Jan 11 2008
Collaboration Fees? Space Fees?
A Nurse Practitioner in NJ has written in with a couple of questions regarding negotiation for office space and collaboraton fees.
Here’s my situation-Ihave been working as an independent contractor for the last 2 yrs seeing patients in their homes for disease management teaching/coaching. I wanted to expand that concept. I though of getting my own clients through advertising etc, but also wanted to be able to treat patients at home if unable to reach
their PCP and then ultimately have my own practice. I called a MD recently to try to see if he could be my collaborative physician for this venture. He wants a proposal. I thought I might work for him 1 day per month instead of paying him. What is the going physician fee for collaboration? Also how do we negotiate office space usage?. Looking foward to hearing from you.
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For those of you who have experienced this, what have you found? Feel free to comment below, or contact me with your thoughts.
Tags: collaboration fees, office space, Startup
The going rate in our area (South LA) is $100/hour including travel time. Some people pay a % of their take home net receivables such as 5% if they make enough money.
As for renting office space - it all depends on if you have to pay part of electricity, gas, water, phone, internet, salaries of employees, etc. It would probably be figured on the amount of square footage you would be accessed to use as your own if any and figure out that amount as compared to the entire square footage in the office and do the % of the monthly expenses.
Good luck,
Nina Ravey, FNP-BC
I am from NC and it may be totally different here. From what I have heard the rates vary from $500 - $1500 a month and some use the percentage of collections method. I am relatively new in Practice. Just opened in December. My collaborating physician has agreed to payment based on amount of money collected and has it gradually increasing until the practice builds.
I am also from NC and my collaborating MD didn’t ask for anything. I offered him 500 a month and an “hourly rate”…I will most likely pay him 100/hr for face to face meetings when they are a requirement. I still haven’t opened my practice and he is not “officially” my collaborator, but he has agreed. My rent will be $15 a square foot…but my practice will be in a rural area. Seems like you’d come out a little cheaper by just paying your MD instead of working a whole day for him. Ya’ll tell me if I’m wrong, but assuming an lowball reimbursement of $60 a patient, and if you were able to see 20 people a day for him…you’d make his practice about $1200 that day. Seems like you’d be better served staying at your site and building your own practice! Jan D.
Jan,
A lowball reimbursement in my state for medicaid (99213) is about $35.00! I’d love a lowball of $60!
I’m surprised at your rates for rent…$15.00 a sq ft seem rather high to me. In our area, which is also rural (WA State), that would be unheard of. Even for a brand new space, in another town, it was under $5.00 sq ft.
This is interesting…
Barbara
I agree. I think you would be better off staying in your own practice and building it and agreeing to a fee with your supervising physician. My rent runs just under $10 a sq ft, which for the area I felt is pretty good. I live in a somewhat rural area, however it is a coastal town.
Sherry K
Yes, I’m sure medicaid will be a killer, but most of the people I will see will have private insurance (at least if I can believe my own market research). I hope to do a lot of procedures which should get my numbers up. Not positive, but hopeful. Regarding the rent..I’ll bet it’s all over the place according to area. I wonder what the NP’s in private practice in NYC pay??! Jan
How are other NP’s financing the start of a new practice?
Boy you guys are all over the place! For Wilsonville Oregon where my practice is rent runs 18-22.00 a sf, plus triple net fees, (for grounds maintenance).(This adds about 25% more to the rent) Most places want a 3-5 yr lease. This is why I am in a tiny space. I cannot afford a 1300 sf space. I bought a non plummed sink for 100.00, and keep it in my exam room.
Medicaid pays for me 35.00 per rvu. I am not sure if they are using the most up to date 2008 RVU rates. But I do get paid 87.00 for a 99214. I believe it is about 60.00 for a 99213.
But remember for all of you, please negotiate with your insurance companies for better reimbursement. You are not stuck with the “rates”.. When your contract comes up for renewal negotiate for a higher rate per RVU, and make sure the companies are using the most utd RVU rates.
Carla
Oh, and for Cecilia,
I would love to hear also how all the NPs finance their start up. It cost me about 15,000. 7,000 dollars up front from savings for initial rent, malpractice insurance, licensing, and furniture, and then over the last 5 mos I have spent several thousand on an EMR (Amazing Charts), a second computer, advertising, vaccine and supplies for the practice.
I now have one employee- an ma/front desk person who is working 18 hrs a week. She costs about 1,000 a month. I have set up payroll for myself and her with ADP (like Paychex)… Minute Clinic is a large retail clinic, and also uses ADP, and I have heard other good things about them. They will handle payroll, tax deductions, and set everything up for tax issues at the end of the year.
I am single and pay for my own health insurance, home mortgage, and other bills all out of my practice income. I am almost in the black after 6 mos. I am getting about 5 new patient calls a week, and still would say 80% of each patient visit is a first time visit. So we are still building a base.
Hi Carla, I had visited your web site and really liked it. As a matter of fact, I had requested for you to contact me few months ago, but I guess with your new practice you are extremely busy. Rigt now I do independent work for an med ins company and that is my business. But I want to set up practice within next 1-2 years. I have been reseasrching etc but still have not put things into place. As they say, one may not see a profit for the 1st 2 yrs or so. hang in there.
