Chiro and PT practice (Full Version)

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cowboybuboy -> Chiro and PT practice (February 21, 2008 10:14:52 AM)

I have an offer to work with a DC. It sounds really good. He said that I will have my own practice in the same building, about 6000 sq ft, and I will be entitled to a 40% gross, like a partnership. So, I don't know if this is actually a good idea. The way it sounds now is really good. I will be starting my own private practice with no cost,  no marketing, no billing problems and everything set-up already. He said that I will be working with a DC and we'll be both managing a decent caseload. Also, he said that my practice is totally different from the DC since I will handle all PT patients like total knee, total hip and other PT related patients.
I really wanted to start a private practice and I guess this one is my ticket to get started sooner.
I guess, the main question is, how much usually is the gross collection PER patient in a DC setting? Or is it PT additional treatment?
Thanks to all!



TexasOrtho -> RE: Chiro and PT practice (February 21, 2008 2:12:00 PM)

quote:

It sounds really good. He said that I will have my own practice in the same building, about 6000 sq ft, and I will be entitled to a 40% gross, like a partnership. So, I don't know if this is actually a good idea. The way it sounds now


Ask to see his profit and loss statements over the last 12 months.  Don't bother looking at the gross.  Look at the net revenue.  Reimbursements to chiros are steadily declining.  Make sure the DC is not simply using you as a revenue stream.  I rarely say never, but I would never work with or for a chiropractor.  Too many legal, financial, and ethical issues at stake.



jlharris -> RE: Chiro and PT practice (February 21, 2008 2:16:53 PM)

A "partnership" to me would be:
1. Share overhead costs (lease, billing, maybe support staff)
2. Possibly share marketing if the point is to offer "one-stop" shopping type of care
3. You bring in your money from pt care, he brings in his and what ever you have left over after paying 1 and 2 is yours.

IMO, the set-up you describe is more of a way to use you to bring in money for them, not for you to build your own practice.  But that's just off of the description you profided.

BTW, I'm not absolutely against a PT-Chiro partnership.  I am against a PT working for a Chiro type of relationship.



Kaden -> RE: Chiro and PT practice (February 21, 2008 3:11:54 PM)

If you are interested in starting up your own practice without all the startup costs and risks that come along with it there are many PT owned clinics out there that support you in doing this.  Obviously the downside is you work some of this off in sweat equity and they will require you to give a percent of profit back to the company to invest.

I think you have to decide what kind of practice you want.  If you want to be in charge of staff, schedules, hiring, firing, etc then going with a PT owned company who will help you with the set up is the way to go.  You give up some profit for less risk, more centralized billing that you don't have the constant headache of dealing with, combined marketing, obtaining ins. contracts, etc

However, I know a lot of bright PTs with good business sesne that also don't mind putting up with the billing headache, obtaining contracts, etc and the better option for them is to open your own practice most likely putting in more work than the previous scenario but for a bigger return.




cowboybuboy -> RE: Chiro and PT practice (February 21, 2008 8:02:04 PM)

The DC wanted to start with Medicare reimbursement and they had the same set-up before with other therapist. Apparently, right now they just want a PT in there to treat 35-40 patients a day for manual therapy, modalities or for some other reasons.
Personally, I don't care about working with DCs as long as they don't interfere and they said it's my own decisions and the billing will be done by them and payments sent to me directly and I can pay them their percentage.
So, it looks like a good thing.



TexasOrtho -> RE: Chiro and PT practice (February 21, 2008 10:08:24 PM)

quote:

ORIGINAL: cowboybuboy

The DC wanted to start with Medicare reimbursement and they had the same set-up before with other therapist. Apparently, right now they just want a PT in there to treat 35-40 patients a day for manual therapy, modalities or for some other reasons.
Personally, I don't care about working with DCs as long as they don't interfere and they said it's my own decisions and the billing will be done by them and payments sent to me directly and I can pay them their percentage.
So, it looks like a good thing.


