A Complete Guide for Medical Practice Start-Ups (Part 6)

Revenue Generation and Quality Measures

The key to success for any medical practice is always vested in keeping is practically profitable. In today’s hyper-competitive healthcare space, it becomes even more important to sustain your profitability while you’re over-burdened dealing with crushing administrative and ever-increasing operating costs. If you are a medical practice start-up and are struggling with revenue generation and establishing quality measures, here is your practical guide to it.

Build an Online Presence

The foremost thing that attains priority on the to-do list of a medical practice startup is perhaps building an online presence. If you intend to launch and continue without one, you are sure to fall behind. Research suggests that more than 72% patients consult the internet for healthcare related information and around 62% rely on online reviews to look for new practices – this inevitably makes online presence a pre-req for your survival. If you’re not online, chances are that you are missing out on many potential patients.

Apart from setting up your own dedicated website, you might also want to submit your practice to online directories and also create your profile on major review sites. This will not only direct traffic to your official website but also spread awareness about your practice amongst potential patients. Similarly, setting up a profile on social media is equally beneficial in facilitating your practice to pop up in search results.

Improve Patient Collection Strategy

Revenue generation primarily relies upon patient collection, which is also directly linked to ongoing headache for many startup practices. Particularly owing to the increasing number of patients on high deductible insurance plans, revenue generation for start-ups becomes even more of a daunting task. It is a common observation that 20% of most medical practices’ revenue comes from patient co-pays but still many practices only collect 60^ of what is actually due. It becomes much more of a concern when you are a startup and meeting costs remains a concern. It is best to hire a collection agency and outsource your billing and collection tasks to a reputable and experienced vendor. However, if this sounds like too much of spending as of now, you might want to evaluate and re-evaluate your overall collections strategy.

Offer Telemedicine

Telemedicine has secured its long-due credit in recent COVID-19 times. When the entire world went into lockdown, and when uncertainty ran rampant in the streets across the globe, and when healthcare was the most important requirement of all, telemedicine came to our rescue. This has opened up new avenues for not only patient care but also for revenue generation. Start-ups have a lot to learn from this, and telemedicine makes perfect sense in a highly digital environment such as todays. You can cater to a lot more patients through virtual visits as compared to in-person visits; you can compete much mor effectively with nearby practices that only offer 9-5 service hours; you can offer your patients more convenient and flexible scheduling options – and the list goes on. Telemedicine will allow you to not only increase your patient footfall but also recapture lost revenue streams from uncompensated time, while perfectly balancing work-life balance for you.

Renegotiate Your Payer Contracts

Many established practices do not ever bother to renegotiate their payer contracts to improve their fee schedules. But being a startup, you certainly won’t want to miss out on ‘any’ revenue streams, would you? If you have enough data to reflect that you are offering great patient care outcomes in a cost-effective manner, you can enjoy the leverage of going back to payers and asking for pay raise. You might seek professional expertise of a healthcare business consultant for this, but you can also do this in-house to enjoy a much better ROI.

Establish Appropriate Quality Measures

You can certainly not put numbers to a standard of excellence but you can definitely establish benchmarks to measuring outcomes of care to determine quality. This will eventually translate into higher patient satisfaction ultimately leading to better revenue generation. Establishing quality measures and constantly seeking quality improvement, must, therefore, remain a priority of medical practice startups.

Patient Safety

Quality controls to reduce medical errors and enhance patient safety are important quality measures for healthcare startups. Errors pertaining to prescribing medicines, the percentage of patients who develop complications as a result of care, and post-procedure deaths are definitely amongst the alarming medical errors that you want to avoid. Patient safety comes first.

Data Security

Security and confidentiality of patients’ medical data remains another important concern for startups. Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) store critical patient data using digital technologies to allow easy access and retrieval on need basis. This has significantly aided the quality of health care offered by practices but at the same time flagged serious concerns over maintaining security and confidentiality of such data. You a medical practice startup, data security fundamentally means corresponding action between controlling access to patient data while allowing free and easy access to authorized individuals who need that information.

