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    11 Replies Latest reply on Mar 30, 2010 1:44 AM by drjamesdiaz

    How do I start a healthcare community clinic?

    drjamesdiaz Wayfarer

      I am interested in starting a non-profit community healthcare clinic in rural mendocino county, california. Staffing would include Medical,chiropractic,acupuncture,physical therapy,massage, dietician,midwifery,naturopathic, homeopathic. Onsite Xray,MRI, therapeutic swimming pool for rehab., Doctors would consult with each other for the benefit of the patient. Instead of automatically prescribing a drug for the treatment of a condition, first consideration would be non-drug solution if appropriate.
      I need help with business plan and nearly all aspects. Pres. Obama has indicated that community healthcare clinics are a priority in his agenda for healthcare and I would like to take advantage of this. Multidisciplinary practice is an awesome venture and virtually guaranteed success if properly set up. The timing couldn't be better. I am a chiropractor with 15 years experience in private practice. The fact that this is a rural community bodes well to find financing/grants.
        • Re: How do I start a healthcare community clinic?
          LUCKIEST Guide
          How do I start a healthcare community clinic?? Welcome

          Who are you?? Where are you??

          I am a SCORE Counselor and would be happy to help you start a healthcare community clinic and also help you with your business plan.

          Talk to me, LUCKIEST
          1 of 1 people found this helpful
            • Re: How do I start a healthcare community clinic?
              drjamesdiaz Wayfarer
              Hello Luckiest, Not sure if my first reply went through or not so here goes again.
              I am Jamie Diaz, husband of one wife, 14 years, father of 5 homeschooled children. I am a chiropractor, 18 years in private practice. I am active in my church, Rotary Club member, Chamber of Commerce member, Big Bros./Big Sis. sponsor, Board member of Nuestra Casa, Marketing volunteer at Center for Live Choices.

              I practiced initially in the San Francisco bay area for 15 years then relocated my family to Ukiah, Ca area and built a new practice from scratch 6 years ago. Last Aug I opened a satallite office in a smaller town north of Ukiah where there was a shortage of chiropractors.

              My dream: Establish a multidisciplinary healthcare facility with Medical/Chiropractic as the bedrock. Affiliate disciplines would be acupuncture, homeopathy, naturopathy, physical therapy, midwifery, dietician. We would need xray and mri.

              I have looked at business plan formats and some of the stuff that is over my head is: projected expenses, projected income, etc., etc., I have never done something of this scope before. I just know that the time is now and the opportunity is huge. JD
            • Re: How do I start a healthcare community clinic?
              bmt2008 Adventurer
              Start with either SCORE - www.score.org - or find a local SBDC in hyour area. They can help you get started on planning your clinic.

              Sounds like a great idea if there is need and demand in your area. These organizations will help you find out and they are free.
              1 of 1 people found this helpful
              • Re: How do I start a healthcare community clinic?
                bmt2008 Adventurer
                Dr. Diaz,

                Projecting income and expenses are hard for any new business as you are making an estimate of the unknown. If you already have a practice, you should be able to use that information to estimate income items, costs items and their projected amounts. Further, as your business moves forward into the unknown, you will find that you have to modify all of your numbers. Costs may be higher or lower - revenue may take longer to recieve or you could out grow your current cash flow - the market could rebound changing all of your projections or it could worsen. There is just so much beyond your control that it is nearly impossible to accurately predict the future. I would suggest that you do the best that you can - at some point - it will be good enough - and move on with other aspects of the business. But, keep monitoring your financials and make changes as you move along.

                Question, Are you going to seek funding - either traditianl bank loan or SBA loan - for this venture? If not, I would not spend a ton of time worrying about a business plan or your financial projections. Do, sketch out the basics - but, you don't need the details of a formal plan.

                Have you talked to other providers - others that you would invite into your clinic? I assume that each will run their own practice - thus you would not need to estimate any information on them. If you have not talked to these other providers - now would be a good time. Find out if they are interested. How much they would pay or revenue share or what ever you have in mind. Find out what they need to run their business - this should help you better predict costs and expenses.

                If you are seeking equipment for your venture - try a non-bank equipment loan or lease. Banks just are not lending to start-ups. Usually non-bank equipment financiers require much less than banks (no business plan) and are very competitive with rates and terms. Leasing may even be a cheaper option with all the benefits of purchase.

                Do contact your local SBDC or SCORE office. They can provide a lot of insight into what you will need or what you should be at least thinking about to make this venture a success.

                Just some thoughts - best of luck
                  • Re: How do I start a healthcare community clinic?
                    drjamesdiaz Wayfarer
                    Dear BMT,
                    Thank you for the help. Since chiropractic is going to be only one of many of the services provided (ie: medical, acupuncture, homeopathy, physical therapy, etc.) I don't feel like I can extrapolate current numbers out for chiropractic and get an accurate number for the community clinic as a whole. Any other suggestions? Secondly, I need to seek funding as a non-profit and recieve grant monies under Obama's plan of increasing funding for new and existing community clinics. I have checked into the US federal gov't website and so far haven't found a solid lead. Thirdly, the other providers/doctors/therapists that provide services that are reimbursable under the medicare, mediCal, and insurance-covered fee schedules will be billed-out through the non-profit tax ID number. The providers will be paid by salary or percentage of total collected. They will not operate under a seperate entity. JD
                    • Re: How do I start a healthcare community clinic?
                      drjamesdiaz Wayfarer
                      Dear bmt,
                      I was unable to view my reply to your helpful advice. Here goes again. Since my service is only one modality and doesn't include medical,acupuncture,physical therapy, etc., I don't think my numbers generated through my chiropractic practice will extrapolate out and give me projected expense vs income for a multidisciplinary community clinic. The other providers will not be independent but rather part of the non-profit community clinic so they will be paid a percentage of collections for thier services.
                      I hope to find grant monies to fund the set-up through Obama's healthcare initiatives. Community healthcare clinics are big on his agenda and he has appropriated monies for new and existing clinics. I just don't know how to access. Any suggestions? JD
                        • Re: How do I start a healthcare community clinic?
                          bmt2008 Adventurer

