Deciding where to practice

1. Deciding where to practice • Best Advice Ever • Go where you really want to live and you will be a success.”

2. First Step • The first hurdle in starting a practice is securing an office address • Helpful Hint: Use the onsite leasing office as your address until you actually move in

3. Office Space • Need minimum of 600 square feet • Office for consultation • Two exam / procedure rooms • Reception area • Office personnel and work areas • Bathroom • Helpful Hint: Use background in exam room for taking pictures

4. Office Space

5. Getting Started • Explore options for a practice setup • solo fulltime office • space sharing only • space and office help sharing • part-time office sharing • (arranged in decreasing order of cost)

6. Financial Tips • Plan for no income for first 6 months • Save all profits until current and estimated taxes have been paid (and leave one month’s overhead in the bank) • Obtain low interest, no fee credit cards for emergency backup

7. 12 Months Ahead • Visit the area chosen for practice • Visit the hospitals in the area • Warning: Some hospitals have congested and restrictive ER call schedules, so plan accordingly • Decide on and commit to office space • Make out a personal and business budget

8. 9 Months Ahead • Apply to hospitals for privileges • Leasehold improvements of office space • Reserve telephone number (a (a catchy number may cost extra) • Place yellow pages ad • Interview and hire advisors • Apply for open medical provider plans

9. List of Advisors • Accountant • Attorney • Insurance broker • Banker • Medical consulting firm

10. 6 Months Ahead • Address changes for DEA and medical licenses • Open business checking and credit accounts • Apply for UPIN • Print business cards • Obtain outpatient surgery center privileges • Remember to study for the In Service Exam (or you won’t be starting practice anywhere)

11. 3 Months Ahead • Arrange for Visa/MC merchant terminal through your bank • Meet referring physicians • Apply for Federal EIN (SS-4 form) • Apply for State EIN • Purchase office equipment and supplies • Write your fee schedule

12. 3 Months Ahead • Confirm and interview for hospital privileges • Secure insurance coverage • malpractice • office overhead • umbrella liability (check with malpractice) • health • (remember your own disability, life, auto)

13. 1 Month Ahead • Hire office personnel • Advertise locally • Print office forms • Plan open house

14. Office expense Payroll (not yourself) Rent Insurance Telephone Advertising Total Monthly 3,000 2,900 2,500 1,100 500 200 _____ 10,200 First-year Monthly Business Budget

15. Options to Reduce Office Expenses • Share office space and furniture • Borrow office furniture • Purchase used or refurbished equipment • Give employees incentives to cut costs

16. Options to Reduce Payroll Expenses • Hire a relative or spouse • Utilize non-licensed personnel • Hire part-time personnel • Offer monthly profit-sharing incentives in lieu of higher salaries • Know wages in your area

17. Options to Reduce Rent Expenses • Office space share • Start with smaller overall space • Part-time office space • Helpful Hint: Most telephone services can transfer calls to anywhere (even the second line at home) without the caller knowing which allows you to practice some days from home!

18. Options to Reduce Insurance Expenses • Shop for competitive malpractice coverage • Utilize low-cost medical insurance • Enlist yourself as a covered dependant of your employed spouse (Even if employed by you!) • Large groups (e.g. AMA) offer competitive rates for life, disability, practice coverage.

19. Options to Reduce Telephone Expenses • Maintain minimum number of lines (three are usually sufficient, one FAX / Visa and two voice) • Utilize smaller yellow pages ad • Limit and concentrate yellow pages ads to your local area

20. ER Practice Tips • Always enter and exit hospital through ER • Write down names of hospital personnel • Provide outstanding pediatric trauma care • Never ask or complain about insurance status (or lack thereof) • Number ONE - All time best tip: • Buy pizza for the ER during your consult

21. Office Practice Tips • Hire personnel with superior phone manners • Discretely let patients know you perform all types of Plastic Surgery • Spend time with your patients • Never make patients wait • Add a personal information charting page

22. Practice Building Tips • Send personalized notes when appropriate • Keep referring physicians updated on each patient’s treatment and progress • Organize your “Picture Book” (start now) • Send flowers to every postop patient • Call all ER patients within 12 hours • Attend as many tumor boards as possible

