Start an Independent Oncology Practice

1. 1

   Fix the ownership structure and licensing first

   Only a licensed physician can practice oncology, and in states with corporate-practice-of-medicine law only a physician can own the clinical entity. If you are not the oncologist, the durable structure is a management services organization (MSO) you own contracting with a physician-owned professional corporation. Pay a healthcare attorney to design this before you sign a lease, because retrofitting it later is expensive.

2. 2

   Pick one modality to anchor the practice

   Medical oncology (systemic drug therapy and infusion), radiation oncology (linear accelerators and imaging), and surgical oncology are three different capital and staffing profiles. Radiation requires a multimillion-dollar vault and equipment; medical oncology requires an infusion suite and a large drug inventory financed against buy-and-bill. Choose the one your anchor physician is credentialed for and build depth there rather than spreading thin.

3. 3

   Solve drug purchasing and buy-and-bill economics

   Medical oncology practices buy expensive drugs upfront, administer them, then bill payers, carrying real inventory and reimbursement-timing risk. Join a group purchasing organization (GPO) to lower per-unit cost, and model the spread between acquisition cost and reimbursement carefully. Declining drug margins are the single biggest threat to independent practice viability, so this math decides survival.

4. 4

   Secure payer contracts and Medicare enrollment

   Contract with commercial insurers and managed care organizations and enroll with Medicare, including any value-based oncology payment model you choose to join. Reimbursement rates negotiated here set your revenue ceiling. This is slow, technical work best supported by a payer-contracting specialist.

5. 5

   Build the infusion, imaging, and clinical team

   Oncology nurses, an infusion suite, pharmacy support for hazardous-drug handling, and, for radiation, physicists and dosimetrists. Hazardous-drug compounding follows USP standards and state pharmacy rules. Malpractice coverage for oncology is a material recurring cost.

6. 6

   Plan for consolidation pressure from day one

   Private equity is aggressively acquiring independent oncology practices, and declining reimbursement makes standalone survival harder every year. Decide early whether you are building to stay independent, to join a consolidator later, or to sell, because clean financials and compliance make the practice worth far more in any of those paths. Build it as a real, documented company, not a personality-dependent clinic.

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