Big drops in patient visits during the pandemic have decreased U.S. primary care physicians’ revenues, a Harvard study reports in the June 25th issue of Health Affairs.
Researchers report that, “…..as a result of decreases in office visits and fees for services from March to May during the pandemic, a full-time primary care physician will lose an average of more than $65,000 in revenue in 2020. Overall, primary care practices nationwide stand to lose nearly $15 billion.
The losses may force many practices to close, and weaken the health system dramatically. Revenue may continue to fall with a second wave of infection this year or if reimbursement rates for telehealth visits return to pre-pandemic levels. There is already a shortage of primary care providers in the United States.
Our healthcare accountants and advisors understand that half of primary care practices are small and physician-owned with limited access to capital and other support that could help them weather the pandemic storm. Thus the Fuoco Group and team at TFG Health Services has developed a presentation to assist healthcare providers in understanding and maximizing the SBA assistance out there, whether PPP loans, or EIDLs, or available pandemic tax credits. Power point presentation is attached HERE.
Reach Out To Us: Researchers said their findings show the need for a financial plan to support independent primary care doctors and small, independent practices. Although physician clinics, surgery centers, dental offices, small hospitals, and other health care businesses were among the most common recipients of loans under the Paycheck Protection Program, that alone is not enough. Talk to us about your viable options. We can help you gather the information and calculate the numbers you need to present to your bank for forgiveness. A new financial action plan or restructuring may help you and your practice weather the economic pressures on the medical field right now. Prepare to position yourself for the recovery after the pandemic with: • Budget analysis • Cash flow analysis • Expense analysis • New financial projections
The IRS has confirmed that Provider Relief Fund payments made available through the federal Coronavirus Aid, Relief, and Economic Security Act (CARES Act) cannot be excluded from taxation under a disaster relief exemption. Therefore, the payments do constitute gross taxable income, unless otherwise carved out under an existing exclusion, such as if the provider is a 501(c) nonprofit.
The IRS clarified that for-profit healthcare providers including hospitals and independent physician practices will be subject to the 21% corporate tax rate on the grants they received from the COVID-19 Provider Relief Fund, even though the two laws that set aside $175 billion in grants to help providers cover lost revenue and Coronavirus-related expenses didn’t explicitly state that the funds would be taxable.
The IRS issued guidance stating that the grants are taxable income days before a tax filing deadline on July 15. Both hospitals and independent physician practices will be subject to the 21% corporate tax rate. The IRS guidance came in response to a question about whether a health care provider that receives a Provider Relief Fund payment may exclude it from gross income as a qualified disaster relief payment under section 139 of the Internal Revenue Code. The IRS responded “No,” and said a payment to a business does not fit the definition of a qualified disaster relief payment under section 139, even if the business is a sole proprietorship. The relief fund payment is therefore included in gross income under section 61 of the code.
Tax-exempt healthcare providers are not subject to tax on relief payments, the IRS said. However, the relief payment may be taxable under section 511 if the payment reimburses the tax-exempt provider for expenses or lost revenue attributable to an unrelated trade.
The American Medical Association is asking Congress to exempt physicians from being taxed on the payments received from the Provider Relief Fund. This provision may be included in the next COVID-19 relief package expected at the end of July.
Reach Out To Us: Given that many healthcare providers may ultimately return unused payments from the Provider Relief Fund, taxpayers should be conscious of the tax consequences of payments received in one tax-year and returned in another year. Additionally, the guidance only applies for federal tax purposes so taxpayers should also consider the state and local tax treatment of the payments.
Our February client in the spotlight is the distinguished and award-winning dentist, Dr. Jay Ajmo, DDS, DABOI, DICOI. Dr. Ajmo has just shared the exciting news that he has expanded his practice for sedation dentistry and minimally invasive dental implants offered at PGA Dentistry and opened a Jupiter location. Now you can also “Change Your Smile, Change Your Life” conveniently at Jupiter Dentistry if you live in North Palm Beach County!
