Understanding the Successful Practice Management Consulting Engagement

Characteristics of an Integrated Financial Review

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

Generally, although the presentation and style may vary, a well thought out and comprehensive medical practice management review should contain at least the following 10 elements. This should be obtained by completing a confidential business financial or data gathering questionnaire, or by personal interview.

At our firm, the Institute of Medical Business Advisors, Inc www.MedicalBusinessAdvisors.com, we believe in the adage, garbage in = garbage out, and feel that any consulting engagement will only be as good as the information used to perform it.

1. Goals and Objectives with Practice Data:

This means your business data and a prioritization of your goals, with estimated time line, and economic benchmarks for achieving them. For example, you may not expect to jump-start your practice over night, but it is not unreasonable to improve its efficiency and profitability over time. Or, you may be able to decrease variable costs now, and slowly reduce fixed costs, in the long run.

2. Special Issues:

May include illness, practice continuation or, buy/sell agreements.  Especially noteworthy, according to Dr. Rex Huber, MBA, a professional practice management consultant in Minneapolis, MN:

“Are the myriad new concerns involving practice mergers, acquisitions, anti-trust, IPA, or regional network contracting issues”.

3. Business Economic Assumptions:

Will change over time but usually include such items as medical specialty focus, payer and inflation factors and real rates of return, personal and corporate risk assumptions, geographic location and demographics, reimbursement rates, inflation, economic indicators, training, age and sex, as well as personal risk tolerance or aversion.

4. Consolidated Financial Statements:

Should include at least the last three – or four – annual corporate financial statements (balance sheet, net income statement, retained earnings, and statement of cash flows) with tax returns. According to Dr. William P. Scherer, MS, a HIT guru in Ft. Lauderdale:

“Initially, financial software such as Quicken® made the creation of consolidated financial statements a pleasure – rather than a chore. But now, there are many ASPs (application service providers) to outsource this function.”

5. Net-Worth Statement:

Net worth on the balance sheet represents practice equity levels obtained by subtracting short and/or long term, liabilities from assets, at a particular point in time; as well as future estimates and projections. Practice net worth however, is not income and professional expenses are paid out of cash flows, and not net worth. Nevertheless, more is usually better, except when assets are overstated, or liabilities under reported. Physician practices are increasingly particularly prone to have high gross incomes but low profit margins and net worth because of this problem

6. Income Taxation:

Should include, but may not be limited to: a review of corporate and personal income tax statements for all relevant years, deductions, credits, tax liability and rates, especially EGTRRA 2001, and the Tax Act of 2003 with “sun-set” considerations for 2010-11.

7. Insurance and Risk Management: 

This minimally should include an analysis of your personal and corporate financial exposure, relative to malpractice liability, morbidity, property-casualty, health, life, annuity, long-term care, buy-sell and key-person agreements, and disability insurance. It should also include an analysis of corporate buy/sell agreements and a review of all polices in force.

8. Benefits and Retirement Planning:

Contains an evaluation of all traditional and Roth IRAs, SEPs, 401-Ks, 403-Bs, annuities, social security projected benefits, personal pension and profit sharing plans, of both the defined contribution and defined benefit types. A comparison should also be made of the taxable, and tax-exempt rates of returns for these investment vehicles.

9. Operational Audits:

Should generally include a review of most of the following: processes, patient flow and controls; accounts receivable and cash management; fee schedule review with CPT and ICD-9 coding and compliance; IT and security; cost expense analysis; practice financial ratio creation and analysis, marketing and advertising plans, and stationary; profit maximization and reimbursement issues; human resource issues and workplace violence; insurance and third-party payer processing and controls: personnel polices, administration, job structure, benefits and productivity reviews; as well as any special concerns of the practice.  

10. Recommendations, Implementation and Follow-up:

Oral and written communication between you and your consultant is important in order to understand, execute and achieve your management goals and the costs associated with them, as well as the risks and benefits of each.

Assessment

A prioritized schedule and action list is used to implement or reject recommendations, as described in all of the above In short; the practice management planning process denotes the method of how individual doctors can meet their business goals through proper management of resources. It is a broad based approach that distinguishes the exceptional management consultant from other professions or non-integrated advisors who typically focus on only a single area of the management picture.

And, for larger practices, ASCs, clinics, hospitals and healthcare institutions, we suggest the 2-volume, quarterly print journal guide, Healthcare Organizations [Financial Management Strategies] www.HealthcareFinancials.com, for starters.

 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What do you reasonably expect from your consulting engagements? Have you been pleased or disappointed, in same?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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