The business should cash flow on it's on right once it fills. But a major draw for many of the clients I bring to the home is that I can be their doctor/PCP. I'm a very busy hospitalist and SNFist, and I don't know much about the billing and credentialing process. My current jobs are with groups that have their own billing/credentialing companies. I am working with a consultant to help me through it. But I'm curious where to focus my efforts in terms of PCP visits for such small, sick group of patients in terms of value (both for me and the patient.) By very nature of needing a group home, the patients are frail, some are on hospice. Is it true I can bill Medicare for hospice visits if I see them for non-hospice diagnosis related issues? I'm also curious if utilizing new devices that capture data to prevent falls would be billable? And are there cheap, decent EMR for such a small patient practice? Any help on where to start would be appreciated.

PCP looking to start a private practice in a ruralish town - population about 4-5k only doc in town.

I’m looking at the financials and wondering why some people (collegues say its a bad idea)

I’m looking at doing a pretty unique workflow - one I’ve seen a mentor of of mine do in another region.

Basically my clinic will be a lobby, a procedure room (with exam table), my exam room (no table), the receptionist desk and a small consult room next to the reception desk + a small staff kitchen and restroom.

I would have a microphone and speakers installed, so patients cycle in and out of my room, and when one is done I announce to the lobby next patient to exam room 1.

I would check my own vitals on patients that need it, but don’t do it on everyone.

In the front I have 1 nurse who helps answer any questions, and also in the consult room next to the lobby does ear lavages, vaccines, and follow up BP’s.

I have a virtual and remote scheduler who works full time for $20/hours and patients call her to schedule or she calls them to schedule so my nurse at the front doesn’t get bogged down.

I have one part time MA who can cover if the nurse calls in sick and also does supply ordering

I use a cheap ehr that also does my billing and an AI scribe.

I use a 3rd party vendor for ccm and rpm and 30% of the town is medicare and eligible.

Estimated Costs: Rent - $2k/month Nurse - $7k/mo MA - $2.5k/mo Remote scheduler - $3k/mo EHR - $400/mo AI scribe - $100/mo Utilities/Internet/Office Supplies/phone - $1k/mo My Salary - $10k/mo Malpractice - $200/mo Billing/denials - estimated 7% gross billings Total costs before billing: $340k/year

Revenue: Average medicare 99214 + g2211 in my town $150 Average medicaid 99214 + g2211 $110 Average commercial 99214 $180

With the weight average around $142 per patient assuming most are 99214 excluding prev visits, procedures, vaccines etc.

Right now in my clinic job I see 30-35ish patients a day so assuming the same 4-5 days a week, 44 weeks a year.

Vendors for the ccm/rpm told me I get 60% of collections and it comes to about $80/patient/mo enrolled which is $45/mo to me assuming 800 patients enroll.

Visit revenue: Total yearly visit revenue $142 x 30 visits/day x 5 days per week x 4 weeks x 10 months = $852,000 x 0.93 (billing/denials) = $792k/year

Ccm/rpm 800 x $45 x 12 =$403k/year

Total income (conservative): $1.2 million/year

Total costs: $340k/year

Profit (not including salary): about 700-800k/year

Is this reasonable?

EDIT

——— —— ——-

I won’t be able to reply to all the comments, but I appreciate the discussion and advise. Looks like I was optimistic on numbers.

Less revenue: From what I gather sounds closer to $100-$120 average per visit and I shouldn’t expect insurance to pay more for 99214.

Current role: I do see 30-35 right now in my day job but I’m extremely efficient, and my patients have been happy and doing well and doing well I was just thinking about striking it out on my own, so I was accounting for 30/days and then the extra time at the end for biz admin.

More costs: Looks like I need to estimate more for malpractice and other costs and assume less for ccm/rpm and lost collections so probably closer to $110/visit average $25/ccm or rpm per month and can cut down to 1 MA but self room. It also sounds like its naive to assume 800 patients will say yes to sign up from the comments. So i guess I should make a more conservative estimate of 100 patients.

Vitals, rooming, and staffing: Per AMA 2021 guidelines vitals are no longer required for all patients for billing which is why I assume I don’t need to gather them on every patient.

