Buying a medical practice in Treasure Coast

• 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?

This region covers Martin, St. Lucie and Indian River counties on the Atlantic coast and Okeechobee and Highlands counties inland: Stuart, Palm City, Port St. Lucie, Fort Pierce, Vero Beach, Sebastian, Okeechobee, Sebring and Avon Park. Port St. Lucie is the largest city and has grown quickly as a suburb within reach of Palm Beach County to the south.

The coast draws retirees and winter residents, and health care, construction, real estate, boating and sport fishing are big parts of the economy. The coast lies in the Indian River citrus district, named for the lagoon. Inland, Okeechobee and Highlands are cattle, dairy and citrus country around Lake Okeechobee and along the ridge near Sebring, with many retirees of their own. Home service companies, the building trades, marine businesses and medical practices find steady customers here.

The coast is seasonal, with winter residents filling restaurants, golf courses and service schedules, and summer is quieter. Hurricane Nicole came ashore near Vero Beach in November 2022, and the region has a long history of storms, so check insurance, flood zones and how a business came through recent ones.

Water quality in the St. Lucie River and the Indian River Lagoon is a recurring problem, and in a bad year it can hurt fishing, boating and tourism businesses. Inland, distances are longer and the labor pool thinner. A company in Sebring or Okeechobee may be one of very few of its kind nearby, which can mean loyal customers and little competition, but also few people to hire. Most new homes on the coast are going up in and around Port St. Lucie.