1. Acquiring an Independent Practice: A Step by Step Guide to Grow the Business of Family Medicine Nipa R. Shah, MD University of Florida, Jacksonville

2. Disclosures None

3. Reality “Academic centers need to generate greater professional revenues from clinical activities. This is necessary in order to fund their academic mission and to operate their clinical practices more efficiently. Decreased state, federal, philanthropic, and research funding, along with lower reimbursements from commercial insurers, have had a big impact.” Tommy Bohannon, Divisional Vice President of Hospital-Based Recruiting for Merritt Hawkins, a physician-recruiting company based in Irving, Texas. http://www.medscape.com/viewarticle/806617_2 accessed 10/27/15 http://www.medscape.com/viewarticle/806617_2 Goal: increase revenue for the academic health center

4. Planning and Development Strategic Plan Goodwill? (yes or no)

5. --Advisory Board Road Map Strategic Plan Overview Volumes Patients Payers Payment Reform Employers Physicians Competitors Technology Regulatory Changes Goals & Objectives Initiative Design Initiative Prioritization Financial Summary Implementation Timeline Mission and Vision Previous Strategic Plan Review Total Investment Summary Interdepartmental Support Performance Scorecard Communication Plan CURRENT PERFORMANCE ANALYSIS FUTURE MARKET ASSESSMENT PLAN DESIGN PLAN SUMMARY 1234

6. Research Can’t compete with existing clinics Location is key Clinic in owner occupied property? Local competition/market share Nearby competing hospital/specialists

7. Initial Costs to the Organization Capital equipment (independent evaluator to be hired) Renovation plan and costs (contractor to give estimate) Trainers Hiring/Credentialing costs

8. Approval by various committees Business Development Committee Planning and Development Committee Finance Committee (review final proforma) Board of Directors for final approval

9. Preparation for Site Visit Introduction Convenient time Meet with the physician directly (not the office manager) You’re not the first A brief packet of information about your organization Benefits of being affiliated with a University Non-compete discussion What happens if they decide to leave?

10. Be prepared to discuss Clinical operations Transitions Nepotism policies ‘No Free Pen’-policies regarding relationship to industry/pharm companies Marketing Plan Payor rates/contractual ommissions Accounts Receivable EHR maintenance costs

11. Steps 1. Confidentiality Agreement 2. Required information list sent to Practice 3. Develop Proforma (2-3 years outlook) 4. Review Proforma with the Practice 5. Present to respective approval bodies within the organization 6. Begin hiring/transition process

12. Required information list sent to Practice-handout 1. The detailed charge data for at least two years (by financial class) 2. Copies of any contracts that Health Dept. currently has that UF would be expected to assume as Agape’s new partner. 3. Detailed staffing information (salary, FTE status, etc.) for support staff that would be required to continue operation(s) (I recall hearing there were two locations). 4. Any physician detail (how many physicians are covering now and would be needed to continue services) 5. Copies of any lease agreements that UF would be expected to assume. 6. Any software that’s required for the FQHC, which UF would need to purchase in order to continue the process 7. Understanding of any reporting requirements for a FQHC. 8. Detailed expenses that the University/organization would be expected to assume (office supplies, medical supplies, drugs, - all the types of expenses we currently pay). 9. Ownership arrangement for capital equipment (furniture, medical equipment, etc.). Would UF be expected to purchase? 10. Copies of any licenses/certifications that UF would need to apply for. 11. Fee schedule currently being used.

13. Transitions Hiring/credentialing training Staff Providers Physicians

14. Challenges Have to report to a boss: request time off, adhere to policies, audited by compliance dept. etc. Referral patterns may need to change Ramp-up needed Staff/providers/physicians adjustment period, esp. to EMR No Free Pen transtions, especially hard for patients

15. Rewards Financial Gain (including downstream revenue) Less administrative hassles for acquired physicians-better lifestyle

16. Any questions?