, because that’s going to be the second, third, fourth line for every application you fill out for anything.”
9-10 Months Out
Somewhere in this period a lot of nitty-gritty things need to be dealt with. It’s a good time to find an office space and negotiate your lease. If you plan to build-out an office, you will need to hire the contractor, work with the architect and make sure things get started so you have a place to work from.
It also is the point at which you start applying for licensing, tax and insurance access. “You need a DEA (Drug Enforcement Agency) number,” says Guiliana, “your license number, Medicaid provider number–all the insurance. At this point we should start contacting insurance companies for applications to become a panel provider. Tax ID numbers, the EIN.”
Also, it’s time to gather information about the area you’re going to be practicing in and making contacts with local hospitals. Dr. Gary Mellon, DPM, of Podiatry Practice Management Institute of America, LLC (Dallas, TX) says, “If you go into a real small area, a lot of times you can get money from the local hospital where they will sort of guarantee you a salary. A lot of times we’ll recommend that. If you’re going to an area like that, we suggest you go to the local hospital and see what kind of arrangements you can make with them–specialties like wound care or things like that; and they may help you with opening the office.”
Although you may not actually need an office for another eight or nine months, the reality is … you may need an office—or at least an office address. “There are times,” says Angotti, “when we have used the physician’s home address to apply for some things. There are some instances where that you can’t do that. You’ve got to have a real office. For many insurance companies now, they won’t fully process a doctor’s application until they do a site visit, and that has in recent years complicated things. If you’re building-out space and you don’t have a certificate of occupancy, you can’t go in and actually set things up in any way in advance.”
7-8 Months Out
You’re picking up speed now. This is a good time to establish benefits and retirement plans for yourself, decide if you’re adequately covered by malpractice insurance, and work on putting together your disability and worker’s compensation coverage. The types of benefits and insurance coverage will depend a great deal on the type of business structure you have created for yourself.
“A solo practitioner is one issue,” says Mellon. “If you’re an LLC or a corporation, that’s a whole different set of issues. I think you need to make a determination of what the advantages are of the various and different structures. For the most part, you have different types of protections, usually S Corps and LLC’s are the way to go these days. Insurance: if you’re going to take out a loan, the bank typically will require you to have life insurance to cover the amount you’re borrowing, and disability insurance so if you become disabled it’s going to be able to pay back your loan. You really need to have an idea of where you’re going to get your financing and how much in order to make a determination of the types and amounts of insurance you’re going to need.”
5-6 Months Out
Halfway there, and it’s a good idea to take a deep breath and make sure you’ve done everything that needs to be done. Most important, if you haven’t gotten your medical license for where you need to be, it’s time to make sure you do. “You also need,” says Mellon, “to have an idea what your situation really is with the hospitals, and have an idea really how things stand with getting on the various insurance plans.”
But the license should be locked in by now. “Typically the exams are given twice a year,” says Mellon. “To get on the hospital staffs and insurance plans, you really need your license. If you don’t have that, you can put all your applications in, but they’re just going to sit there until you get your license.”
On the fun side, you get to go shopping. Hopefully your office is taking shape, and you’re in the process of remodeling or building-out your space. Now is the time to determine what furniture, equipment and supplies you need.
Possibly not as much fun is the need to decide on what type of computer system you need. Going paperless? Do you plan to have digital X-ray that interfaces with the electronic medical records system? Now’s the time to decide. Hopefully you made decisions about the type of practice you want when you initially consulted with your practice management consultant, but now is the time to make the final decisions as you invest in the specific systems.
3-4 Months Out
With less than a quarter of a year away, it’s time to begin hiring personnel and starting your marketing plan. Guiliana says, “Get out and meet primary care physicians face-to-face, do lectures for their staff or for the hospital that you’re becoming staff of. Contact drug reps–they can be a huge commodity in terms of helping with the marketing plan. They can set up and be happy to fund the grand opening with lunch for physicians and their staff, and perhaps another grand opening for the community.”
Mellon agrees, saying, “The group that is usually neglected is the drug reps and drug companies, who may send out fliers for you, and sometimes sponsor an open house for you. At this point, you want to start talking to them and you want to get the printings and things like that out.”
With all the new technology, you need to train people to use the EMR and any other protocols you may need. Says Angotti, “We want to give people enough time to give notice if they’re going to change jobs. And there are so many systems that have to be installed, set up and then the staff has to be trained on, that more and more you have to bring the staff on before the office is going to open. You have computerized billing, you have electronic medical records, you have a new phone system, you have medical equipment that they need training on.”
It’s also important to develop your office polices and procedure manuals now, not after people start working for you. “To me,” says Mellon, “it’s really critical that before you start your hiring you really have your policies and procedures manuals in place.”
Although interviewing and hiring has numerous regulations put in place by the Federal Trade Commission (FTC), Guiliana has a good piece of advice. “In a very broad stroke I would say that you should hire for attitude. You can train anybody specifically for a job whether it be collections, whether it be coding. It’s really critical to hire for attitude and train for success.”
1-2 Months Out
To extend the “falling off a cliff” metaphor, this is the time in which you hit “terminal velocity,” which is to say, you’re going to be busy, busy, busy and moving fast. Says Mellon, “I think the most important thing is to have a timeline and a checklist and really have assignments and due dates, that everybody knows who’s responsible for what. There has to be constant communication to make sure everything is getting done in the prescribed timeline, because a lot of times people don’t have the plan in place for what basically needs to be done.”
In this period, you need to make sure you’re on track and that everything is running smoothly. There are a numerous systems that should be in place — phone system, laundry, janitorial, security, collections, bookkeeping and payroll. You should know who will be working for you and are probably training them for their jobs. Your marketing plan, already in place, is gearing up. Websites have replaced the Yellow Pages in terms of large ads, and are considerably less expensive. Glen Lombardi of Officite (Oak Brook, IL), says, “We can usually set up a site in five to ten days, and they cost anywhere from $1,500 to $3,000. There’s usually a nominal monthly fee, usually $50 a month for upkeep. We find that a lot of our doctors are just going down to a basic listing in the Yellow Pages and going with the Website, and our doctors say they are getting from five to ten new patients a month from the site.”
About to Open
Hopefully everything is in place. Your staff has been trained and has practiced dry-runs so that when patients hit your office, the staff isn’t not learning at the patients’ expense. Guiliana says, “Big-time marketing. You’re throwing everything into marketing. The telephones are being answered. Appointments should be scheduled. This is when the marketing blitz really begins to take shape, getting the town involved, having a ribbon cutting ceremony, whatever is appropriate.”
Mellon agrees, saying, “You want to get out in the community. In the beginning you’re idealistically not going to have a full day’s schedule. You want to have yourself or somebody out in the community every day making contacts, whether taking physicians to lunch every day, having your staff visit offices or giving talks. There should be some marketing done every day for the first three months your practice is open.”
And finally, now that your practice is open, remember to take a deep breath, smile, and say, “Good morning. Welcome. How are you today? What seems to be the problem?”
#Podiatry #Practice Management #DPM