Doctors join supergroups with great promise and hope. They are clearly a good idea, especially if they have strong operations. That said, doctors rushing to train rarely consider the risks associated with a doctor’s departure from the group. They need to!

When a physician joins a supergroup, he stops billing through his old practice (the “PA”) and begins billing through a new group (the “LLC”). The LLC has a tax identification number and a Medicare group number. And the LLC enters into many managed care payment agreements. Simply put, the doctor puts all of his eggs in the LLC basket. So what is the risk?

When doctors leave supergroups, they have to face difficult facts, such as:

1. It will take months to get a new Medicare provider number. If you haven’t billed through your “old entity” for a while, that number is gone. And getting a new number for the leaving doctor takes time, during which the revenue associated with Medicare patients is lost (until the number is obtained);

2. It takes even longer to purchase insurance plans. If the LLC is hired (usually it is), how long will it take for the PA to get back up and running? Can it take up to six months (and sometimes even longer)? That means the deceased doctor is out of network with all plans! This exposes your patients to higher costs and can affect referral patterns. This alone can be crippling for a doctor who has left the supergroup.

3. Leaving may also mean ending access to patient programming and electronic medical records. Many supergroups do not guarantee access to patient scheduling or billing to allow the departing physician to recover; and this can be devastating.

4. Non-competitors can play an important role in how an exiting physician recovers. Ideally, she will know that being alone is not as good as being part of a larger practice. But what if the supergroup imposes a restriction on the outgoing physician that prevents him from being part of another group? This is common and often very damaging, as some physicians who leave supergroups have no effective options other than joining other groups.

Supergroups exist to benefit physicians. It makes no sense that they are used to harm them, which is precisely what can happen (and sometimes does) if doctors don’t pay as much attention to the “back” as they do to the “front.” That means things like

1. Ensure that, whenever possible, the outgoing physician has sufficient time to professionally recover. It will take time to form a new practice, get a new Medicare provider number, and get back to your insurance plans;

2. Ensuring that the outgoing physician has adequate access to medical and scheduling records;

3. Carefully consider whether non-competitors make any sense. Some may say that it is important to protect the new practice (like the old one), but these are different types of practices. They are not built from scratch. They are built because successful competitors who have been in business for years essentially decided to “lend” their practices to the supergroup for certain unique advantages.

Supergroup arrangements continue to grow. Some of them even become fully integrated and sophisticated businesses. Doctors who join them must consider all “angles”, not just how good it will be or can be when they join.