### Ultra-Practical Startup Guide

*For a freshly-minted veterinarian opening a sports-animal rehab practice*

—

#### 1. Validate the Niche—Fast

1. **List target disciplines** (e.g., sled dogs, polo ponies, racehorses, agility dogs).
2. **Phone-survey 10–15 trainers/owners** in each sport:

* “What rehab services do you pay for now?”
* “Biggest frustration with current providers?”
* “What would you pay for \_\_\_?”
3. **Size the local pie:** count active kennels/stables within a 3-hour haul radius; multiply by average injuries per season × rehab spend to get a back-of-napkin TAM. If it won’t support at least \$250 k in year-3 revenue, pivot or broaden the radius.

#### 2. Lock Down Compliance

| Task | Typical Time | Notes |
| ——————————————————– | ———— | ——————————————————- |
| State/provincial vet license | Already done | Ensure it covers *equine & canine*. |
| *Optional* board cert. in sports medicine/rehab (ACVSMR) | 2–3 yrs PT | Market differentiator; start application paperwork now. |
| DEA/controlled-substance permit | 4–6 weeks | Needed for intra-articular injectables. |
| Premise permit + zoning | 6–12 weeks | Check noise & waste rules. |
| Business entity (LLC/Corp) | 1 day online | Buy malpractice + general liability ASAP. |

#### 3. Design a “Minimum Viable Clinic”

* **Space:** 1,500–2,000 ft² warehouse or barn bay; rubber flooring; 10 × 12 recovery stalls or kennels.
* **Core gear (<\$50 k used):** underwater treadmill, therapeutic laser, PEMF blanket, ultrasound, folding treadmill for dogs, small-item kit (therabands, wobble boards, ice boots).
* **Mobile module:** pickup + 14-ft bumper-pull with inverter, exam table, and portable shockwave. Lets you bill travel fees and test markets before committing to a large facility.

#### 4. Money Math

| Line | Rule of Thumb |
| ————— | ——————————————————————————————- |
| Up-front capex | \$75–120 k (used equipment, minor build-out, truck down-payment) |
| Working capital | 6 months fixed costs (rent, loan, insurance, 1 tech salary) |
| Break-even | 18 evals + 40 treatment sessions / month at \$150 average ticket |
| Price anchor | Elite equine clinics charge \$180–250 per 45-min session—set dog fees \~30 % lower to start |

#### 5. Build the Team

1. **Certified rehab tech/assistant (CCAT/LVT).**
2. **Part-time farrier/hoof-care specialist** (contract).
3. **Receptionist/dispatcher** who rides or mushes—credibility matters more than admin skills.

#### 6. Sell While You Build

* **Demo Days:** free gait-analysis pop-ups at race meets, sled-dog checkpoints, polo tournaments.
* **Referral loops:** pay trainers 10 % credit on first course of treatment.
* **Content flywheel:** weekly IG reel of a rehab case → cross-post to Facebook groups → pitch local sports-radio.
* **Email nurture:** short “injury-prevention tip” every 2 weeks; CTA = schedule seasonal screening.

#### 7. Run on Systems, Not Heroics

* **SOAP + invoices in one cloud app** (e.g., ezyVet, Rhapsody).
* **Color-coded treatment plans** on stall cards/kennel doors → avoids missed modalities.
* **Monthly KPI review:** new evals, avg sessions per case, revenue per hour, DSO (days-sales-outstanding).
* **Quarterly retro with mentors** (local vet, sports-med specialist, small-biz CPA).

#### 8. Ramp & Expand

* **Year 2:** add regenerative therapies (PRP, stem-cell); hire second tech.
* **Year 3:** second mobile unit or satellite stall in a high-traffic equine facility.
* **Year 4:** publish outcome data → position for referral contracts with regional insurers or racing commissions.

**Bottom line:** validate demand, keep overhead light, systemize everything, and market where your clients already compete. Open small, learn fast, then scale what works.

