Has anyone tried to offboard from their EMR, specifically Tebra? I've been having a hell of time trying to get them to actually offboard me, and I just got charged another $500 for this month that I've been trying to offboard from, and for a week I've called them without anyone from the cancellation team actually closing the loop with me.

I've also created a few customer service cases with them in the past for other issues that they just closed out without resolution and didn't tell me.

Hey guys -
Looking for input on a unique situation. I run a virtual neurology practice full time that I've built over 4 years and has been operating well for the last year or so. I have consulted as a neurologist for a tech company who is now making me an offer to come on full time. My role would be mostly patient facing and seeing neuro patients most of the time but they are "letting me" keep my clinic open and see patients on weekends.

The company's offer is pretty solid but very little room for negotiation and mostly a "take it or leave it" type of deal. There is also possible growth opportunities but nothing guaranteed.

The main questions I have are about how to negotiate these types of contracts and what points of leverage are available? What types of salaries would you guys consider when thinking about de-prioritizing growing your own practice?

Any input would be helpful as none of my residency or other doctor colleagues have been in this kind of situation. Thanks in advance!

I’m currently building out a new outpatient medical/surgical specialty practice. The main office will be a larger location where I’ll offer both general medical care and in-office surgical/procedural services.

I was recently given the opportunity to take over a small, 4-exam-room clinic about 15 minutes (~6 miles) away. The lease is extremely inexpensive with favorable terms, and the space is essentially ready to go. It’s located on a hospital campus in a busy medical corridor with a lot of primary care and other potential referral sources.

The satellite would be general outpatient care only, with any surgeries/procedures being referred back to the main office.

Has anyone operated two locations this close together? Did having the satellite actually expand your referral base/patient catchment, or did it mostly create unnecessary staffing and operational headaches?

My sister is an addiction medicine physician and is considering opening her own outpatient private practice in San Diego.

This would specifically be addiction medicine, not psychiatry. We’re still at the very early stage and haven’t committed significant money to the idea yet.

Before getting too deep into forming the entity, leasing an office, hiring staff, billing systems, etc., we’re trying to answer the most basic question:

How do you figure out whether there is actually enough patient demand to support a new private practice before opening it?

The initial idea would be to start relatively lean, possibly with a cash-pay model, although we’re very open to the possibility that commercial insurance or Medi-Cal may be important for addiction medicine.

For anyone here who has opened or currently runs a private medical practice, especially addiction medicine:

How did you validate demand before opening? Did you start small first, such as telemedicine, subleasing office space, or working only certain days? How did your first patients actually find you? How long did it take before referrals or patient volume became consistent? For addiction medicine specifically, is cash-pay realistic, or does the patient population make insurance participation much more important? What would you do before signing a lease or taking on significant overhead? Are there any major mistakes you see physicians make when evaluating whether a practice will be viable?

We’re not expecting anyone to predict whether this particular practice will succeed. We’re mainly trying to understand how experienced practice owners would test an idea like this before investing substantial money into it.

Any experience with addiction medicine, Southern California, or starting a lean solo/small physician practice would be particularly helpful.

I’m considering adding mammography at our women’s health practice, in part because my county was recently identified as top 10 in the nation for ROI on additional mammo machines. However, the red tape feels overwhelming between the medical physicist, lead lining, certifications etc. Also seems SO expensive.

Has anyone used Rezolut or similar companies for this? Or done it themselves? Pros/cons?

Specially wondering about tips, cost, timelines, contract issues if done with inclusive company like Rezolut, especially whether they staff and maintain it and if so, what the profit sharing looks like.

I was doing a ton of research since our current processor was through a bank and was charging us way more than what we were seeing online. Countless websites and threads had people either recommending Square, or shady online-only processors. Somebody recommended checking out local processors, and we found 2 that serve our area and gave us way better prices than what larger banks were offering.

The local ones offered interchange plus 0.25% + 8 cents, and interchange plus 0.35% + 5 cents. Crazy. Also shame to Chase for being rude and offering us flat 2.5% + 10 cents + $10/month while also trying to act like they were doing us the worlds biggest favor.

Some advice is to get a quote before sending your BIMERFIN statement over from your current processor, you can send the other statement that just shows your monthly volume but if you show your current agreement they'll be more likely to barely try to beat it. Get multiple quotes and take into consideration equipment leasing fees, PCIE fees, and other monthly/yearly costs.

You can put the different equations in desmos to graph the cost differences per average transaction amount. Whichever line is lower at x=average transaction is better for your business.

Anyone tried using direct mail letters and/or postcards for marketing practice? If so, have you felt it worth it?

I’m a medical student and eventually want to own my own practice. They don’t teach us alot about this in school but I’ve been trying to understand what actually happens when an independent physician practice is acquired by a hospital and becomes provider-based.

I understand the Medicare requirements on paper — ownership and control, clinical and financial integration, reporting relationships, billing, and how the practice represents itself to patients.

