More Unexpected Perils of PA Practice Startups

[jmj11]

So after doing years of research and then launching out about 10 months ago, I've faced the following unexpected road blocks;

 

State would not credential my practice . . . took three months to get approval rather than one week.

 

Bank wouldn't loan me money because I'm a PA, took 6 months of fighting, rather than 4 weeks as promised.

 

Mal practice insurer, even after smiling and saying that they would be happy to write a policy for a PA-owned practice and could do it in about three weeks. Instead, it took about three months of hostile fighting to get a policy. Then it was written in a crappy way. Now I have a new and better policy but I had to pay for two.

 

Now, as of last night, the number one insurer in the region, and which has made up about 40% of my previous practice, has decided to boycott my new practice and, I'm trying getting them to admit, because it is PA-owned. I'm getting ready to sue them if I can get enough evidence for restrain of trade.

 

So, are you sure you want to own your own practice? My doors open in two weeks but it has been the road to hell and back to get to this point.

[xxbowiexx]

Kudos to you for sticking it through though. Your experience will be invaluable for future PA-owned Clinic to start up and transition more smoothly, so keep on trailblazing.

[Hemegroup]

I noticed last night while looking for the legal requirement of SP chart reviews that PAs aren't allowed to own their own clinic in CA ... unless the document I read was outdated?

[EMEDPA]

there are ways of working around that in ca

I have friends there who are clinic owners. last time I checked an individual pa can't be >50% owner and an md must be a partner....so 3 pa's can each be 33% owners and an md can be 1% owner with a requirement they sell back their 1% if they leave or pa is 48% owner, his wife is 48% owner and 2% for the doc, etc.

[andersenpa]

AAPA:

http://www.aapa.org/images/stories/Advocacy-state-summaries/Physician_Assistant_Ownership_of_Medical_Practices.pdf

 

California

A medical practice in California may be owned by a professional corporation, a professional partnership or certain other types of entities, but not by a limited liability company.

PAs are expressly permitted to own, or to co-own with certain other types of licensed health care practitioners, a physician assistant professional corporation in California. PAs must own at least 51% of the shares of the physician assistant corporation and the other 49% must be owned by other specified types of licensed healthcare professionals. Further, the number of non-PA shareholders may not exceed the number of PA shareholders.15

California law also expressly permits PAs (and other specified types of licensed healthcare professionals) to own up to 49% of the shares of a medical professional corporation, provided that 51% of the shares are owned by one or more licensed physicians. Further, the number of non-physician shareholders must not exceed the number of physician shareholders.

PAs may not be partners with physicians in a partnership that owns a medical practice.

[EMEDPA]

wow, bummer. I guess that's been changed in the last few yrs...

[andersenpa]

So the difference between a "physician assistant professional corporation" and "medical professional corporation"....

 

The former being something like the first assist/surg PA groups that incorporate?

Vs. an actual medical practice (the latter)....???

[marilynpac]

there are ways of working around that in ca

I have friends there who are clinic owners. last time I checked an individual pa can't be >50% owner and an md must be a partner....so 3 pa's can each be 33% owners and an md can be 1% owner with a requirement they sell back their 1% if they leave or pa is 48% owner, his wife is 48% owner and 2% for the doc, etc.

What about NP?

[Z'sMom]

So the difference between a "physician assistant professional corporation" and "medical professional corporation"....
The former being something like the first assist/surg PA groups that incorporate?
Vs. an actual medical practice (the latter)....???

 

Any update on this? Can a "physician assistant professional corporation" be a consultative practice?  EMEDPA - still have contacts in CA that do this? Able to provide any details?  thank you

[ventana]

in mass my I own a Professional Corp - 1% owner is the doc - it is a medical corp....   not a PA corp or doctor corp - just a medical corp

[jmj11]

In our state all professional associations (companies that have one professional role, such as providing medical services, or providing legal services) are in PLLCs (Professional Limited Liability Corporations).  It doesn't matter who owns what.  Medicare limits ownership of PAs to below 100% (eg. 99%).  