35-40 patients per day for "manual therapy"...alarm bells are going off my friend.  How can you work with this DC, see HIS patients, and he not interfere?  The fact that the billing is done by them should be even more alarming.  You will want to know the details of any claim that goes out with your name on it.  Otherwise you are at extreme risk for civil liability.  I would make damn sure you are able to practice under these circumstances without incurring legal or other risks.  I don't know all the details of your situation but it sounds very risky to me.



jlharris -> RE: Chiro and PT practice (February 22, 2008 12:52:03 AM)

Do the math:  8 hr day = 32 units.  So, to see 32 medicare pt's you'd have to only bill one unit each.  More units, or more pts it seems like it'd be fraud.  Would seem pretty questionable for private insurance, too.



OAK -> RE: Chiro and PT practice (February 22, 2008 11:37:23 AM)

This is definately NOT a partnership.  In reality you are simply working for a DC who is paying you 40%, which is on the low side.  Why not just work in a PT clinic?



orthotherapist -> RE: Chiro and PT practice (February 22, 2008 1:04:53 PM)

I would agree with the above posts.  Chances are they have no idea what/how to legally bill Medicare.  You treat and they bill - sounds very fishy.  I had a former employee that left to go into a similar situation against my advice/warning.  He was ethical with regards to billing and thought things would be "fine".  Long story short lasted only a few months as they were billing improperly per Medicare guidelines etc, etc.  and would not change even after he provided them with the proper billing references.  Good luck



Kaden -> RE: Chiro and PT practice (February 22, 2008 9:37:20 PM)

With current regulations I don't see how anyone could treat 35-40 patients ethically or effectively unless you worked directly with a PTA which it didn't sound like that was the case.  Otherwise as Jason pointed out you would bill 1 unit per patient seeing each for 10-15 minutes.  If that is the case then we run into as issue of effective care, and I believe you could not provide effective care to the MC population in this amount of time. 

I echo the statement about fishy billing.  You can't always assume that someone doing billing for you is doing it correctly or ethically.

By the way in your post you throw out the 35-40 patient number like it is no big deal.  That would have been an absolute red flag for me.  Are you typically seeing that many patients?



cowboybuboy -> RE: Chiro and PT practice (February 22, 2008 11:45:53 PM)

Well, I talked to them about it and it seems that 35-40 is between me and the DC. Billing will be based on the coding that I provide them. Also, the 40% is basically everything I'll earn without having to think about the rent issues, billing fees, secretary/receptionist cost, equipment cost and office misc expenses.
The way I see it, I'm walking with just my skills and without any financial risk to start a private practice.
In addition, they will apply for me a provider number and include me/my company to the insurance network without me having to worry about it, which later on I can use to actually start another clinic.
Anyway, just wanted to get some feedbacks from everyone. At least now, I can watch out for whatever problems that may arise later on.
Thanks to all!




TexasOrtho -> RE: Chiro and PT practice (February 23, 2008 12:07:10 AM)

quote:

ORIGINAL: cowboybuboy

Well, I talked to them about it and it seems that 35-40 is between me and the DC. Billing will be based on the coding that I provide them. Also, the 40% is basically everything I'll earn without having to think about the rent issues, billing fees, secretary/receptionist cost, equipment cost and office misc expenses.
The way I see it, I'm walking with just my skills and without any financial risk to start a private practice.
In addition, they will apply for me a provider number and include me/my company to the insurance network without me having to worry about it, which later on I can use to actually start another clinic.
Anyway, just wanted to get some feedbacks from everyone. At least now, I can watch out for whatever problems that may arise later on.
Thanks to all!


Man...I think you really don't get it.  Nothing is free mate.  Start a private practice with no financial risk?  It doesn't happen.  If someone tells you that, do not drop the soap and watch your back.  Best of luck.  You will need some.