Choosing the right dentist can make all the difference in your appearance and your overall health. It can even affect your ability to eat and speak properly. Just like PGA Dentistry, the staff at Jupiter Dentistry is dedicated to the highest standard of care. The professional care team is led by Dr. Ajmo, at this state-of-the-art facility who is committed to delivering the best experience possible. Dr Ajmo works closely with Dr. Jessica Wyatt in the Jupiter office. They both use the latest technology to provide the safest, most effective, and most comfortable care possible like 3D CT scans, digital x-rays, and lasers. If you suffer from dental anxiety, there are IV sedation services available for all procedures. Patients can receive the dental care they need in a private treatment room without having to feel nervous or worried.
Patients choose Dr. Ajmo and Dr. Wyatt because they are well known for exceptional restorative dentistry services, stunningly beautiful smile makeovers, and comprehensive dental implant services.
Dr. Jay Ajmo has been practicing cosmetic, implant, and reconstructive dentistry in Palm Beach Gardens since 1987. He is committed to continuously updating his skills and techniques and has earned post-doctorate credentials and internationally recognized certifications in cosmetic dentistry, dental implant surgery, and reconstructive dentistry. Dr. Ajmo also holds a Mastership from the Misch International Implant Institute. Voted “South Florida’s Most Distinguished Cosmetic Dentist” by The Best of South Florida and a “Top Doctor” by Consumer Research Counsel of America, Dr. Ajmo is one of only 400 dentists in the USA to hold a Diplomate Certification with the American Board of Oral Implantologists. Dr. Ajmo’s passion for his patients is evident in the quality of his care and patient referrals that extend throughout South Florida, and even across the globe in Europe.
Dr. Jessica Wyatt graduated from the University of Miami with a Bachelor’s of Science in Chemistry and Biology. She earned her Doctor of Dental Surgery from Columbia University College of Dental Medicine in New York, New York. Dr. Wyatt is an active member of the American Academy of Cosmetic Dentistry, the America Academy of Facial Esthetics and the Academy of General Dentistry. Dr. Wyatt’s areas of focus are in cosmetic & restorative dentistry. She’s also proficient in all forms of the most extensive non-surgical and non-invasive facial injectables.
No matter what your age or your dental needs, if your New Year’s resolution included a promise to yourself of a smile makeover and healthier set of teeth, either Jupiter Dentistry or PGA Dentistry is the right choice for exceptional results in restorative, cosmetic, and implant dentistry. Both locations are dedicated to improving patients’ quality of life with beautiful, healthy, teeth and smiles that they can enjoy for a lifetime.
Visit www.jupiterdentistry.com to explore the full range of options and services available to you such as: single or multiple tooth replacements, implants, crowns, bridges, dentures, full mouth reconstructions, oral surgery, root canal therapy and so much more. And don’t forget to ask the staff about “Teeth Next Day,” the exciting new zirconia implant bridge which is the ultimate in full-arch dental restorations. Jupiter Dentistry is conveniently located in the Three Palms Plaza at 2151 Alternate A1A South, Suite 1300, in Jupiter, FL 33477. Call (561) 250-0995 for hours and appointments available.
Of course you can still get the full range of options and services available from Dr Ajmo and his team at PGA Dentistry in Palm Beach Gardens. The office is located at 7100 Fairway Dr #59, Palm Beach Gardens, FL 33418. For hours and appointments visit www.pgadentistry.com or call (561) 468-5565 or 561-627-8666.
The Fuoco Group is proud to provide Dr. Jay Ajmo a full range of tax and accounting services, as well as a 360 degree business and financial advisory program for both his locations as part of our “new financial dialogue.” Become a part of the Fuoco client family and enjoy the benefits of our expertise. We are more than just accountants, we are trusted business advisors that will beat your expectations.
Fuoco group is proud to announce that our latest client in the spotlight is the award-winning pediatrician of Jupiter and the Palm Beaches, Ivy Faske, MD.
According to experts the most important things to consider when choosing a pediatrician are: credentials, experience, current best practices, confidence in their philosophy of care, and how your doctor interacts with your child or newborn. Dr. Ivy Faske has it all, as well as a special superpower: “…..the ability to keep the parents calm as well as the child.”
