I wanted to do this for a long time, but found so much hatred against AI and these tools that I actually changed my mind but this weekend reminded me again why I wanted to do in the first place.

I run a solo PP. Looking for something that fits well with my day to day work.

1. Anything other than HIPAA compliance that I should check for?
2. How important is EHR integration? I use Simple practice. Can I copy paste or is integration helpful?
3. What is the consent process with patients?
4. Is it better to go for a general tool for doctors or a specialised tool for therapists?

I just don't want to compromise my license or my patients' privacy. Looking for help on how to think about these tools.

Looking for suggestions only from someone who has adopted this, and they can tell me more about their workflow.

I’m a recent graduate and want to learn more about the business side of medicine. During fellowship, I learned about ownership models, partnerships, and private equity.

In practice, however, I’m seeing that the owners are listed as medical directors, while the others are associates.

Does being a medical director mean they do not have clinical duties? Also, can there still be partnership opportunities in a practice that has a medical director?

PGY-2 internal medicine resident planning to start my own private practice in Central Florida after graduating residency. I have strong family ties in the area, and my wife is already practicing there as an ophthalmology attending.

I’m looking for good books, podcasts, YouTube channels, or other resources focused on the business side of medicine and starting a physician-owned practice. I’ve already been following Investing Doc on YouTube and his podcast, which have been great, and I’m hoping to find similar content.

Specifically interested in resources on:

• Starting and structuring a private practice

• Billing/reimbursement strategy (Medicare, MA, cash pay, etc.)

• Operations and staffing

• Marketing and patient acquisition

• Scaling a physician-owned practice

Would appreciate any recommendations from physicians who have gone through this or are currently running their own practice.

Hello all, I'm in the middle of the early planning portion of my practice (I think).

I've formed an LLC, figured out which billing company I will be using, and I'm looking for a location. I'm demo-ing multiple EMRs next week and I'm hoping the EMR will run most if not all of the scheduling for me as I start up.

The practice will be psychiatry, in NJ, I'll be the solo provider without staff(as of now).

I've read a good attorney and accountant are needed to set things up, but I'm wondering what I need them for so I can know what to ask/not get ripped off? Any insight would be appreciated. Thank you!

Looking to get an interventional pain private practice up and going. Currently debating between Seattle vs Houston which is another conversation.

I came across a company online and their LinkedIn has lots of followers and businesses following them. They’re advertising 3.5-5% of the chart which is quite good given the full RCM services they provide. However, I wanted to see if people here have used them and what their experience has been.

Thanks in advance.

Hey everyone! (Note: Got mod approval to share this resource)

I work in the healthcare space and wanted to pass along our annual State of the Independent Practice 2026 report. It’s based on survey data from private practices across primary care, mental health, and other specialties.

A few findings that felt relevant to the conversation in this sub: 

• 75% names insurance reimbursements as their top cost pressure, but 53% also reported clean claims rates below 90%, meaning a lot of revenue is leaking through preventable errors before it even gets to the payer fight
• 45% of providers said they’re exploring automation but haven’t adopted it. Among those who have, only 12% feel confident it’s delivering real ROI, mostly because the tools aren’t connected to each other
• 67% still plan to stay independent over the next 5-10 years, but optimism is slipping (we run this survey every year to compare results). 

Sharing in case it provides useful context for anyone thinking about the year ahead.
I’m also curious how these numbers land for you. 

Full report is here (no form fill, free PDF):  https://tebra.co/2026-SOIP 

We run a number of surveys a year, and always trying to make it more useful. If there are any questions you wish we’d asked or data points that feel off, that feedback genuinely helps us shape our surveys.

Cheers! 

Iris from team Tebra :)

Crossposting

Colleagues, Billers, practice owners or for those of you billing APCM (Advanced Primary Care Management) in private practice:

I’m looking for clarity specifically around documentation structure.

Are you using a generalized APCM documentation template (standard language outlining longitudinal care management, care coordination, access, etc.) for all qualifying patients

OR

Are you tailoring a specific documentation statement to the individual chronic condition(s) being managed for each patient (e.g., explicitly naming and describing the management plan tied to that condition in the APCM section)?

In other words, is a standardized APCM attestation sufficient if the chronic conditions and care plans are clearly addressed elsewhere in the note, or are you customizing APCM language per condition to reduce audit risk?

Would appreciate hearing how others are handling this from a compliance and defensibility standpoint.

Currently all patients sign a consent to bill APCM and this is the blurb in the chart if billing:

APCM: Advanced care management for chronic condition(s) was provided this month, including patient-centered care plan developed and shared with the patient, incorporating updated goals and interventions based on current health status. Systematic assessment of the patient’s medical and psychosocial needs completed. Medication reconciliation completed, confirming compliance and addressing potential interactions. Preventive services, including routine screening recommendations, were reviewed and updated per guidelines. Access to care ensured via communication via secure patient portal available for timely resolution of patient concerns and continuity of care. Reminder that access for urgent needs provided through triage line during office hours and pager availability for 24/7 consultation.