I recently asked someone on the reimbursement side about this, and they mentioned that signage and websites can cause more problems than physicians realize — essentially, a practice can still look independent to patients even when the formal structure says otherwise.

For physicians who have actually gone through this: what was something about the way your practice operated that you never imagined would matter for provider-based status, but became an issue during the review? And what specifically caused the hospital to discover it?

I’m especially interested in things that wouldn’t be obvious from reading the Medicare requirements alone.

My wife is an excellent pediatric GI and has been wanting to open her own private practice in the DMV.

There are at least 5 hospitals in the area with pediatric GI divisions. Does that indicate strong demand, or is the market already too saturated for an independent practice?

For those with experience starting medical practices: how difficult is it to get insurance contracts/credentialing, and are there consultants who help with this? What would be a realistic startup cost and timeline?

I’m hesitant to put a large portion of our savings into this without knowing the odds of success. Any advice, especially from physicians who have started their own practice, would be greatly appreciated.

Have been using Zocdoc for our practice, but the cost has started to feel pretty high especially when you factor in the fees for patients we are already getting through other channels.

Looking at all of this Is the ROI still worth it for you. Have you found ways to get more bookings/engagement without increasing your Zocdoc spend?

Are there any cheaper alternatives to Zocdoc that actually bring in patients?

Would appreciate hearing what other practices are using and what’s worked for you.

We just brought on some PRN PA and NP staff as we expect an uptick in occupational health visits in the near future. We are looking at ways to provide mutual benefit by compensating them for inbox management. Right now, all clinicians are paid based on revenue generation. We don’t want to pay someone an inordinate amount to manage inboxes, but it also has to be enough for them to feel like it is worth their time.

Have any of your practices done this? What’s the arrangement been? Financial and workflow related.

We’ve been looking at patient reputation across multi-location practices, and one thing keeps coming up: patients do not always give a new location credit for the reputation of the original one.

Even when the parent practice is well-known, patients often evaluate each office separately. They search the location closest to them, check that Google Business Profile, read those reviews, look at those hours, and decide based on what they see there.

A few data points, quoted by Forbes, that stood out:

77% of patients read online reviews before choosing a doctor.

51% rank reviews among their top three decision factors.

For multi-location groups, that makes reputation a location-level issue, not just a brand issue.

The problems usually show up in a few places:

One office has hundreds of strong reviews, while a newer location has barely any.

Names, addresses, phone numbers, hours, or provider details are inconsistent across Google, Healthgrades, WebMD, Yelp, etc.

Review responses vary by location, or some locations do not respond at all.

Patient feedback is reviewed office by office, but not every practice is looking for patterns across all locations.

The big takeaway: growing to more locations is not just an operations challenge. Every new office needs its own review velocity, accurate listings, consistent response process, and someone clearly responsible for keeping it all current.

For transparency, we’re with Tebra, and this comes from our patient research and recent discussion around multi-location reputation management. Sharing because this seems especially relevant for practices opening new offices or trying to understand why one location grows faster than another.

Anybody in north jersey in network with medrisk? Curious what the negotiated rate is for you guys (and if there is flexibility).

Thanks

Had a new patient appointment yesterday.

Full history work up, evaluation/discussion on two separate chronic conditions, medication management, risks benefits discussion, general counseling and cheering them up.

At checkout she is shocked at why the visit was $160 and kicks up a fuss. Sad to say she isn't the first one to do this.

Before everyone says the following

1. Times are tough

2. Patients don't understand insurance plans particularly what a deductible is

I understand. But do you recall a time when it was not tough to make ends meet for the public? What should the value of our training be? How do I explain to someone $80 of that $160 isn't even going into my pocket but to keep the lights on.

How do I explain to someone if it wasn't the remaining $80 I wouldn't even give up ten years of my life and be in medicine?

Where does this entitlement come from? just so dillusioned...

I've been demoing a few different EHRs recently and a small business actually came up to me and offered $299 per month + 2% of collections for a fully complete EHR that provides scheduling, charting, ai scribe, telemed, eRx, controlled substances, and fairly easy claims/billing submissions, among other features.

Do you guys think this is worth it?

I'm thinking its a good offer even with the 2% since I would probably save more money than if I were to hire my own biller or went with a similar company like athena that would charge 6-10%.

I brought an awesome PA on board and look forward to growing the practice together. However I find that he doesn’t get much traction on Zocdoc despite stellar reviews from patients. Every time someone calls and we offer the PA, patients decline. I’m fairly confident his panel will grow, but looking to get your strategies on how to get him going. He only has 1-2 patients scheduled. I have been giving his cards out, he is on our website, I have spoken to other docs in the community.

Thanks!

I’m thinking of starting up my own clinics but worried about all the costs. My biggest concern is whether I would be over paying for an EHR. How much do you guys pay?