In fact, it was a “cool, calm, and collected” pediatrician that inspired Ivy to take the leap into medicine. As a little girl, she was fascinated by what the doctor was doing and why. As a new medical student at the University of South Florida, Ivy was hooked on pediatrics the day she worked with a pediatrician who was able to calm a child in order to examine them, and then cared for them with compassion and cured them with skill. That was in 1982!
Fast forward to current times and Dr. Faske has been in private practice in Palm Beach Gardens for more than 33 years. Dr. Faske is a Fellow of The American Academy of Pediatrics. She served for 6 years as Chief of Pediatrics for the Palm Beach Gardens Medical Center, and was a past president of the Palm Beach Pediatric Society.
It is her devotion to her patients, and the desire to share the skills she developed over the years, that was her inspiration to write her book, “They Do Come With Instructions!” It chronicles years of diagnosis and observations about the physiology, care and development of newborns to young children. It features photos of Dr. Faske’s patients throughout the years so that you can easily identify newborn rashes, sore and strep throats, chicken pox, conjunctivitis, fifth disease, eczema, hives, poison ivy, ringworm, and so much more. It also includes vaccine information sheets for all routine childhood vaccines.
Florida born and raised, Dr. Faske is originally from Miami. She now calls Palm Beach Gardens home. Giving back to the healthcare community in which she works and lives has always been a priority for Dr. Faske. Over the years she has served as President of the Palm Beach County Medical Society, and currently is President of the PBCMS Services, which is the charitable arm of the Society. Dr. Faske was the Chair of the Women Physicians section of PBCMS, and won the Women in Medicine Leadership Award in 2008. In 2015, the PBCMS presented her with its Humanitarian Award during the Heroes in Medicine Celebration. Dr. Faske was the recipient of the Society’s coveted Excellence in Medicine Award in 2019.
Dr. Faske has been voted by her peers as a “Top Doctor” in Palm Beach County almost every year since 1998. In 2020, the readers of the Palm Beach Post and community at large voted her the “Best Pediatrician” in Palm Beach County. What continues to inspire this award winning pediatrician and leader in the medical community? In Dr. Faske’s own words: “I love seeing children develop through the years, and hope that by having good experiences at the doctor while they are young, they will continue to seek proper care as an adult.”
The Fuoco Group is proud to provide Dr. Faske with a customized range of tax and accounting services, as part of our “new financial dialogue.” Become a part of the Fuoco client family, and enjoy the benefits of our expertise. We are more than just accountants, we are trusted business advisors that will beat your expectations.
On March 30, 2020, the CMS issued the Stark Blanket Waiver in response to the COVID-19 pandemic in order to facilitate Coronavirus related medical services. Retroactive to March 1, 2020, the circumstances and conditions under which the waivers apply are strictly and narrowly described as relating to the physician self-referral law (Stark Law).
Although temporary (at this time), health care providers, physicians and clinicians have a unique opportunity to take advantage of the Stark Blanket Waiver as it will protect financial relationships, remuneration and referrals (and the claims submitted as a result thereof) that are related to a broadly defined set of “COVID-19 Purposes.”
The blanket waivers define “COVID-19 Purposes” broadly to include the following:
• “Diagnosis or medically necessary treatment of COVID-19 for any patient or individual, whether or not the patient or individual is diagnosed with a confirmed case of COVID-19;
• Securing the services of physicians and other health care practitioners and professionals to furnish medically necessary patient care services, including services not related to the diagnosis and treatment of COVID-19, in response to the COVID-19 outbreak in the United States;
• Ensuring the ability of health care providers to address patient and community needs due to the COVID-19 outbreak;
• Expanding the capacity of health care providers to address patient and community needs due to the COVID-19 outbreak;
• Shifting the diagnosis and care of patients to appropriate alternative settings due to the COVID-19 outbreak; or
• Addressing medical practice or business interruption due to the COVID-19 outbreak in the United States in order to maintain the availability of medical care and related services for patients and the community.”