Effectiveness and Efficiency of Services

These quality measures relate to the services offered at your practice. While effectiveness refers to the outcome of medical treatments and knowledge, efficiency hereby relates to measures that focus on optimal resource utilization (time, equipment, expertise). Timeliness of services or promptness of services relates to both of the measures above. Factors such as patient wait times and patient satisfaction levels might come in handy herein.

About Author:

Alex Tate is a Health IT writer for various platforms. He provides perceptive, engaging and informative consultancy on industry wide topics. He knows that no single approach is the right one for every practice, and so shall advice according to the requirements. The consultancy is based around EMR Systems, Practice Management and Billing Solutions. MACRA/MIPS consultancy is also available to achieve the highest returns and revenue for your practice.

A Complete Guide for Medical Practice Start-Ups (Part 5)

For the smooth running of a practice, an electronic health record (EHR) software is a necessity, without which a practice cannot function optimally. Practices are making the switch from paper records to EHR on an ongoing basis. Partly, because of the HITECH act, which offers incentives to healthcare ventures for making use of EHR systems.

The implementation of these systems come along with both positives and negatives, and it’s frequently associated with the choice of EHR selection, as EHR plays a crucial role in the day-to-day lives of physicians.

According to Software Advice:

“Lawmakers continue to incentivize EHR adoption in reimbursement programs, though. Today, under MACRA and the current value-based care model, EHR use is a heavy factor in MIPS scoring. And yet, practices operating on paper records have to weigh those incentives against things like cost and data migration to decide if EHRs are truly worthwhile.”

Thorough evaluation of medical software is the key to an efficient practice, as the future of medical care will be powered by technology. One useful way to assess the usability of an EHR system is to validate it against a checklist. We have jotted down a list of features that will make or break your decision to use an EHR system.

Factors in EHR Selection

  • Functionality and Usability
  • Service and Support
  • Deployment
  • Integration
  • Cost

Functionality and Usability

The functionality of an EHR system is powered by a variety of technology dynamics, and by the constant user demand for more advanced features that improve the quality of care being delivered. The core purpose of an EHR system is built around the collection of clinical patient data and its analysis, storage and retrieval.

There are some features which should essentially be there for a practice to run successfully. These include:

  • Clinical Decision Support
  • Electronic Prescribing
  • Patient Charting
  • Interoperability
  • Patient Portal
  • Scheduling
  • Reporting

The key takeaway is to identify which features are required, from which you’ll be able to choose what medical software would best serve your needs.

Service and Support

Tech support serves as a crucial consideration when assessing EHRs. From a wider viewpoint, the support is either outsourced or in-house, depending on the size of an EHR vendor.

With the in-house support service, the staff is more acquainted with the application, and the help being provided stands on firsthand knowledge. In addition to that, the support would be provided natively through the application, leading to a more hassle-free experience. On the contrary, outsourced support is limited by the capacity of the company to troubleshoot deeper issues.

Moreover, some EHR companies offer dedicated support as an add-on service, which is why it’s always better to go through the terms thoroughly before signing the contract, so you always know whether the required level of support is included in the package or not.


When it comes to deployment, the customer has between two choices on what sort of deployment they can opt for, with altered implications on the functionality and cost of the product.

Local deployment Is when the product would be installed directly on the computer system in the practice. This way, the data would be saved on a local hard drive, and would significantly cut down on hosting subscriptions.

Web-based EHR is hosted on the cloud, and is usually maintained by the EHR vendor. This form of EHR has a low upfront cost, but is based on the recurring revenue model, so a monthly fee would be incurred.

What form of EHR to opt for is highly dependent on the practice budget, so it’s always good to take a look at the available options before settling for one.


Cross-connectivity with other electronic systems plays a major role in EHR selection. As an EHR systems is unable to independently work, and needs integration with other modules, such as patient portal, revenue cycle management and appointment scheduling to capably manage the practice workflows.

