STARTING A DPC PRACTICE CHECKLIST

1. First Steps: Creating a Plan

Identify and meet with mentor(s)-- successful DPC physicians are great; other entrepreneurs and business owners also give good advice & support.
- Ask questions. Lots of them
- How do you want to shape your own practice? As you speak with others, have your own vision in mind. What works for others may not work for you, and that’s ok.
- Start researching and exploring other DPC practice websites. Get familiar with the basic commonalities.
Connect with DPC organizations
- DPCA
- local/regional organizations of independent DPCs
Find your resources: guidebooks, startup books, DPC workbooks, etc.
Attend DPC events
- DPCA masterminds
- DPC summit
- HINT summit
- D4PC Nuts and Bolts to 2.0
Write a business plan
- Mission and Vision statements
- Timeline to opening (3-18 months depending on lots of factors)
- Determine the medical services (broadly) you’d like to include in “primary care”
  - Medication dispensing? Allowed in most states, but review your state’s regulation/restrictions here.
- Decide on features of practice (accessibility, house visits, texting, emails, hours, etc.)
- Financial plan
  - Calculate total start-up (one-time) costs = $ _
  - Calculate ongoing (operating) expenses = $______________/year
  - There will be lots of unknown expenses that you could not possibly have predicted, so add a nice buffer category of “unknown expenses”
  - Determine desired self-pay (take-home) pay = $ _/year
  - Set membership prices on a cost-basis (tips here)
- Decide if you’d like to work with employers (sponsored memberships for employees)
  - If so, will need to create unique contracts for employers, employer-sponsored memberships and consider marketing to employers.
- Get personal financial house in order
  - Secure some side gigs! (i.e. moonlighting options to make income outside of DPC practice while you're ramping up)
    - Tips on jobs if opted out of Medicare
  - Personal/household budget
  - Personal insurances: Life, disability, health
  - Personal retirement accounts

2. Make it Official: Legal Items

Pick a practice (business) name -- more info on creating a brand below
- Review this article for considerations on your name
- Run the options by others: mentor(s) vs. crowdsourcing vs. branding consultant
- Check name “availability” by Google search, trademark database search, social media platforms, and/or https://www.namecheckr.com
- Register a trademark? (not absolutely needed, but may be helpful if wanting to protect the name and brand) (Tips here.)
Set up accounting services
- Hire accountant and/or bookkeeping course
Select & learn accounting software (e.g. Quickbooks, Xero, etc)
Review your state-specific issues that may relate to DPC practice
Consider attorney(s) if/when needed--may not be needed for many basic matters
- One for general business matters (help with most issues in business formation)
- One for issues specific to medical practice (strongly suggest one familiar with helping DPC practices--many will not be familiar)
Decide on and apply for business structure (LLC, PLLC, S Corp, C Corp)
- Tips here, ask your accountant/lawyer for personalized advice
Register business with state agencies (DIY, LegalZoom, or use attorney)
- Usually this is easy to do on your own. Find your state’s Secretary of State website to register your LLC
Obtain federal employer tax ID (FEIN) number
File for DBA (Doing Business As) if needed
Obtain State employer tax ID number
Obtain practice (business) NPI (IF you are going to be billing Medicare - may also be beneficial if you opt-out)

3. Financial Basics

Open business checking account with bank or credit union
If needed, secure start-up loan and/or line of credit
Get business credit card
Obtain retail tax license (only needed in some states, or for some services/items)
Obtain sales tax license (only needed in some states, or for some services/items)
Obtain business insurance (aka businessowner's policy). This covers property and general liability; not related to malpractice.
Obtain personal malpractice insurance policy
Obtain practice malpractice insurance policy (separate from individual policy)
Obtain any other insurance your lease or state requires. Such as commercial auto insurance, disability, business interruption insurance.

4. Create Brand and Establish Identity

Create Logo
- Use local graphic designer or online design options (99 Designs, Fiverr, Canva, etc)
Create brand identity/theme: colors (2-3), fonts, etc.— provided by any graphic designer & can be included in logo design
Purchase domain (web address) name (e.g AcmeHealth.com): Can use Google, GoDaddy, Hover.com other domain registrar, or a website builder service
Set-up email host (G-Suite makes all below easy, but other options available)
- Set up personal domain name (e.g. @acmehealth.com)
- Sign a HIPAA BAA with email host
- Obtain address for each user needed (e.g. doctorX@acmehealth.com, hello@acmehealth.com, etc.)
Create website
- Browse other DPC practice websites to get ideas, ask your favorites who they used/how they did their site
- Decide if can do DIY with website builder such as SquareSpace, WIX, etc. -or-
- Hire website design professional (warning: can be quite expensive)
- Info to contain: bio, services, pricing, FAQs (policies), disclaimers (“not insurance”), clinic location, hours, contact information, social media accounts. By law must include privacy policy.
- Embed enrollment form or information on how to enroll
Register with Google “My Business” (hugely helpful for web traffic)
- Do both your clinic name and your name (you will have 2 google business listings)
Create social media profiles (not all-inclusive list)
- Facebook and Instagram (most helpful for marketing and community connections/brand awareness)
- Twitter (good in some communities, but better for media & policy outreach)
- Yelp (may help increase search engine optimization)
- LinkedIn (only good for connecting with potential business partners)
- Tiktok
- Others
Claim online "review" profiles and change practice information

