Every now and then we come across great companies providing great value for their clients along with the correct information we feel are great resources of knowledge any Healthcare professional can benefit from. Here is what Tenant Advisory Group of Chicago has to say about what to expect when locating a new Medical or Dental space.
Obtaining a loan for your small business is a great way to boost investment and even grow your business when the time is ripe. You might have heard some grumbling about small business loans: they’re hard to obtain; your credit has to be flawless; don’t ask for too much money or you’ll be denied. Fortunately, these prominent myths surrounding small business lending aren’t necessarily true.
It’s important to manage debt properly, but doing so can help grow your business at a faster rate than scrimping and saving. To help you obtain a small business loan for your company, Business News Daily spoke with finance experts to debunk five common myths about getting a business loan. Myth No. 1: Getting a small business loan is the hardest thing you’ll ever have to do. Like other forms of financing, obtaining a small business loan is all about preparation. Ensuring your books are transparent and you maintain the reserve liquidity to encourage the lender that you’ll be able to service your debt on time and consistently will lead to success. And experts agree the best way to avoid unnecessary snags is to prepare ahead of time for the application process. Myth No. 2: You must have perfect credit to get a small business loan. Low credit scores are a concern for some lenders, but banks aren’t the only lenders out there. Alternative and private lenders are often able to offer more flexible terms, including which level of creditworthiness they can approve. Alternative lending sites tend to base lending decisions on the financial realities of a business rather than the financial history of business owners. Myth No. 3: The worst way to obtain a loan for your business is through a bank. Just because you can obtain financing elsewhere, doesn’t mean conventional lenders and bank loans are not for you. Sometimes, a bank offers exactly the funding option you need. In fact, for established businesses looking to grow at a moderate rate, traditional bank funding is generally a great option. It’s when a business doesn’t fit those criteria that business owners should consider shopping around. To decide whether a bank loan is right for your business, research both traditional loans and alternative funding sources. It’s also important to know your business inside and out. If you are growing like crazy and you know you will need to keep increasing your loan size by large increments each quarter, then entertain a non-bank lending partner, as banks may not be able to keep up with your needs. Myth No. 4: The more money you ask for, the less likely you are to be approved for a small business loan. The requested principal amount of the loan should not have an adverse impact on whether or not you’re approved. Lending institutions are generally prepared to fulfill large financing requests for the right borrower; it’s more lucrative for them in the long run anyway. Don’t be afraid to ask for the amount of money that you really need! A business should apply for the amount it needs — no more and no less. Officials recommends considering both how much money you really need to grow your business, and how much money you can afford to pay back every month. Myth No. 5: The most important factor to look at is the interest rate. It’s easy to hyper-focus on the interest rate of the loan. Essentially, the interest rate is telling us just how much this money is going to cost us by the end of our repayment period. It’s certainly a crucial piece of information, but it’s just one aspect of the entire deal. Although interest rates are an important aspect to consider when choosing a lender, there are many other factors to keep in mind like what the terms of the loan are, how soon you need to repay the money, and what you can use the loan for. If you would like to learn more about want programs are available for your Medical or Dental practice, fill out our on-line questionnaire and a FundingDocs representative will be in contact within 24hrs. Click the button below to begin the process By: Dr. Rock Rockett
The healthcare provider landscape has been shifting as of lately and vibrations have been felt across the country. In the past few years, multispecialty clinics have grown to a thousand or more physicians. Other large multispecialty groups remain housed within large hospital systems and include hundreds of physicians affiliated with tertiary care systems. As these groups were being developing and acquiring more and more primary care practices other specialties became acquisition targets long before multispecialty groups came knocking on the doors of gastroenterologists. Cardiology practices have largely been subsumed under the umbrellas of large health systems. As well as many orthopedic groups. In the Chicago area alone, for instance, there are two large GI groups each with 45+ Board certified gastroenterologists plus additional midlevel providers. Chicago’s large health systems, including Advocate, Northwestern, Northshore University, and Amita, are competing to attract or retain GI’s within their employed physician groups or within their affiliated physician partners. Timing was right in the past few years as independent GI groups saw the storm clouds forming around them and felt that there was safety in numbers. Member physicians purchased shares in the new