Buying a chiropractic or therapy practice in South 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?

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.