Buying an outpatient clinic, lab or imaging center in Jacksonville and Northeast Florida

• Many referring doctors, with no single practice sending most of the volume.
• Contracts with the major insurers in the area at stable rates.
• Equipment in good condition, under service contracts, and recent enough that insurers and referring doctors accept the images and results.
• Current accreditations, and stable agreements with the radiologists or medical director.
• Fast scheduling, quick results, and staff who handle insurance pre-approvals well. That is often what referring offices care about most.
• For urgent care: a visible location, good hours and short waits that bring patients back.
• A billing team that tracks denied claims and appeals them instead of writing them off.

Ask for volume by referring doctor for the last two or three years. If a few practices send most of it, ask to meet them before closing. Find out whether any referring doctor owns part of the business or receives payments from it, such as rent, medical director fees or marketing deals. Have a health care attorney review each one, because federal and Florida referral laws apply.

Get the age, service history and remaining payments on every major machine, and price out replacing anything near the end of its life. Check whether equipment leases and service contracts can be assigned to you. Look at the mix of payers and recent rate changes, since Medicare and insurers revise their rates. If auto insurance claims are a large share, confirm the center has the license and accreditation that Florida's no-fault law requires for it to be paid. A licensed clinic that offers MRI must hold national accreditation, and AHCA will deny a change of ownership if the clinic is out of compliance (section 400.9935(7)), so get the accreditation file. Finally, plan the timing of licenses, enrollments and payer contracts so billing doesn't stop.

• Which doctors or practices send you the most patients, and how long have they worked with you?
• How old are your main machines, and what do the service contracts cover?
• Who reads your scans or directs the lab, and could that agreement easily continue under a new owner?
• Which insurers do you have contracts with, and have any cut rates or dropped you recently?
• How long does a patient wait for an appointment, and for results?
• Do any doctors who refer to you have an ownership stake or another financial arrangement with the business?
• Has the center had any audits, inspections or repayment requests from Medicare or insurers?

This region covers Duval, St. Johns, Clay, Nassau, Baker and Putnam counties: Jacksonville, Jacksonville Beach, St. Augustine, Ponte Vedra Beach, Orange Park, Fleming Island, Green Cove Springs, Fernandina Beach, Yulee, Macclenny and Palatka. Jacksonville merged with most of Duval County in 1968, which makes it the largest city by land area in the lower 48 states.

The economy leans on logistics, the Navy and financial services. Logistics runs through JAXPORT, major rail lines and the meeting of Interstates 95 and 10. The Navy has Naval Air Station Jacksonville and Naval Station Mayport. Insurance and health care matter too. St. Augustine, founded by the Spanish in 1565, and Amelia Island draw steady tourism. Trucking and logistics firms, the building trades, medical practices and home services all fit this market.

Northeast Florida is less seasonal than South or Southwest Florida, with fewer winter residents and more year-round employers. Direct hurricane landfalls have been less common here than on other parts of the coast, but storms still bring flooding along the St. Johns River and the beaches, so check insurance costs and flood zones.

Military families bring skilled workers and working spouses into the labor pool, though they also move on when orders change. St. Johns, Clay and Nassau have added the most new homes, and companies serving those suburbs have grown with them. Georgia is close, and some companies here serve customers across the state line. Work in Georgia may need Georgia licenses, so ask how much revenue comes from there and who holds those licenses.