mega groups in order to be voting members and to participate in decision making. So what’s involved in merging multiple GI practices together? How is the leadership of the group established? And are they effective in reducing costs per practice, achieving better rates with payers and maintaining their volume of referrals from PCP’s in their area? STRUCTURE By consulting with health law attorneys experienced in mergers, you’ll find several options for how best to structure a mega group, depending on physicians’ goals, regulations in your state, etc. A popular approach is one which minimizes control from the top and maximizes independent decision making and control locally. Each practice typically has two representatives on the Board of Managers and each physician has an equal ownership share in the mega group organization. As it’s being formed the founding members make decisions about all the detailed provisions of the group’s Operating Agreement. These include size of board, officers, authority level of the Board on expenditures, etc. FINANCIAL INTEGRATION Financial integration is required to show that the group is functioning as a single entity and not just trying to exploit the use of a single tax identification number (TIN) to gain certain benefits. To demonstrate financial integration the practices must combine their accounting, banking, payroll, employee benefits program and retirement programs. Over the course of several months, the mega group must select vendors for the above services and reach consensus within the Board of Managers to implement the integrated financial services for all SBU’s. This should be accomplished within the first twelve months following formation of the group. REVENUE & EXPENSES Of the significant reasons for forming a mega GI group, is the advantage of owning their own pathology lab and of gaining reductions in medical malpractice coverage are two of the most significant advantages. The pathology lab can be formed within one of the practices and then purchased by the new mega group’s corporate entity from the practice in which it was spawned. Assuming the base global reimbursement fee for pathology is about $60 and that there are about 2 specimens per GI procedure, the gross revenue opportunity for a group of 20 or so GI physicians is in the range of $2.4M to $3.0M. Not as significant of an impact to the financial statement are the discounts achievable from medical malpractice premiums. Nevertheless, the reductions of 15% to 25% per practice are significant for GI physicians who had been paying $20,000 to $30,000 each per year for such insurance. In addition, there is coverage at the group level which also carries its own premium. Malpractice insurers seeing the consolidation trend among physicians are willing to discount premiums for the newly consolidated groups who now are under one TIN instead of previously operating as separate practices. SYSTEMS.....UGH! Merging onto a single EMR platform is a substantial task for multiple practices. This is one of the most important decisions. It needs to be made very carefully and requires the endorsement of all participating groups. The Board must consider the systems that are in place with the current practices and the advantages of using one of the existing systems or selecting a completely new system. Important questions that must be answered include how the EMR will function as an enterprise wide system for all the groups, will the system be easily interfaced with hospital systems for auto transmission of medical records between the practices and the hospitals, and what costs will be incurred for license fees, data conversion costs, system interface programming costs, etc. BILLING.....UGH, UGH!!!! In addition to challenges on the EMR side of the practice, there also is the issue of billing system and practice management system capabilities. Is the preferred EMR sufficient to support a mega group on required EMR as well as billing capabilities? Should there be an internal billing department or does the group prefer to outsource billing and collections? Every practicing GI physician has their own nightmare billing experiences, which actually allows the physicians to compare notes and perhaps reach consensus on the best route to proceed. As most physicians know, there are no easy answers to this question, but there are a number of ways to reduce the risk as you negotiate with billing services, if that’s the decision the group makes regarding billing. Setting up an internal billing unit requires selection of the right leader, coordinating with all the SBU’s and providing a vision of how the billing unit will develop from the merger of existing practices. Certainly there are advantages to having an internal billing unit and you should be able to gain greater control, track and report expenses transparently and more easily allocate billing costs based on a per member basis or on a percentage of collections basis. PARTNERSHIPS As GI mega groups overcome their inevitable growing pains they may begin looking at more opportunities to solidify their position in their market and grow revenues. It’s important to identify key partnerships with major payers as well as with major health systems. Founders or select Board members may take the lead in enhancing relationships with major payers through bringing value to the payers that they aren’t getting from small independent practices or from large practices that are controlled by a health system and which the payers deem not to be not trustworthy. For health systems there are increasing competitive pressures to consolidate provider