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Does the world need another start-up physician practice?,[object Object],Daniel James Scott, MS, MBA,[object Object],CTBC, CBA, CRC, CGBP, CMQ/OE, CQPA,[object Object]
Does the world need another start-up physician practice?
Sandy Lutz, Woodrin Grossman & John Bigalke,[object Object],From Med Inc.,[object Object],“America has twice as many physicians as it needs.” ,[object Object]
Dr. Elliott Fisher,[object Object],Center of Evaluative Clinical Sciences,[object Object],Dartmouth Medical School,[object Object],“If we sent 30 percent of the doctors in this country to Africa, we might raise the level of health on both continents.”,[object Object]
Does the world need another start-up physician practice?
PCP Concentration,[object Object],FL = #4 in US for Population,[object Object],FL = #4 in US for Physicians,[object Object],PCP's = 36% of doctors in US,[object Object],PCP's = 37% of doctors in FL,[object Object]
PCP Concentration,[object Object],6.1% of US population located in FL,[object Object],5.6% of US PCP's are located in FL,[object Object],FL Population = 17,922,260,[object Object],FL PCP's = 21,269,[object Object],Assumed PCP Shortage = 1,708,[object Object]
PCP Concentration,[object Object],Excess specialist physicians in FL?,[object Object],215,[object Object],Real Current PCP Shortage,[object Object],< 1,500,[object Object],What are Florida’s population forecasts based primarily on?,[object Object]
PCP Concentration,[object Object],1:780,[object Object],US,[object Object],1:1,176,[object Object],5 miles from USF Health South Tampa,[object Object],1:843,[object Object],FL,[object Object],1:749,[object Object],5 miles from USF,[object Object],Main Campus,[object Object]
Market Focus,[object Object],Find potential locations,[object Object],Analyze competitive practices (within a three-to-five-mile radius),[object Object],Survey demographic (especially income) information on the area to be served,[object Object],Note population projections for the area,[object Object],Include any other factors pertinent to the location,[object Object]
Wilfred Peterson,[object Object],Author, The Art of Living,[object Object],“Big thinking precedes great achievement.”,[object Object]
Warren G. Bennis,[object Object],Founding Chairman, The Leadership Institute at USC,[object Object],“Leadership is the capacity to translate vision into reality.”,[object Object]
Does the world need another start-up physician practice?
Russell Robertson, M.D., Chair ,[object Object],Council on Graduate Medical Education,[object Object],Lori Heim, M.D., President ,[object Object],American Academy of Family Physicians,[object Object],“When you look at other nations with comprehensive policies with regard to universal access to health, the ratio of generalists to (sub)specialists is about 50/50. But the U.S. physician profile is only 31% primary care and 69% (sub)specialty care.”,[object Object]
Don Berwick,[object Object],Harvard Medical School,[object Object],“We’re in the Internet age, and the average patient can’t email their doctor.”,[object Object]
Does the world need another start-up physician practice?
How Will I…,[object Object],Compete to harness specific word of mouth or internal marketing strategies,[object Object],Maximize the benefit of my location,[object Object],Build referral sources (schools, local merchants, other health care providers),[object Object],Reach potential new patients (including leveraging PR, joining and speaking to community organizations, etc.),[object Object],Plan for advertising and direct mail,[object Object]
Competitive Advantage,[object Object],Over the past decade, the key driving force has been specialization, both in facilities and practitioner offerings.,[object Object],Companies have sought to maximize revenues from what they do best, while outsourcing standardized and nontechnical services in order to lower costs.,[object Object],[object Object]
Specialist?  Concierge? Corporate Services? Preventative? Immediate Care? Technology? Breadth of Practice or Payer Base?  Quality Assurance? Alternative Medicine? Customer Service? Green/Carbon-Neutral Policies?
What is the firm’s value above and beyond you?,[object Object]
Everything you can do I can do better,[object Object]
Unknown,[object Object],“If you fail to plan, you plan to fail.”,[object Object]
George Van Horn,[object Object],Senior Analyst, IBISWorld,[object Object],“Healthcare practices who thrive and prosper will be noteworthy for their heightened focus on competitive marketplace positioning and for superior cost containment.”,[object Object]
Does the world need another start-up physician practice?
Quick Analysis,[object Object],Target Sales = Overhead + Target Income,[object Object],Specialty? Third-party payer mix? Collections via each payer? Average Collections per source?,[object Object]
Quick Analysis (cont’d),[object Object],Divide Target Sales by average collections to determine rough # of patient volume,[object Object],Divide Target Sales by $162,000 to determine rough # of employees,[object Object],Divide Target Sales by 2.3 to determine rough $ of payroll,[object Object]
Trending,[object Object],Some Upside,[object Object],Higher spending levels!,[object Object],Larger profits!,[object Object],Bigger cash reserves!,[object Object],Still a fragmented industry!,[object Object],Demographic shifts!,[object Object],Some Issues,[object Object],Greater competition!,[object Object],Larger offices!,[object Object],Increased effectiveness!,[object Object],Concentrated payers!,[object Object],Internal concerns!,[object Object]
Financial Benchmarks,[object Object],100% sales,[object Object],45.23% payroll,[object Object],23.8% owner compensation,[object Object],4.54% rent,[object Object],0.93% advertising,[object Object],12.1% operating profit,[object Object],9.5% net profit,[object Object],Simple Valuation Techniques,[object Object],0.45 x Net Sales (0.45 x $1.6MM = $720,000),[object Object],5.04 x Operating Profit (5.04 x $193,600 = $975,744),[object Object],5.28 x Net Profit (5.28 x $152,000 = $802,560),[object Object]
Cash Flow,[object Object],Collection rate – current collections divided by current charges (60-120 days),[object Object],Realization rate – current collections divided by the sum of current collections plus current write-offs,[object Object],Presence of “outside income” – any income not from direct patient care, such as stipends from hospitals, nursing homes, etc.,[object Object],Staff salaries as a percent of collections,[object Object],Occupancy costs as a percent of collections,[object Object],Collection of patient co-pays (should be in the vicinity of 95% or better),[object Object]
Loan Requests,[object Object],[object Object],Medical equipment and supplies,[object Object],Office equipment and supplies,[object Object],Furniture and furnishings,[object Object],Leasehold improvements,[object Object],Insurance needs,[object Object],Operating and personal expenses (aka working capital) – some allowance, possibly 10-20%, should be considered for expense coverage or income shortfalls,[object Object],The advancing loan should have an initial six-month term without scheduled payments of principal, which would be due at maturity. Such terms are typically extended for another six months, allowing time for positive cash flow.,[object Object],Ultimate repayment of three to seven years.,[object Object]
Peter Drucker,[object Object],Author & Management Guru,[object Object],“Plans are only good intentions unless they immediately degenerate into hard work.”,[object Object]
Does the world need another start-up physician practice?
A (non-exhaustive) To Do List,[object Object],Conduct a feasibility analysis,[object Object],Retain advisors,[object Object],Prepare a business plan,[object Object],Obtain financing,[object Object],Identify a location,[object Object],Negotiate the lease,[object Object],Choose and order furniture, equipment, billing system,[object Object],Hire employees,[object Object],Develop employment policies,[object Object],Develop a filing system,[object Object],Develop marketing materials,[object Object],Advertise for patients,[object Object],Prepare patient charts,[object Object],Develop coding and compliance policies,[object Object],Develop an encounter form,[object Object],Develop a general ledger system,[object Object],Develop a compensation system in a group practice,[object Object],Establish professional relationships,[object Object],Recruit patients,[object Object],Register patients in the billing system (database),[object Object]
Recap,[object Object],Opportunities are defined by geographic ‘pockets’ – not US or state averages,[object Object],Know what you want, and build structure around those goals,[object Object],Growth potential exists for well-run, flexible and innovative physician practices,[object Object],Working capital is always a concern in healthcare, but no bigger or worse than most other industries – focus on success,[object Object]