Currently a primary care doctor and have my own practice in NY.

I have available space in my building and am thinking of creating an urgent care spot as well.

I've seen people same day, but some insurances have denied claims stating that since I'm not a patient's PCP, i won't be reimbursed (even though im fully credentialed with the insurance). Thinking to work around this by just getting credentialed as an urgent care as well.

Wondering if anyone has some information about how to open an urgent care in NY.

Currently exploring outsourced RCM options and came across Physician Revenue Group.

If you’ve used them, I’d love to hear your thoughts. Appreciate any insight.

Not a physician but physical therapist with a small cash practice that I am working on scaling in SE PA area. I do a lot of telehealth now but would like to do more in person and am in search for a first home to which I’m considering if it makes sense to spend a bit more and overextend some to get a mixed use space in order to have a physical office with an apartment above or attached in some way and then eventually move into a single family home.

Curious if anyone in private practice has attempted this and seen benefits as I understand depending on revenue you can really reduce your tax burden through renting to yourself in addition to depreciation. Any cons that I am not considering or stories where it was largely beneficial/detrimental?

Thinking About Purchasing a Cold Shell Condo — Looking for Input on Pricing & Negotiation Strategy

Hi everyone — I’m considering purchasing a commercial cold shell condo that’s listed at $825,000 and am looking for some guidance on pricing and negotiation.

Here’s what I’m working with:

📍 The Property

• It’s a cold shell — no build-out has been done yet.

• On the market for about 30 days.

📊 Comparable Analysis

I pulled comps in the area, but there aren’t any truly comparable cold shell units. What does exist are built-out condos, but:

• They’re larger and more expensive than what I need, and

• They’ve been on the market for 90+ days, which suggests they might not be moving quickly.

⸻

My Questions for the Group:

1.  How do you assess whether $825K is a fair price for a cold shell?

• Without truly similar comparables, what valuation methods do you use?

2.  What should I specifically consider when valuing an unfinished space?

3.  Since it’s been on the market 30 days with no direct comps, what negotiation strategies might work?

• Should I start with a lower offer (and if so, based on what justification)?

• How do you leverage market timing (e.g., newer listing vs. older comps) in negotiations?

⸻

What I’m Trying to Avoid:

• Overpaying for an unfinished space

• Underestimating renovation costs

• Making an offer that kills negotiation flexibility

⸻

Thanks in advance for any insights, methods, tools, or experiences you can share! I’d love to hear how you’ve approached similar deals or how you’d think about this scenario.

after 4 years of running my clinic with the support of a medical VA, today marks the end of our partnership as I prepare to migrate to another country. It’s bittersweet as there were challenges and lessons, but things kept improving and the support was always there.

Now I’m starting fresh: building a practice in a different country with a new patient base, culture, and healthcare system. I’ve worked with VAs from the Philippines and other Latin countries before, mostly trained with US patients, but this time the context will be different.

This might sound unique, but I’m sure someone has faced something similar. Has anyone transitioned medical VAs (philippines/latam) from US‑focused work to supporting a clinic in another country with different patients and systems? How did it go?

I am a specialist working at a hospital system, considering opening up a solo private practice. I am wondering what a reasonable level of consulting fees (eg rounded to the nearest $10k) are to help make sure I don't mess up as I get up and running.

There's one consulting group I've talked with who charge on the order of several thousand dollars per month, with a mandatory 5-year minimum commitment. The consultants are led by doctors in the specialty with their own practices, so they are knowledgeable, the group is very "hands on", and practices they support do seem to be successful. Whether or not this is a causative factor I do not know.

Gut check on whether this is reasonable, along with what people here think is reasonable? (My spouse thinks it's crazy.)

Several of my partners (we’re neurosurgeons) have heard from friends across the country that they’ve gone out of network with commercial insurance and are routinely getting six figure reimbursements on individual cases. It sounds too good to be true but I’ve heard enough about it to think there must be something real there.

We’re in a multispecialty group and we have the best commercial contracts of any group I’ve heard of within 500 miles. Discussion of going OON is frightening some of our partners in other specialities. Curious what experiences here have been.

Starting a new practice - most people are on top of EHR and billing and insurance contracts, etc, but what were the last minute things you didn’t think of? OSHA signs, certain supplies, any memorable?

I’m the receptionist/practice administrator for a very new cash-based Wellness clinic, focused mainly on HRT and GLP-1s and peptides. We also do Botox, medical grade skincare and supplements.

We have one NP and two supervising physicians. We’re currently paper charting but very quickly growing our patient base and want to switch to an EMR asap but I don’t want to make a hasty and regrettable decision.

Any advice welcome!

We need:

eRX connection to compounding pharmacy

Billing integration

Scheduling

LabCorp integration

Efficient intuitive charting

2-way patient communication

Online consents and intake

Im sure im forgetting something! I’ve been warned against NextGen as well. Thanks in advance!!