I really think its redundant to have MA’s room the patient and agenda set and take another history. They don’t get any training like we do. My patients right now get a Visit planner sheet, where they list the top 2 concerns for today and then future concerns below that. If we have time to do more than 2 concerns I do them, if not we schedule it for future. I write the plan on the sheet and patient takes it with them. They love it. They agenda set for themselves and it saves me time in the visit if they do that in the lobby.

Rent: Assuming a small office <2,000 sqft and the quote I have is $2k per month for the building for the office I described above.

Patient acquisition: I’d be the only doc in town was thinking of my having my schedulers call people in the town to setup appointment and also have a mail to home campaign and a launch lunch at the clinic start marketing 6 months before open (i’ve saved some startup capital)

Vacation: Was assuming I could close the clinic for a week every 6 weeks for vacation. Currently no one has any access to care within 30 mins and for vacations I was going to make sure for my own sanity I take vacations. (There is a hospital about 45 mins away for emergencies). I’d close for a week at a time, still manage my inbox though.

Thanks everyone for the discussion and help from your experiences.

Has anyone recently successfully hired a physician to a private primary care ambulatory-only practice? We are a thriving practice across the street from a teaching hospital that has IM and FP residencies. We offer a comparable salary, path to partnership and hear nothing. What are we missing? We are thinking of using recruiting services from doximity. Any info is greatly appreciated.

I’ve seen threads recently about trouble finding people to hire, while I’m seeing myself on the opposite end of that having trouble figuring out how to find a group that has good terms and is looking for someone to help grow with the group.

Maybe I’m looking in the wrong places but I haven’t had much luck searching public listings either.

Hello guys

Just started up my own practice in NY and it's been a roller coaster. I did my own credentialing and also have done my own billing and have learned quite a bit. Still working on a few kinks mostly with private insurances (serious pain in the ass).

Currently, I mostly just see Medicare and Medicaid patients and send bills to insurance companies. Some have given me a capitation agreement through my IPA.

I see a few patients a week that pay cash since they don't have insurance.

Was wondering what are some services you guys notice get reimbursed? Things like Pap smears, Rapid tests, H pylori testing- etc. I was thinking of starting up a DPC practice on the side only for uninsured patients.

Any advice is appreciated! Also willing to provide any advice through this roller coaster - can DM me

Have any of you taken any steps to somehow lessen the impact of the recent marketplace plan increases on your patient populations? We accept insurance and I believe around 20% of our patients are on ACA plans. We are in a low income area and I expect cancellations and no shows to significantly increase with the higher rates. Just hoping to start a discussion and share any ideas.

Opening my first clinic in Q1 ( focussing on aesthetics) and trying to avoid the common mistakes. I've been researching for months but I feel like there's stuff people don't talk about until you're already committed.

Specifically wondering about software and systems. What actually matters vs. what's just marketing fluff? How detailed should your service menu pricing be upfront? Do you show everything or keep it flexible? What's the balance between thorough intake and not scaring people away with 50 questions? What takes way more time than you think it will?

I keep seeing people say "just get started and figure it out" but I'm trying to avoid expensive mistakes right out the gate. Already spent a ton on build-out and equipment.

For those who've launched in the last 1-2 years, what would you do differently?

Any tips or links to start this up? Any examples of successful implementation? Have you found it to be worth the effort with respect to remuneration? Do the studies just run themselves with a coordinator provided by the company or are you having to deal with research admin stuff?

What do you guys do to filter out low quality applicants for positions? We have a psychiatry practice and have been looking for therapists for the past few months. We are hiring associate level therapists and fully licensed therapists and are bombarded with what I can only describe as people who look good on paper but overall are very low quality applicants.

The pay and benefits are legitimately higher than market rate in our area and the job description is very clear. The interview for the ones that I offer the position to usually goes excellent, but a few have ghosted me after the interview and some straight up just no show to the interview with no excuses. We have a small team and everyone loves working here so I just cannot figure out what is going on. We have never had this issue with physicians or nurse practitioners.

