The Next 3 Things You Need to Learn

1. The Next 3 ThingsYou Need to Learn Louis Joseph HCA Physician Services Emory 11-13-08

2. Finding the perfect practice Signing the right contract Starting your practice successfully

3. Finding The Perfect Practice

4. Taking Stock • Where do you want to live? • What kind of practice do you want? • Is the amount of your loan repayment an issue? • What family ties are involved? • What about your spouse’s career? • Have you considered your hobbies and other interests?

5. Finding a Position • Physician Recruiters • Specialty Board • Locum Tenens • Program • Medical Journals • Internet • Visiting Local Medical Offices • Networking • Hospital CEOs

6. Solo Practice Source: AMA

7. Small Group Practice Source: AMA

8. Large Group Practice Source: AMA

9. Employment Source: AMA

10. Presenting Yourself • Pick a format and be consistent • Have a short CV in reverse chronological order • Include a cover letter • Include your present and permanent address, phone, pager and e-mail address • No typos! • MySpace, Facebook and social networking sites

11. Writing a Great Cover Letter • One page, 3-4 paragraphs • Brevity • Personalization • Passion • Write directly, avoid generalities • Highlight special expertise • Request confidentiality • Get some to review, critique your letter

12. The CV gets you theinterview,the interview gets youhired.

13. CV Outline • Identification • Education • Postgraduate • Experience • Licenses and Certification • Professional Affiliations • Publications • Presentations

14. Success Over the Phone • Have no interruptions or distractions • Stay calm and listen carefully • Pause before answering any questions • Have your CV and schedule in front of you • Don’t appear overeager or desperate

15. The Site Visit • Do your homework • Arrive 15 minutes early • Bring extra copies of your CV • Have a firm handshake • Practice good eye contact • Have your list with you • What not to wear

16. Traveling Tips • Focus on less than ten practice opportunities and then narrow the field from there. • Spend two full days at each location, depending on the distance. • On the first visit, go alone. On the second visit, include your spouse and family. • Remember, there is a good fit out there for everyone. If it just doesn’t feel right, move on to another opportunity.

17. While You Are There • Prepare a two-minute speech about yourself and stay on message • Feel free to ask questions about anything • Jot down the names of those you interact with and write them a “thank you” letter • Show courtesy and respect to everyone you encounter

18. Signing the Right Contract

19. Never say these words:“I’m just a doctor. I don’t know anything about business.”

20. Simple Steps for Contracting Read it. Understand it. Get at least two opinions.

21. Definition of a Contract An important and legally binding agreement between a physician and another party that defines the working relationship with mutually agreed upon duties, responsibilities and rights.

22. What a Contract Isn’t • A handshake • A letter of intent • A promise • An understanding • What someone said, thought, meant, or hoped for

23. Physician Due Diligence • How long has the practice been in existence? • Does the group have enough patients to support a new physician? • How many new patients a year does the practice attract? How many does it lose? • Does the group have a marketing plan? • What will the group do to send patients my way? • How many managed care contracts does the group have? Do the payments cover the costs of treating patients?

24. Financial Due Diligence Balance sheet, P & L, cash flow statement Overhead-to-revenue ratio Physician productivity Debt/loans Payor mix Capital reserves Managed care contracts Accounts receivable Audit history Malpractice claims

25. Talking to Partners Start with the oldest and youngest partners and work your way in towards the middle. Talk to all of the physicians, if possible. Probe for their views, both personal and professional. You are looking for compatibility while you are assessing the culture.

26. Joining a Partnership or Group • Determine who owns the group and their corporate structure (PA, PC, LLC, etc.) • Determine how ownership is obtained • Determine the time frame and $ amount • Decreasing role of sweat equity • Determine who really “calls the shots”

27. What a PartnershipAgreement Should Include • Buy-in, buy-out and liquidation provisions, including retention of the location, equipment and records of the partnership • Call coverage arrangements • Division of management duties • Illness, disability and LOA policy • Income distribution • Mechanisms for settling disputes • Ownership and valuation of assets, including AR • Physician’s liability for lawsuits against the practice • Purchasing policies with spending limits • Vacation policies

28. Value of a Group Consider paying for: • Accounts Receivable • Furniture, Fixtures, Equipment (FFE) • Supplies Don’t pay for: • Charts • Goodwill • Trained Staff

29. Typical Revenue Guarantee One year of financial support with a three year promise to stay.

30. Revenue Guarantee Example: Hospital guarantees a physician net revenues of $20,000 per month for 12 months. Total contract worth $240,000 per year.

