It feels at least this good to start your own practice.
When planning how to start a new ophthalmology practice, it is very easy to become overwhelmed. Partially, this is because there isn’t a readily accessible ophthalmology-specific resource to help you on your journey. This website was originally planned to help in this area.
This page provides a checklist of items to accomplish along the road to opening the doors of your new practice. Further information about each step can be found in other sections of the website. In general, I found it helpful to separate the steps into those you can do before having a practice address and those that require having your address settled.
This list can look very daunting (and it is when looking at it as one unit), but I promise that if you can make it through ophthalmology residency you are very capable of starting your own practice. These steps are simply time consuming, not difficult.
Without Practice Address
Decide to go solo.
The sooner the better. I recommend making this decision about 9-12 months before you enact your plan. If you aren’t doing fellowship, this means beginning to make concrete plans about the time your co-residents are doing fellowship interviews.
Find location. Approximately 6-9 months to go.
In general, look for about 1700sq ft for two exam lanes, one testing room, and one private office.
Consider getting a commercial real estate agent
If building from an empty shell, you will need more time for to hire an architect to design a floor plan, hire contractors, and have your new office built out to your specifications.
State medical license. 6 months to go.
Depending on the state in which you will practice, it can take up to 6 months to get a medical license. Always plan to be on the long end of whatever timeline your state licensing board quotes.
DEA number & Type 1 NPI (T1NPI) number. 6 months to go.
You likely already have both of these, but if not you must register for each one independently.
T1NPI: https://nppes.cms.hhs.gov/#/
Pro Forma. Begin as soon as possible. Complete with 3-6 months to go.
The sooner you start the better. This can be a somewhat lengthy process and its nice to break up the work into multiple sessions.
Financing. 3-6 months to go.
Name practice. 6 months to go.
It’s not enough to have a great name for your practice. You will also have to register it with the state and federal governments. I recommend doing this as soon as you can but in the same calendar year that you plan to open doors to keep your accounting easy.
Personal and business malpractice insurance. 3 months to go.
Website design. 3 months to go.
Registering the domain name and having some sort of website up is good because the length of time the site has been active is built into how search engines rank results. So greater than 3 months is also okay.
EMR & PMR choice. 3 months to go.
I recommend an integrated solution. You should choose a clearinghouse that integrates with this software.
Buy equipment. 1 month to go.
You can get your equipment order planned and negotiated in a couple of weeks, but it’s good to think about your equipment needs before the last month.
Business phone number. 3 months to go.
You’ll want this number comparatively early so that you can put it on all your insurance contracts and hospital/ambulatory surgery center applications.
Write forms. Any time.
Includes employee manual, intake forms, consent forms, etc
There is a great library at the AAOE website: https://www.aao.org/practice-management/practice-forms-library
OMIC offers free consent forms on their website: https://www.omic.com/risk-management/consent-forms/
WIth Practice Address (should have address with around 4-6 months to go).
DEA registration & T1NPI address change. After finishing your current job.
You must keep your address on file with these governmental bodies up to date.
Incorporate. This makes it official.
Hire a lawyer to make sure that you have the correct type of incorporation for your state. This could be a PLLC, SC, etc and the best type varies by state.
Tax ID number.
You’ll get this when you incorporate. This number is critical to the remaining steps because it acts like a corporate social security number.
Business bank account and credit cards.
Typically wherever you obtain your startup loan is a good place to have an account and credit cards. Sometimes this is a requirement to get the loan in the first place.
Type 2 NPI number.
An NPI number for your medical practice.
Business insurance. 3 months to go.
Most insurance companies won’t even give you a quote with more than 3 months before the business is scheduled to open.
Insurance contracting & credentialing. 6 months to go.
In general, commercial insurance should take about 2-3 months and government (CMS) takes about 4-6 months.
Medicare (PECOS). Register here: https://pecos.cms.hhs.gov/pecos/login.do#headingLv1
Medicaid. Registration can be state dependent. Your state’s Department of Health and Human Services website should have more information.
Commercial plans (CAQH application) is crucial to get credentialed with most commercial insurance plans. https://upd.caqh.org/oas/
Independent physician association (IPA). A group of independent physicians who act as one group to contract with various companies (e.g. insurance companies). In the context of insurance, if you join an IPA you will get their negotiated reimbursement rate and be credentialed with all the insurances with which they are contracted.
Hospital privileges. 3 months to go.
If you desire to take hospital call or are required to have hospital privileges by your ambulatory surgery center.
Local business licenses. 3 months to go.
ASC privileges. 3 months to go.
Contract with credit card processing company. 1-2 months to go.
Middlemen that allow you to accept credit cards.
One Month Before Opening.
Purchase medical & office supplies, business cards, prescription pads
Some good resources are vistaprint.com, amazon.com, and 48hourprint.com
Buy office furniture
Update address on Google places, Healthgrades, Vitals, insurance companies
Advertise for employee (if needed)
Interview, background check, hire
Payroll service
Gusto, Surepayroll, or QuickBooks are all reasonable options for doing payroll yourself with automatic tax withholding
Find colleagues to help with call
Meet local doctors and referral sources
Continuing Business Education
Learn bookkeeping, accounting, billing, and revenue cycle
Be sure to keep up on CME
Get a retirement plan
Avoid penalties for MIPS and MACRA
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