Addressing Financial Gravity In Practice
Bringing simplicity to the financial complexities of a Doctor by Garrett B. Gunderson Gravity is no respecter of persons. It doesn’t matter how nice of a guy or gal you are, if you jump off a cliff, there are harsh consequences simply due to the principle of gravity. As a Financial Advocate to professionals that have become business owners (especially doctors), I constantly encounter people that are not efficiently dealing with the financial gravity that comes with being a business owner. Just like gravity, it doesn’t matter if you are a good person, have the right intentions, or are working hard, if you do not deal certain financial aspects, you will lose money. When you raise your hand and opt in to becoming a business owner there are certain rules that apply just as sure as gravity exists. These are more complicated rules of finance and business that if not understood and addressed cost millions of dollars over ones lifetime. At the same time, these are some of the greatest advantages to entrepreneurs when these items are properly understood and addressed. Some of the things that take a higher degree of knowledge and attention include tax strategy, acquiring loans and negotiating the best interest rates, acquiring proper insurance coverages (the types only bought or used by a business owner), employee benefits, and many others. Most of the time rather than being more efficient or effective in these areas, the doctor merely tries to work their way beyond this by adding more space, hiring more people, selling more procedures, working more hours, etc etc. Rather than address the gravity, docs use hard work to temporarily help or even increasing marketing or reducing expenses or eliminating staff and asking some to just do more by working them harder, but this is a limiting view that leads to frustration and eventually can be very destructive. There is a better, although little known way to address this issue and keep more of your money without wearing yourself out by working harder. First, it is critical to realize that financial planners are not the right professionals to address this situation. Unfortunately, most people who call themselves “financial planners” are actually just salespeople. Because they get paid from commissions on selective products, they have little or no incentive to give you an accurate, comprehensive, and efficient financial plan that accounts for every variable. Hence, their recommendations are skewed and incomplete at best and their objective is not one of efficiency and effectiveness, it is mostly about saving, sacrificing, delaying and deferring through the purchase of retirement plans and products. My firm works on a personal level with more than 500 doctors. With thorough research we have proven that 93% of them take home far less money than they should—regardless of if they have financial planners. Even if your financial planner is trustworthy and knowledgeable, most likely he or she is just one part of what should be a more complete financial team and strategy. Use the following guidelines to determine whether or not you are addressing the financial gravity that weighs on you as a business owner. Once again, it doesn’t matter if you are a nice person or not, the numbers just don’t care. It matters if you have an awareness and address the “gravity” of the situation to keep more of your hard earned money. Do you analyze the expense structures and uncover hidden financial fees and commissions in all your existing financial products. Fees on your retirement plans 12b-1 Fees Expense Ratios Administration Fees Advisor Management Fees Do you have any investments that are not outperforming the cost of some or all of your loans? Consider paying off the guaranteed cost vs. earning the non-guaranteed interest. For money that stays invested, do you have strategies for limiting your exposure to market risk while also giving you as much upside potential as possible? Do you analyze your accounting strategy and every aspect of your taxes to ensure you’re keeping as much of your money as possible? Have you considered cost segregation if you own your building? Do you separate out your activities from a salary vs. dividend perspective? Do you have the type of corporation that best fits minimizing your taxes? Do you talk with a tax strategist throughout the year versus just during tax season? Does he teach you to defer your taxes until later when your tax burden will be higher, or do your tax strategies limit or eliminate your taxes when you withdraw on the back end? Do you have a current strategy to provide you with practical exit strategies on all your investments, or will you be subject to unexpected penalties, fees, and taxes? Do you know of ways to prepare your business now if you were to sell it in the future to: Limit taxes Maximize your multiple (how many times earnings you sell for) Have you reviewed all your insurance coverages to check for duplicate coverage and ensure the most efficient structure and best possible premiums while transferring as much risk as possible? Do you have a Business Owner Policy for liability protection? Do