3/31/2017. Financial Statements. Financial Statements WHY. Financial Statements WHAT ARE THEY. This is our report card or scoreboard

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1 Financial Statements RICHARD J. DONNELLY, MS ASRS 2017 (DALLAS) Financial Statements WHY This is our report card or scoreboard It tells us how well, or not so well, we are doing. Financial Statements WHAT ARE THEY Financial statements will consist of: Balance Sheet (Assets & Liabilities) Income Statement (Profit & Losses) Statement of Cash Flows (Timing of Cash Inflows and Outflows) The financial statements should include a comparison to an annual operating budget. Also include Forecasts throughout the year as well. 1

2 Financial Statements TYPES Audit Seldom required unless physician s practice is quite large and subject to regulatory or outside audit requirements Highest level of assurance; receive Accountant s Opinion on financial statements Review Provides limited assurance that there are no material modifications to financial statements Analytical procedures and inquiries of management Compilation No assurance provided on financial statements Assist management in presenting financial information in the form of financial statements Financial Statements METHODS OF ACCOUNTING Financial Statements Are usually Prepared under U.S. Generally Accepted Accounting Principles (U.S. GAAP) Requires accrual accounting (i.e., revenues are recognized when services are provided and expenses are recognized when incurred) Not beneficial to organizations who deal with Medicare, Medicaid and insurance companies (Healthcare) Other Bases for Presenting Financial Statements Cash Basis of Accounting Revenue is recognized when money is collected and expenses are recognized when paid Income Tax Basis of Accounting Financial statements will match income tax returns Financial Statements TYPE OF ENTITY Corporation C Corp or S Corp Limited Liability Company (LLC) Partnership Sole Proprietorship (Not Likely for a Medical Practice) 2

3 Financial Statements - FREQUENCY Monthly Quarterly Annually Ad Hoc - Anytime Financial Statements WHO IS THE AUDIENCE Doctors Practice Administrator Banks Accountants Internal and External Financial Statements ADDITIONAL REPORTING Variance Analysis Explain your changes period over period and to your YTD operating budget. Trend Analysis This is a multi-period comparison (Years or Running Quarters) Metrics Put together a Dashboard with these metrics. Make it easy to review. 3

4 Financial Statements Metrics DASHBOARD Create a Dashboard of important metrics that are the dynamics of the Practice. Involve the Doctors in what is included in the metrics. These important ratios should give you the financial pulse of your practice or office. The result should be a One-Page End-of- Month Financial Report that makes sense and is understandable. Financial Statements Types of Metrics or Other Information Types of Fee Income (Clinical/Surgical, Drugs, Clinical Studies, Consulting, Other) Allowables Can be RVUs or Dollars based on the CMS GPCI Patient Encounters & New Patients Doctor Days Clinical Staff Ratios (Encounters, Doctors & Fee Income) Days the Practice is open Accounts Receivable (Days O/S, Collection %s, Comment on Inv. Doctors & Payors, etc.) Drug Float Practice Overhead Operating Expenses Financial Statements Types of Metrics or Other Information All of this information should be compared to your Budget and prior periods Also look at these metrics over multiple periods to see trends This will help with your variance analysis 4

5 Financial Statements Types of Fee Income Types of Fee Income (Clinical/Surgical, Drugs, Clinical Studies, Consulting, Other) By Doctor and Office Clinical/Surgical Fee Income Total Fee Income Drug Fee Income Total Fee Income Clinical Studies Income Total Fee Income Financial Statements Allowables Allowables Can be RVUs or Dollars based on the CMS GPCI Depending on your PM system, you can either Reprice the encounter data at the prominent Medicare GPCI Fee Schedule and illustrate in dollars. Payor mix is not consistent among the Doctors. Levels the playing field. Use RVUs to measure the level of work. Financial Statements Patient Encounters & New Patients Doctor Days = # of Days that the Doctor saw patients measured as AM and PM Number of days (per month) a doctor is in the office or surgery This helps account for the effects of vacation, adding a new doctor, or partial retirement. Patient Encounters / Doctor Days New Patients / Doctor Days 5

6 Financial Statements - Clinical Staff Ratios Clinical Staff Ratios (Encounters, Doctors & Fee Income) Encounters / # of FTEs Encounters / Doctors Fee Income (Non-Drug) / # of FTEs Fee Income (Non-Drug) / # Doctors Fee Income (Non-Drug) / Encounters Financial Statements Days the Practice is Open Days the Practice is open is looking at how you are utilizing your capacity and resources. Do this by Office and in total. Total Encounters / Days Open Fee Income / Days Open Financial Statements Accounts Receivable Metrics A/R Days Outstanding Your PM system will calculate this for you or use the traditional accounting formula. This can be done by Doctor, Office and Payor. Collection %s -- How much of what was collected this month relates to days outstanding days = 70.2% days = 17.1% days = 5.2% days = 2.9% days = 2.8% days = 0.4% 181+ days = 1.4% Highlight the problem Payors and comment on the >90 days by Doctor. Track your Denied Claims and know what is causing them; this adds to you re A/R Days. 6

7 Financial Statements Drug Float What is Drug Float -- Defined as the amount of money that we owe to the injectable drug vendors at any point in time for Lucentis, Eylea, Avastin, Ozurdex, etc. As we contacted peer practices, each one had their own respective spin on this definition. Some defined this as the amount they owe the drug vendors less the amount of receivables outstanding for drug claims less the amount of inventory that they have on hand. Others defined this as the amount that they owe to the drug vendors period. This is what we consider the range. Financial Statements Drug Float If you are on a Cash Basis accounting method, you are not required to recognize expenses in the same period that services are rendered and therefore have taken into income. This means that at year end the Shareholders/Partners realize a false profit in the amount of the outstanding Drug Debt. So effectively this is a loan paid out to the Practice that needs to be paid back to the pharma vendors. Conceptually this is money that the Shareholders have received over the years that needs to be returned so that it can be paid back to the pharma vendors. If a disruptive technology, for example, a long term implant that is purchased by hospitals and placed by us surgically, came along today, future receivables would not be collected and you would still need to pay the expense within the Drug Float period. Financial Statements Practice Overhead % Operating Expenses Collections (Non Drug) 35% to 70% is the typical range 7

8 Financial Statements Practice Overhead Per RVU Operating Expenses Number of RVUs Worked $11 to $20 is the typical range Financial Statements % of Billed Charges Collections (Non Drug) Gross Billable Charges (Non Drug) Average is 65.7% (Range 43% to 96%) Result is dependent on how often you adjust your Billed Charges and at what multiple of Payor Reimbursement Financial Statements Collections per RVU Collections (Non Drug) Number of RVUs Worked Typically $38 for Medicare $48 to $55 is typical for commercial insurance 8

9 Conclusion Remember your Audience Dynamics that run you Practice What works for you 9