When should I renegotiate my contract?

As an associate dentist, its easy to get lulled into the continuous cycle of contract auto-renewals. You sign a contract, put your head down and start working hard to build a schedule, continue to educate yourself, and produce in order to justify your position. Before you know it, you’re 2 or 3 years in and still getting compensated under the same terms you signed while in school or residency. So when is the right time to renegotiate?

The answer is, it depends. It depends on your goals with the renegotiation. It depends on how well your first few years have gone in terms of production and development. It depends on the employer. More important than timing is preparation. Are you prepared to support your proposals with information that demonstrates good reason for those changes?

While timing is not the key factor, when it comes to the terms in your agreement, timing is key. For example, if the contract specifically requires you to renegotiate during specific time frames, you must abide by those time frames. This means preparation in advance and ensuring you’ve had access to production reports and additional documentation that demonstrates your success thus far. In any case, don’t be afraid to broach the subject. If you don’t ask for it, you won’t get it. 

Can Chiropractors offer Direct Primary Care Agreements to their Patients?

Prepared by: Carlos Arce, Esq.

Florida Healthcare Law Firm

With the uncertainties of personal injury protection benefits (“PIP”) lurking, providers who focus their practice on PIP, are thinking of the next plan to stay in business. It is unclear what will come of HB837 and what parts of the bill will be accepted or denied by Gov. Ron Desantis. What we do know is tort reform is an inevitable thing, and providers, especially Chiropractors must be ready.

So as a Chiropractor how do you stay in business if the PIP law changes? Concierge Medicine. On July 1, 2018, the Florida legislature enacted the “Direct Primary Care Agreement” (“DPC”) statute. Prior to this, providers had to jump multiple hoops to provide plans to patients that had insurance characteristics, which was limited to primary care only. These types of agreements were only limited to primary care services, the new law allows specialist or group practices to enter into DPC’s for specialty type services. The legislature added a list of the providers who would qualify as allowed specialists, Chiropractors are a type of provide allowed.

The statue has a list of items which are required in the DPC. See below:

  1. The DPC must be in writing and signed by the provider and the patient.
  2. Must include termination language allowing termination by either party upon 30 days in writing, immediately if there is a violation of the physician-patient relationship, or a breach of terms in the agreement.
  3. Describe the scope of the primary care services covered by the monthly fee.
  4. Specify the monthly fee and any other fees for primary care services not covered by the monthly fee.
  5. Specify the duration of the agreement and any automatic renewal provisions.
  6. Offer a refund if the provider ceases offering primary care services for any reason.
  7. Must include the following statement, in a contrasting color and 12-point font: “This agreement is not health insurance and the primary care provider will not file any claims against the patient’s health insurance policy or plan for reimbursement of any primary care services covered by the agreement. This agreement does not qualify as minimum essential coverage to satisfy the individual shared responsibility provisions of the Patient Protection and Affordable Care Act, 26 USC §5000A. This agreement is not workers compensation insurance and does not replace an employer’s obligations under chapter 440, Florida statutes.”

This list is a minimum requirement of what is required by a provider allowed under the DPC to engage a contract with their patient for concierge services (cash pay). When creating a DPC, having a legal counselor assist you in this type of arrangement is heavily recommend. The agreements not only contain binding terms, but they implicate various concerns that surround a provider.

A few of those concerns are, compliance with current payor agreements, billing patients who may be Medicare, compliance with the “No Surprise Act”, and proper accounting protocols (specifically relating to Chiropractors). As you can see, the DPC is a blessing but could ultimately be a curse if you fail to engage an attorney to assist you in its creation.


Attorney Carlos Arce works with the Florida Healthcare Law Firm in Delray Beach, FL. He has deep experience with bodily injury trial work and in health law. Carlos has handled multi-million-dollar healthcare transactions and serves as out-of-house counsel to various small to large types of healthcare entities. He can be reached via email at [email protected] or by calling 561-455-7700.

Has Private Equity Turned Its Sights to IV Hydration Therapy?

Physician, dental, and veterinarian practices have all gone through the run of private equity roll-ups. But are PE-Backed Firms now focusing their funds on cash-pay, elective wellness services? If recent activity has been any indicator, PE-backed firms are not only examining the IV and wellness industry but have already begun picking up and purchasing these clinics.


What are they looking for and how can you position yourself for an opportunity?


  1. Is your company set up in a way that would easily allow a new owner to buy it, take over assets, employees, and licensure, without having to re-structure in the middle of a roll-up?
  2. Do you have branding and operations streamlined and structured in a way that you can easily replicate it if you were to open future sites?
  3. Are you operating in compliance? Have you had a legal audit conducted on your operations within the last 6 months?
  4. What do you financials look like? Do you keep clean and accurate books and run the company like a truly separate entity?


PE-backed Firms want and look for opportunities that are turn-key and cash-flow from day one. They have entered this space and already begun the roll-up of multi-site operations that have address the points above in a way to create an attractive business structure that will success in any economy.