Sebastian Asselbergs -> RE: Chiro and PT practice (February 24, 2008 12:26:37 AM)

And your not building for yourself - and there is no more than a two week notice - and what growth is there for you - what happens when a newer and more desperate one comes along who does it for 38 percent.....Where is your autonomy - what are your checks and balances for the use of your provider number - what access do you have to do random reviews of billings, etc etc.  look before you leap...[;)]



SJBird55 -> RE: Chiro and PT practice (February 24, 2008 9:05:25 AM)

Cowboy, you are an interesting character.  From reading the various posts you write... technically, you are always looking to make a quick buck.  You never want any risk and you want to make as many bucks as you can.  Sad state of affairs if you need to use a forum as a sounding board for all the various endeavors you happen to have offers.  I believe the reason that you tend to have so many offers (assuming what you write is true) is because the physicians or the chiropractor or whoever it is that offers you "something for nothing" knows that you'd go for it without giving much grief or much of a fight to the proposal.  It's almost as if they know you'll be their personal slave... that's what they are always asking you to be.



cowboybuboy -> RE: Chiro and PT practice (February 25, 2008 4:33:31 PM)

SJBird55, I recent that comment of yours. You don't know me to say that I'm trying to make a big buck? And to be a personal slave? Is that your personal experience? A lot of PTs in this forum are against DCs. I don't know what they did to you, but they have not done anything to interfere with my practice. Don't make such accusations especially when people are trying to see what others may think about an idea. The reason why a lot of DCs are in private practice is because most of them are trained to be in business in the first place. As for me a physical therapist, when I attended school, nobody taught me how to be in private practice. So, in such case, I'd like to learn from people who actually know what they're doing. I'm not out trying to make a quick buck. If that's my motive, I wouldn't last in this profession. To tell you frankly, I am going back to Med School so I can deliver a better care compared to a lot of physicians out there. I'm investing money in education so I can be a lot better. It's not just about making a quick buck like you're accusing me. If you don't like DCs, you don't have to impose it to other people. It's like to some therapists, I feel like I'm discussing religion or politics when I touch that topic. If you don't think what I'm doing is right, then, keep it to yourself. I don't need you or anyone judging me just because you don't like DC/PT practicing together. Now, if I'm wrong about this move, I will be the one accountable for that, not you. I know you have a private practice and I asked you before how you did it. The way I see it, it worked for you. But it didn't work for me. So, I'm trying out something that might work for me. This forum was started to help other therapist with their private practice, not judge them. We don't have the right to do that. It's an individual practice, individual responsibilities. Nobody's accountable for anyone. Now if you don't like what I said, then, it's your problem, not mine.



jesspt -> RE: Chiro and PT practice (February 25, 2008 6:52:16 PM)

Cowboy,

You started this thread to get the opinions of some of your peers, and now you're upset that some of them have given them to you? Doesn't make sense to me.

Now, I'll admit that SJ used some strong language, but the gist of her post does not differ greatly from every previous post on this thread. Not one single poster thought that this soudned like a good idea. I am inclined to agree with them.
 
Why start the thread in the first place if your mind is already made up? It's quite obvious that you want to accept the offer of the DC - if so, go ahead and do it, but you certainly won't get the blessing of many of those that frequent this site.

And another thing - you state that
quote:

A lot of PTs in this forum are against DCs. I don't know what they did to you, but they have not done anything to interfere with my practice
I hope that you're not practicing in a state where DCs are trying to change the PT practice act. I have lived in Virginia and now Illinois, both states in which DCs lobbied hard for legislative changes to the PT practice act to limit our ability to perform thrust manipulation, I can tell you that collectively, DCs have tried to interfere with my practice a great deal.



SJBird55 -> RE: Chiro and PT practice (February 25, 2008 11:26:47 PM)

Cowboy, Cowboy, Cowboy... click on your name there on the left and view your posts.  (Your track record... asking for evaluation forms... unsure about how to set up a business.... physician interesting in paying you to treat patients... unsure when to discharge a patient.... now partnering with a DC!!)  Personally, I had the most fun mentally chuckling and responding to your post dealing with discharging a patient.  I really don't have anything necessarily against chiropractors - they are nice people.  (Chiropractice on the other hand, that's a whole different topic.)  I believe you could say that I have more of a problem with someone who doesn't do his or her homework!  I don't think you do your homework and I'll stop there.