According to HealthCatalyst:

“EHR integration brings forward and leverages data and insights from digital health tools to provide relevant information, alerts to threats and opportunities, and financial and operational guidance at the point of care.”

If there is limited integration, the user would have to spend long hours on adding extensive information into the EHR system manually, which sometimes becomes a leading factor of physician burnout.


One key hindrance that healthcare providers face during EHR transition is the cost. There is always ambivalence if such a large scale investment would bring high returns as well.

Healthcare ventures should always look beyond the EHR as more than just a compliance obligation, since it provides with substantial cost-savings in the long-term.

According to Health Affairs,

“Practices can expect to cover the cost of EHR in approximately 2.5 years, and then receive an average of approximately $23,000 per year per full-time employee in net benefits.” 

This proves that a practice can have reduced cost in the form of faster workflows, minimized cost of labor, and a greater volume of accepted claims, amongst other things.

Final Thoughts

There are many factors which should be on the table before finalizing an EHR software for your practice. No matter how hard the transition is, every practice would eventually have to make the switch, if it intends to stay in the industry for a longer while.

Any sort of resistance will only be unfavorable for the healthcare venture. You can always check out several EHR systems available in the market before deciding what to go with, and most of the systems already come bundled with user training and tech support, so your practice will be up and running in no time.

About Author:

Alex Tate is a Health IT writer for various platforms. He provides perceptive, engaging and informative consultancy on industry wide topics. He knows that no single approach is the right one for every practice, and so shall advice according to the requirements. The consultancy is based around EMR Systems, Practice Management and Billing Solutions. MACRA/MIPS consultancy is also available to achieve the highest returns and revenue for your practice.

A Complete Guide for Medical Practice Start-Ups (Part 4)

Government policies and compliances

Healthcare is one of the most highly regulated industries in the US, and the regulations just keep on increasing with the passage of time. Moreover, the series of regulations that affect a provider’s office are no exclusion. Keeping that in mind, physicians usually have a healthy professional relationship with an attorney who is focused on the relevant law, and is responsible for clearing all procedures before they are implemented, so that the risk of future complications is lowered.

According to a Health IT source, “Federal and state healthcare laws and regulations change constantly and the interpretation of those laws and regulations changes just as frequently. Effective healthcare compliance must be an ongoing process of continually reviewing and updating the processes, policies, and procedures of the organization. The organization also must continually update the training provided to its employees based upon changes in the regulations.”

This validates the fact that health organizations need to be caught up with the latest changes in compliances, in order to stay on top of the challenges that they would face otherwise. A sizeable healthcare organization would have many people working under its Chief Compliance Officer, who specializes in keeping the organization aligned with the state compliance programs.

Why do you need Healthcare Compliance?

The eventual goal of all healthcare compliances is to improve the quality of patient care. This can only be done if the decisions are based on appropriate clinical standards. Moreover, it aids the providers by helping them stay on board with the government authorities, and reduces the risk of financial fines or imposition of unforeseen sanctions.  The liability of malpractice is also reduced if the healthcare organizations have an effective compliance program in action.

Following are some of the regulations that directly affect a practice, and should be in place to deliver optimum patient care.

Fraud Regulations

 The Stark Law

The essence of this law is that it disallows physician referrals of Medicare or Medicaid patients for “designated health services”, particularly If the physician has any sort of financial association with that body. Designated Health Services is a broad term which covers a number of services, such as durable medical equipment, supplies, labs, and therapy whether occupational or physical.  The underlying purpose Is to prevent Medicare and Medicaid abuse, which was becoming a common practice in healthcare organizations.

The False Claims Act

This act refers to a federal statute, that forms liability for intentionally presenting a fraudulent claim against any federal health care program. This encompasses any program that offers health benefits, whether directly or through insurance, which is financed by the US government or any state healthcare system. Examples of this act being intentionally violated include, billing for services that are not rendered or giving a kickback for a referral.

