Medical Practice Startup

Before discussing square footage, staffing, or equipment, it is critical to define what you are actually building and why.

We work with you to articulate the core concept of the practice, the patient population you intend to serve, and how the practice will differentiate itself within the local market.

• Practice model and scope of services
• Target patient population and market positioning
• Competitive landscape and referral dynamics
• Payer mix assumptions and reimbursement considerations
• Growth objectives and exit optionality

Outcome: A realistic, defensible concept that can support financial modeling and operational planning.

Once the concept is defined, we translate strategy into numbers. Early-stage financial planning is less about predicting the future with precision and more about understanding capital needs, cash flow timing, break-even dynamics, and key sensitivities.

We develop forward-looking models that support decision-making and help you avoid common startup pitfalls such as undercapitalization, overbuilding, or unrealistic ramp expectations.

Topics often include:

• Startup and pre-opening cost estimates and timing
• Pro forma income statements and cash flow projections
• Break-even and ramp-up analysis (including sensitivity ranges)
• Capital sourcing considerations (personal capital, bank financing, partner contributions, etc.)

Outcome: Clear visibility into capital requirements, timing, and financial expectations.

Structural decisions made early can have long-term implications for taxes, compensation, compliance, and future transactions. While legal and tax counsel ultimately drafts and finalizes documents, we help you frame the strategic questions and evaluate practical tradeoffs.

We coordinate conceptually with your advisors to help ensure governance and alignment choices support growth, manage risk, and preserve flexibility as the practice evolves.

Topics often include:

• Ownership and governance concepts (including decision rights and partner alignment)
• Compensation philosophy and incentive alignment
• Regulatory considerations that affect structure and operations
• Forward-looking considerations (future partners, ancillaries, and potential transactions)

Outcome: A structure that supports growth, compliance, and future flexibility.

Real estate is often the largest fixed commitment a startup practice will make. The wrong site, too much space, or a mismatched build-out can create financial strain before the practice has the volume to support it.

We provide strategic guidance to help you think through location selection, space needs, and build-out scope based on your care model, staffing plan, and financial assumptions—helping avoid overbuilding or misalignment between space and operations.

Topics often include:

• Site selection considerations and tradeoffs (visibility, access, referral proximity, demographics)
• Space sizing and layout concepts aligned with workflow
• Lease vs. purchase considerations and risk management
• Build-out budgeting, vendor sequencing, and timeline planning

Strong financial projections are only achievable if operations are intentionally designed. Operational planning connects your strategy to how the practice will function day-to-day and how patient experience, throughput, quality, and staff efficiency will be achieved.

We help you define core workflows and operating principles so you can scale thoughtfully rather than reactively.

Topics often include:

• Staffing model design and role clarity (clinical and administrative)
• Scheduling and access philosophy (new vs. established, procedure blocks, templates)
• Clinical and administrative workflows (front desk, rooming, documentation, checkout)
• Technology stack considerations (EMR, practice management, phones, patient communication tools)

Outcome: An operating model that supports efficiency, patient experience, and scalable growth.

Credentialing and payer enrollment is one of the most common causes of delayed cash flow for new practices. Even excellent clinical operations can struggle if enrollment timelines are underestimated or if a single application error restarts the clock.

During a startup engagement, DoctorsManagement can handle credentialing and enrollment for your practice. We manage the application process end-to-end, monitor payer portals, follow up consistently, and keep CAQH information current so that approvals and effective dates stay on track.

Where appropriate, we also help align credentialing with contracting strategy so you are not only approved but positioned for competitive reimbursement and a realistic cash-flow ramp.

Credentialing services commonly include:

• CAQH profile setup, maintenance, and attestation support
• Commercial payer credentialing submissions and status tracking
• Medicare and Medicaid enrollment coordination (as applicable)
• Payer portal monitoring, follow-up, and documentation responses
• Enrollment sequencing and timeline planning tied to your launch plan
• Contracting support and negotiation coordination to pursue competitive reimbursement rates

Outcome: A credentialing and payer enrollment process that reduces revenue delays and supports a smoother, more predictable launch.

