Buying a chiropractic or therapy practice in Jacksonville and Northeast Florida

• 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.

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?

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.