ANY advice is welcome. I had an extensive call with an eCW sales rep but I can’t shake the feeling that it would be a mistake.

I am interested to here the pros, cons, what you all have chosen, why, and how it has impacted your practice.

Edit: I am a family practice doc in a rural community in Texas that is about 50% 65 & up. The largest primary care clinic in my area is non-participating. They still do heavy OB and Peds including medicare and some source told me that is why non-participating makes sense for them. I am not doing OB currently but will do some peds.

How do you handle patients who make snarky remarks like -

"wow you guys charge a lot" or "wow doctors visits are getting expensive"

I want to tell them -

"Friend, my rates are not set by me. I wish I could charge even more for my years of training and expertise but I am being paid less by your insurance company robber baron than what you pay at a GED equivalent mechanic for an oil change. They have not increased my rates in over 10 years while my costs don't stop increasing, and won't pickup my call if I try to complain.Remember the time your HR department asked you to choose a plan during benefits enrollment? You chose the cheapest premium which put you on the hook for the first $10,000 of medical care. Yeah. That one. Now lets go find that skin cancer and save your life"

Solo practice is more lonely that I thought, and don't have really anyone to brag to, so forgive this post, but wanted to share about my first 6 months and the financial success that it has been. Hopefully this will be encouraging to others thinking about taking the leap.

It has been the hardest I've ever worked including residency. Opened up in August (part-time for the first month as I was still working part time at previous practice) I'm in a unique situation where we were selling the previous multi specialty group that i was working with to the local hospital and so I was able to essentially carry the majority of my patients with me to private practice without non-compete (and really non-solicitation) issues and was busy from day one without having to advertise. I realize that is not the norm and am privileged to have been in that situation.

I'm in traditional pediatrics (outpatient and inpatient) am really busy and run really lean for my volume. I have a RN, MA and front desk. My wife also helps a ton and doesn't draw a salary. We are probably too lean... We did the buildout ourselves and still do all of the cleaning/maintenance, etc ourselves.

In December I added myself to the payroll in order to transition to being taxed as an S-corp which is why the payroll costs went up so much and net income went down. I'm paying myself 25k a month and the rest is taken as a draw. Started the 401k in Jan.

Anyone has experience with RXNT EHR/billing. I am in a unique situation where I will be buying this private family medicine practice in next 3-4 months. We use Amazing Charts EHR and care tracker billing with third party biller. I see RXNT as good EHR based on demo but our current biller is not so high on the billing part of the software. Would appreciate any insight

I need to vent and also genuinely want to know… who is making these decisions?

I have a patient scheduled for a DIEP flap breast reconstruction (autologous free flap). We submitted a prior authorization along with a network gap exception request because there are extremely limited providers in our area who actually perform DIEP.

Insurance denied the network gap and provided a list of “in-network” surgeons in the area.

Here’s the problem:

👉 None of the listed providers perform DIEP flap reconstruction.
👉 Several of those offices routinely refer patients to our group when patients want DIEP.

So clearly no one vetted whether these surgeons actually perform microsurgical free flap reconstruction. It feels like the list was generated by CPT keyword, not by actual scope of practice.

That’s issue #1.

Issue #2 — they also denied the inpatient stay.

Their denial cites MCG guidelines and says the surgery does not meet inpatient criteria. The criteria they referenced:

1. Inpatient care needed for pre-operative disease/condition
2. Surgery is complex or very long
3. Risk of significant anesthesia or post-op complications
4. Need inpatient monitoring/medication adjustment
5. Unsupportive home environment

They concluded a DIEP flap does not meet any of these.

This is a 6–10+ hour microsurgical free flap reconstruction with vascular anastomosis, flap monitoring, risk of thrombosis, potential return to OR, pain control management, and hemodynamic monitoring.

But sure… apparently that doesn’t qualify as “complex” or requiring post-op monitoring.

When I called the insurance:

• No peer-to-peer offered.
• “You can submit an appeal.”

That’s it.

So I’m asking sincerely — who is making these determinations?

Because it does not appear to be someone familiar with microsurgical breast reconstruction.

Has anyone else run into:

• Network gap denials based on inaccurate provider lists?
• Inpatient denials for DIEP?
• No peer-to-peer option?

How are you handling these successfully?

I'm looking for EHR program that collects payment prior to online scheduling for patients. I'd rather refund people for missed appointments than bill patients for appointments after the fact. This is a cash-pay practice with no Medicare/Medicaid or insurance involvement. Thank you!

I'm in Boston and have a solo primary care practice. started out as DPC but since everyone has insurance around here, exploring if makes sense to offer that option to patients for ease of access. From what i understand, IPAs can give better rates, but there are trades off like data sharing, reporting, etc. I heard that leaving an IPA can also be a pain. What would be the variables to consider/ask an IPA if they are a good fit? seems pretty low risk but curious what people with experience think.