Starting my own practice

[JFarnsworth]

I have been offered the opportunity to start my own practice within a practice, and need advice. The idea is that I would start my own business but would be incorporated into a longstanding medical clinic, with multiple MDs supervising me. I'd work in the clinic providing medical care, and my business would be a cash pay cosmetic scenario. I would have unlimited access to the facilities and staff, including marketing, website promotion, open houses, e mail blasts, referrals from the MDs and ancillary staff there. Has any one done this before? What tips or suggestions can any one give me? My malpractice for the medical side would be added onto my SPs insurance, and I'd pay for the costs of the cosmetic side.

Right now I am in negotiations and dealing with the contracts. Any positive advice or insights are welcome.

[JFarnsworth]

Really? Has no one done this before?

[wjm7]

I'm not even out of PA school yet, so I will be of no help.  But I do know that there are previous threads regarding opening practices, so I would search for them. 

[Guest Paula]

Whatever you do make sure you get paid well for your "own business" like 90 % of the profits and the SPs only get the 10% or so.  It seems like you could be put in a position of doing all the work with multiple MDs wanting a piece of your pie.

 

I have never been an owner of my own practice or practice within a practice so take my words with a grain of salt.  But I said it to put a pebble in your shoe so you will consider all aspects......negative and positive. 

 

Are you a derm PA? 

[JFarnsworth]

Yes I am a Derm PA, as well as having experience in many other specialties. I thank you all for your input.

[ventana]

doesn't sound like truly your own practice, but instead a job paid on productivity

 

Are you doing all your own billing? are you responsible for staffing?

 

I would assume (?) that they are going to charge you overhead or give you a % of collections

If you can get near the 50% mark of collections that is great

 

if they are charging you overhead and taking it out of your receipts be careful - they can charge anything they want and they are unlikely to share the books with you and you will get the short end of the deal......

 

this is where attny are helpful

[FBIDoc]

Contact Tricia Marriott and Michael Powe at AAPA to get handle on the legalities of this arrangement.  It's tough to say based on your description if you really "own" your clinic or are a subcontractor, ie 1099.  If you have a separate EITN then you will need to lease the staff and facilities from the other entity otherwise you run afoul of inurement and Stark violations which can cost you more than you will care to fathom...looking again at the description of your relationship with the clinic/SPs scares me from the medicolegal aspect...do your homework thoroughly before you sign any contracts...most physicians in this country I would argue have no clue about what I just described BTW...

[JFarnsworth]

Ventana, I am still hammering out the datails. Thank you for your insight. The offer I got was to get 50% of profits, with no overhead (they have several rooms that are not being used at all right now), no staffing expenses (they provide the staff, unless I want to bring in my own), the biller is on site and not calculated as part of the profits, and all I have to do is finance my machines and equipment. We are working on a contract now, and I plan on having my attorney scrutinize it carefully.

FBIDoc, I will contact Tricia and Micahel and get some more info. I appreciate your help.

[CorpsmanUP]

I agree very much with FBIDoc.  A big issue is what the MDs financial interest will be in "your" company, and if it is actually separate or part of the doctor's office in consideration of Stark's and self referrals.  An attorney familiar with the ins and outs of Stark's is going to save you a lot of headaches if you are going to take any federal insurance business at all.

[JFarnsworth]

Thank you CorpsmanUP! I see I have a lot to learn. I will not be taking any federal insurance at all, it will be a cash based scenario. The MD's interest is that I can generate a lot of cash paying procedures and they can reap the benefits without doing much. I have to carry my own insurance and will have consent forms, release of liability forms (as carefully worded as possible, with my attorney's input), and a comprehensive contract with my SPs. I really appreciate all the input!

[ventana]

Ventana, I am still hammering out the datails. Thank you for your insight. The offer I got was to get 50% of profits, with no overhead (they have several rooms that are not being used at all right now), no staffing expenses (they provide the staff, unless I want to bring in my own), the biller is on site and not calculated as part of the profits, and all I have to do is finance my machines and equipment. We are working on a contract now, and I plan on having my attorney scrutinize it carefully.

FBIDoc, I will contact Tricia and Micahel and get some more info. I appreciate your help.

sounds like a producitvity pay model

are they going to provide the typical bennies for employement?

 

this is NOT a 1099 position - you will loose every single audit so don't let them make it one - (they save $$ by trying to make it this but open themselves up to a HUGE liability)

 

a 50% of collections with full bennies (health insurance, $2500 cme, 8 weeks PTO) is a sweet package

[JFarnsworth]

Thanks, Ventana. I have decided to have an aesthetic component that's part of the office rather than start my own business. Getting 50% of a cash pay practice plus bennies would be nice but that's not going to happen. Luckily I have bennies through my husband and set up my own retirement fund. Thank you all for your input and advice. I learn so much whenever I post here!