32. $90,000 \ 36 month forgiveness period = $2,500 to be “forgiven” every month the physician stays in the service area.

33. Revenue Guarantee Questions • Forgiveness versus Non-Forgiveness • Payback versus Non-payback

34. Restrictive Covenant Prevents you from practicing in the same general area for a given period of time after you leave the practice. • Time • Scope of Practice • Distance

35. Types of Salaries

36. Benefits to Consider • Malpractice (with tail coverage) • Health Insurance • Paid Vacation/Holidays/Sick Time • CME Allowance • Disability Insurance • Dues and Subscriptions • Licensure Fees • Pagers, Cell Phones, Mileage, PDA

37. Negotiation Tips • Do your homework. Develop your own yardstick. Start with the end in mind. • During the interview, listen to both what is spoken and what is unspoken. • Remember: strong, established practices are less flexible. • If it’s not written in the contract, it doesn’t exist. • The best predictor of future behavior is past performance. • Let the other side talk. No one has ever “listened” themselves out of a job. • Take turns. Don’t bid against yourself. • Pigs get fat, hogs get slaughtered.

38. Points to Remember • The contract is always drawn up by the practice or institution. Be aware that it is designed to protect them. • Always read the entire contract yourself. Ask for clarification if you don’t understand something. • Statements like “may,” “to the extent possible,”and “under certain circumstances” do not guarantee performance. • Do not pay for goodwill to join a group. • Obtain the services of a competent attorney and accountant. Look for someone specializing in healthcare.

39. Finding an Attorney or Accountant • Ask other physicians for a referral • Talk to more than one • Personal compatibility is important • Ask for references • Be clear about fees up front and negotiate a fixed amount before you start the engagement

40. Starting Your Practice Successfully

41. Successful Medical Practices • Provide Excellent Patient Care • Demonstrate Operational Excellence • Are Financially Solvent • Constantly Innovate

42. Three Keys • Patients First • Being a Business Owner • Compensation Drives Performance

43. 1. Patients First Quality Physicians Excellent Office Manager Find and Retain the Best Staff Mission, Vision and Physician Leadership Recognizing Where Patients Come From

44. Quality Physicians Qualified and caring Board certified Good work ethic Do your due diligence The best predictor… Importance of good chemistry

45. Excellent Office Manager Parent position Sets the tone, sense of urgency FILO Utility player Flash meeting Over-communicate “Patients First” philosophy Relentless, assume nothing

46. Physician/Provider Information Provider staffing roster Employment agreements Shareholder agreements Restrictive covenants Provider compensation records (W-2s, K-1s) Call coverage agreements Medical directorship agreements Recruiting agreements Other physician contracts Malpractice policies Legal Information Incorporation documents Partnership agreements Buy-Sell agreements Joint-venture or subsidiary agreements Contracts, Licenses & Permits Office lease Equipment leases Software licenses Service agreements State/local licenses and permits Practice Assets FF&E inventories Drugs and injectibles inventories Prepaid expenses IT&S Practice Liabilities Debts and liens Leasing obligations Pending litigation and government actions Tail coverage Non-Provider Employee Information Employee roster Employee benefit plans COBRA liabilities Start-Up Checklist

47. IT&S General due diligence Remediation Equipment installation Other equipment Human Resources General due diligence Assessing staffing needs and compensation Recruiting and/or hiring employees Employee orientation Managed Care General due diligence Notification letters to payers Credentialing Billing & Collections General due diligence A/R review Real Estate General due diligence Preparation of new lease or sublease Payroll Set up of employees

48. Find and Retain the Best Staff DISC profile “Special Forces” philosophy Positive look and feel of office Hire grown ups Reward system, monthly payout Background checks References Cross Training

49. Recognizing WherePatients Come From Marketing to your referral base Personal relationships Follow-up and over communicating Always “returning” the patient Assuming nothing Not taking anyone for granted

50. 2. Being a Business Owner The idea that all managers should treat their area of responsibility as a business-within-a-business