Cash flow stability is essential to early-stage success. Our focus is on revenue cycle process design and oversight—not transactional billing or coding execution. The objective is to ensure the foundational workflow and accountability are in place so that clean claims and predictable collections are achievable.

We help define how revenue cycle responsibilities will be handled (internal vs. outsourced), what “good” looks like, and which KPIs should be monitored from day one.

Topics often include:

• Revenue cycle workflow design (intake, eligibility, authorizations, charge capture, posting, follow-up)
• Outsourced billing/vendor evaluation considerations (high-level)
• Key benchmarks and monitoring cadence (A/R, denial trends, net collection rate, lag days)
• Payer strategy considerations that affect revenue predictability

Outcome: A revenue cycle framework capable of supporting clean claims and predictable cash flow.

Early hiring decisions shape culture, capacity, and patient experience—often before the practice has stable cash flow. HR planning helps you balance the need for strong team members with the realities of ramp-up volume and payroll burden.

We advise on staffing models, role definitions, and onboarding frameworks so the practice is adequately supported at launch and positioned to scale. While we do not replace your HR provider, payroll company, or attorney, we help ensure the employment infrastructure is thoughtfully planned and aligned with your operating model.

Topics often include:

• Organizational chart and staffing plan by phase (pre-open, launch, growth)
• Job descriptions, compensation ranges, and incentive considerations
• Benefits strategy considerations and administrative setup coordination
• Onboarding, training, and early performance management framework

Outcome: A staffing and HR roadmap that supports launch readiness and sustainable growth.

Compliance readiness is not a ‘nice to have’—it is foundational. New practices must establish policies, training, and documentation early so that operations are safe, professional, and defensible. In many cases, compliance items also affect timelines (e.g., CLIA, controlled substances processes, laboratory workflows).

We provide a compliance readiness roadmap and help you prioritize the core elements needed for launch. Execution typically involves a combination of internal leadership, third-party vendors, and counsel; our role is to help you create a clear plan, identify gaps, and sequence work appropriately.

Topics often include:

• HIPAA privacy and security readiness (policies, training, risk considerations)
• OSHA and workplace safety planning (exposure control, training, documentation)
• CLIA considerations for in-office testing (where applicable)
• General compliance infrastructure (incident response, record retention, vendor oversight concepts)

Outcome: A compliance foundation that supports safe operations and reduces regulatory risk.

Vendor decisions made early can materially affect ongoing expense structure and day-to-day friction. A thoughtful vendor strategy helps manage costs, reduce supply issues, and create a repeatable operational backbone.

We advise on procurement strategy and vendor selection considerations, including how and when a Group Purchasing Organization (GPO) may be appropriate. We also help ensure vendor choices align with the practice’s care model and revenue cycle workflows.

Topics often include:

• GPO evaluation and cost-saving considerations
• Core vendor categories (medical supplies, vaccines/biologics where applicable, lab, IT/phones, shredding, waste)
• Sequencing and accountability for vendor setup and contracting
• Ongoing supply chain process design (ordering, par levels, controls)

Outcome: A vendor and procurement approach that supports reliability and cost discipline

The period immediately before and after opening is where many issues surface. Launch planning ensures the practice is not simply ‘open,’ but operationally ready—with clarity on the critical path tasks, responsibilities, and early performance expectations.

After launch, we help clients monitor early KPIs and prioritize improvements so small problems do not become structural ones.

Topics often include:

• Launch timeline and milestone tracking
• Early KPI monitoring and operational check-ins
• Identification of bottlenecks and near-term fixes
• Prioritization of improvement opportunities across access, staffing, and cash flow

Outcome: A smoother ramp-up with fewer surprises and a clearer path to stability.