What kind of physicians do you have to have on staff, and do they just drop in or are they full time, nurses, lpn's? What is the staff to pt ratio. Seems like a very interesting business.
You need a lobbiest, could be huge in the future if the decriminalization of drugs continues and you could lobby for court ordered stays for people.
I always wondered what kind of profits hospice centers made, pretty easily managed pts, no big deal if they die, that's sort of what they are expected to do, and some of the worst staff I've ever seen anywhere (which I can only assume translates into very low pay).
"What kind of physicians do you have to have on staff, and do they just drop in or are they full time, nurses, lpn's?". The MDs are just one day a week each for three scheduled days. They're employees although one has to be the "medical director" and we'll be giving him a 5% ownership stake. The MDs are just there to basically do a quick "are you alive and are the meds working" type of physical and then order the appropriate meds for drug titration, order the various testing (urine, blood etc..), and order any specific therapy modality that would be appropriate (massage, physical therapy, dietbans nutrition, smoking cessation etc...). All of that really should take little or no time so while the MDs (or DOs) with the appropriate certification are pricey it's not a 24-7 type of situation for that staffing. The 3 PhDs (aka lead therapists) are who do the real work and work a full work week as they're setting the patient's schedules, leading some of the group and individual therapy, and basically ensuring the patient is getting all of the appropriate treatment. One is your main lead therapist and will get paid in the $120-200k range while the others are usually in the $60-100k range. The bulk of the actual facetime with patients is still with your "mental health counselors" which are basically psych BAs that are a dime a dozen as every college pumps out thousands of coeds with relatively useless (other than this) psych BAs so we'll have 8-10 depending on scheduling and probably pay in the realm of $12-15 per hour. We'll have an in house urine testing lab with probably two lab techs and one of the aforementioned MDs also serving as the medical director of the lab. All of the above plus your office manager, a couple of cheap case managers/entertainment directors, and some billing input (not true billers we're outsourcing that) staff are full employees. Then we're outsourcing for one uniformed security guard 24-7, one 24-7 male nurse and probably 3 generic office staff positions 24-7 from three separate staffing companies. On top of those 24-7 staffing positions, we'll be using independent contractors for the limo/bussing, yoga, PT, diet/nutrionist, equine therapy, dolphin therapy, golf therapy and probably some others I'm not thinking of right now. Food is being catered locally so no food staff. So fully staffed it will be about 21 full time employees, 3 positions staffed 24-7 by staffing companies and an odd assortment of independent contractors.
"What is the staff to pt ratio?"
Very high. 21 full time staff, 3 24-7 positions staffed by probably 4-8 people depending on hours scheduled, and probably at least a dozen independent contractors. Meanwhile we'll probably have about 40 each of residential, PHP and IOP patients any given month with probably another 30-40 regular outpatient patients (this pays incredibly poorly and I'll make $0 on it as it barely covers the staffing but it's a good service to provide as it keeps the local regulatory system happy). So maybe a 3 patient to one worker regardless of classification.
"You need a lobbiest, could be huge in the future if the decriminalization of drugs continues and you could lobby for court ordered stays for people."
Yep. Not only can I function as a lobbyist (I don't do the dirty functions of greasing the wheels but have the "expert" knowledge to push my points across once the meetings have been facilitated by the nonexpert lobbyist), but we've got some in place. Originally I was working on a project to be a small time owner of one of the new medical marijuana facilities but at the last minute our required "large" and "old" licensee grower dropped out because their 85 yo father who still had a controlling interest in their tree farm/paper company didn't want to be in the "pot business" no matter how often we said that the Charlottes Web strain had zero street value other than as any real working med would like a heart med and made no one high. So that scuttled that deal but we already had lobbyists and phone bank callers in place as we (if we had been one of the med marijuana producers) needed to simultaneously expand the definition of medical marijuana from the highly limited antisiezure med it basically was to a full spectrum pain and appetite med while simultaneously fighting off legalisation of recreational pot (because once you can grow your own %+%* pot for nothing that gives you a nice buzz on top of the medicinal benefits, no one would purchase the expensive highly monitored, tested and regulated marijuana oils we would be producing). So I've got all of those connections in place and will be using them.
"I always wondered what kind of profits hospice centers made, pretty easily managed pts, no big deal if they die, that's sort of what they are expected to do, and some of the worst staff I've ever seen anywhere (which I can only assume translates into very low pay)."
I don't know about hospice centers but I've helped set up and run nursing homes and they are the closest you'll come to as lucrative an investment as addiction centers. The nursing homes pay substantially less per head but don't require as many truly trained professionals (for example you don't need board certified psychiatrists with a specialty in addiction, any old MD or DO will do pretty much regardless of previous training and experience). So the upside isn't as good but you'll still make plenty of money and need less specialists. My addiction facility will cost about $3mil a year to operate with an initial investment about the same but will make between $6-22 mil a year with us expecting about $12-14milz. The nursing home of similar size would probably be $1.5-2 mil initial investment and yearly costs but make about $4-8 mil.
