Buying a chiropractic or therapy practice in Florida

These are offices where licensed practitioners treat patients over a series of visits: chiropractors, physical, occupational and speech therapists, massage therapists, and others such as podiatrists, acupuncturists and counselors. A patient usually comes in with a plan of care covering several weeks of visits, so revenue depends on how many new patients arrive and how many finish their plan.

Who pays depends on the specialty. Physical therapy clinics bill Medicare and health insurers, and pediatric therapy clinics often rely on Medicaid plans. Chiropractic offices mix health insurance, cash visits, prepaid packages, and auto insurance claims under Florida's no-fault personal injury protection (PIP) coverage. Workers' compensation is common for injury care. Massage and wellness offices are mostly cash, often through monthly memberships, which make revenue more predictable.

New patients come from referring doctors and surgeons, insurance directories, word of mouth and online search. The team is the licensed clinicians, assistants such as physical therapist assistants, aides, a front desk that verifies insurance, and someone who handles billing. You'd be buying the referral relationships, the patient schedule, the clinicians, the equipment and the location.

• Referrals from many sources, so losing one orthopedic group or one family doctor doesn't empty the schedule.
• Patients who finish their plans of care, with few cancellations and no-shows.
• A mix of payers, without heavy dependence on auto insurance claims.
• Several clinicians treating patients, not just the owner, and therapists who have stayed for years.
• Documentation that clearly supports why each visit was needed, which is what auditors look for.
• For cash and membership businesses: a steady membership base with low monthly cancellations.
• A front desk that checks benefits before the first visit, so patients aren't surprised by bills and the practice isn't chasing unpaid balances.
• Equipment that fits the work, such as treatment tables and exercise space, in good repair.

Each clinician holds a personal license from a Department of Health board, such as the boards of Chiropractic Medicine, Physical Therapy Practice, Occupational Therapy Practice and Massage Therapy.

Chiropractic has a real ownership limit. Under section 460.4167, only certain owners may employ or contract with chiropractors. Mainly, they are:

• businesses wholly owned by chiropractors (or by a chiropractor plus a spouse, parent, child or sibling);
• businesses wholly owned by medical, osteopathic or podiatric physicians;
• clinics licensed by the Agency for Health Care Administration (AHCA) that also offer care by medical or osteopathic physicians, with one of them as medical director;
• hospitals, nonprofits, public companies and insurers.

If you aren't licensed, you generally can't own a stand-alone chiropractic office. Optometry has a similar rule: only optometrists may employ optometrists, with narrow exceptions (section 463.014).

The physical and occupational therapy laws have no similar rule. But under the Health Care Clinic Act, a practice that isn't wholly owned by licensed practitioners (or by one practitioner plus close family) generally needs a clinic license from AHCA and a medical or clinic director. A massage establishment license can't be transferred (section 480.043), so a new owner applies for its own. Confirm your structure with AHCA and a health care attorney.

If the practice treats car accident patients, find out how much revenue comes from PIP. Florida's no-fault law pays only when care starts within 14 days of the accident. It pays less when no emergency medical condition is found, pays only certain kinds of providers, and excludes massage and acupuncture. Auto insurers can also dispute or audit these claims, so ask for the history.

Have someone review a sample of charts to make sure the plans of care and visit notes support the billing. Each clinician has to be approved by each insurer individually (credentialing), so ask how long it will take to add new clinicians under your ownership. Check for prepaid packages and memberships you'll have to honor. If doctors who send patients own any part of the practice, that raises referral law questions, since Florida's Patient Self-Referral Act covers physical, occupational and speech therapy. Offices with x-ray machines register them with the Department of Health. If you buy the assets, you register the machines within 30 days and before using them; if you buy the company, you report the changes within 30 days (rule 64E-5.511).

• Where do most new patients come from, and which referral sources have grown or faded lately?
• How many visits does a typical patient complete, and how often do patients stop coming early?
• What share of your work involves auto accident or workers' compensation claims?
• How many of the clinicians are employees, and how long have they been with you?
• Do you sell prepaid packages or memberships, and how many visits are still owed?
• Have any health or auto insurers audited your claims or asked for money back?
• How do you see your own role after a sale, and would you keep treating patients for a while?