Hi Clavel,
I am sorry, I did not see where you asked for me to contact you. Thank you regarding the website. I still am going to get some better pictures, including one in front of my car (as I do housecalls, and my lettering and log is on my car window, in my labcoat, and one in my exam room with a baby or another patient. One great thing about my website, is it is attached to many many key words. Some one can type in health clinic, or medical clinic, or urgent, or medical clinic wilsonville and my entire website link will come up, or the dex knows or yellow page ad… so it links me to all sorts of places..
Do you have an email you want me to contact you at? Or you can go on my website, and go under “contact me” , and it sends it directly to my regular email..
I would love to answer any questions from what I have learned by not going around, but going “through” the learning process.. Take Care, Carla
Hi. I think trading a days work/clinic coverage/call coverage instead of paying the physician for collaboration may be the way to go. If physicians really want to pick up extra hours/$$$ they can find that type of work. In my opinion, what independent physicians are really short of is…time. This is your true bargaining chip. If they are solo providers they are often on call many/most nights of the week unless they are part of a larger call group. Most physicians work long hours to support their lifestyle. Offer first to take call for him. This would be something you could do from home that wouldn’t cost you time in your own clinic. If you do work one day a week in his clinic, your value to him will probably be higher if he gets to be off that day. In reality, you are not going to collect $60 per visit. Don’t see it as money you don’t make. See it as a trade that allows you to do what you want to do on your terms.
Just my 2 cents,
Cindy
As for rent, shop carefully. I have four locations and spend months looking at the local commercial market before I bite. I like using craigslist and officespace.com to look for space. Because I don’t run a full service medical office my needs are less that what you might be looking for but I am a firm believer in keeping your overhead low. I pay on average $9 to $15 per square foot/year. This includes my satellite office in high-rent Redmond, Washington. Looking for space has almost become a hobby to me…I really need to get a life!
Cindy
Carla, can you give me some more details on Amazing Charts. I am looking into a system and it looks like a good deal.
Grace
I just discovered this web site and I wish something like this was around 30 years ago when I started my practice. I have seen lots of NP’s try to open practices and frankly most have failed. So, you have to do your homework and I think you have to start small. The first office I had I rented and sublet an office within to psychologists and massage therapists. Let someone else help you pay your rent. They were totally independent of me - own phone, made their own appointments, collected their own fees. This could cut your rent by a third and could bring in traffic to your office that you might not otherwise see. In the beginning I had a collaboarative MD. I never paid him. I never worked for him. I did sent him referrals. Find out what the MD’s in your area need and fill that need. Do they need help with call? Do they need referrals? It sounds like you are offering too much. Don’t pay them if you dont have to. Find out waht they really need and fill that need if you can. And then - get the laws changed in your state that require this relationship. We hated the concept of collaborative MD’s and so, in NH we got the law changed. I haven’t had a colloaborative MD for over 15 years.
The office I previously worked at had Amazing Charts, so I am familiar with it. I also wanted to say I am researching private practice as well. Some rental space, at best that I have seen has been $10-$12/sq. ft. and I have also heard of arrangements where rent is based on 25% of earnings (to which I hope their is a cap). Some who only do minimal consulting rent space by the hour. I don’t know what collaborative MDs should be compensated, mine has not asked for anything, but I have not actually “started” yet either. I will not be accepting insurance (they won’t pay for a holistic practice as far as I know). Start up costs are unreal….but I have learned a few ways to decrease some pf them, at least initially. Does anyone have any ideas of how to assess marketability and time commitment to run the business? I am not looking to work full-time, although I know there will be additional hours for running the business that are not patient contact hours. Thoughts?
In regards to Nancy,
First of all, congratulations that you started your practice 30 yrs ago! How progressive and brave you were. I completely agree about starting small. I want to get a massage therapist who really needs a space to come in a couple days a week, and it will also bring business in for me, and allow us to advertise an entire new service, with discounts or specials, and help the massage therapist too. And an acupuncturist or psychologist would have a great space to come in once a week too! I am keeping my overhead super small, although in this area the rent space prices are double what they are in the Portland area ( I am in an affluent suburb 20 miles south)..but I got a pretty good deal.. I would like it to be 300 dollars less a month, but other than that utilities are paid with a one year lease. I just need help with the keeping track of bills..my biller is offsite, and I am going to need an in house biller to help me. It is just not working. I have no idea what she is doing or what she is not doing. And she sent out some inflammatory bills, and lost me some good patients. Carla , Oregon
I have a speciality private practice (incontinence center) just outside NYC. NPs have to sell themselves and their value to a practice. If you are thought to be taking away patients rather than building a practice, they will never accept you. I advise you to find a niche. Something MDs dont have time for, like, smoking cessation, diet programs, etc.
I made a deal with the MD that if he refers his patients to me for incontinence that he can bill for my services at his rate (100%) and that he can pay me based on the amount collected.
I was also able to secure 2 contracts for annual physical exams with 2 local utilities companies that employs 300-400 employees which increases his revenue and exposure as well.
I dont pay a penny out of pocket for using the space, phone, lights as well as the secretarial staff and medical assistants and he allows me to precept students too.
Get more business savvy, and sell them your value. Make them a proposal and show them on paper what you are worth to their practice.
Would love to know more about how you decide what to pay your collaborating MD in the states that require one. When you say a percent of income, what percent? 5% sounds high to me.
I am so glad I stumbled upon this website as I work hard to get my new clinic off the ground. Leslie
I would also like to hear about collaborating physicians. Here in Florida we cannot even prescribe controlled substances, let alone get this law changed. Is there anyone in florida paying a collaborating physician? I would be interested to see how much is paid in Florida.