1. Enhancing Services to New & Existing Physician Practices
Reed Tinsley, CPA

2. Why I Don’t Like My CPA Not enough attention
Doesn’t help me in my business
Brings few new ideas to my attention
NOTE: IT’S RARELY ABOUT PRICE IF THE VALUE IS THERE

3. How to Enhance Services
Add Value to Current Accounting & Tax Services
Develop Specialized Healthcare Services
Create Client Contact Program
Formal Management Meetings
Fixed Meeting Dates
Get In Front of the Client Often!!!!

4. Specialized Services to Consider
Contract Review
Practice Management Reporting
EOB Review
Billing/Collection Analysis
Accounts Receivable Review
Visit Coding Worksheet/Analysis
Managed Care Contract Negotiation
Physician Compensation

5. Specialized Services to Consider
Regulatory Review
Stark
OSHA
HIPAA
Strategic Planning
Practice Transition
Practice Valuation

6. Adding Value to Current Services

7. Practice Financial Statements
Why so Important and What to Look For
Balance Sheet
Aging of Accounts Payable
Excessive Non-Strategic Debt
Income Statement
Proper Presentations
Compare revenue to payments posted in billing system

8. Financial Statement Analysis
Financial Statement Review
Analyze overhead % of collections
Comparison to prior year
Must see comparative financials
First step: compare total overhead amounts
Line item overhead category analysis
Department overhead analysis

9. Comparison - % of Collections
Industry Benchmarks
MGMA
Medical Economics
National Society of Certified Healthcare Consultants
Other client practices in similar specialties

10. Comparison - % of Collections
Flaw in this Analysis
Assumes practice has maximized its collections
Assumes there has been no decrease in production/collections
Assumes a comparison of “apples to apples”

11. Provide Opportunities for Overhead Reduction

12. Payroll Costs Analyze Total Personnel Needs
Too many or too few?
Analyze Actual Compensation Levels
Overpaying for specific positions?
How to handle long term employees
Analyze Overtime Pay
Exempt vs. non-exempt employees
What is causing excessive overtime?

13. Employee Benefits Analyze Health & Other Insurance Costs
Benefit coverage
Employee subsidy
Analyze Retirement Plan Costs
Hidden Costs
Vacation leave payouts
Sick leave payouts
PTO payouts

14. Supply Costs Medical, Office, Drugs, etc.
Inventory control
Review Vendor Relationships and Pricing
Bid periodically
Centralized management
Use purchase order system
Utilize internet purchasing

15. Unique Cost Saving Strategies
Merging Medical Practices
MSO Formation/Utilization
IPA Formation
Adding a Physician
Changing the Physician Compensation Formula
Office Sharing with Another Practice
Implementation of EMR
Make Stakeholders out of the Employees

16. Help Build New Revenue Opportunities

17. How to Build Revenue – Generally
Adding Ancillary Services
Adding Non-Ancillary Services
Adding Physician Extenders
Adding Locations
Improving Practice Operations
Creating Alliances (Merger)
Research
Six Sigma – Practice Reengineering

18. How to Build Revenue – Generally
Renegotiate Managed Care Contracts
Implement EMR
Track Quality Measures
Have a Strict Recall Program
Pay Attention to Lower Portion of Referring Doctor Report
After Hours/Saturday Clinic
Surgery Center Development

19. How to Build Revenue – Generally
Do You Have a Practice That Patients WANT to Refer to?
Meet Human Resource Director at Largest Employers in Your Service Area
What Services Can You Provide On Site?
What are Educational Opportunities for Employee Group?

20. How to Build Revenue – Generally
Walking and Talking – Free Talks
Churches
Senior Centers/Assisted Living Facilities
Neighborhood Associations
Schools
Integrate Yourself with Hospital’s Marketing Program
Build a Public Relations Program

21. Review and Implementation
Of Practice Internal Controls

22. The Front Desk

23. Billing/Collection
The Business Office

24. Accounts Payable

25. Look for Signs of Financial Problems
Sudden Change in A/R Tendencies
Failing to Reach Benchmarks
Sudden Changes in Production by Doc
Escalating Overhead Costs
Doctors Holding Their Paychecks
Cannot Pay Vendors Timely
Borrowing Money

26. Are you taking care of the physician’s personal finances
Adequately insured
Asset protection
Retirement planning
Is a will in place
Estate planning
Building Net Worth

27. Example of Specialized Service
PRACTICE MANAGEMENT REPORTING
(You can’t manage what you don’t measure)

28. Concepts Numbers Don’t Lie!!!! Benchmarking
Only one benchmark that counts: Did the physician make more money this year than last year

29. Practice Management Reports
PMR
For the Practice
By Individual Physician
On a Comparative Basis
Clinical Activities Reports
Accounts Receivable Reports
Dashboard Indicator Report

30. The Numbers Gross Collection Percentage Net Collection Percentage
Days in A/R
A/R Ratio
A/R in excess of 90 days old
This year better than last year?
Clinical Encounters
Provider Work RVUs
Referring doctor trends

31. Organizations to Join Medical Group Management Assn
American Health Lawyers Assn
1. We really do believe that we are in an end game move the result of which will be a true national CPA firm focused on meeting the needs of middle market clients with the capital power to invest in the systems, technology, products and people and the size and scale to deliver high value products and services at a competitive price. No one has been branded as this firm yet and we want to win the race of getting there first.

32. Healthcare Listservs MGMA Discussion Groups Part-B Listserv
Part-B Listserv
AHLA listservs

33. Keys to Success Quit using the “I don’t have time” excuse
Make a commitment as a Firm
Stay very hands-on with your MD clients
Stay visible!
Work for free if you have to (to shorten the learning curve)

34. Reed Tinsley, CPA, CVA, CFP, CHBC
Questions and Answers
Reed Tinsley, CPA, CVA, CFP, CHBC