Buying an outpatient clinic, lab or imaging center in South 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?

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.