Leaving the Hospital to Start an Independent Practice
“While the journey seems long and hard at the beginning,
with perseverance and dedication the rewards at the end last a lifetime.”
~ William R. Francis, Baylor College of Medicine
A physician’s journey through the healthcare world can often feel like a long and winding road. Some physicians decide to go into private practice, and then transition to the hospital environment. That has been the trend for a long period of time now. Due to COVID-19’s overwhelming impact on the hospital system, however, some providers are considering an alternate route – moving out of the hospital and into an independent practice.
The benefits of being in private practice are considerable, compared to those of the hospital. Many physicians appreciate the new-found autonomy and closer patient relationships they find when striking out on their own. But the subtleties of practice management can elude them. Because hospital administrators took care of the day-to-day details, they may not realize all that goes into starting and running such a multifaceted organization without this support. This article looks at some of the best practices involved in starting a medical practice that can survive and thrive.
Steps in Starting a Successful Independent Medical Practice
The joy of starting a new practice is that it comes with a clean slate. You have the ability to decide what your practice focus will be, how you want to treat patients, and what practice management steps you will take to help your office run smoothly. Here are some foundational questions you will want to ask yourself as you make plans to open your new operation:
Why do I want to open an independent practice?
It is important to know why you want to take this big step. If your motivation is exclusively to make money, that will drive your decisions about the type of patients you will see, how many you will take on, and how you will provide care. If your motivation is to develop a better work-life balance, you might decide to see fewer patients, or provide concierge services with a more personalized approach. There is nothing wrong with whatever choice you pursue, but this does impact the office space you need, the type of staff you hire, and the support mechanisms you put in place to provide patient care. Reasons often cited for becoming an independent physician include:
- The ability to practice medicine and run a private practice on your own terms, develop treatment plans that you feel are best suited to your patient, and directing patient care to meet health goals instead of corporate financial goals.
- Establishing and maintaining control and responsibility for the emotional and financial health of a practice.
- Forming closer relationships with patients, staff and the local community.
- Growing and competing as an independent business in a given market.
- Having the ability to find and analyze information on which to base informed, strategic decisions.
- Finding the services and support tools necessary to provide care in the most efficient, appropriate way possible.
- Building a legacy that survives and thrives, despite societal and industry upheavals.
- Adding to the overall health of the general population, while improving lifestyle and health choices on an individual patient basis.
- Receiving admiration and respect from patients whose lives you have been able to positively impact.
How will I allocate care between in-person visits and virtual care?
One big trend that has emerged as a result of the pandemic is that patients are open to the telehealth trend. With this in mind, you can set a system of seeing patients in-person initially, and perhaps on a yearly basis thereafter, unless a condition develops that requires more in-person attention. The balance of your appointments could then be held via teleconferences. This determination means that you will need to hire staff members who are comfortable with this method of providing care. You can also make adjustments to office size and capabilities, with a focus on computer and teleconference requirements. Look for telehealth solutions that will enable you and your medical staff to quickly and easily initiate telehealth video and secure text conversations, and maintain logs of those chats and videos for billing and audit purposes.
What is my vision for the future of my practice?
Most providers have an idea of what they want their practice to look like in the future. If you want to concentrate on the idea of providing patient-focused care, think about what that means in terms of the ways you will grow your practice. Will you continue to bring on more professionals who provide a similar type of care as you do, or will you look at expanding to offer other areas of care that complement your offerings? This will have ramifications on the type of space you look for initially, and whether you need something that has future expansion capabilities.
How will I keep track of my patients’ progress?
Efficient charting is critical to the success of patient care, but it also affects the efficiency of the office environment. The old way of paper charts required tremendous amounts of space and time but replacing that with Electronic Health Records (EHR) requires computer capabilities that are enhanced, team members who are comfortable with computers, and a partner that offers an easy-to-use, state-of-the-art system. Amazing Charts offers the latest in Electronic Health Records (EHR) capabilities that make smoother charting a breeze. Components of our comprehensive EHR systems include intuitive charting capabilities and templates to maximize provider time, e-Prescribing, better scheduling capabilities, and a patient portal for enhanced communication purposes.
What type of brand will I establish?
This is a relatively new idea in the world of medicine, the thought that a medical practice can have a “brand.” But you do want to have an idea of how you will present your practice to your prospective patient population. This means you have to put some thought into your practice name, logo, and appearance. You want to encapsulate your approach into a mission statement that can be easily communicated to others. You will need to have a website, social media outlets, and marketing strategy that reinforce your brand statement.
