by Alisa Vaughn, Gil Kochman, and Nancy Babbitt

Pediatric Practice Start-Up Checklist

While it might seem that a new pediatric practice magically opens out of nowhere, there is a great deal of behind-the-scenes work that goes into launching a practice. In fact, there can be so much work involved in opening a start-up, it may seem overwhelming at times.

Fortunately, like many things in life, if you break down this huge task into smaller chunks, it will be more manageable and less stressful. Check out our handy checklist to help you get your pediatric practice up and running.

Secure Patients

The first step you should take to secure new patients is to get into the best-managed care plans accepting new providers. Look for plans that have a large panel of insureds in your area, with a good fee schedule and reasonable terms. Many parents are in an insurance network of some kind, so pediatricians should be in one too. Very few parents will be willing to pay the higher out of network costs. Contact a number of insurance companies ahead of time and get it in writing that you have been accepted into a network; otherwise, you might be priced out of the market. In many cases, the credentialing process can take up to six months, and even longer for Medicaid. Plan ahead and do your due diligence now on how you are going to get patients into your practice. This way, when you open your doors, there won’t be any unwelcome surprises about insurance networks.

Secure Financing

Some pediatricians are under the impression that getting a loan from the bank to help open their new start-up is easy. Unfortunately, that is not always the case. Like any other business that needs capital, banks typically want doctors to have a solid business plan created with the help of an accountant or financial institution. So, prior to heading to the bank to apply for a business loan, meet with a reputable accountant and get that business plan on paper. Other items on your financial To-Do List include:

• Open a business checking account so it’s ready to accept deposits when your start-up opens
• Arrange for a working capital loan, if needed
• Find an accountant who can help with taxes and other financial issues – this may be the same professional who helps create your business plan
• Incorporate the new practice in preparation for tax time
• Obtain a federal tax ID number
• Obtain an employer ID number
• Arrange for liability insurance, disability insurance, workers comp insurance, retirement plans, and health insurance
• Set up your practice’s fee schedule
• Request fee schedules from payers – for example, you can get the Medicaid fee schedules from the public record

Choose a Location

When deciding where to hang your pediatric shingle, you should first decide on how much space you will need. A small pediatric start-up with one pediatrician will do well in a smaller office with a few exam rooms, as opposed to a larger start-up with multiple pediatricians. After deciding on an approximate amount of square footage, work on finding a location. Using a healthcare real estate professional is a best practice, as they have access to demographic and market analysis data to make sure you find the best location to meet your goals. They know the going rental rates and tenant improvement allowances and will negotiate on your behalf. The best news of all is their fee is paid by the landlord or seller. Check out several options, taking into account important things like close parking for the parents of your patients and proximity to local neighborhoods. Once you have selected the ideal spot for your pediatric start-up, sign your lease or mortgage and then get busy designing your office layout. Set up the exam rooms, waiting area, and meeting rooms well ahead of your opening date.

Purchase Technology

In addition to providing the best possible hands-on care for your patients, a great deal of technology will help to keep everything running smoothly behind the scenes. Start by choosing an electronic medical record (EMR) that is created by and for pediatricians. It’s crucial to find a cloud-based EMR solution that offers the best workflow options for your practice, and that can optimize everything that pertains to your specialty – for example, growth charts, vaccination schedules/records, and coordination with The American Academy of Pediatrics to keep up to date on everything they recommend.

Some additional technology-related tasks for your To-Do List include:

• Select a practice management system (billing, scheduling, registration, etc.)
• Select a cloud-based EMR
• Set up a patient portal
• Set up online bill-pay for patients’ parents/guardians
• Select a patient payment solution provider for credit card processing and “credit card on file” functionality
• Select a merchant services vendor — for example, a company that can process credit cards. This is especially vital if your patient payment solution provider doesn’t provide this.
• Purchase needed computers, monitors, and printers
• Purchase an adequate number of faxes and copy machines for optimum efficiency
• Set up Internet service and test it to be sure it is working
• Set up phone service and also put it through some tests
• Order medical equipment
• Create a functioning email account
• Order phone/fax/high-speed internet access lines

Hire the Right Personnel

If you currently work with an outstanding staff, you may be tempted to ask some of your personnel to accompany you over to your start-up. While you would definitely like to continue working with these great employees, you should also think about if and how you will be able to match the benefits package that they are currently receiving. For example, if you are coming from a hospital/large healthcare system, which traditionally has great benefits/extensive packages, you might not be able to offer this in your new start-up, at least not at first.

If you are hiring a brand new staff, consider bringing a manager on board, in addition to staff who will handle billing, scheduling, check-in, and transcription work, along with staff members who will provide clinical and ancillary support.