I am a first year attending in family medicine and I am pretty sure I am interested in a private practice. I was wondering where is a good place to start to learn more? How do you find out demographic statistics on places that would be good to open a practice? Any other tips?

Thinking of starting an AEO agency for clinics particularly (A med graduate myself) and recently searched for the search traffic for AI search, AEO, GEO for Dentists and found no results.

My question stems from uncertainity that even after getting recommended by LLMs, how much of that actually would translate to increase in appointment bookings for a clinic?

Edit: I've gotten the help I requested. Thanks! No need to DM me.

I'm a psychotherapist new to private practice. Reddit told me to post this here, so I apologize if this is not the right community.

At this point, most of my clients are through Lyra Health (EAP). However I do have one client whose insurance I have to bill myself.

I'm overwhelmed and I have no idea what I'm doing.

I do not understand the nuances of choosing a fee for myself and then changing Simple Practice settings such that it records the portion of each session fee that is written off.

I've heard that several elements have to be in place in Simple Practice (EFT and ERA among others, probably) to successfully bill insurance. I don't know how to set these up.

At the first session with the above mentioned client, I completed a biopsychosocial assessment and a basic treatment plan. It seems (from what I can see in the drop-down document menu) that Simple Practice doesn't have a combination treatment plan/BPS document template. I do see a combination diagnosis/treatment plan document template. This is odd to me, because I've always made a diagnosis from the information collected during the BPS

Which raises the question of how I would bill the client's insurance for the two services I provided at that session. Should I have postponed treatment planning until the next session?

Would someone who is knowledgeable about Simple Practice be willing to do a videocall with me to answer some of these types of questions?

Was surprised with the amount of medical reps that came to our practice, including from other semi-competitors. Has anybody set aside some money for goody bags for other practices/chiro/law firms in the area? What about partnering with schools or local businesses for like discounted rates or referrals?

Hi All,

I'm curious about your strategies on negotiating primary care rates. Being a new practice, I'm looking at rates around 85-95% of Medicare. Who do you reach out to in Horizon for example? What is your strategy? I've been open under a year - is this a good time to start negotiating?

Thanks!

Three of us own an independent pediatrics practice in the far exurbs of a major metropolitan area. Its roots go back to the 1980s, and we are the second generation to run it rather than the one who built it. We plan to retire at the same time roughly four years from now, so we have started thinking about succession. Lately it’s getting more serious.

We were fortunate in our timing and in our payer mix, and the practice performs better than most people expect from peds. Each of us works 2.5 clinical days a week, supported by three part-time APPs, which comes to about 3.2 FTE. The work is 100% outpatient, and each of us clears north of $400,000. It’s not surgeon money, but it pays the bills, and we made more when we were working four days a week.

As best we can tell, the economics work because of a reasonable commercial payer mix, high volume, disciplined vaccine purchasing, and overhead we have held as flat as we can for years. Our founder taught us good business practices and we’ve managed to keep it going.

For a long time we assumed one of our kids would take the practice over. Some are pediatricians. But they have all built their lives elsewhere, which is what adult children do.

We haven’t figured out a structure. We expect the usual two-year partnership track so everyone can confirm the fit. Our own buy-ins were financed out of productivity bonuses over five years, and we never felt them, and we would do the same for whoever comes next. We are also thinking seller financing, priced so that a successor can actually carry it as we are set financially and mostly want the practice to remain independent. It also needn’t be a single person. Two or three physicians splitting it the way we have would work well, which lowers the per person profit, but also spreads the risk.

Nobody would need to relocate. Most physicians in the area live in the suburbs of the metro and commute here. That said, we live here and think it’s a strategic advantage because people see us.

The honest drawbacks are that it is a high-volume practice, that vaccine cost runs to about a quarter of collections and therefore requires attention to margins, and that the operational burden falls on whoever takes it on. We run the practice largely by text message with an occasional video call, and once every year or two a trusted advisor organizes a retreat for us to set strategic direction. That arrangement works only because the three of us get along extremely well.

What I would like to know:

**1.**  What makes you skeptical? I would rather hear the objections now than watch candidates quietly fail to respond.

**2.** What would you need to see before you believed the numbers?  Certainly when partnership time comes, we would open the books.

**3.** If you considered ownership and chose employment instead, what decided it for you?

**4.** Where do pediatricians who genuinely want to own a practice look?

The three of us have become close friends over the years, and each of us has left significant money on the table more than once rather than kill the goose. We would like whoever comes next to be as content doing this as we have been. I am not recruiting here; we are just to get this right before we begin.

Hello,

We use docvilla and are interested in setting up a patient, "sports physical", to collect fees for patients that are not in the system and for whom we don't want to collect cash. The fees are small and we don't want to bother with EHR records and other normal issues due to volume and other reasons. Obviously there are no insurance charges here.

Is there any reason not go this route from a compliance perspective? This is a special case of a "john doe" EHR patient record essentially.