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Table of Contents

I. Timetable for Starting a Practice

ABSTRACT: When you're starting a practice, it can be difficult to know what needs to be done and when to do it. A little advance planning can go a long way toward giving you confidence when your practice opens for business. Chapter I provides a sample timeline that shows how early you should begin working to open a new practice and when to attend to particular details.

II. Getting Started

ABSTRACT: First things first! Unless you recently won the lottery, you probably need financing to make your practice a reality. This chapter provides practical information to help you estimate your start-up costs and operating expenses. Also, get tips on navigating the twists and turns of the loan application process. Once you've secured financing you're ready to start seeing patients, right? Not so fast! Find out what licenses federal, state and local laws require you to have, and don't forget to cover yourself and your employees with adequate insurance. Administrative issues don't stop there, so Chapter II also includes information on the processes of credentialing and clinical privileging. Plus, you'll get a helpful reminder: You don't have to do everything on your own. Setting up a call schedule and a referral network, joining professional organizations, and seeking the expertise of legal and accounting consultants are all ways to get more out of your practice
  1. Corporate Structure
    1. Sole Proprietorship
    2. Partnership
    3. Limited Partnership
    4. Corporation or Limited Liability Company (LLC)
  2. Financing Options
    1. Table 2.1. Average expenses for selected items for family physicians
    2. Table 2.2. Four things to bring to your meeting with a loan officer
    3. Table 2.3. Sample cash flow budget for a solo practice
  3. Licenses
    1. Medical
    2. Business
    3. Narcotics
  4. Insurance
    1. Malpractice
    2. Personal Liability
    3. Property
    4. Workers' Compensation
  5. Credentialing and Clinical Privileges
    1. Clinical Privileges
    2. Lab (CLIA)
  6. Professional Relations
    1. Call Schedules
    2. Referral Networks
  7. Memberships
    1. American Academy of Family Physicians (AAFP)
    2. AAFP State and Local Chapters
    3. American Medical Association (AMA)
    4. State Medical Society
    5. City/County Medical Society
    6. Chamber of Commerce
  8. Professional Advice
    1. Accounting
    2. Legal

III. Buying/Leasing a Practice

ABSTRACT: To buy or not to buy? If that's the question, this chapter can provide some answers. Finding out how to analyze potential practice sites before you buy can mean the difference between an office that's bustling and an office that's a bust. Chapter III includes advice on analyzing the market for your new practice by defining a catchment area and considering demographics, competition and traffic patterns. Also learn how valuation can help you get your money's worth. If leasing office space is more your style, this chapter covers what you need to know before you sign on the dotted line. Knowledge is power when you're negotiating a lease, so get the facts on lease terms, default, indemnification, exclusivity and more.
  1. Selecting a Practice Site
  2. Valuation
  3. Negotiating Your Lease

IV. Office Design

ABSTRACT: Chapter IV discusses bringing your office space up to code and includes steps to ensure that your new or existing building complies with Americans with Disabilities Act (ADA) requirements. You'll also find suggestions for designing your practice space with the future in mind. For example, you should select a design that allows for flexible use of existing spaces and makes future renovations possible with minimal disruption to you and your staff. And after you've determined your design needs, check out Chapter IV's list of recommended medical architects:
  1. Fire Code/ Building Code Compliance
  2. Americans With Disabilities Act (ADA) Compliance
  3. Space and Future Growth Requirements

V. Supplies & Equipment

ABSTRACT: OK, your office space has been designed to fit your practice's needs. Next step: all the stuff that'll go in it. Where to start? Chapter V's checklist of supplies might come in handy. Find out what should be on your shopping list, from the chairs in the waiting room to the soap in the bathroom, and everything in between. This chapter also provides complete contact information for recommended vendors of medical supplies, records and equipment.
  1. Supplies Checklist
  2. Resources for Medical Supplies
  3. Resources for Computer and Medical Equipment

VI. Personnel

ABSTRACT: The usual approach to overhead costs is that less is better. But when it comes to hiring staff, remember that your employees are an investment in a successful practice. Chapter VI will help you build a high-quality staff to keep your practice running smoothly so you can spend your time practicing medicine. Get tips on determining the ideal staff size for your practice and learn the "must-have" functions to include in employee job descriptions. This chapter also walks you through the steps of recruiting potential employees and sorting the best from the rest through interviews, background checks and pre-employment testing (including information on your legal rights and responsibilities as an employer). Chapter VI includes information to help you define an acceptable salary and benefits package once you find the right employee. Plus, it provides suggestions for training new employees and creating a useful policy and procedures manual so everyone is on the same page.
  1. Staffing Requirements
  2. Job Descriptions
  3. Recruiting and Interviewing
  4. Reference/Background Checks and Pre-Employment Testing
  5. I-9 Documentation
  6. Orientation/Training
  7. Salaries
  8. Employee Benefits
  9. Security Bonding
  10. Policy and Procedures Manual
  11. OSHA Requirements

