Buying a chiropractic or therapy practice in Treasure Coast

• 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 Martin, St. Lucie and Indian River counties on the Atlantic coast and Okeechobee and Highlands counties inland: Stuart, Palm City, Port St. Lucie, Fort Pierce, Vero Beach, Sebastian, Okeechobee, Sebring and Avon Park. Port St. Lucie is the largest city and has grown quickly as a suburb within reach of Palm Beach County to the south.

The coast draws retirees and winter residents, and health care, construction, real estate, boating and sport fishing are big parts of the economy. The coast lies in the Indian River citrus district, named for the lagoon. Inland, Okeechobee and Highlands are cattle, dairy and citrus country around Lake Okeechobee and along the ridge near Sebring, with many retirees of their own. Home service companies, the building trades, marine businesses and medical practices find steady customers here.

The coast is seasonal, with winter residents filling restaurants, golf courses and service schedules, and summer is quieter. Hurricane Nicole came ashore near Vero Beach in November 2022, and the region has a long history of storms, so check insurance, flood zones and how a business came through recent ones.

Water quality in the St. Lucie River and the Indian River Lagoon is a recurring problem, and in a bad year it can hurt fishing, boating and tourism businesses. Inland, distances are longer and the labor pool thinner. A company in Sebring or Okeechobee may be one of very few of its kind nearby, which can mean loyal customers and little competition, but also few people to hire. Most new homes on the coast are going up in and around Port St. Lucie.