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Explore This IssueJune 2017
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Want to Open Your Own Practice? Read This First
Thinking of going solo? If so, you may want to think again, says Karen S. Kolba, MD, rheumatologist, Pacific Arthritis Center, Santa Maria, Calif. “In today’s payment environment, it would be very difficult to start your own practice, especially a solo one,” she says. “The economies of scale are just not there.”
Dr. Kolba explains how expenses can pile up. She introduced an electronic medical record system in 2000, and now has 17 computers. “The acquisition was gradual, but my staff and I could not function with less,” she says. Since then, she has traded a minimum-wage medical record clerk for a $150-per-hour computer tech. She contracts with a local company for these services, as well other companies for billing, collections, cleaning, maintenance, hazardous waste disposal, shredding, off-site storage and a security system.
Presently, Dr. Kolba has an in-office infusion center for her patients’ use only. “But with new Medicare price changes, this may not remain viable,” she says. “I used to have dual-energy X-ray absorptiometry, but when payments dropped, I had to pay to have the machine carted away.”
The bottom line, Dr. Kolba says, is if you start a new practice—either solo or a small group—you will need significant financing to cover your own income for the first couple of years, even with a full schedule. “You must have the right people working for you and pay them well,” she says. “Good help is hard to find.”
Jonathan M. Greer, MD, FACR, FACP, president, Arthritis and Rheumatology Associates of Palm Beach, and affiliate clinical professor of medicine, Nova Southeastern University, Boynton Beach, Fla., would also frown on starting a practice on your own. “Instead, start a practice with others or join an existing practice,” he suggests.
Further, he advises that you know your tolerance for risk. “If Medicare changes MACRA reimbursement or reimbursement for our infusion services is cut, it could greatly impact us,” he says. “We are all worried about this; nothing stays the same in this business. In recent years, we’ve had multiple stressors to deal with, including changing to Meaningful Use for electronic health records, making changes to meet HIPAA compliance and adapting from ICD-9 to ICD-10 codes.”
Robert L. DiGiovanni, DO, FACOI, FACR, program director, Rheumatology Fellowship, Largo Medical Center, Nova Southeastern University College of Osteopathic Medicine, a rheumatologist at Suncoast Internal Medicine Consultants in Largo, Fla., says opening a rheumatology practice is not for the squeamish. “If you choose this path, surround yourself with excellent staff,” he advises. “Stay abreast of medical education to keep you on your toes. As your practice develops, don’t hesitate to bring on young physicians who have new ideas and techniques.”