23. Practice Building Tips

24. Practice Building Tips • Send personalized notes when appropriate • Keep referring physicians updated on each patient’s treatment and progress • Organize your “Picture Book” (start now) • Send flowers to every postop patient • Call all ER patients within 12 hours • Attend as many tumor boards as possible

25. Practice Building Tips

26. Practice Building Tips • Send personalized notes when appropriate • Keep referring physicians updated on each patient’s treatment and progress • Organize your “Picture Book” (start now) • Send flowers to every postop patient • Call all ER patients within 12 hours • Attend as many tumor boards as possible

27. Practice Building Tips

28. Practice Building Tips • Send personalized notes when appropriate • Keep referring physicians updated on each patient’s treatment and progress • Organize your “Picture Book” (start now) • Send flowers to every postop patient • Call all ER patients within 12 hours • Attend as many tumor boards as possible

29. Practice Building Tips

30. Practice Building Tips • Send personalized notes when appropriate • Keep referring physicians updated on each patient’s treatment and progress • Organize your “Picture Book” (start now) • Send flowers to every postop patient • Call all ER patients within 12 hours • Attend as many tumor boards as possible

31. Practice Building Tips • Send personalized notes when appropriate • Keep referring physicians updated on each patient’s treatment and progress • Organize your “Picture Book” (start now) • Send flowers to every postop patient • Call all ER patients within 12 hours • Attend as many tumor boards as possible

32. Financial Tips • Use “QuickBooks” and do you own bookkeeping • Keep careful mileage / travel expense records even before starting practice • Consult accountant / attorney about incorporating • Encourage patients to pay OR / Anesthesia costs directly

33. Insurance Billing Tips • Always consider billing auto insurance first • Helpful Hint: Medpay pays on a firstcome/ firstserved basis and in full • Delay billing those with large deductibles • Always send patient statements • Have lien forms signed for those involved in lawsuits

34. Insurance Billing Tips • Always bill for a consult on ER cases and add CPT modifier - 57 (Decision for surgery) • Send all claims by certified mail with return receipt • Learn how to properly fill out HCFA 1500 forms (purchased at office supply store)

35. Organizational Tips • Keep a log of all work done for accounting purposes • Keep a photo log book • Organize your camera / brief case • Enter your board cases every Sunday

36. Organizational Tips • Keep a log of all work done for accounting purposes • Keep a photo log book • Organize your camera / brief case • Enter your board cases every Sunday

37. Organizational Tips

38. Organizational Tips • Keep a log of all work done for accounting purposes • Keep a photo log book • Organize your camera / brief case • Enter your board cases every Sunday

39. Organizational Tips

40. Organizational Tips • Keep a log of all work done for accounting purposes • Keep a photo log book • Organize your camera / brief case • Enter your board cases every Sunday

41. Setting Up Your Web Site • Find a reputable design firm such as Velocity Multimedia, Inc. • Your firm should be able to set up, design, host and promote your site to your specifications. • Ask the design firm how much of said services will be outsourced. (you only want to be dealing with one company-not several.)

42. Setting Up Your Web Site • Customer Support is Essential. Your firm should be able to provide you with support on demand – not at their leisure. • Ask your firm for prior references and methods to contact said parties. • Ask your design firm for a list of previously designed web sites and get a sense of their style. Does the design firm’s style match yours.

43. Setting Up Your Web Site • Price? Cheaper is not necessarily better, but a large price tag doesn't mean your getting the best either. • You should expect to pay between $3000 to $10,000 depending on your requirements. • Be wary of "deals" that sound too good to be true. Often these "great deal" companies go under or cannot live up to their promises.

44. Setting Up Your Web Site How To Expedite Production of Your Site • Have all site text prepared and in digital format such as Microsoft Word. • If possible, have any images or video in digital format. • Check out several sites, let your designer know what you liked/disliked about each.

45. Setting Up Your Web Site • Make sure that when you are researching web design firms that they are able to address each of the above concerns to your satisfaction.

46. Miscellaneous • Remember to apply for board exam during your first six months