Expand Your Reach
Qué hacer y qué evitar cuando se abre un consultorio satélite

by Karen Childress
Karen Childress is a writer for Physicians Practice

Opening your second, third or tenth office isn’t as daunting as opening your first one, but it’s not a decision to be taken lightly. Assuming the process is handled properly, expanding your reach could be a positive move from both a patient service and bottom line perspective. As you consider growing by adding locations, bear in mind that this will add a level of complexity to your practice. Done efficiently and for the right reasons, however, it can be well worth the effort.

Why am I doing this?
Before leasing one square foot of office space, ordering one piece of equipment or hiring one new staff person for a satellite office, ask yourself this most important question: “Why am I doing this?” Not only is it a financial risk, but the process of opening another office will consume a good deal of time. Be sure you are doing it for well thought-out business reasons.

Carl Rudd, administrator of the Jackson Clinic in Jackson, Tenn. (with 12 locations and 130 physicians) recommends opening a satellite office for one of three reasons: to add to the convenience of your patients, to discourage a competitor from going into an area, or because you are bringing a new practice into your group and that office is in an area where you want to maintain a presence.

Paul Angotti, president of consulting group Management Design, LLC in Monument, Colo., works with many physicians who have more than one office. He says that maximizing revenue by making better use of equipment is another good reason to consider a satellite office. If, for example, you’ve invested in an expensive laser or scope that is portable, why not offer that service to patients in a neighboring community? Working one or two days a month out of a referring physician’s office or using a procedure room at the local hospital can make sense for everyone involved.

There are some not-so-good reasons for opening a satellite office as well: just because everyone else is doing it, boredom with day-to-day practice and the desire for a new project, and the feeling that some small-scale empire building will give you a sense of power. If you are motivated by any one of these reasons, rethink your plan.

Know your market
If a satellite office is in the cards, as a first step, you’ll need to determine what the market is like in the area you are considering. Is another physician in your specialty needed? How many are there now? How booked up are they? What’s the population in the community, and is it growing? What major insurance payers are there?

Do an analysis by ZIP code to determine how far your current patients travel to see you and where they are coming from. If you have a large number of patients from a nearby community, it would be a convenience for them to have you closer. The question is whether you’d attract even more patients from that area if you had an office there, or if your presence might discourage a competitor from moving in.

According to Angotti, there is an easy and inexpensive way to assess a market. “Visit the hospital, talk to the administrator, ask ER (emergency room) doctors what they do with their cases, ask other physicians what would happen if you came to the area,” he said. You can also let your fingers do the walking. “Call around and see how long it takes to get an appointment. You can do all the statistics, but it’s not as good as making a few phone calls,” added Angotti.

Full-time versus part-time presence
As you ponder going into a new location, think about whether you intend to staff it on a full-time basis, or if the satellite is simply a place to see patients one or two days a week. It’s not uncommon for subspecialty physicians and surgeons to have a very part-time presence in an outlying community to accommodate patients and referring physicians. If your practice is surgical or procedure-oriented, decide whether you’ll do cases at the local hospital or have patients travel to your primary hospital for those services.

Whether you are working up to a full-time presence or are only in your satellite location two days a month, it’s important to commit to the community. “A big mistake that [new physicians] make is to open a second office because they’re not busy. When their practice matures, they can no longer take care of patients at the satellite, and they close it. In that situation, everyone probably would have been better off if it had never been opened,” said Rudd. “You need to be part of the community; otherwise, you defeat the purpose of being there. Patients will expect you to be available 24/7.”

Financial factors
Angotti approaches opening a satellite as if it were any other new practice: projecting how many patients can be seen, how quickly the practice will fill up and, of course, the expense involved.

Consider at the outset whether a satellite office will pay for itself. “Will you collect enough revenue to pay for the expenses … including compensating the physicians for their work there? My general observation is that satellites are almost never profitable, so you have to go back to the original reasons why you are there to determine if the additional cost can be justified by those reasons,” said Rudd.

Since you won’t duplicate everything in your satellite office, the cost to get up and running will not be as high as opening a primary office. But you’ll need to plan for ongoing fixed costs, such as rent, utilities and staff. If you are in primary care, in a location that generates walk-in patients, or intend for the additional location to eventually be full-time, consider having a staff person onsite from day one to help establish your presence.

Save money by not building out or furnishing the entire suite right away. During the first few months, you may be able to get by with only one or two exam rooms. Wait to add any ancillary services, such as lab and radiology until the volume is there to justify the capital expenditure and staffing necessary to provide those services.

One area often overlooked is the cost of travel time. “A key question is whether the time [a doctor] spends traveling to the satellite will be rewarded by enough additional revenue to justify his time,” said Rudd. Angotti agrees: “If a doctor is traveling he’ll see fewer patients because he’s in his car — or in his plane — for part of the day.” If you’re already seeing as many patients as you possibly can at your main office, will having another office accomplish anything? Again, refer to your original strategic reasons for opening the satellite.

Centralized functions = cost effectiveness
As a rule, you’ll want to maintain business functions, such as administration, human resources, billing, transcription and medical records, at your main location. Not so many years ago, having a satellite office meant carrying medical records around in the trunk of your car. The result was a lot of missing charts. Electronic medical records systems (EMRs) have solved this problem; if you have satellite offices, then an EMR is a necessary investment.

Appointment scheduling may be done centrally or at each location, depending on your specialty, patient flow and how many satellite locations you plan to have. Since staff is so instrumental in making this process work well, be sure to involve them in the decision about whether to do scheduling centrally or locally.

As Albert Einstein once said, “Everything should be made as simple as possible … but no simpler.” Remember those words of wisdom as you go about deciding to open your next office. Do it for the right reasons, don’t complicate the process unnecessarily and enjoy the benefits of having an expanded reach and providing high-quality, convenient care for your patients.

Volver arriba