Other key items for your personnel To-Do List should include:

• Decide upon and obtain employee benefits, including health insurance, life insurance, and employee leave
• Write up your employee policy manual
• Arrange for payroll services, if you would like to use them
• Consult the Medical Group Management Association (MGMA) benchmarks for staff per FTE physician information
• Implement Occupational Safety and Health Administration (OSHA) requirements
• Write partnership and/or employment agreements for physicians, including policies for compensation, overhead allocation, calls, part-time work, retirement, buy-in requirements and leave (which can include military and maternity)

Decide How You’ll Handle Billing

Another important topic to consider before opening your practice is how you will handle billing. Will you do it internally or hire a billing company? When answering this question, it is important to consider the pros and cons of each option. For instance, for start-ups, outsourcing can be a great option because it will free up your new staff to concentrate on other, more pressing revenue-generating tasks like collecting patient balances and overseeing vaccine management. At the same time, if you are bringing your old billing staff with you to the start-up, you may want to keep your billing in-house with a team that already knows what it is doing.

Other points to consider prior to your grand opening include:

• Apply to become a participating provider with commercial and managed care payers
• Obtain provider numbers from Medicaid
• Obtain your DEA number
• Obtain your state and federal narcotic licenses, if needed
• Obtain your state medical license, if needed
• Order CPT, HCPCS, ICD-10, and Correct Coding Initiative books
• Interview pediatric billing companies, if you are planning on using one
  • Note: This is often the best route for pediatric start-ups
• Set up electronic payments with the plans and your bank
• Develop accounts receivable systems and policies
• Contract with a collection agency
• Contract with a third-party clearinghouse, if needed

Order Supplies and Furniture

Your new building will likely feel like an empty shell when you first move in. To prepare your office for its young patients and their parents, you need to order a number of supplies in addition to furniture. Order kid and parent-friendly chairs and tables for the waiting room, as well as exam tables and chairs. You will also need medical supplies ready to go, including anything needed for ancillary services like lab equipment. Lab coats – which may be monogrammed with your staff’s names and/or name tags – and staff uniforms and scrubs should be decided on well ahead of opening day. Since you are working with children, you may want to order a whimsical pattern or color for your staff’s scrubs. You should also be sure that parents can easily spot your new practice, so an eye-catching sign should be on the To-Do List. Finally, because young children will be the crux of your business, order some “kid-friendly” accessories for your waiting room – this can include a TV and DVDs of popular kid shows and movies, books, and washable toys.

Get Your Forms and Processes in Order

Prior to opening your pediatric start-up, you should also decide on and arrange for a wide variety of systems, processes, and forms. For example, if you decide that you will be using a professional transcription service, now is the time to interview companies that offer this service and select the one that you would like to work with. Also, you should choose which scheduling method you will use and arrange to program the practice management system. Other key issues to consider and decide upon prior to opening include:

• Arrange for call coverage, if needed
• Set up answering/paging service, if needed
• Establish a charge capture system: both outpatient and inpatient
• Obtain licensure for ancillary services: for example, CLIA (Clinical Laboratory Improvement Amendments) for laboratory
• Create and/or obtain a number of forms, including:

• • HIPAA Notice of Privacy Practices
  • HIPAA Business Associate Agreement
  • Consent to Treat (as required by state law)
  • Assignment of benefits
  • Registration forms
  • Medical history forms
  • Advance beneficiary notice, needed for services not covered by insurance
  • Financial policy for parents

Business Development

In today’s computer-driven world, the Internet is the number one way that patients, or in your case, patients’ parents and guardians, will find new doctors. With this in mind, it is crucial to take care of a number of tasks all related to developing your new practice and getting the word out about your upcoming opening and services. For instance, hire a professional writer to create press releases that can be distributed to the local media. Set up social media pages on Facebook, Twitter, LinkedIn, and Instagram and post regular updates about your services and when you will be open. Run ads on social media networks and search engines like Google, and plan for an open house where members of the community can come in and meet you and your staff and tour the new facility. Other items for your To-Do List may include:

• Consider hiring a practice management consultant, healthcare lawyer, and other professionals as needed along your journey. Finding trusted advisors, who are professionals with proven track records will increase the odds of a successful practice. It may be tempting to save money and hire family and friends; but many times, they do not have the expertise and end up costing more.
• Create a business plan for the first two years
• Review non-compete agreements, if applicable, to make sure you are not in violation
• Create and print business cards and stationery
• Arrange for hospital privileges
• Introduce yourself to referring physicians
• Develop and launch a user-friendly and eye-catching website – unless you are adept at such things, then you should hire a professional website designer

Congratulations on Your Start-Up!

As you can see, launching a successful pediatric start-up involves much more than a passion for helping children. There is a lot of work to be done behind the scenes prior to the grand opening celebration, including financial decisions, staffing choices, supplies, EMR decisions, and dotting plenty of I’s and crossing lots of T’s. But with hard work and dedication, you’ll get through these suggestions, one To-Do List at a time.

It’s crucial to find an EHR solution that offers the best workflow options for your practice and can optimize everything that pertains to your specialty.

Request a walk-through of a pediatric-specific EHR – Office Practicum, the proud sponsor of the Pediatric Success Series.