Eyeworld

78 | EYEWORLD | SUMMER 2024 P RACTICE MANAGEMENT Contact Pinto: pintoinc@aol.com, 619-223-2233 Wohl: czwohl@gmail.com, 609-410-2932 2. Always explore a "temporal" expansion before adding facilities—that's to say, think about expanding office hours rather than add- ing facility space and cost. If you are trying to make just four exam rooms stretch to serve two doctors who both want to work in "prime time," Monday through Thursday from 9:00 a.m. to 4:00 p.m., shift clinic hours around so that the providers are a little less bunched up. For exam- ple, one doctor can work on Friday in alternate weeks, or run from 8:00 a.m. to 5:00 p.m. 3. Let's say you absolutely need to expand, but have to do so on a tight budget: • Eliminate non-essentials. Do you need a private washroom for every doctor? (Over the course of an average year, this owner perk may cost you up to $5 per bathroom break.) • The same goes for private doctor office space—a group office with a meeting table and separate cubicles not only costs less but facilitates communication. • Use cubicles for business staff rather than erected, fixed walls. • Fit out a "wow" waiting/reception area, but leave the back clinical space more industri- al. Consider doing what Hampton Inn and similar mid-grade hotel chains do with a plush foyer and serviceable but plain guest rooms. • Leave out the crown molding, premium car- pet, custom wall treatments, and original artwork. • Make sure your builder takes a second pass through your architect's plans to "value engineer" the final project. • Don't under build. If you build for today's needs in a growing practice, the second phase of near-term construction will be far more costly per square foot than being right-sized the first time around. • Unless you feel you must, don't try to win architectural awards with off-beat, expen- sive designs. Build a box, and leave out the curves, both on the shell and on the interior buildout of the practice. • Don't buy more land than you need but leave room for any obvious, future expan- sion. Very few ophthalmologists should take the entrepreneurial approach of building the 10,000 square feet they need today, plus another 30,000 square feet to rent to other users. • In most cases, create a new facility rather than redesigning an existing structure. • Don't try to save money by buying cheap, out-of-the way land. The appreciation of your facility in the coming years will be far lower, and you'll lose the promotional value of being on a major thoroughfare. • If you're in solo practice and have no solid succession plan, don't build a new facility if you plan to work for any less than 10 more years. If you plan to practice for 10 years or longer, try not to rent, unless you work in a high-priced inner-city environment. 4. Don't overlook exterior appeal. Your senior patients may be avid gardeners who will frown at your dying shrubbery and may project their first impression of your landscaping on the quality of your medical and surgical care. Keep up the parking lot resurfacing. Purchase the largest/brightest signage local zoning will allow. 5. Don't pursue any significant expansion or building project without first preparing a realistic pro-forma showing the cost-benefit of the project in the years ahead. There are many factors to consider here: • Will your total facility costs, as a percent of total collections, be at or under 10% immediately post-project and fall to 6% or less within 5 years? • Are you realistic in your projections of how fast practice collections will grow with a new facility? • Do you possess the risk tolerance to handle the prospect of having facility costs escalate as a percent of collections if payment re- form leads to materially lower professional fees? • What will be the future appreciation on your new property? Will you be able to find a buyer when the time comes, or is your area overbuilt with professional space? • Are you properly hedged and able to carry higher facility costs in the event of a tem- porary disability, loss of a key provider, or similar difficulty? • Will your personal net worth be higher or lower in 10 to 20 years if you expand or develop a new facility? continued from page 76

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