The Anti-Kickback Law

This is a healthcare fraud bill which forbids the exchange of compensation, in return for anything of value, in order to influence a healthcare provider to make choices that may directly or indirectly benefit the body offering the compensation. The fines can range up to $25,000 for each violation, or in severe cases, imprisonment for up to five years as well.

Patient Information Regulations

Patient Protection and Affordable Care Act

This act is fairly broad, and covers individuals, employers, hospitals and companies. It talks about a number of payment alternatives, with addition to growing the count of patients that are covered by insurance.

Health Information Technology for Economic and Clinical Health (HITECH) Act

It is a trifurcation of the American Recovery and Reinvestment Act (ARRA) of 2009, which creates benefits associated with the use of EHR systems amongst the providers. In addition to that, the act follows up on the security and privacy concerns that were linked to the transmission of health information electronically.


The primary intention of this law is to create boundaries on the usage and release of health records. Also, it defines the precautions that should be taken in order to protect confidential patient information and the penalization framework for violations. It Is a broad law, which is not restricted to practices only, and even covers dentists, nursing homes, psychologists and pharmacies.

Physician Payments Sunshine Act

This is another law branched out from the affordable care act, it requires group purchasing organizations and applicable manufacturers to publicly report any payments made to providers.

What you can do?

Before opening a medical practice, it is crucial for a physician to take out the time and go through these regulations (preferably with a legal advisor), so that the key concerns of shareholders are addressed. Moreover, when the organization would open its doors to the world, it would be immediately accountable to the local, state and federal government, and that can be troublesome if the practice doesn’t have an effective regulatory and compliance program in place.

About Author:

Alex Tate is a Health IT writer for various platforms. He provides perceptive, engaging and informative consultancy on industry wide topics. He knows that no single approach is the right one for every practice, and so shall advice according to the requirements. The consultancy is based around EMR Systems, Practice Management and Billing Solutions. MACRA/MIPS consultancy is also available to achieve the highest returns and revenue for your practice.

A Complete Guide for Medical Practice Start-Ups (Part 3)

Feasibility Report and Budgeting

To make sure that your new healthcare venture does not get hindered by unpleasant surprises along the way, it is essential to carry out a financial feasibility analysis and conduct detailed budgeting, so that you know exactly how much capital you need and figure out how to acquire it. A financial feasibility study should be the direct follow up of your market study, and should include assumptions, potential income, expenses, cash flow, and balance sheet.

Elements of Financial Forecasting

To create a detailed and truly effective profit and loss statement, your financial projections must take into account several elements. Some of these are:

  • Capital investment
  • Direct costs
  • Overhead costs
  • Units of service
  • Breakeven point
  • Inflation trends
  • Potential bad debts
  • Expected collections
  • Labor rates
  • Benefit costs

Creating an Effective Budget

As surprising as it is, many independent practices never come around to creating a set budget. Others establish a budget at some point but never follow it. Is it careless practices like these that cause finances to go awry, which is when these practices end up looking for financial consultants. To avoid trouble, it is essential that you establish a budget right in the beginning, and then make sure you create a workplace ethic for yourself and your team that makes sure the budget is strictly considered at all stages.

Since budgeting for a healthcare facility is not taught in medical schools, it is somewhat understandable why even the most skilled medical practitioners have trouble when they have to take care of the finances of an entire business – and one that lives depend on. Nevertheless, budgeting is a valuable skill to develop and can become the single factor that can make or break a medical practice.

Here are a few tips to ensure that your practice budget is effective.

Track your expenses

Physicians often don’t know the exact costs of running their business. Make a detailed plan of your expenses, ideally with a practice-specific list of cost categories. A common mistake is mixing clinical and administrative expenses, which is why practices often fail to keep a track of specific expenses and run into trouble.

Do your research

If you have never run a business before, don’t worry. There are benchmark practice costs that you can use to create your own budget. For this, you can use of:

  1. Group Management Association’s (MGMA) Cost Survey
  2. National Association of Healthcare Consultants (NAHC) and Academy of Dental CPAs’ Statistics Report on Medical and Dental Income and Expense Averages.

