New to Practice Toolkit

The New to Practice Toolkit is an outline designed to provide guidance for surgeons considering opening a new practice, whether you are transitioning from an employed, academic, or group practice or embarking on a new practice post-training.

Table of Contents

I. Clinical

  1. Define your mission statement.
  2. List of services you offer.
  3. Office staff
    1. Administrative
      1. Front end/Patient Service Representative
      2. OR scheduler
      3. Office manager
    2. Clinical
      1. RN, MA, NP, PA, MD
  4. Clinical templates
    1. Office
      1. Intake forms
      2. Checklist for new patients
      3. Consent forms
      4. Patient handouts
      5. Preoperative instructions
      6. Cancellation policy
    2. OR
      1. Procedure templates
      2. Postoperative instructions
      3. OR booking checklist
  5. Common CPT® codes
    1. Office Visits
      1. 99024 POST OPERATIVE VISIT
      2. 99203 PR OFFICE/OP VISIT, NEW PT, LEVEL 3, LOW MDM, CXWD
      3. 99204 PR OFFICE/OP VISIT, NEW PT, LEVEL 4, MODERATE MDM, CXWD
      4. 99205 PR OFFICE/OP VISIT, NEW PT, LEVEL 5, HIGH MDM, CXWD
      5. 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN [99213]
      6. 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN [99214]
      7. 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN [99215]
    2. Procedure Codes
      1. 10140 PR DRAINAGE OF HEMATOMA/FLUID
      2. 10160 INCISION AND DRAINAGE
      3. 11104 PR PUNCH BIOPSY SKIN SINGLE LESION
      4. 19000 PUNCTURE ASP OF CYST
      5. 19001 FOR EACH ADDITIONAL CYST
      6. 19083 BX BREAST 1ST LESION
      7. 19084 FOR EACH ADDITIONAL LESION
      8. 19120 BX/EXC BREAST LES
      9. 19125 PR EXCISE BREAST LES W XRAY MARKER
      10. 19301 PR MASTECTOMY, PARTIAL
      11. 19302 PR MASTECTOMY, PARTIAL, WITH AXILLARY LYMPHADENECTOMY
      12. 19303 PR MASTECTOMY, SIMPLE, COMPLETE
      13. 19307 PR MASTECTOMY, MODIFIED RADICAL
      14. 36561 PORT PLACEMENT
      15. 36590 Removal of Central Venous Access Device
      16. 38500 PR BIOPSY/EXCISION, LYMPH NODE(S)
      17. 38525 PR BX/REMV, LYMPH NODE, DEEP AXILL
      18. 38745 PR REMOVE ARMPITS LYMPH NODES COMPLT
      19. 38792 PR IDENTIFY SENTINEL NODE
      20. 38900 PR INTRAOPERATIVE SENTINEL LYMPH NODE ID W DYE INJECTION
      21. 76098 CHG X-RAY EXAM, BREAST SPECIMEN
      22. 76641 U/S BREAST, complete
      23. 76642 U/S BREAST, limited
      24. 76942 ULTRA GUIDANCE NEEDLE BIO
    3. Modifiers
      1. -50 Bilateral procedure
      2. -58 Staged or related procedure performed during the postoperative period of the first procedure by the same physician
      3. -80 Service performed by a medical doctor (MD)
      4. -81 Minimal surgical assistant services by a medical doctor (MD)
      5. -82 Performed by an MD when no qualified resident available
      6. -AS Service performed by a physician assistant, nurse practitioner, or clinical nurse specialist
  6. Genetics
    1. If you offer it, compare different companies and panels
    2. If you do not offer genetic testing, identify where to refer patients
  7. Office/surgical equipment
    1. Equipment:
      1. Exam tables, procedure table, electrocautery, autoclave, procedure room light, etc.
      2. Ultrasound machine (purchase vs. lease)
    2. Supplies (sutures, dressings, syringes, suture removal kits, etc.)
    3. Biopsy devices and markers
    4. Localization
    5. Special instruments
    6. Specimen Imaging
    7. Lymphatic Mapping
    8. Dye
      1. Blue dye
      2. Technetium
      3. Preoperative vs. intraoperative
    9. Preference Card
      1. Include equipment, assistants, etc.
  8. Referring providers
    1. PCP
    2.  OB/GYN
    3. Medical Oncology
    4. Radiation Oncology
    5. Plastic Surgery
      1. Consider reconstructive options they offer
      2. Consider insurance they accept
      3. Consider where they are credentialed
    6. Handouts: business cards, pamphlets, etc.
  9. Other partnerships/referrals
    1. Radiology
      1. Breast fellowship-trained?
      2. NQMBC certified?
      3. Imaging access (portal vs. existing EMR)
    2. Wellness groups
    3. Exercise oncology (Maple Tree Cancer Alliance)
    4. Physical Therapy
      1. Lymphedema specialist
    5. Occupational Therapy
    6. Post surgical boutique
    7. Hair prosthetic/headcover boutique
  10. Unlink your NPI from your prior practice, if applicable
  11. Update address with:
    1. State medical society
    2. DEA
    3. State-controlled substance license
    4. Professional societies
    5. Social media platforms
    6. Online physician review websites