5. Offline marketing plan

Promotional print materials (local print services, or online options)
- Business cards
- Flyers/Brochures/Rack cards
- Other swag (pens, notebooks, chapstick, hand sanitizer, etc.)
Send a press release to local/regional news outlets announcing your opening
Set up meetings/presentations to spread the word (audiences may include churches, Lion’s Club, Rotary Club, various Chambers of Commerce, 1Million Cups, small-business groups, insurance brokers, financial advisors/accountants, realtors, etc.)
Join business/networking organizations - Chamber of Commerce, Rotary Club, Lion’s Club, AWBA, BNI, church groups
- Attend networking and business meetings - meet business owners, spread the word, make connections
- Practice 30 second “elevator pitch” and be prepared to give this at every meeting
Community involvement
- Develop relationships with a teaching hospital: teaching students, FM rotation, research, residency, etc.
- Join the County Medical Society, City Medical Society
- Join to Chamber of Commerce(s)
- Visit small businesses and specialists in the area
- Booth at community events (Farmer’s Market, etc)
- Local podcasts
Plan open house/town hall meetings
- Promote on social media
Traditional marketing strategies? (Many will not see benefit or good return on this investment--very dependent on your local market)
- Mailers? Flyers? Local newsletters?
- Billboards?
- Newspapers?
- Yard signs?
- Radio?

6. Leaving practice or transitioning existing practice to DPC

Employed positions may pose more challenges here

Review relevant professional and employment contracts for transition
Notify existing patients: 3 notices (by all methods possible)…
- 90-180 days out….First announcement letter-- tell the “why”, and broad goals for leaving/switching to a new model of practice (don’t need much details yet)
- 60-120 days out….Further introduce new DPC practice (more details, website). *** Notify no longer can serve as PCP if not in DPC plan (especially important if transitioning insurance-based practice) ***
- 30-60 days out….Reminders, share more details of practice (pictures, features, etc.), build excitement for future
Cancel existing insurance contracts (some require 90 days or more notice) -- tips here
Opt-out of medicare if desired
- Submit opt-out form at least 30 days prior to the quarter you want to begin seeing medicare patients

7. Creating a clinic space (if necessary)

Consider hiring a commercial realtor (can help with many issues below)
Find physical space for clinic
- Decide on renting (typically 3-6 month process; longer if major renovations) versus purchasing (typically a minimum of 6-12 months of planning; longer if new construction)
- Hire contractor (+/- architect if major stuff) if renovations, or DIY if handy
  - Special local building codes for medical practice?
Register or update new clinic address with all agencies
- State business registry (typically Secretary of State’s Office)
- State medical board
- Malpractice Provider
- Medical license and DEA
- County or city agencies
- Add address to website and social media accounts
- Add clinic to DPC mapper
Register with Google “My Business” (hugely helpful for web traffic)
- Do both your clinic name and your name (you will have 2 google business listings)
- NOTE: you need a Brick and Mortar address that is accepting USPS mail first, because to verify you they snail mail you a confirmation code
Obtain business insurance (aka. businessowners policy or BOP). This covers property and general liability; not related to malpractice.

8. Hiring staff & HR issues

Decide on staff members needed
- Clinical staff (e.g. RN, LPN, MA, etc); _________________
- Non-clinical staff? *not always required with small, lean practice
Obtain payroll services (accountant or online service)
Obtain workers compensation insurance policy (local insurance broker, or built in payroll service options). See state laws.
ID Badges (may be required by state)
Clarify OSHA type requirements
Post appropriate federal wage and OSHA posters in “workroom”

9. Running the Practice: Legal Items

Obtain CLIA waiver if doing onsite simple lab testing (e.g. urinary dipstick, rapid strep, etc.)
Patient Forms: write your own, or borrow from others with permission.
- Privacy Policy
- Patient Contract
- Release of Records
- Authorization to Discuss PHI (i.e. w spouse, parent, etc)
- Credit Card Authorization for Recurring Payments
- If working with employers: Employer Contract
  - Patient contract for employer-sponsored memberships
Agreement for Controlled Substances (if applicable)
Consent for Procedures
CMS waiver (if opting out)
HIPAA waiver
Ensure Business Associate Agreement (BAA) in place for any non-employee who has (or could have) access to records.