Both provide information on different categories of medical budgeting, with average numbers you can use to create your own financial forecasts.

Important Things to Keep in Mind

While equipment, staff salaries, and procedure costs are naturally included in budgeting, there are some important things that are often forgotten:

  • Number of visits or procedures required to make a profit
  • Add-on services
  • Marketing efforts
  • Software expenses
  • Potential collection gaps

Once you know what your budget is, it is then time to dive into funding options, ranging from personal capital to bank loans to private investments. Remember that your funding process will only be successful, no matter how impressive the funding may seem, if you are certain about your expenses and projected revenue, and are ready for what may come.

About Author:

Alex Tate is a Health IT writer for various platforms. He provides perceptive, engaging and informative consultancy on industry wide topics. He knows that no single approach is the right one for every practice, and so shall advice according to the requirements. The consultancy is based around EMR Systems, Practice Management and Billing Solutions. MACRA/MIPS consultancy is also available to achieve the highest returns and revenue for your practice.

A Complete Guide for Medical Practice Start-Ups (Part 2)

Creating Your Business Plan

Before you begin your practice, it is essential that you have a business plan in place. Any successful business starts with a business plan that is based on forward-thinking, and is thorough but simple. For a medical practice, your initial plan needs to be sufficient enough to cover and evaluate all important aspects of your business, and to communicate this information to all stakeholders involved.

There are several fundamental considerations to keep in mind while creating your business plan.

  • The structure of your practice
  • SWOT analysis
  • Location and property leasing
  • Setup requirements and costs
  • Fixed and variable costs
  • Operation plan and procedures
  • Licensing and other legal policies
  • Insurances
  • IT infrastructure and data security
  • Recruitment and staffing
  • Finance and accounting
  • Target audience and demographics
  • Detailed billing structure
  • Marketing plan

Master the Basics

A successful practice stands on strong basic planning. If you get this right, chances are you will be prepared for most challenges thrown at you later. Decide whether your practice is going to be a tradition practice, a visual practice, or an associateship. It is imperative that you get business advice before settling on this, along with analyzing your own potential and aptitude. Following this is a through SWOT analysis – a detailed overview of the Strengths, Weaknesses, Opportunities, and Threats. This will help you identify the benefits as well as the gaps, while also preparing you for the competition and devising a plan on how to tackle it.

A good SWOT analysis should give you a sturdy blueprint you can build your practice on. From there on, it is a matter of making sure your plan is detailed and strategic, and that you start off with your practice fully equipped. Even if the planning stage takes time, remember that this is worth it because it is only with a well-thought and thorough plan that you will be able to achieve great outcomes and satisfied patients right from the beginning.

 Create Simple and Fast Processes

Remember that they key is not to create complex but straightforward and comprehensive processes. When this principle is applied to a medical practice, you have to make sure your processes are agile and simple. Ideally, create processes that are extremely easy to understand and learn, since this will define how smooth the training processes for your staff as well as patients are.

Understand the Market and the Selling Position

For any business to survive amidst rigorous competition, it is imperative that they find and recognize their unique selling position. Before you kick off, research and understand the marketplace that you are about to step into. Know your competitors, and decide what you are going to do differently or better than them in order to stand out to your potential clients – patients looking for quality healthcare.

Don’t Start Without Cloud Software

Gone are the days when medical clinics and hospitals could be effective with paper-based patient records. Now, with practices in the entire country switching to EHR programs, it is absurd to start a new practice without one. The efficiencies that cloud software provides your practice with are unmatched. With the right software and effective implementation, you will find yourself with streamlines operations, excellent internal and external communication, minimal time wasted, well-managed financial operations, and overall better care delivery.

Business Planning Mistakes to Avoid

In the process of creating your business plan and ensuring that you equip it with everything that it requires, keep an eye out for these common pitfalls to save your time, effort, and money.

