PA owned practices?

I would like to discuss the pros and cons and associated roadblocks that any other PA's may have experienced in setting up a PA owned and run practice in any medical field, especially dermatology!!!! Anybody?

Thanks

dermpa

dermpa, I'm currently working with a surgeon who is on active duty in the military. When he finishes his obligation next year, we will be starting a joint practice with co-ownership. He was recruited by a hospital in another states. The "recruitment" for the physician has many benefits which include "guaranteed" income for his support staff and rental of the health care facility. Although my surgeon made it clear that he would not accept the position unless I went with him and was welcome with him, the hospital CEO and leadership put full obligation to the surgeon only. The hospital has agreed to cover my moving expenses, but beyond that the contract is solely with the physician....At the end of the first year, he will be out of contract and at that time, the only "obligation" we will have with the hospital will be to pay off any outstanding money "loaned" during the first year. To get full benefits of starting up a practice, it seems the hospital staff only wants to deal with the physician. Fortunately for me, my surgeon and I are great friends and have an excellent working relationship. I don't know of any support network for P.A.s starting up their own practice, although I've heard that it has been done successfully in Texas. I'll try to contact some of the P.A.s I know there and see if they can provide any resources for you.

I didn't know PAs could own their own practice. How do you go about doing that?

I'm guessing you must have a phsyician sign the papers w/you in ownership?

yup- you pay them to do whatever the minimum chart review is and be available by pager if required in your state. lots of folks doing this now. many of the supervisors are retired md's happy to make an extra 1000 dollars a month to just sign a few charts.....

I forgot where you are . . . Portland? Anyway, what do you know about PA clinic ownership in the state of Washington? I've been looking into the idea of starting my own urgent care clinic in town (I get busy and put the project on the back burner from time to time) and haven't had any clear answers.

A doc that I know told me that it is illegal in the state of Wa for a PA to have ownership in a clinic where he/she works.

I've contacted WAPA and haven't heard back.

I made contact with a department in the state gov that overlooks the licensing of new clinics. They didn't (or couldn't) answer the question clearly. They told me to talk to the local hospital CEO. We were just about ready to meet (he was very eager to meet with me) and then a local MD friend told me to "beware of him." This CEO has ambitions to start his own urgent care clinic and would not tell me the truth.

Anyway, what do you know?

Mike

Jmj11...

You fall under: Chapter 18.71A RCW PHYSICIAN ASSISTANTS

See here: (http://search.leg.wa.gov/pub/textsearch/ViewRoot.asp?Action=Html&Item=0&X=924155052&p=1)...:cool:

type "PLLC" in the second search box and put a mark in the RCW checkboxes... hit search... then scroll to the bottom of the page...

This should answer your question in (6)(a)

DocNusum

I'm game... (especially since I pass anacortes 3-4 times a week)

My "contracted" SP would very likely be interested...he lives in LaConner (20 min away from anacortes)... and is a EM MD...

The PLLC is already set up (PrimeCare PLLC)... you guys become "members" and we divide the stock... based on investment... and each pay the MD 15 % of reimbursement...:cool: :cool: :cool: :cool:

DocNusum

I'm game... (especially since I pass anacortes 3-4 times a week)

 

My "contracted" SP would very likely be interested...he lives in LaConner (20 min away from anacortes)... and is a EM MD...

 

The PLLC is already set up (PrimeCare PLLC)... you guys become "members" and we divide the stock... based on investment... and each pay the MD 15 % of reimbursement...:cool: :cool: :cool: :cool:

 

DocNusum

Okay guys you're getting ahead of me:) . I'm just starting to work on the business plan and need to do a lot more research. I did visit a great office in a great location, which is for lease today.

Do you (are anyone) know of any good software that will work on a PDA and PC platform that can generate clinic notes, billing sheets etc. I saw a demo once where you just click answers (starts with Male or Female, age, complaint etc.) and ends up with a good scripted note and codes for billing after you click the Dx at the end. It even faxes your Rx to the pharm.