10. Clinic Office Equipment

Computer(s): Laptops vs desktops vs tablets (or some combo)
Printer (laser B+W most efficient option)
Scanner (w/ double-sided capabilities)
Label maker(s) for printing medication, lab, & shipping label stickers
Phones (landline, VOIP phones, or mobile phone)
Shredder (ideally P4 or higher for HIPAA-complaint shredding)

11. Practice Software and Communications

Choose patient health records system
- Paper records? If you want!
- Electronic: Commonly used EHR options in DPC = Cerbo (formerly MDHQ), Atlas.md, Elation, Practice Fusion
Choose patient billing service/software that can do recurring billing/payments
- Commonly used DPC specific options: Hint Health, Atlas.md (also serves as EHR)
- Other web-based subscription billing platforms (trickier to implement with integrations and HIPAA-compliance)
Patient communications
- Allow regular (non-secure) email?
- Allow regular (non-secure) text messaging (SMS)?
- Require or offer secure messaging services/apps: Commonly used = Spruce, Hale, Twistle, Twine (some will integrate with EHR & other softwares)
VOIP phone (voice) services: Good for rerouting calls, and other functions. Some local phone companies will offer this, but lots of internet-based, HIPAA-compliant options, but commonly used HIPAA-compliant are: Ring Central, 8x8, RingRx, Answer Advantage, Grasshopper, Ooma, MightyCall, webfones among others
Fax service:
- Traditional (phone-line + machine)
- HIPAA-compliant web-based options including RingCentral, Interfax.net, UpDox, Faxage, FaxCentral, eFax, etc).
Other software
- Pharmacy dispensing software (stand-alone or combined with EMR)
  - MDScripts
  - FlexScanMD
  - Atlas.MD
- Mail hosting
- Intraoffice communications
- Macro/text expanding software
- AI software
- PDF Editing software

12. Practice Operations

Purchase initial clinical supplies (bandages, gauze, syringes, needles, etc.). Will depend on clinical services, but common supply list here, or ask a mentor!
- For surgical supplies, check eBay and Craigslist- generally surgical equipment is massively marked up from medical supply places, but there is good equipment available affordably on eBay.
Get basic office supplies (i.e. pens, printer paper, stapler, scissors, etc. etc.)
Non-legal policy documents developed:
- Philosophy of care & clinic explainer
- Employee Health Assessment (for employers who give discount for well checks)
- Equipment Lease Agreement (for crutches, splints, etc.)
Create account with wholesale medication/medical equipment supplier (regardless of if you’re dispensing meds or not)
- Vendor options: Andameds, Henry Schein, McKesson
If dispensing meds, decide on medication formulary (what you will stock)
- Make initial order (most practices will start small, but may eventually stock 50-150 meds)
Obtain lab contract & pricing: typically done via “client billing” arrangement
- First check your state’s laws. Some states make difficult or have restrictions.
- Possible companies: Quest, LabCorp, Physicians Reference, Local lab -- ask local mentors)
- Pathology: (can potentially be tricky d/t legal restrictions)
Create repository of clinical worksheets/forms
- ADHD Evaluation, PHQ-9, Epworth Sleepiness, ASQ, etc.
Storefront Sign & Sign permit
Internet service
- Broadband options and requirements
Office network
- Wired vs. Wireless
VPN/remote access
Backup procedures: onsite, cloud, offsite

13. Medications (if applicable)

Dispensing license regulations by state
Create account with wholesale medication/medical equipment supplier - Vendor options: Andameds, Henry Schein, McKesson, Bonita
Decide on medication formulary (what you will stock)
- Make initial order (most practices will start small, but may eventually stock 50-150 meds)
Order meds, bottles, lids, other supplies
Consider pill counter vs Pilleye App vs other

14. Labs/Imaging

Client billing for labs/pathology/imaging not legal in all states

Contact Quest, LabCorp, CPL and ask for “client bill rates”
- Consider using GPO/GPP
Contact local imaging centers for cash list of all services offered
- Ask about possible “client bill” discounts
Contact local pathology companies
- Consider MC Pathology for basic pathology needs

15. Open Clinic

Start seeing patients
Continue online and offline marketing
Plan ribbon cutting ceremony through Chamber of Commerce 3-6 months in