  • A poor or incomplete business structure
  • Only short-term goals, with no long-term vision in mind
  • Not considering all stakeholders, like banks and investors
  • Underestimating the business and leadership skills required
  • Overcomplicating your business plan
  • Not planning early enough, or not spending enough time planning

At this stage, providers must remember that their primary goal is to create a business plan that is comprehensive and future-proofed, so that the practice comes into being with processes pre-streamlines and risk analysis and strategies prepared in advance.

Read on to Part 3: Feasibility Report and Budgeting


About Author:

Alex Tate is a Health IT writer for various platforms. He provides perceptive, engaging and informative consultancy on industry wide topics. He knows that no single approach is the right one for every practice, and so shall advice according to the requirements. The consultancy is based around EMR Systems, Practice Management and Billing Solutions. MACRA/MIPS consultancy is also available to achieve the highest returns and revenue for your practice.

A Complete Guide for Medical Practice Start-Ups (Part 1)

Are you ready to open up your own medical practice?

The decision is indeed a significant milestone in your medical career and can be the defining moment of your future in the healthcare service industry. The current healthcare landscape is rapidly changing, as are patient expectations, and more and more physicians are now going solo. While this increased competition certainly means the service quality will get better, it also poses a greater risk to practice survival, especially for new startups.

There is no denying that with the innovating healthcare ecosystem, only the most advanced, updated and streamlined practices that aim to add value to patient care will survive. It is for this reason that we have developed this guide – to help the most motivated and talented physicians understand what they need for a medical practice startup and prepare them for it.

In this guide, we will cover:

  • The basics of starting a new practice
  • Business planning and cost analysis
  • Government policies and compliances
  • Medical software for efficient running
  • Revenue generation and quality measures

1. The First Steps

While opening up a practice is a complicated process that needs detailed planning, perhaps the most important part of it is being absolutely certain and realistic about it. Medical practice startups often fail because they start off with a little too much optimism and get thrown off along the way because they realize they were in fact unprepared.

Why Start Your Own Practice?

Even though opening your own practice comes with its risks, there are several benefits to it if done right, which is why more and more providers are now drawn towards it. Since most of the healthcare business is concentrated in the hands of big-name hospitals, more private practices opening means the competition increases and the profits are more evenly distributed in the industry. Providers also enjoy greater autonomy over their practice and can create their own workflows. They are also free to choose the area they want to practice in, which means many providers target smaller areas with less access to healthcare, thus not only serving more people but also securing a market just for themselves. In addition to this are the entrepreneurial benefits, like being able to create your own schedule and be your own boss, which drives many into entering private practice. Naturally, the ownership and agency associated with a private practice is attractive compared to working in an already established system like a large hospital.

Are You Ready to Open Your Practice?

A successful practice can become a great lifelong career, but are you really ready for it? As a provider, you must ask yourself a number of questions to make sure you are not rushing into a private practice unprepared.

  1. What is your vision and motivation?
    While high profits are attractive, have you weighed them against the risks that will come with running a business alone?
  2. Do you have the necessary support?
    Even with a small business, you need the right people and systems that can help you sustain and grow. This means locating the right managers, referral systems, advisors, partners, doctors, etc.
  3. Do you have the necessary resources?
    It is almost certain that you will need more money than you think you need. It is essential to have the resources to not only start, but also to support you in case you run into difficulties.
  4. Do you understand the business aspect?
    You could be a great doctor, but still fail to run a practice on your own if you don’t understand the running of a business. Before you start, it is essential to make sure you are thinking like an entrepreneur and a businessman, and acquire the skills needed by a CEO.

It is only after you are certain about the answers that you should start your own practice with the guarantee that you will be able to handle the business.

Read on to Part 2: Creating Your Business Plan

About Author:

Alex Tate is a Health IT writer for various platforms. He provides perceptive, engaging and informative consultancy on industry wide topics. He knows that no single approach is the right one for every practice, and so shall advice according to the requirements. The consultancy is based around EMR Systems, Practice Management and Billing Solutions. MACRA/MIPS consultancy is also available to achieve the highest returns and revenue for your practice.