Buying a medical practice in South Florida

• More than one clinician seeing patients, so the practice doesn't stop when one person leaves.
• Clean billing: claims paid on the first try, coding that holds up to review, and no open audits by Medicare or insurers.
• A mix of payers (Medicare, Medicaid plans and insurers), with no single one large enough to hurt you if it cuts rates.
• A steady base of returning patients with scheduled follow-ups.
• Referral relationships with many doctors and hospitals, not one.
• An office manager who runs the day without the physician owner.
• In-office services, like lab or imaging, that earn their keep and are set up within the referral rules.
• A records system the staff use well, with a patient portal and online scheduling.

Start with how much of the practice's collections come from the selling physician's own work, and how long they'll stay. Then hire an independent coder to audit a sample of charts: past overbilling can become a repayment demand, and how the deal is structured affects whether that debt follows you. Check every clinician against the federal exclusion list, which names people barred from Medicare and Medicaid.

Read each payer contract to see whether it can be assigned to you, and plan for a gap in cash while new enrollments and credentialing go through. If any referring doctor owns part of the practice, or the practice sends patients to labs, imaging or therapy it owns, have a health care attorney check the arrangement against federal law and Florida's Patient Self-Referral Act (section 456.053). Ask about malpractice claims and who pays for the seller's tail coverage (insurance for claims filed after a policy ends). Work out with your attorney how patient records will transfer and who will keep them.

• How much of the practice's collections come from your own visits, and how long would you like to keep practicing here?
• Which insurers make up most of your revenue, and when did you last renegotiate your rates?
• Who handles billing and coding, and has the practice had any audits or repayment requests?
• What brings in revenue besides office visits?
• How do new patients find you, and which doctors or hospitals send you the most?
• Who owns the practice today, and does it have an AHCA clinic license or rely on an exemption?
• Do your other clinicians have contracts, and are any of them planning to leave?

South Florida covers Miami-Dade, Broward, Palm Beach and Monroe counties: Miami, Hialeah, Doral, Fort Lauderdale, Hollywood, Pompano Beach, West Palm Beach, Boca Raton, Jupiter, and the Florida Keys down to Key West. It's the state's largest metro area and its most international. PortMiami, Port Everglades and Miami International Airport tie the region to Latin America and the Caribbean, which supports a deep base of wholesalers, freight forwarders and logistics firms, many of them near the airport. Tourism and cruises, finance and wealth management, health care, real estate and construction carry much of the rest. Palm Beach County adds wealthy seasonal residents and, out west near Lake Okeechobee, sugarcane and vegetable farms. In the Keys, nearly everything turns on visitors, fishing and boating.

Companies that serve homes, condo buildings and other businesses do well here: the building trades, property services, insurance agencies, medical and dental practices, and professional firms.

Costs run high: commercial rent, wages and, above all, property and windstorm insurance. Price the insurance before you make an offer, not after. Miami-Dade and Broward make up the Florida Building Code's High-Velocity Hurricane Zone, with stricter rules for roofs, windows and structures. That raises building costs, and it also gives steady work to the contractors who know those rules well.

Much of the workforce and many customers speak Spanish as well as English, and a company that works well in both languages has an edge. The winter season matters more in Palm Beach County and the Keys than in Miami. In the Keys, the cost of housing makes hiring and keeping staff one of the hardest parts of running a company. Ask any seller there how they find workers and where those workers live.