1. Strategic Foundations

Break‑even math:

Break‑even visits/week=Fixed Costsmo(Average Reimbursement−Variable Cost/Visit)×4.33\text{Break‑even visits/week} = \dfrac{\text{Fixed Costs}_{mo}}{(\text{Average Reimbursement} – \text{Variable Cost/Visit}) \times 4.33}Break‑even visits/week=(Average Reimbursement−Variable Cost/Visit)×4.33Fixed Costsmo

2. Legal, Licensure & Compliance

1. Entity formation

   • Most states require a Professional LLC or Professional Corp. Check corporate‑practice‑of‑medicine statutes.

2. Tax, ID & Enrollments

   • EIN → NPI → CAQH profile → PECOS for Medicare & Medicaid.

3. State PT Board

   • Facility license (some states).

   • Direct‑access rules (visit limits without MD referral).

4. Malpractice & General Liability

   • Typical PT solo premium ≈ $1,000–$1,400/yr; add Cyber liability for HIPAA.

5. HIPAA & Security Rule

   • Adopt an EHR with SOC 2 Type II + BAAs for every vendor (video‑hosting platform included).

Medicare specifics for 2025

3. Financial Architecture

Start‑Up Cost Matrix (USD)

Funding paths: SBA 7(a) loan, equipment lease, personal LOC, angel, or bootstrap.

4. Operations Infrastructure

1. Electronic Health Record (EHR)

   • Look for direct integration with billing, outcomes collection (e.g., FOTO, CareConnections), and your custom video‑exercise library platform so HEP links auto‑embed in patient portals.

2. Workflow Engineering

   • Day 0: E‑verify insurance → Intake + e‑sign consents (DocuSign) → Baseline PROM (e.g., LEFS).

   • Day 0 + 1 h: Comprehensive evaluation (97161‑97163) → Plan of Care → Teach 2–3 custom exercises; record quick demo on phone; upload to library; send secure link.

   • Ongoing: SOAP note within 24 h → Charges batched nightly; 837P to clearinghouse; ERA auto‑post; re‑assess every 10th visit.

3. Key Performance Indicators

   • Visits/Case, Cancel‑No Show %, RPV, CPV, Net Collection %, Patient Activation Measure (PAM). Add “Video Engagement %” once your library is active.

5. Marketing & Growth Flywheel

Phase 1: Establish Authority

Phase 2: Digital Multipliers

• SEO: Build topic clusters around CPT codes + conditions.

• Ads: Retarget site visitors on Meta/TikTok with your branded exercise snippets.

• Partnerships: Concierge MDs, CrossFit boxes—bundle “movement screens + custom HEP videos.”

6. Technology Stack

7. Scaling Beyond the Solo Phase

8. Quality, Risk & Continuous Improvement

• Internal Audits: 10 charts/therapist/quarter; score on defensibility, proper CPT use, time‑based services attestation.

• MIPS Quality Pathway: Pick measures 128 (BMI Screen), 226 (Tobacco), 130 (Medication Review), 182 (Functional Outcome Assessment), 291 (Functional Mobility in Home Health), 479 (Functional Change—Low Back).

• Patient‑Reported Outcomes: Integrate PROMIS or FOTO; publicly share aggregate improvements to strengthen marketing.

9. 18‑Month Timeline (Example)

10. Resources & Checklists

• APTA Private Practice Section: contract templates, KPI benchmarks.

• CMS CY 2025 PFS Final Rule Fact Sheet for annual reimbursement updates. cms.gov

• KX Threshold Tracker Spreadsheet (download from APTA).

• MIPS Measure List (see MDInteractive summary). mdinteractive.com

Final Thoughts

Yes, reimbursement is shrinking and compliance is complex, but PT practices that pair rock‑solid clinical outcomes with frictionless digital delivery—like a HIPAA‑secure custom video library—capture retention, referrals, and premium pricing even in a fee‑squeezed landscape. Build robust systems from day one, measure relentlessly, and expand only when every process is SOP‑ready. Your practice can grow bigger and better—without sacrificing the craft that brought you into PT in the first place.