groups and to expand geographically across large markets, such as in Chicago with its population of about 9.5 million. Perhaps there are opportunities to be anointed by the health system as the preferred GI group or perhaps there are opportunities to sell a minority interest in the mega group to the health system, thereby generating cash for the mega group and its member physicians and building long term referral relationships. Whether they form alliances with a single health system or multiple systems, there are significant benefits to be gained from doing so. NEW RECRUITS Along the course of the initial years of the mega group other GI physicians should be attracted to join. The Board members and the lead Administrator make calls to interested GI physicians to explain the process of joining the mega group. There is a modest capital investment required of each participating physician, signing of the Operating Agreement and signing the Membership Agreement in order to gain the benefits of belonging to a mega GI physician group. Many of the corporate integration projects listed above should be developed during the first year along with recruitment of additional groups. New groups joining the mega group will need to convert their data into the mega group’s EMR system and therefore this affects the timing of bringing new groups into the mega group and realizing the mutual benefit of having them participate and spreading the startup costs across more physicians. NEW VENTURES In less than two years mega groups can successfully expand their number of physician members, set up reliable infrastructure of EMR and billing, take advantage of new revenue opportunities and reduce expenses in certain key areas. So, what’s next? Initiatives that may come up or discussion include recruitment of new members, pursuit of specialty pharmacy capabilities, creating a group purchasing organization, creating an anesthesia group to serve all the endocenter locations, and more. All these new ventures should generate additional revenue and offset the startup costs and overhead expenses associated with a large single specialty group in a major metropolitan area. OUTLOOK FOR MEGA GROUPS The outlook for mega GI groups in the US is strong. Many have been formed and benefits of these mergers are being realized, although there are challenges in doing so. Success depends on a variety of factors. Leadership is a key consideration as much work is involved in forming a mega group and considerable time and money have to be invested to achieve the gains they all hope to realize. Compatibility of the practices is another consideration. Practices should have similar goals and similar practice structures to begin with. As with any other partnership, being compatible at the outset and having common goals are key considerations and should be discussed and evaluated openly at the outset. Timing in each market is also an important consideration. As each market develops and local health systems consolidate, determining whether the time is right also helps to determine potential for success for physicians interested in forming a group. * * * * * * * * * * * * * * Rock Rockett, PhD is Principal Consultant of Rockett Healthcare Strategies and operates his business out of Chicago. He works with GI physician groups around the country and provides his insights on mergers as well as strategies for increasing revenue and making the independent GI group sustainable over time. Like to learn more? Contact: rock@rocketthealthcare.com or visit, www.rocketthealthcare.com by Dr. David Silber If you’re thinking about joining a dental service organization, you’re probably weighing some pretty heavy financial questions — between office debt, rent, bank note, and other fixed expenses, the offers that a DSO rep makes are probably starting to sound pretty good. I want you to take a step back though, and take a deeper look at the DSO question, because this decision is one that can change the path of your career and your life overall. Dental Service Organizations can be great! First off, it’s important to understand that DSOs really can be a good fit for some dentists. I know many doctors who’ve benefited from the DSO relationship. They’ve been bought out, their loans got paid off, accounts payable is cleaned out, and they come out keeping around 25-30 percent of the practice’s profits. This outcome though, requires a lot of ideal situations. You’ll normally see dentists who are close to retirement getting the most out of working with a DSO because for that stage of a dental career, it makes sense. If you’re a younger doctor or have any financial issues that require special consideration, you should be asking some critical questions about your DSO decision. Questions You Should Consider With dentistry coming in as the number 1 job for debt (many of our colleagues are walking around with more than $400,000 in negative net worth) the DSO decision is one that you’re going to want to ask very good questions around. Here are the ones I recommend starting with. Do I Understand My Financials? Before you even consider a DSO it’s important to understand your financial situation. What do your taxes look like? What do you pay in rent? How much do you owe in student loans and on your bank note? What’s the state of your accounts payable? How much does your practice bring in annually on average? All of these are factors you’re going to want to grasp, because once a DSO buys you out, the best case scenario is that you’re left at $0. If you’re in the dark about any of those issues, you might still come out with debt.
