Starting Your own Practice Presented by: Dale Rothenberg, CHBC Exec. Vice President, Partner DoctorsManagement, LLC drothenberg@drsmgmt.com

6 Months before opening Obtain State Medical License Select an Attorney Select an Accountant Determine Practice Entity Choose an appropriate Practice Name Develop a Logo Determine Financial Resources Available Develop a Budget and Cash Flow projections Determine Appropriate Physician Compensation

5 months before opening Apply for Federal Employer Identification Number Apply for State Unemployment and Income tax numbers Determine practice Location Prepare Commercial Loan Proposal (if needed) Open practice checking account Decide on Lab Complexity – Waived or Moderate Finalize office layout Determine Site and or Office improvements Needed Negotiate Leasehold Arrangements Reserve Office phone and fax Numbers

5 Months Con’t 20. Obtain NPI numbers 21. Initiate Enrollment with Commercial and Government Payers Obtain Federal and State Narcotics Licenses Review Managed Care Contracts

4 Months before opening Arrange for Proper Insurance Coverage General Business Liability Malpractice Worker’s Compensation Health Disability Life 25. Compile List of In- House Lab Tests Aquire a Telephone System Obtain pager and other Communication services as necessary Determine Office and Medical Equipment Needed (Place order) Decide on Medical Records and Billing system

4 Months con’t 30. Determine Office hours and Scheduling system 31. Select and purchase needed Computers 32. Arrange for Employee Computer system Training

3 months before opening 33. Place Ads, Conduct interviews and Hire Practice Manager 34. Determine Fee schedule 35. Order Stationary, Business Cards 36. Order Clinical and Office Supplies 37. Order CPT and ICD-9 coding books 38. Design Encounter form (Charge slip) 39. Decide on Accounts Payable system 40. Develop Appropriate Marketing Strategy 41. Develop Practice Web Site

2 months before opening 42. Meet with Potential Referral Sources 43. Develop Personnel Policy Manual 44. Obtain Regional Wage Scale 45. Develop Employee Job Descriptions 46. Acquire Required Federal and State Employment Law Posters 47. Develop Patient Information Brochure 48. Develop Office policy Operations Manual 49. Arrange for Payroll Service 50. Develop OSHA, HIPAA & CLIA Compliance plans

1 month before opening 51.Place ads, interview, Hire Front and Back Office Staff 52.Order Lab Supplies 53. Create Personnel Files 54. Order Reception Area Publications 55. Arrange for Janitorial and Laundry and Security services 56. Select Collection Agency 57. Apply for CLIA Certificate 58. Announce Practice Opening and Plan for Open House 59. Assemble Patient Registration Packet.

2 weeks before opening Start Accepting Appointments Staff Training

Hourly Wage Comparison Job Title Hourly Rate Relative Value Administrator $34.93 3.33 Bookkeeper $14.59 1.39 Collections Supervisor $15.24 1.45 Data Entry Clerk $11.03 1.05 Front Desk Clerk $12.37 1.18 Insurance Supervisor $16.63 1.58 LPN $15.44 1.47 Medical Assistant $12.49 1.19 Office Manager $20.50 1.95 Receptionist $10.50 1.00

NSCHBC Data Family Practice (2010) Charges $864259 Adjustments $275,224 Collections $559,584 95% Adjusted Collection Ratio Personnel $178,836 32% 1Mid level, 4staff Supplies $ 44,024 7.9% Facility $ 40,981 7.3% Equipment $ 16,470 2.9% General Admin $ 78,224 14% Total Overhead $358, 534 64.1% Profits $201,050 35.9%

Concierge Medicine Also known as “Boutique” or Personalized” Practices Non reimbursable fee for 24/7 access, same day appointments and a greater degree of personalized attention. Average $1800 Lower hospitalization rates? In 2012 4,400 private physicians . American Academy of Private Physicians 350 to 500 patients vs 2500 patients in traditional practice More focus on education and prevention not reactive and episodic care More money for the doctor means more time for the patient. Less Staff means lower overhead Critics argue it will exacerbate the physician shortage providing care to elitist type patients. Some physicians were “burned out” and chose the concierge route.

Thank you!