you have an umbrella policy to protect from liability anytime you are not acting as a doctor? Does your umbrella policy include uninsured/underinsured coverage? Have you looked into Health Savings Accounts? Have you increased your deductibles to lower your premiums? Have you increased your elimination periods to lower your premiums on your disability policies? Do you know how to present yourself to a bank in order to ensure you’re getting the best terms and rates, maximize deductibility and to provide the best debt payoff strategy? Do you have a credit score above 780? Have you renegotiated your loans in the last year? Mortgage Credit Cards Business Lines of Credit These are just a few of the areas where we find docs leaking money. In the areas of credit score, debt structure, and cash flow optimization (increasing cash flow from efficiency, not reduction or
Chiropractic Software | New Network Members | May 2014
Eighty-three new members across fifty-four practices joined Genesis Chiropractic Software and Billing Network in May 2014! Congratulations! There is strength in numbers due to the shared knowledge – we call it the “Billing Network Effect,” as the billing performance of each member practice improves in step with the total volume of processed claims. Please welcome our new Genesis network members: Monica Vaghela of Absolute Health, LLC, Scottsdale, AZ. Crystal Hagood and George Scheuchenzuber of Abundant Life Chiropractic, The Woodlands, TX. Stewart Gillespie of Active Care Family Chiropractic LLC, Summerville, SC. Desiree Caputo of of Aliante Chiropractic & Integrated Health, LLC, Las Vegas, NV. Mikayla Banman, Paige Matis, Katie Reum and Rebecca Viljoen of Aligned Chiropractic Corporation, Kelowna, BC, Canada. Keysha Benzing and Jason Gillis of All About Chiropractic, Madison, WI. Alex Stokes of All The Way Chiropractic, Shreveport, LA. Kelly Lehn of American Family Spine And Health LLC, Concord, NC. Kacie King of Justin Ard DC, PLLC, Brentwood, TN. Rinna Goloyugo and Jennifer Morales of Backsmart Wellness Center, Edison, NJ. Courtney Wenker of Back To Health Chiropractic And Wellness, Winona, MN. Mari Riley of Benchmark Medical Group, Inc., Windsor, CO. Tammy Bachmann of Big Pine Key Chiropractic Inc., Key West, FL. Sandra Ward of Kevin R. Candino, DC, LLC, Manalapan, NJ. Laura Naghib of Chad C. Wills, DC, PA, Naples, FL. Natalie Caruso, Robin Demartini, Theresa Doran, Kate Kesenheimer and Erick Torres of Chiropractic Works, Oakland, NJ. Kaitlyn Magno and Krysten Scheets of Complete Care Chiropractic & Wellness Center, Medford, NJ. Dr. Robert Lizak of Connected Chiropractic, LLC, Johnstown, CO. Dr. Chris Laurenzi of Cornerstone Chiropractic, PC, Hiram, GA. Kaelyn Adams of Cummins Chiropractic And Wellness, Bellevue, WA. Danielle Boll, Antonella Cioffi, Dr. Chris DeCarlo, Anthony Manoy and Lauren Mykalcio of DeCarlo Chiropractic, PC, New City, NY. Lea Pizzarelli of Family Chiropractic Center Of East Rutherford, East Rutherford, NJ. Darrys Johnson of Focused On You Chiropractic, PLLC, Round Rock, TX. Ginger Galt of Galt Chiropractic, Marion, IL Megan Sokolovich of Glen Mills Chiropractic Health Center, Inc., Glen Mills, PA. Marilyn Curtis and Delisa Oakley of Dr. Matthew Stuart Green, DC, Oakland, CA. Megan Melville of Hallie Chiropractic, Chippewa Falls, WI. Kristi Martinez of Hooten Family Chiropractic, Dallas, TX. Ruby Chandler of Kestner Family Chiropractic, Nashville, TN. Mark Liebich and Trevan Price of Living Well Chiropractic, Hendersonville, TN. Keely Danielson of Longmont Spine and Physical Medicine, Longmont, CO. Kathy Merrill, Dr. Douglas Neiverth and Tammy St. Michel of Maine Advanced Spinal Care, LLC, Wells, ME. Jennifer Rowe of Marble City Chiropractic, Knoxville, TN. Karen Featherston, Dr. Tiffany Miller, Annie Pruneda and Xavier Villalobos of Miller Family Chiropractic Care, LLC, Edinburg, TX. Dr. Matthew Barnhart and Lauren Cartwright of Mill Pond Chiropractic, Lexington, KY. Brenda Regan of Milonas Chiropractic, Naperville, IL. Jessica Sargent and Kaylee Wiseman of Neck Attack, Inc., Overland Park, KS. Kyle Innes of Dr. Taras Odulak, New York, NY. Tina Brandt, Lawrence Crockett and Dr. Tim Vierheller of Ohio Health Partners, Ontario, OH. Elder Velarde of Optimum Spine And Health Clinics, PC, Salt Lake City, UT. Casey Keesling of Paris Chiropractic, Rockville, MD. Ricca Watt of Patriot Family Chiropractic, Omaha, NE. Antonio Rodriguez of Planet Chiropractic, Douglasville, GA. Megan Cofiell and Ricki Mable of Postureworks, San Francisco, CA. Grant Sikes of Race City Chiropractic, Mooresville, NC. Courtney Gorman of Summit Family Chiropractic, Coeur D Alene, ID. Jessica Franco and Nicole Joaquin Symmetry Spine And Wellness Center, Alameda, CA. Morgan Zack of The Balanced Spine, LLC, Issaquah, WA. Rebekah Romano of Dr. Justin Tinsley, Kennesaw, GA. Kim Mckenna of Transformation Health, Livonia, MI. Jenna Glover of Tri-City Family Chiropractic, LLC, Arlington, TX. Debbie Bagwell of Triune Of Life Chiropractic, PC, Murrells Inlet, SC. Briana Beatty of Woodbury Family Chiropractic, Woodbury, MN. Jennifer Johnson and Emelia Walker of Zenaptic Chiropractic, Vancouver, WA.