II. Administrative

  1. Starting your company
    1. LLC vs PC
    2. Applying with the state
  2. Bank loan
    1. Proforma/business plan
    2. 3-year financial projections
    3. Opening day balance sheet
  3. Bylaws
  4. Attorneys
    1. Practice attorney
      1. Need to obtain a certificate by Regulatory Board from your state board.
      2. Operating agreement
      3. HIPPA notice of privacy practices
    2. Trademark attorney
    3. Real estate attorney
  5. Medical accountant
  6. Hospital credentialing
    1. OR block time
    2. Clinical responsibilities
    3. Administrative responsibilities
  7. PM/EMR system (Athena, Cerner, Epic, etc.)
  8. Billing/coding
  9. Contracting with medical insurance companies
  10. Practice insurances
    1. General liability
    2. Medical malpractice
    3. Cyber
    4. Long-term disability
    5. Umbrella
  11. Practice paperwork
    1. Bylaws
    2. Employee handbook
  12. Staffing
    1. Job descriptions: learn how to integrate APPs into your practice.

III. Costs

  1. Lease
    1. Can you sublease to help defray the cost?
  2. Utilities
  3. Taxes
    1. City
    2. State
    3. Federal
  4. Office cleaning
  5. IT and equipment
    1. Internet and IP addresses
    2. Fax can be analog or VOIP
  6. Internet
    1. Does your town offer FiOS?
      1. Make sure HIPAA compliant
  7. Communications company
    1. Phone
    2. Fax
  8. Computers
    1. Make sure any laptops are encrypted as well
  9. PM/EMR system
  10. Printer/scanner/fax
  11. Shredder
  12. Phones
  13. Office staff (manager, PSR, PA, MA, RN, etc.)
  14. Benefits
    1. Varies by state
  15. Medical malpractice insurance
  16. General insurance
  17. Cyber insurance
  18. Disability insurance
  19. Business loan
  20. Marketing
  21. Website
  22. Branding
  23. Credentialing
  24. Office supplies
    1. Clerical
    2. Medical
      1. Gloves, gowns, syringes, etc.
    3. Stationary
      1. business cards, stationary, envelopes, brochures
  25. Medical equipment
    1. Exam tables, procedure room bed, ultrasound, autoclave, electrocautery, etc.

IV. Building Your Practice

  1. Branding/Marketing
    1. Online/website
    2. Social media
    3. Paid advertising
    4. PR firm
    5. Media (television, radio, etc.)
  2. Networking
    1. Referring providers (conferences, lectures, lunches)
    2. Direct to patients (educational events, podcasts, etc.)
    3. Hospital events (Grand Rounds)
    4. Community networking events (Chamber of Commerce, local committees, fundraisers, health fairs, etc.)
    5. Hospital tumor board

V. Life Balance

  1. Clinic schedule
    1. Consider administrative time, staff/hospital meetings, weekly, conferences, etc.
  2. Create add-on slots into your schedule
  3. OR schedule
  4. Call coverage
  5. Vacations
  6. Maternity/parental leave
  7. Conferences

VI. Leaving Your Current Practice

  1. In person meeting then follow up with a written email the same day to document resignation
  2. Non-compete (varies by state)
  3. Notifying your employer/partners
  4. Notifying patients
  5. Notifying referring providers
  6. Medical malpractice insurance coverage between practices
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