Mike

This is great finally PA's talking about ownership! Would love to hear from anyone in California who has put together a clinic or corporation that has ownership. I am trying to do the same in California and just began looking into the legalities of the whole thing.

I have a Doctor lined up, but I am not sure how to begin the business without being in breach of california PA laws, which say you can only own 49%. I really don't have another PA who is interested to doing this so the ownership has become difficult. I am trying to think outside the box!

Any sugesstions?

Okay guys you're getting ahead of me:) . I'm just starting to work on the business plan and need to do a lot more research. I did visit a great office in a great location, which is for lease today.

 

Do you (are anyone) know of any good software that will work on a PDA and PC platform that can generate clinic notes, billing sheets etc. I saw a demo once where you just click answers (starts with Male or Female, age, complaint etc.) and ends up with a good scripted note and codes for billing after you click the Dx at the end. It even faxes your Rx to the pharm.

Mike

see here: http://www.medtuity.com/default_main.asp?ID=home

also here: http://www.medscribbler.com/index.php

also here: http://www.sanvas.com/Pricing/default.htm

and here: http://www.emrupdate.com/forum/default.asp

I use this daily for charting to my EMR... and it fits in a Labcoat pocket...:cool: :cool: :cool: : http://www.motioncomputing.com/products/tablet_pc_ls.asp

DocNusum

see here: http://www.medtuity.com/default_main.asp?ID=home

 

also here: http://www.medscribbler.com/index.php

 

also here: http://www.sanvas.com/Pricing/default.htm

 

and here: http://www.emrupdate.com/forum/default.asp

 

I use this daily for charting to my EMR... and it fits in a Labcoat pocket...:cool: :cool: :cool: : http://www.motioncomputing.com/products/tablet_pc_ls.asp

 

 

DocNusum

Thanks. I'm working my way through each of the above and am impressed. Is there one out there that most people like? I open this for anyone reading the forum to comment. I may even make it a new thread (EMR, which is the best?) I, of course am looking for one that works best in the ER, urgent care settings.

Mike

This is great finally PA's talking about ownership! Would love to hear from anyone in California who has put together a clinic or corporation that has ownership. I am trying to do the same in California and just began looking into the legalities of the whole thing.

 

I have a Doctor lined up, but I am not sure how to begin the business without being in breach of california PA laws, which say you can only own 49%. I really don't have another PA who is interested to doing this so the ownership has become difficult. I am trying to think outside the box!

 

Any sugesstions?

It has taken me twenty years to get to this point. I've been thinking about ownership for a couple of years. The reason? I have watched five clinics (usually from the inside ) crash and burn over the years . . . all due to mis-management. Almost each case was directly due to not only thinking "inside the box" but usually caused from the business being "physician-needs centered" rather than either patient-centered or at least business-centered approach.

For example (what I've seen over and over) the front office workers (the practice's front line) are verbally abused by the MD, over worked, not given the tools . . . no computers, chairs that are falling apart etc, then they are expected to work (often off the clock) doing all kinds of extra things for the docs while being paid the least amount as possible. While at the same time, the MD is pushing his salary through the roof.

The other issue I've face is the MD-owners who have personality disorders (child in the sandbox mentality). I watched an office manager speak her mind to a MD-owner (about something trivial . . . such as garbage pick up or something). The MD-owner verbally abused her to the point that she had no choice but to quit (and she was very good at what she did). A year later, after choosing not to replace her to save money, the practice finds itself on the brink of failure because they are collecting 45 cents on the dollar (no one is following up on declined billings); the clinic lost its credentials with insurers because no one kept the paper work up to date.

I watched another practice fail when the MD-owner replaced the very competent office manager with his bimbo--patient--turned mistress. The practice went bankrupt because she was throwing away insurance billing forms because she didn't know how to submit them (she had his baby and he left his wife at the end as well).

I have no doubt that I could run a successful clinic . . . with happy, hard-working, competent employees and happy patients.

