First Step analysis

PINNACLE III's free First Step analysis is a brief but thorough business study of your proposed new service. We collect basic data from your practice and provide you with a financial sketch. It's the First Step to success.

PINNACLE III ASC
First Step Analysis

What is PINNACLE III's First Step analysis?
An invaluable step on the road to a profitable ASC.
 
First Steps are scary. Let PINNACLE III shed some light on the ASC path and take the First Step toward ASC success.
 
The following questions are designed to help PINNACLE III learn more about your practice and to better assess your market position. If you have any questions regarding these forms please call Dan Connolly at (303)805-7838.
 
Group Name:
Address:
Phone, Fax, Email:         
Main Contact:
 
Number Of Physicians:
Single Specialty:    If yes please list specialty:
Multi specialty:
If multi, list specialties:
 
Years your practice has been in existence?
Do you lease or own your facility (facilities)?
Legal entity of practice(PC, LLC, etc.)?
 
Ancillary Service(s) you wish to pursue (surgery, rehabilitation, imaging):
 
Ancillary services currently in place (surgery, rehabilitation, imaging):
 
What percentage of your practice falls within the following payor types?
Cash/Fee For Service: %
Discount FFS: %
Medicare: %
Medicaid: %
Workers' Comp: %
PPO: %
Please list PPO's by name:
HMO: %
Please list HMO's by name:
Capitation: %
Please list capitated contracts by name:
Other:
 
List your top five major payors. Percentage of your business Type of contract? (ex. % of billed charges)
1. 1. 1.
2. 2. 2.
3. 3. 3.
4. 4. 4.
5. 5. 5.
 
Are there any particular managed care plan concerns or changes that should be taken into consideration? (example: Plans you are thinking of dropping, Plans that do not reimburse for facility fees, etc.)
 
Number of hospitals in your community?
 
Your relationship with the hospital(s):
 
Please describe your competitive environment?
 
List Physicians' names below. List their specialty/sub specialty:
 
Number of Outpatient Cases Per Year: 2008
 2009(YTD)
Number of Inpatient Cases Per Year
 
Number of Specific Cases per Year
(Outpatient/Inpatient)		 2008 2009(YTD)
List procedure below: Out In Out In
 
How many ASCs are you currently performing cases in?
 
How many ASCs are you currently a partner?
 
Location of these surgery centers?
 
Are you entertaining other ASC partnerships?
 
How much of your outpatient volume is currently being performed at your local hospital(s)?
 
What percentage of your total outpatient volume do you realistically see being done at this ASC that you are considering? %
 
What percentage of your total inpatient volume do you realistically see being done at this ASC that you are considering? %
 
Does your practice have any plans to add or retire partners in your group over the next three years? Add:     Retire:
 
If so what is your timeframe?
 
What specialty will be added or retired?
 
Will this be a new site from ground up or a build out of existing space?
 
How much space is being allocated to this project?
 
Approximate cost of square footage in your area?
 
Who will pay for TIs (Tenant improvements)?
 
Do you want to own or lease the building?
 
Do you want to own or lease the land?
 
Are you leaning toward purchasing or leasing equipment?
 
Are you interested in our Centralized Billing and Collecting office's services?
 
Are you interested in PINNACLE III developing the center?
 
Are you interested in PINNACLE III managing the center?
 
Percentage of management equity? %     or No management equity
 
What is your anticipated time frame to move forward with this project?
 
Notes: Please use this section to clarify any of the answers above.
 

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