Automatic Transmission
Doing things electronically can help make processing simpler Can automation make a difference in Dr. Ben’s credit card costs? “Did you know,” Carmen asked her husband, “that there’s talk of bringing robots into restaurants like mine?” Carmen’s pizzeria wasn’t exactly a fast food place, but Dr. Ben Wilson had seen something in the news about fast food restaurants going in for automation. “Wasn’t it in Japan that robots are taking the place of noodle chefs?” “Japan and China both,” Carmen said. “They make sushi, too.” She stretched. They had gotten their son to bed and cleaned up the kitchen.”I’m not sure a robot could make good pizza, but I could sure appreciate one that cleaned the kitchen.” Ben frowned in thought. “You’d think they could do that, but I guess cleaning requires a lot of mobility and dexterity.” “And good pizza is an art,” Carmen added. “You can’t automate creativity.” “You couldn’t replace your servers with robots either. There’s something about being served food that would be lost if it weren’t a human being.” “I guess you’re safe from being replaced by a robot, then,” Carmen teased. “You need dexterity, expert knowledge, and people skills.” Ben agreed. “But you know, a lot of things in the practice could be automated. Credit cards, to return to something we’ve been talking about recently. I know you didn’t come up with a way to reduce the fees, but what if we had a credit card system that automatically billed patients and collected their payments and posted them to the right accounts. It could alert us when a card was declined, charge the amount back to their accounts, maybe even alert the patient, too, so they could take care of it themselves.” “That would be handy,” Carmen said. “People might want to talk with a human when they’re served food, but they’d probably be just as happy to avoid talking with a human when they have to sort out a payment.” “It could even let us know if a card is about to expire. Those recurring charges — we pay a fee when the card is declined, and patients hardly ever remember to update their information with us.” “That doesn’t sound impossible to me,” Carmen responded. “We get an email at the end of the business day showing how much we took in by credit card so we can reconcile it with our POS system. Why shouldn’t you get a daily report?” “It would have to be connected somehow with the software we’re using to keep track of patient accounts,” Ben said. “But you’re right — it doesn’t sound as though it would require futuristic technology.” “It wouldn’t even need a robot like the ones in the movies. If it were web-based so the information was accessible, a computer could do what you’re describing.” Ben looked at Carmen seriously. “It would be more fun if it were like Jonathan’s toy robot. Something with arms and treads that would travel through the office would be pretty cool.” “It might cost a lot, though,” said Carmen, getting into the spirit of the game. “Jonathan’s robot would probably use up as much metal as a car if it were life-sized.” Ben laughed. “Seriously, though, a system that automated all that could save us a lot. You wouldn’t really need a human being to do those things, but they take up a day or more each month when people do them manually. An automated system could cut down on the time that goes into that and free someone up to do other things. It could be a savings for us even if the fees weren’t any lower.” “That’s true. And the fees might actually be lower. I didn’t get anywhere negotiating with our bank, but I didn’t compare new systems with what we’re using now. So many things are automated now, it could really be a savings — especially if you caught errors.” “Right — our plan to finance Jonathan’s college career through avoiding errors.” “Don’t laugh! You could easily be losing that much money to errors. Find that payment processing robot and we can tell Jonathan a robot put him through college.”
And… action!
By Reuven Lirov Practice management software ensures your movie has a happy ending. What belongs on Ben’s list of must-have features for practice management software? “Do you remember,” Ben asked his wife, “how you were saying that lines in the parking lot made it easier to park cars?” “Wow,” Carmen answered, “I must have been feeling very deep and philosophical that day.” She was scrolling through the local movie offerings on her phone. They had a babysitter lined up, and she was planning to enjoy a rare date night with her husband. “It was kind of deep,” said Ben. “You were talking about how it’s easier to change a situation than to change the people in the situation.” “Oh, right — we were talking about the issues at your office, right?” “Yes, and I’ve been thinking that maybe this new practice management software might help.” He stared into space for a moment. “Well, okay, to be completely honest, I’ve been thinking that maybe I’m just no good at this, but today I’m entertaining another possibility.” Ben looked into his wife’s eyes. “Am I fooling myself?” “Not at all!” Carmen spoke passionately. “Just imagine if I had to run the pizzeria without my fancy industrial dishwasher and my computerized ticketing system. What if I had to milk sheep and make cheese by hand and grind flour and cook in an oven in the courtyard.” “Sounds picturesque.” “It would be back-breaking labor. They say our modern appliances even in a home kitchen are the equivalent of having several extra pairs of hands to help. The industrial appliances make all the difference.” “I can see that,” Ben agreed. “So why shouldn’t having the right tools make all the difference in your practice, too?” Carmen asked triumphantly. “So how will I know the right tools when I see them?” “Let’s make a list.” Carmen opened an app on her phone. “You need something complete — not a bunch of different programs that might not work together.” “Been there and done that,” sighed Ben. “It has to be a turnkey solution that won’t require an IT department, because I don’t have one. But it has to work for all the people I do have. We don’t need information silos or duplication of efforts across the team, and we don’t want to be delayed if someone is out of the office.” “Training would be good,” said Carmen, adding a note to the list. “Effective training,” Ben specified, “with real human beings to answer questions if we happen to have any.” “It would be great if you could access it on your phone,” Carmen pointed out, “in case of emergencies.” “Or even in case of date night,” Ben smiled. “Shoot that list to me and let’s pick a movie. I can smell the popcorn already!” What belongs on Ben’s list of must-have features for practice management software?