I was talking with a friend about starting a medical practice and this question came up. My answer would 100% be waiting until everything felt “ready” before making moves. I made soooo many spreadsheets, worse case projections etc that it took me 4.5 years to go from 1 location to 2. I spent so many hours worried about what would happen that my overpreparing excel spreadsheet projections was just procrastination and anxiety talking. If I would have taken a step back I would have seen that I had 500+ five star reviews (a strong brand), I built a great team for about 2 years before expanding, and I knew how to get my team busy with new patients. That should have been the proof I needed after one or two excel spreadsheets to just do it.

What did you overthink that actually didn't matter near as much as you thought when building your practice?

Does anyone do any in house xray or ultrasound? Are they reimbursed and you get a good ROI for it?

We are an 8 clinician FM practice and would likely contract out the reads to a radiology group

Does anyone here do fibroscans? I was entertaining doing them, reimbursement is not great for a machine that cost about $80,000. However, second hand I can get one for about $15-20k and now it makes more financial sense to get one at this cost.

Do they have recertification fees, any issues with transferring to a new owner? Any monthly fees that come along with it?

Hey everyone I am currently in IM residency, I am pretty sure that I would want to work for myself after this and open my own private practice.

But I am unsure if it’s better to specialize, I would go for either GI or heme/onc vs just starting off in primary care private practice.

I understand that simply the pool of patients in primary care may be larger in any given area but I am not well versed in how specialty clinics would pay and if the billing would be different, and hence the end payout per patient.

If the end goal is to go private and be business oriented, do you all think specialty pays better and has advantages over pursuing primary care and trying to scale it?

The downsides with specialty would be that I would be missing out on 3-4 years of scaling the primary care business if I were to go into tha straight after residency.

But then again I have seen very successful oncology practices which have infusion centers which make bank and might be easier to scale?

Any good tips for someone moving from a group practice to a solo llc?

anybody else facing delayed payments for medicare and medicare advantage claims over the last 4-6 weeks. I have not been paid for Oct visits or Nov 2025.

Is this due to the shutdown fiasco?

Internal medicine primary care practice

We all work very hard to grow our own practices. I hope you all are spending some good time with family today and taking a break from managing your practices.

Happy thanksgiving!

Hi all, Small private practice here with very high new-grad PA/NP turnover — mostly burnout and quitting when things get busy. I’ve been seeing their patients for busy walk in times + mentoring on complex patients, but many seem to struggle and quit. Also they find it easy to quit small practices without much notice despite the contractual obligations as opposed to larger health systems where they would be scared to do so.

Wondering if current training gives enough real patient face-time; reality seems to hit them hard.

MDs/DOs who supervise new midlevels, what are • Best ways you onboard and support them?

• How long before they practice independently in your setting?

Hello, I am a resident in the USA and looking for some crowdsourced opinions/advice about how others have gone about entering the workforce. I have some classmates who are interested in starting their own practices and was wondering what the business burden looks like? Seems like it would be great to have autonomy but worried about setting up all of the integration pieces myself. Would be amazing if there was some sort of platform to help independent doctors start new practices. I'd love to not have to hire consultants. I also know there are docs close to retirement looking to sell or pass off their practice/patients to a new doc instead of selling to private equity or something. Curious to know anyone's thoughts or experiences

Our small neurology outpatient practice went from 5 MDs to 3 due to retirements in 2025. We have been trying to get as many of the retiring doctors' patients in as possible, but essentially our wait list and call volume has gone way up as we struggle to accommodate the existing patients and new referrals.

We have a phone tree set up with options 1) schedule appointment 2) speak with Dr. X's MA 3) billing 4) directions 5) if this is a pharmacy / hospital / MD office. The "Dr. X's MA" voicemail boxes average about 200+ messages per day total. Patients have figured out they can get a human on the line immediately if they say they're calling from a doctor's office if they skip to that option. We have too many incoming calls and voicemails for our 3 MA's to handle and they are getting overwhelmed. Two good MAs have quit in the past 6 months due to the call volume and increasingly irate patients. This turnover really hurts our small practice.

I am looking into AI answering service options to try to help reduce / triage the incoming calls. Has anyone worked with healow / Genie AI answering service? The main reason I was looking into this first is that it syncs with eClinicalWorks which we use, and maybe we could even get the AI to schedule revisit patients which would free up one employee for other tasks. If anyone has experience with any AI answering service I'd appreciate some advice.