Healthcare ops background, noncompete just expired: looking for honest feedback
Been in clinic operations for about 10 years. Started my first practice by building and running a psych telehealth company in 2020 and because of COVID reduced statutes we grew quickly, 12 states covered, about 700 patient encounters a month at peak and also staffed facilities across detox, residential, PHP, IOP, and some OP programs. I ran the whole business side of things like credentialing (awful learning experience), payor contracting, built scheduling systems, EHR buildouts, billing workflows, the whole monster. Made some bad calls bringing in private equity money and eventually burned out and stepped away.
After that I moved into a CIO role at a psychiatric group covering 14 hospitals, 9 emergency departments, and 2 inpatient units. Rebuilt operations during live hospital takeovers, filled credentialing gaps, fixed scheduling holes, and helped put together the proposal that landed a regional services agreement with a major health system (approx $5.6M) all in 8 months.
For the last couple of years I have been under a noncompete that just expired. During that time I did some contract work mostly on systems architecture and engineering.
Now I am figuring out what the next chapter looks like and I have a vision based on what I have seen and done from private practice to group practice to hospital systems.
Here is what I keep seeing from the outside that I want to pressure test:
Most independent practice owners I have worked with are wondering why they are working 60+ hours a week and still need to look for PRN work to make ends meet. A lot are leaving real money on the table not because of bad clinical work but because their whole practice is frankensteined and duct taped together, problems like billing set up wrong, payer contracts that are ancient and never renegotiated, intake that creates no follow up, no SOPs to measure where patients are falling out, or why they spend a bunch of money on ads but convert less than 10%. One clinic I worked with had a patient census of about 900 and was still behind on office rent.
The other thing I see is that the launch process for new practices is completely opaque. Credentialing is a mess, no financial planning, EHR selection based on what they've used not what works for their practice, payment infrastructure is all over the place, there is no clean guide and the advice online ranges from outdated to actively wrong. And the agencies that offer consulting services have $8-20k/month retainers that a doc waiting 6 weeks for their BCBS checks simply cant afford.
My question for anyone willing to weigh in:
If you could have had one person in your business during the first year of ownership who was not a consultant that just gives you a report and disappears (because ChatGPT or Claude can do that lol) what would you have actually needed them to do? And if you are further along and stuck in that "I work my butt off but the whole thing would crash if I took a week off" phase, what operational problem do you have right now that you have not been able to solve cleanly?
Not looking to sell anything. Just trying to understand where the real gaps are before I decide what to build next.