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Does the world need another start-up physician practice?

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Notas do Editor

  1. Much of our discussion will revolve around whether there is, in fact, a physician shortage.
  2. The feasibility analysis framework we will discuss.
  3. Let’s discuss the “doctor shortage” fallacy/misconception
  4. Adapted from “Start-up Medical Practices” by RMA, 2003Your local SBDC can help you find and analyze this sort of data
  5. Adapted from “Start-up Medical Practices” by RMA, 2003 and the Industry Reports atMadduxResearch.com
  6. Taken from “Aging Boomers Likely to Boost Health Care Sector” by George Van Horn, The RMA Journal, March 2010 and the Industry Reports atMadduxResearch.comLet people know you practice medicine, then move on.
  7. Financial data taken from the 2002 Census and 2002 IRS data
  8. …not quality of diagnostics or the actual practice of medicine.
  9. Trending defines boundaries of success– not opportunities.Spending:Receipts per capita increased 80.2% (97-07 Census), Share of GDP from 7.2% to 16% (70-08 IBISWorld)Profits: Net profits up 6.7%, Net cash after operations to sales up 18% (06-09 RMA)Cash: Cash reserves up 4.7%, Receivables down 12.6%, Debt down 3.3% (06-09 RMA); collection and coding issues aside, the common level of receivables & bad debt is low when compared against all US firms, moderate seasonality leading to possible short-term cash flow shortages, most commonly borrow long-term debt to fund fixed assets (MadduxResearch.com)Fragmented: Top 50 firms generate approximately 9.4% of the industry’s sales (07 Census)Demographics:22.8% of General Practitioner Family Doctors and 25% of Specialist revenues are from clients 65+ (2010 IBISWorld);population will double, % of population from 12% to 20% (03-30 IBISWorld)Competition: Offices per million residents increased 1.7% (97-07 Census), GPs are consolidating (IBISWorld)Offices: Physician office revenue doubled 1997-2007, # of offices only increased 12.3%, Employees per establishment increased 20%, Receipts per office increased 77.4% (97-07 Census)Effectiveness: Receipts per employee increased 47.8%, Receipts per $ of payroll increased 14.2%, Annual payroll per employee increased 29.1% (97-07 Census), billing/collection systemsPayers: State and federal government spending accounts for 45% of total national health care expenditure (2010 IBISWorld)Internal: Aging physician population, divorce, addiction, owner disagreements, unintentional billing fraud, long-term disability of physician (MadduxResearch.com)
  10. Financial data taken from the 2010 RMA Statement Studies (all size categories), 2002 Census and 2002 IRS dataValuation data adopted from Inc Magazine’s Valuation Guide
  11. Taken from “Key Indicators for Medical Practice Valuations” by Mark O. Dietrich, The Journal of Lending & Credit Risk Management, June 2000
  12. Taken from “Start-up Medical Practices” by RMA, 2003
  13. Taken from “Key Indicators for Medical Practice Valuations” by Mark O. Dietrich, The Journal of Lending & Credit Risk Management, June 2000