How will I bill my patients?
It might feel uncomfortable to think about billing patients, but that is what any business is about. You have to find the best way to be reasonably compensated for your services. Too many medical practices flounder because the founder did not place enough emphasis on coding, billing and collections. Amazing Charts Medical Billing Service is a fully integrated Revenue Cycle Management service that handles the hassles of billing for you, and at a more affordable rate than most third-party billers.
What are my planning requirements?
There are some technical requirements involved in the process of starting an independent practice, so be sure to create a checklist of items you will need to cover, including: federal, state and local licensing; credentialing; HIPAA compliance requirements; insurance regulations; and human resource mandates. You can research these components yourself or engage the services of outside experts to make the process easier.
Where will I locate my practice?
Even if you will be providing a substantial portion of your services via telehealth, you want to find a location that provides easy access for both patients and staff. The building size will be predicated on your needs. Make sure there are plenty of internet service capabilities in the area and configure your office space to allow for computer access and private telehealth conversations. Consult with your accountant to determine whether renting or buying will be the best option as you set out on your new adventure.
How can I provide patient care in different ways?
Many providers are aware of the benefits of hiring medical assistants and nurse practitioners to expand the level of in-person care they can provide. But more practices are working to expand their remote care services as well. One innovation that helps bring a better balance to the different types of patient visits is a Virtual Preventative Care Assistant. Amazing Charts offers the capability to expand your patient care kit by adding remote staff, or contracting out existing staff, to reduce labor costs while maintaining patient continuity. This takes a huge administrative burden off of the medical professional.
What kind of people will I hire?
You want to hire a team that reflects your personal approach to medicine, and then you want to provide them with the tools and training they need to execute your vision. Start by hiring professionals with good people skills and a caring attitude. Then create an environment where you solicit feedback and act on it.
How will I manage workflow in my practice?
This is an important factor to consider. You will want to decide how you will go about the process of setting and reminding patients about appointments; writing and reauthorizing prescriptions; monitoring patient care activities to ensure compliance; conducting in-person and telehealth appointments; and managing billing/collection issues. Develop a patient experience program that will both improve your practice and increase satisfaction among patients and caregivers. It will also be necessary to work towards high levels of interoperability, so your practice can easily coordinate and quickly share information with other providers and medical care services.
What is the best way to fund my independent practice?
Doctors coming out of medical school usually have large sums of student loans to repay, which is why they often turn to hospital practice or work with another physician initially. When the time arises to set out on their own, they turn to the Small Business Administration or local banks for financing assistance. This requires you to set out a pro forma business plan which estimates your expenses and income for the foreseeable future. Include startup costs for purchasing a practice or building, any construction or remodeling expenses, professional consultant fees, insurance and licensing, and medical equipment and computer costs, as well as estimates for ongoing routine payroll and office administration expenses. You will also need to project how many patients you will acquire on a yearly basis, as well as the projected revenue on a per patient basis. The Medical Group Management Association has a comprehensive checklist for business and financial planning.
What kind of success factors will I track?
There are a certain number of factors that you will want to track to make sure your practice is delivering on your goals. Some key performance indicators include:
- Total number of patients.
- Average patient revenue.
- Number of in-person and virtual visits per month.
- Number of patients being followed through remote care.
- Average patient encounter time.
- Practice income and expenses.
- Total practice revenue.
It can seem overwhelming to consider the thought of leaving a secure hospital environment to open an independent practice and acquire the practice management skills to make it run smoothly, but rest assured there are many doctors who have already gone before you to achieve this goal. Reach out to them for insight and support and find business partners who are equally motivated to make your practice a success. You can also turn to the American Medical Association for a plethora of material on practice management best practices. The journey may be long, but the results are worth the effort.
Healthcare Technology Solutions Designed By and For Independent Practices
Amazing Charts was founded in 2001 by a practicing family physician to help medical practices thrive. We have grown consistently since then by creating easy-to-use solutions for delivering patient care. Today, we offer a variety of additional capabilities designed to help independent practices succeed, including Electronic Health Records, Practice Management, Billing Services, Population Health and Remote Care. Call 866-382-5932 to learn about our products, schedule a practice consultation, and learn more about telehealth pandemic lessons that can help your independent practice grow.