 

But each state has their own laws. For example, I participated in a meeting about "enhancing" PA practice in our state.  An attorney at the meeting is now "very concerned" that people like me, PAs, can own a practice. He is now creating wording to change the laws so that PAs can't own even 1% of any business. I doubt if it will pass but it is a little irritating anyway.

[newton9686]

jmj11, I just wanted to take a moment to publically aknowledge your hard work. Your dedication to running a successful business is paving the way for a better future for PAs and healthcare in general. Would you mind commenting on the current state of your business? I am very interested in learning about your current challenges and sucesses.

[jmj11]

I just saw this note. I keep a blog of current updates but will give a snapshot here.

 

In summary, we have been quite busy from the time we opened our doors but with a slower period once a year. This year there were no slow periods and recently the demand has gone through the roof. I  hate making patients wait but our next appointments are 3 months at our satellite location and over a month at our primary location.

 

Now with that said, we have been a poor practice from the beginning. This has been due to a combination of factors and I will list some here: 1) started with incompetent billers despite putting a lot of energy into this matter, 2) seeing too many poor payers (medicaid related, Tricare etc.), 3) Not being recognized by insurance companies as a specialists, while our patients are very complex (far beyond what the local neurologist would have to offer) and our patients have become more and more complex as time has gone own.

 

With this sky-rocketing demand, I'm trying to find a way to convert this into income so that we can stop living at the bottom of the food chain. Converting demand into money is not as easy as it sounds.  I've increased the number of complex patients I see per day from 12 to 15.  It is wearing me out and so far the income has only slightly gone up.  We are getting ready to launch major policy change including: 1) No more low-paying insurances, 2) No more free care via phone calls. Basic calls will still be customary (schedule changes, asking for refills) but management calls (I'm not doing well and need a change) will be billed, 3) We will require patients to pay co-pays, deductibles at the time of service.  I'm also trying to hire some help. First a MA to help me work faster.  That has been harder then I thought. I could also fill the schedule of another PA or NP if I could find the right one. 

 

We are also poised to have a major shift as my SP (god willing) will find out if he passed the headache medical boards next week. That will be huge for us as we can go back to the insurance companies and demand a better contract. This would also double our demand (too complicated to explain here).  I also will have the opportunity to take the headache boards in March, which is a major breakthrough for PAs and NPs. We have fought for this right for over 10 years.

 

So that about sums it up.

[EMEDPA]

I just saw this note. I keep a blog of current updates but will give a snapshot here.

 

In summary, we have been quite busy from the time we opened our doors but with a slower period once a year. This year there were no slow periods and recently the demand has gone through the roof. I  hate making patients wait but our next appointments are 3 months at our satellite location and over a month at our primary location.

 

Now with that said, we have been a poor practice from the beginning. This has been due to a combination of factors and I will list some here: 1) started with incompetent billers despite putting a lot of energy into this matter, 2) seeing too many poor payers (medicaid related, Tricare etc.), 3) Not being recognized by insurance companies as a specialists, while our patients are very complex (far beyond what the local neurologist would have to offer) and our patients have become more and more complex as time has gone own.

 

With this sky-rocketing demand, I'm trying to find a way to convert this into income so that we can stop living at the bottom of the food chain. Converting demand into money is not as easy as it sounds.  I've increased the number of complex patients I see per day from 12 to 15.  It is wearing me out and so far the income has only slightly gone up.  We are getting ready to launch major policy change including: 1) No more low-paying insurances, 2) No more free care via phone calls. Basic calls will still be customary (schedule changes, asking for refills) but management calls (I'm not doing well and need a change) will be billed, 3) We will require patients to pay co-pays, deductibles at the time of service.  I'm also trying to hire some help. First a MA to help me work faster.  That has been harder then I thought. I could also fill the schedule of another PA or NP if I could find the right one. 

 

We are also poised to have a major shift as my SP (god willing) will find out if he passed the headache medical boards next week. That will be huge for us as we can go back to the insurance companies and demand a better contract. This would also double our demand (too complicated to explain here).  I also will have the opportunity to take the headache boards in March, which is a major breakthrough for PAs and NPs. We have fought for this right for over 10 years.

 

So that about sums it up.

awesome! sounds like a CAQ for H/A!