Cowboy... there are books out there.  The APTA has a 3 manual series on Business Skills.  (They are kind of dry and boring, but the material is in it.  Peter Kovacek doesn't spice them up much to make them memorable reads.)  Samuel Esterson has a better book:  http://www.amazon.com/Starting-Managing-Physical-Therapy-Practice/dp/0763726311/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1203996400&sr=1-1  It isn't boring and he has a sense of humor.

Another piece of advice, if you don't want to know what others are thinking, don't ask!  [;)]



cowboybuboy -> RE: Chiro and PT practice (February 26, 2008 12:37:51 AM)

Who said I asked for opinion? I was asking about the gross reimbursement in the DC setting. I don't need your blessing. And how did you know I'm not doing my homework? I guess there are people here who have so much time to show their ego to somebody who's interested in starting out.  I never asked for your opinion. I asked about the reimbursement issues. I'm new to these things that's why I ask about specific questions. Not opinions. But I will never let anyone judge me because they think their opinion is much better than anyone else. This thread started out to be good. But I don't want to spend my time arguing with people who have problems being friendly in a PT forum. I don't want to create enemies. Just asking about the specifics. But I guess it's a bad thing to some. SJBird, you were a big help then, don't know what happened here.



SJBird55 -> RE: Chiro and PT practice (February 26, 2008 7:50:01 AM)

Okay....  your 40% gross is 40% of what?  Your work or both his and your work?  What is the patient mix?

First you state that your practice would be different than the DC... THA, TKA and the like... Then you change your tune to indicate 35-40 patients/day for manual and modalities.  Again, what is the mix of those patients and what are the rules/guidelines for the third party payors.  It may sound good, but ummm, if you aren't aware, they are allowing you to perform the lowest reimbursed CPT codes.  How much are you going to make only performing the cheap paying codes?  If your 40% is based on what you bill... that 40% chunk is going to be small, don't you think?

If you are paying the DC for their cut and you are receiving the money first, then reality is that you aren't a "partner" you have a role more like a "contractor."  You WILL have your own costs - I'd assume that you'd definitely take out your own liability insurance; you'll have your own taxes to pay; you'll need to worry about your own health insurance; you'd also need to worry about your own short and long term disability plans.
Check out the 2007 Medicare Fee Schedule:  http://www.cms.hhs.gov/apps/ama/license.asp?file=/pfslookup/02_PFSsearch.asp
Remember, the Medicare fee schedule is only at this rate until the end of June 2008 and then there is supposed to be a 10% cut in the fee schedule starting in July IF legislation doesn't change.

With regard to NPI numbers... it isn't rocket science.  They aren't offering you something you can't do all on your own.  There is no cost for an NPI number. 

I'm not an enemy.  You aren't doing your homework.  You want an easy path to what you want long term.  Now you're choosing a DC route to get what you ultimately want in the end. 

I think what happened to me is that I have grown impatient with your line of questions and am seeing a theme that you think there is an easy way... there is NO easy way when it comes to owning your own business.  It takes courage, staying on top of business stuff, staying on top of rules and regulations, staying current with the ever growing body of evidence to support interventions - it isn't easy.  If it was, everyone would be doing it.  IF things don't go well with the DC and your reputation is ruined because of the situation you might get yourself into, what are you going to do then?  Move?  What if things go so badly that your license is suspended or worse?  What are you going to do then?  You have to look at the risks of your decisions too...



cowboybuboy -> RE: Chiro and PT practice (March 22, 2008 1:08:43 AM)

SJBird, I don't really care if you're getting impatient. If you don't want to answer the question, then don't. Do not accuse me of not doing my homework. Asking questions is also part of due diligence. I'm not looking for a faster way of doing things. I know there's no other way. Now if you want to be the jerk that you are now, then, go ahead. I'm not going to get anywhere arguing with you or anyone else. I only asked for a ballpark figure and I get this. The way I see it, you have lots of time posting in this forum and trying to be the know it all. If you don't agree with something, you'll trash the idea. Well, not everybody will be bullied by you. So, just move on f r e a k.



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