Am I paying attention to the negotiation? Like I said before, there are some DSOs out there that really want to help…but there are two sides to every coin. This means that you need to understand what’s going on with the negotiation, ask questions, and read documents. That can be challenging because by the time many dentists are considering a DSO, they’re just ready to get out and find some relief. They’re not thinking. The last thing you want to happen is that you sign something you’re not comfortable with or don’t understand, leaving yourself in a deal you can’t sleep peacefully with. Remember that you know your practice. You know the income, A/R, accounts payable, and debt. Don’t let anyone make projections that don’t make sense or talk you into an arrangement that doesn’t feel right. Am I thinking too much about my staff? This might sound a little callous, but it’s necessary. The DSO decision is about you and your life. As much as you might love your staff or want to be considerate of them, it’s important to accept that the DSO is going to come in and make changes. That might mean reducing generous salaries, cutting personnel, or shifting duties. The whole point of working with a DSO is to take all these decisions out of your hands. The earlier this becomes a reality for you, the easier it will be. Do I understand my future income? On that note, the changes aren’t just happening for your staff, they’re also affecting you. You’re now essentially an employee of the DSO, meaning you’ll be getting a percentage of the practice income (and you’ve got a great excuse to turn down patient requests for discounts). Will that work for you and fit your lifestyle? You’ve got an employer now and should start thinking about your income the same way. Have I talked to colleagues? One of the best ways to learn about which DSO will be the right choice for you is to talk to colleagues. Look for other doctors you trust who’ve been through the transition and remember that every group is different. Some are really out there trying to help doctors out of financial nightmares and others…aren’t. If you’re feeling even a little shaky on any of these questions, I’m going to recommend considering another option. If you’re simply having financial issues in your practice, you might want to consider some additional capital. I have over 20 years' experience in private practice and am dedicated to helping dentists make the best decisions for their careers. Contact me today to get started on a better path for your dental business. 2018 is starting off strong with lots of hospital renovations and expansions, opening the door to beautiful new facilities, better service for patients, and healthier communities across the country.
Vail Health, Colorado Vail Health has announced the beginning of work on the east wing portion of its hospital renovation. The process has been a years-long endeavor but they are now in the final two-year phase of the project. The west wing was completed in 2017 and east wing work will include replacing the ED, building an on-campus helipad as well as a new imaging and radiology department. The hospitals old administration building, which is now over 50 years old, will be demolished. San Antonio State Hospital, Texas San Antonio State Hospital has just received more than $47 million in funding to improve the system. The HHS commission announced this week that the money will be used in renovating campuses in San Antonio and Kerrville. $14.5 million will be used for total reconstruction and an additional $1.2 million will go to repairing the existing campus and helping the hospital support the 54 counties it provides care for in San Antonio and South Texas. DeTar Hospital North, Texas DeTar Hospital North will be investing $3.3 million in renovating its second floor with a focus on delivery and women’s services units. According to Missy Jobe, director of women and children’s services, the staff is excited about the update relating, “It's been 14 years…We're ready for a new look.” The upgrade will include new sleeper recliners to improve guest comfort, rockers, and flat screen TVs. The colors will be calm and relaxing yet modern and enhance the 13 labor, delivery, recovery, and post-partum rooms that help welcome in 1,300 babies every year. If you’re looking to find simple, no-hassle funding for your own hospital renovation or medical office expansion, get started with our simple questionnaire. |
Archives
July 2019
Categories |