VII. Fees/Contracting

ABSTRACT: How much are your services worth? Establishing a fee schedule for a new practice can be difficult, especially if you have little or no experience to rely on in terms of establishing practice expenses, service mix, etc. This chapter provides you with a starting point for setting up a reasonable fee schedule. It also discusses the CPT and ICD-9 coding systems and gives guidelines for negotiating your contracts with managed care organizations. Chapter VII can also be your guide to finding all of the services you need so you can serve your patients -- services ranging from analyzing lab samples to picking up trash. The section on telephone service options may be especially useful for your practice.
  1. Fee Schedules
  2. Coding
  3. Insurance Plan Contracting Negotiations
  4. X-Ray Services
  5. Reference Lab Services
  6. Transcription Services
  7. Telephone Service
  8. Utilities
  9. Biomedical Hazardous Waste Disposal
  10. Trash Services
  11. Janitorial Service
  12. Paging/Messaging Services
  13. Courier Service (if Needed)
  14. Laundry Service (if Needed)
  15. EKG Over-Read Service (if Needed)
  16. Billing Service (if Needed)
  17. Security Service

VIII. Marketing Your Practice

ABSTRACT: What good is a great practice if no one knows about it? If you feel clueless when it comes to marketing, consider this chapter your own Marketing 101. Chapter VIII will help you understand basic marketing concepts and learn tactics to attract patients to your new practice. For example, you'll find out how to use a marketing tool called a SWOT analysis to identify your practice's Strengths and Weaknesses and list the Opportunities and Threats that you might face. Plus, get ideas for promoting your practice and advice on writing promotional materials that won't end up in the trash.
  1. Planning
  2. Marketing
  3. Tips for Writing Promotional Materials
  4. Evaluation
  5. Marketing in a Nutshell

IX. Office Operations

ABSTRACT: Even if you don't have an MBA, your practice is a business, and it has to be efficient to be successful. Chapter IX covers almost everything you ever wanted to know about running a practice but were afraid to ask. It discusses different scheduling options for patient appointments and staffing, so you can choose a system that keeps your practice running smoothly (and keeps employees and patients happy). Get useful advice on how to register new patients and verify their insurance benefits. Plus, get information on handling money matters, both with the money you take in and the money you pay out (e.g., billing, taxes, payroll, petty cash). Learn how to be safe rather than sorry by taking steps to safeguard your money, your records, your computer system, your office, your staff and yourself. You'll also find information on developing workable procedures for routine tasks, such as ordering office supplies, taking phone messages and refilling prescriptions, and establishing an easy-to-use system for filing and maintaining patient records. Chapter IX also covers pharmacy formularies, regulatory compliance and health care quality initiatives.
  1. Policies for Patients
  2. Scheduling Appointments
  3. New Patient Registration
  4. Insurance Authorization/Approval Process
  5. Billing
  6. Collections
  7. Payroll
  8. Accounting/Taxes
  9. Financial Oversight/Safeguards/Internal Controls
  10. Petty Cash Policy
  11. Security
  12. Staffing Schedule
  13. Supply Inventory And Ordering
  14. elephone Messages/Drug Refill Procedures
  15. Regulatory Compliance
    1. Fair Labor Standards Act
    2. Equal Opportunity Employment Act
    3. Occupational Safety and Health Administration (OSHA)
    4. Medicare and Medicaid
    5. Health Insurance Portability and Accountability Act (HIPAA)
  16. Health Care Quality Improvement
    1. The AAFP Quality Initiative
    2. METRIC Program

X. Computerizing Your Practice

ABSTRACT: Get wired! A computer system is a powerful tool for family physicians, so it's important to choose and implement the right system for your practice. Chapter X outlines the five basic tasks for which a medical practice uses computers: patient accounting, appointment scheduling, medical record storage, patient education and general accounting. Learn what key features to look for when you're selecting software to perform these applications. This chapter also describes how to find a reputable computer vendor and what services you can expect to receive. You'll also get tips on readying your office and staff to make optimal use of your new computer system. Increasingly, physicians and patients are communicating through e-mail. If you're thinking about going online, Chapter X provides a useful discussion of this issue, including guidelines for using e-mail wisely.
  1. Patient Accounting
  2. Appointment Scheduling
  3. Medical Records
  4. Patient Education
  5. General Accounting
  6. Choosing a Computer Vendor
  7. Implementing a New Computer System
    1. Site Preparation
    2. Training
    3. Installing Hardware and Software
  8. E-Mail Communication With Patients

XI. Documentation

ABSTRACT: If something happens in your practice and it isn't documented, did it ever really happen? You can leave existential questions to the philosophers, but as Chapter XI points out, thorough documentation is an important consideration for any medical practice. Wondering how to keep track of all of your continuing medical education (CME) requirements for board recertification? Find out how the AAFP makes it easy for members to report their earned credit. Get hints on tracking your practice's expenses and documenting periodic employee evaluations. This chapter also answers the following questions regarding medical record documentation: What are the purposes of the medical record? What formats can be used for the paper-based medical record? What issues about the maintenance of the paper-based medical record concern the family physician?
  1. Continuing Medical Education (CME)
  2. Expenses
  3. Medical Records
    1. Purpose of the Medical Record
    2. Electronic Health Records

XII. Additional Resources

XIII. References

Attachment A: New Employee Checklist

Attachment B: Median and Mean Usual Fees (in dollars) of Family Physicians, May 2004

Attachment C: Employee Performance Evaluation Report
Starting a Medical Practice

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