                          Two suggestions for grants:

                          First, not sure where you are located - but go to your local or regional chmber of commerce. They should be able to point you in the right direction. In my city - there are two sources of local grant funds. 1) our city has an economic development grant (funded by a 1/2 cent sales tax inititive). With these fund, the city is required to fund any business that meets an unmet need in the community, creates jobs (at an average wage) or brings in outside money. 2) We also have a local private health foundation (funded by individuals and businesses looking to support (give back) to the community). This group loves to fund health related businesses - especially non-profit - in the area.

                          Not sure what you have in your area - but your chamber should know. If you don't have a chamber of commerce - approach your city leaders (Mayor's office or city manager) or contact the manageing editor of your local newspaper or TV station - they should know.

                          Second, search for foundations in your industry. There are numerous foundations - especially related to health issue - that fund non-profit organizations. A quick google search should get you started. Search their websites and look for grant opportunties. An example - (not sure if they will fund your organization - but who knows) - is the Bill & Melinda Gates Foundation - http://www.gatesfoundation.org/Pages/home.aspx.

                          Just remeber - in seeking grants - read the foundations guidelines very closely - most only require a brief two page summary of your full proposal. Follow their guidelines and make sure you clearly state how you fit their organization's requirement and the benefits you will provide to your community at large. Also, make sure your summary and proposal is very well written.

                          I would also, if you have not - start on setting up the non-profit. Form the organization and submit to the IRS for your 501(c)(3). This will take a lot of time - but at least in the mean time you could state that you are awaiting approval. Not sure about exact costs - but if you do much of the work, should be around $3,000 or so just in filing fees.

                          Hope this helps - good luck.
                          1 of 1 people found this helpful
                      • Re: How do I start a healthcare community clinic?
                        horizon21740 Wayfarer
                        Hello Dr. Diaz,

                        I am interested in learning how your project is coming along. It appears that it has been nearly a year since the last post.

                        I look forward to hearing from you.
                          • Re: How do I start a healthcare community clinic?
                            drjamesdiaz Wayfarer
                            Not very far and probably just as well. I have become a board member of a local non-profit back in November which has given me precious insight in the workings of a non-profit corp. I have made several contacts with medical doctors in my area and realize better what I am up against in this huge endeavor. Since my posts one year ago, the economy has gotten worse and one of several community clinics in this county has shut it's doors, making the need for what I want to do ever the more needed. My office manager/receptionist resigned leaving me with no knowledge on my software. Not many doctors get behind the computer and i am no exception. I usually have the outgoing person train the incoming person and so I just haven't had the experience of having to do my own billing or to train a new employee how to do it so I was in quite a bind. I've since learned to be functional with the software and hired and trained a new front desk person. I had to drop a General Accounting Principles class that I enrolled myself in when this all went down. I managed to get a cursory overview of some of the basic financial statements I should know how to read and interpret. My steps toward the goal have been slow but I am still moving forward. Today I contact the ER dept at Sutter Lakeside Hospital in an attempt to reach a doctor who I was referred to. This doc thinks "out of the box" which is what it is probably going to require since I want a facility that is more open to non-pharmacology driven philosophy. I don't think I am going to do this as a non profit. There are just too many rules and regulations. Who are you and do you have any suggestions?
                              • Re: How do I start a healthcare community clinic?
                                horizon21740 Wayfarer
                                Thanks for the update. I can understand that the economy has placed a stop on a lot of business plans. I happened to run across your post and I thought it was an interesting concept. I agree, I think the non-profit has a lot of rules and regulations, not to mention the fact that you would have to establish a board of directors, etc. A for-profit organization will probably be the best way to go. It will be interesting to hear how your conversation went with the doc who things out of the box.

                                It sounds like you have a lot going on with your practice. Unexpected turnover always causes some bottlenecks.

                                A little about myself... I have worked in healthcare administration for a little over twelve years. I primarily worked on the health plan side and I have a few years of experience working with pharmacy benfit management companies. In the past year, I have leveraged my experience to start a healthcare consulting firm where we are able to support healthcare providers with administrative tasks, e.g., electronic medical billing, chart auditing, corporate compliance programs, development and implementation of marketing and business development programs, and a variety of other tasks. Our model is slightly differenet from some of our competitors as we focus on working with small to medium-sized providers, only. We are able to manage your billing and accounts very reasonably, so your staff can focus on patient care.

                                If you think you can use our services, let me know. I can be reached at bgeesaman@horizonphysiciansolutions.com.

                                I look forward to hearing from you.

                                Brian
                                  • Re: How do I start a healthcare community clinic?
                                    drjamesdiaz Wayfarer
                                    Hello. I visited your website and wondering about your experience in dealing with multi-disciplinary practices. How do your services do the recievables end when it comes to reconciling EOB's and payments with the database? Some softwares automatically input the payments so that you don't have to go in and manually input the payments. This saves a tremendous amount of work. In fact, this is the most tedious administrative task of all. Inputing patient copays, inputing insurance checks, writing-off for in-network allowables, and detecting underpayments, inappropriate downcoding/bundling and denials is the bummer in the business.