If your ultimate goal is to create an opportunity like this, it’s best to start preparing at least 6-12 months in advance so that you’re ready when the right opportunity presents itself. PE is already here in the IV industry, for clinics and ancillary services and products. Be ready or be last.

What role does a lawyer play in a transaction?

A lawyer’s primary role in a dental practice transition is to protect their client’s interest, whether as the buyer or seller. Most importantly, its important for a lawyer to ensure that the language in purchase documents actually match the spirit and intention of the deal. No one ever expects that a transition will lead to litigation, but if one party misrepresents key facts, or fails to fulfill a responsibility, it can create problems post-closing.

A lawyer should also be the leader of the transaction to ensure that it moves efficiently and without interruption. A typical transaction involves at least 5 parties – the buyer, the seller, a practice broker, a lender, a practice consultant. Sometimes, it involves more than that. Each of these parties have multiple things occurring at once and while deadlines are flexible in general, lending puts the most pressure on a deal closing due to interest rate locks.

A lawyer should also be a mediator. At times, hard conversations have to occur. Whether it be about the structure of the deal, the transition period, post-closing obligations, or otherwise. A lawyer can step in to help find middle ground or the lawyer can be the “bad guy” that the client needs to use to explain a position or proposal to the other party.

Biggest Pitfalls in practice transactions

Buying or selling a practice can be one of the highlights of your professional career. At the same time, for some, its their biggest investments while for others it’s the key to their retirement after a lifetime of achievements and success. Its not all roses, however, throughout the transaction and while ideally a transaction runs smoothly from start to finish there are a number of issues that could arise and derail a deal.

Loans and Liens


Its hugely important to ask the right questions to uncover any lingering practice or real estate loans well prior to closing of the practice sale. A late discovered loan can create a delay until the parties determine who holds the loan, the pay off amount, and if there are any liens attached to the practice.

Legal Issues

               Does the practice have any outstanding or pending legal claims? This could be malpractice, employment, or even business to business. As an example, a seller might have a business name or logo that potentially infringes on another trademark. If this hasn’t been uncovered, or disclosed, it can seriously impact the deal and the transaction.


Corporate matters

Has the seller kept their corporations active? If the seller’s corporation is not in active status, this creates a hurdle to selling assets or the practice real estate. In fact, it becomes a roadblock until that entity becomes active again. As a seller, you want to ensure well in advance that your entity is in good standing and has the ability to transact business, otherwise you will spend additional time and money to bring it to order.



Many buyers seek third party financing to purchase the practice or real estate. What many buyers and sellers don’t realize is the impact and influence a lender might have on the terms of the deal and transition of providers. If there are terms that conflict with the lender requirements, this can create another hurdle for the parties to resolve prior to closing.

While these issues don’t affect every practice transition, they can certainly create a headache if uncovered towards the end of the deal (or after closing!). The key is to prepare early, plan, and do your due diligence whether you’re a buyer or seller in order to optimize you opportunities.


How Medical Technology Impacts the Law

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Advancements in medical technology help proved the medical community with the resources we need to assess the needs of a patient or practice, accurately and quickly. Once that is concluded, then the medical team can administer the treatment that will be most effective in the least amount of time.

Speed, but most importantly, the speed with accuracy, are often the primary goals of innovations in technology. While these can be lifesavers when they work, they can be disastrous if used improperly, without the correct training, or in the wrong situation.

When it comes to medical technology, the law is always changing to keep up with the evolution of the medical field. Which includes, devices, testing, and drugs. Medical professionals have the responsibility with being on the cutting edge of those updates in ogre to maintain compliance.

What Is Medical Technology Law?

Everything that the medical industry uses, from software and devices to pharmaceuticals and testing, is medical technology. As our industry evolves with technology, we naturally benefit from increased abilities to treat symptoms of disease, if not the cause itself, and to improve quality of life and decrease suffering.

Medical technology law, therefore, encompasses everything that has to do with medical technology, from the testing required to get it approved and the actual approval process to its use out in the field and the certifications required to use that technology with patients.

How Do Law, Medicine, and Medical Technology Interact in the Workplace?

In addition to keeping up with changes in medical technology, and then learning how to make use of the latest accomplishments and learnings in the world of research and development, medical professionals are also tasked with keeping up with the laws created and changed to address issues that develop as a result of the last discoveries medical technology.

Both of these are huge tasks on their own. When piled onto the work of doing the job of a medical professional and running a business, it’s easy to get overwhelmed.

Practically speaking, the best way for law, medicine and medical technology to interact in the workplace is in the form of regular trainings on best practices for use of that technology as well as check-ins to remain compliant with industry standards.

How Does Law Enforcement Address Breaches of Law Related to Medical Technology?

In most cases, breaches in protocol and compliance related to medical technology come in the form of penalties, lost licensure, and potentially fines along with direction on how to rectify the situation.

In the worst cases, it can mean litigation that requires defense in a court of law, potential loss of licensure for life, and heavy fines.

Get Help With Legal Issues in Healthcare

If you are concerned about how changing law regarding medical technology may be impacting your business or your ability to do your job safely and effectively, contact Florida Healthcare Law Firm today to get help.