I do have some concerns. One is the political environment. For example, I've already heard that the local hospital CEO wants to "squash my urgent care clinic" even when I'm just thinking about it. Some MDs in the area may also oppose me (how dare a non-MD steal patients from me). I have to work very hard to defuse those situations and make it clear that I am not attempting to "steal-patients" but to provide a service that is not being provided.

The other issue is raising the funds to get started and thirdly, figuring out all the ins and outs of the legal hassles, getting a state license, purchasing mal-practice insurance etc.

So anyone who has conquered these hurdles, please comment.

Mike

For the "education" of all...

What population size is NEEDED... for a "financially healthy" Urgent care clinic...

As in... how many people need to be in the "gen-pop" to have enough business...

Years ago... I read somewhere that a Neurologist needed to practice in a "gen-pop" of 1,000,000 to make a "living" (above $100,000)...

Just curious...

DocNusum

i live in a city(loose def) of between 40-60K, we have 12K established pts.

we do not except tricare prime so that limits us because we live in a town that is a suburb of ft bragg.

we bill on avg 100-120K/month with about 83-85% recoupment. we do well.

"What population size is NEEDED... for a "financially healthy" Urgent care clinic..."

DEPENDS HOW MANY OTHER PRACTICES ARE IN TOWN, WHETHER OR NOT THE LOCAL FP GUYS WILL SEE WALK IN PTS, ETC....LOTS OF FACTORS TO CONSIDER....

I'M GUESSING IF THE LOCAL ER TYPICALLY RUNS A WAIT AND ALREADY HAS DOUBLE COVERAGE THAN A UC WOULD DO WELL IF NO OTHER LOCAL UC AROUND AND FEW FP'S WILLING TO SEE walk in PTS.....YOU WOULD BASICALLY BE HOPING TO TAKE PTS AWAY FROM THE ER BY ADVERTISING LOWER cost, shorter WAIT TIMES, MORE PERSONAL ATTN, GUARANTEED F/U APPTS, ETC.....

woops ...sorry about the caps......

exactly...

when the avg wait time t the ed is 6-8 hours its easy to getem in your door.

I found the past posts rather interesting. I opened a FP/UC group in Camas Washington 3 years ago. I ran into quite a few challenges with a PA owned clinic.

First, you’re right about different states having different rules. Washington really had no ruling on the subject. They deferred to the Medicare rules which have the 99% rule (your spouse, can own the 1%).

Second, your right, a Doc has to be on hand for 10% of the time (in Washington State in a medically served area, medically underserved areas have different criteria). Frankly, I didn't want to practice w/o a doc anyway, just for perception purposes (I have 12 years of practice). So I hired a doc as an employee, who happens to be my medical supervisor. Relationship between the Doc and PA is paramount here. I went through two other docs before finding one that was a good preceptor, respected the PA profession and was good person.

Financing the start up was another challenge. A lot of banks, thought they have great medical finance programs, don't like to finance PA owned groups. I had to present my BP to 3 different banks before I got past that.

Malpractice is another hurdle. Our state malpractice carrier (WSPI) wouldn't cover any practice that was majority owned by a PA. So I again had to search around on that. Finally settle with GE Medical Protective.

Anyway, lots of challenges, but in the end worth it. The once caveat that I tell all the PA students that I precept: Spend the first 5 years learning the practice of medicine before you even consider taking on the business of medicine.

So now I have a question for the forum. I have considered taking my experience on the road to various conferences. Just curious as to the level of interest in PA ownership, and would you attend a break out session if offered at a conference?

Scott Jonason, PA-C

Lacamas Medical Group, PC

www.lacamasmedicalgroup.com

Congratulations Scott- Very nice site- May you enjoy continued success.

I would.:)

I would definitly enjoy a seminar on this issue. Many PA's are already partly there, working as an LLC or contract employee. I too have seen UC's that are owned by MD/PA's. I also did a Peds rotation while in school that was owned by an NP and the MD's were employee's. The idea of owning a practice is appealing. Additionally, because most PA's have worked as employees and know from experience how they would like to be treated, they should be able to set up clinic's that are postive places to work!