The CMS provided the following examples of how the Stark Blanket Waiver will enable flexibility for physicians and DHS entities:
• Non-Fair Market Value (FMV) Compensation. Hospitals and other providers may pay physicians above or below fair market value to rent equipment or receive services from physicians (or vice versa). Hospitals may rent space in a physician office related to COVID-19 patients below FMV or free of charge.
• Flexible Financial Support. A physician owner of a hospital may make a personal loan to the hospital without charging interest at FMV so that the hospital can make payroll or pay vendors.
• Medical Staff Benefits. Hospitals can provide benefits to medical staff, such as daily meals, laundry service or child care services.
• Non-monetary Compensation. Certain items and services that are related to the COVID-19 Purposes may be provided to physicians (e.g., continuing medical education regarding latest care protocols for COVID-19) without exceeding the annual non-monetary compensation cap.
• Hospital Capacity. Physician-owned hospitals may temporarily increase the number of licensed beds, operating rooms and procedure rooms, even if such increases would otherwise be prohibited under the Stark Law.
• Group Practice-Home Care. Any physician in a group practice may order medically necessary DHS that furnished to a patient by a technician or nurse in the patient’s home contemporaneously with a physician service that is furnished via telehealth by the physician who ordered the DHS.
• Relaxation of In-Office Requirement. Group practices can furnish medically necessary MRIs, CT scans or clinical laboratory services from locations such as mobile vans in parking lots that the group practice rents on a part-time basis. Physicians may provide clinical lab services related to Coronavirus detection and treatment because requirements that the DHS be provided in the same building as the physician office are waived; and financial relationship limitations between the physician (or family member) and the DHS provider are also waived.
These examples are merely illustrative, and each arrangement should be reviewed to ensure that it does not run afoul of other applicable state and federal laws including, specifically, applicable fraud, waste and abuse laws. Finally, although DHS entities and physician do not need to notify CMS to utilize the Stark Blanket Waiver, they “must make records relating to the use of the blanket waivers available to” CMS upon request.
We cannot stress strongly enough that the blanket waivers apply only if:
• Providers are acting in good faith to provide care in response to the COVID-19 pandemic; • Financial relationships or referrals are protected by one of CMS’ 18 permitted relationships; and • Financial relationships do not create fraud and abuse concerns.
REACH OUT TO US: These blanket waivers only temporarily permit payments and referrals between physicians and DHS entities if the relationship falls into one of CMS’ stated categories during the COVID-19 pandemic, even if such an arrangement would not meet a Stark Law exception. For now, the CMS is giving providers more freedom and flexibility as the COVID-19 pandemic continues, but keep in mind these blanket waivers will terminate at the end of the public health emergency. In the meantime we urge all physicians to examine their referral relationships, telemedicine practices, and hospital/surgery center connections for opportunities. Keep in mind, the Stark Law Waivers have no impact in the presence of fraud or abuse. We can assist with cash flow, liquidity, loans, insurance, restructuring, Tax credits and much more to get you through this crisis.
Telemedicine and virtual care have quickly become important tools in caring for your patients while keeping yourself and your staff safe as the COVID-19 pandemic evolves. It is a shame that a crisis like the Coronavirus is what it took to make telemedicine mainstream for most of the medical profession. Prior to the pandemic, telemedicine was not the success story it hoped to be.
Fortunately, the CMS reacted and has loosened the regulations for telemedicine in response to the emergency. Telehealth services may now be delivered to Medicare beneficiaries by phone as long as video capability is available. Wondering how to get reimbursed? Have questions about what technology to use? Download these helpful resources:
CONTACT US: Remember, we are here to help you keep your practice healthy during the pandemic! Telemedicine is a financial and economic opportunity. It might just be here to stay as both you and your patients will become accustomed to the convenience. Reach out to us with questions about the financial health of your practice
A State of Emergency exists across the nation due to COVID-19. Many medical practices have been told to cut non-emergency services and elective procedures. Many states have now issued orders to dental offices to only respond to emergencies, and chiropractors have been ordered to shut their doors. Optometrists and ophthalmologists may be next along with therapists. Providers are concerned just like other businesses about paying rent, making payroll, and eventually forking over taxes. Those that are still open are concerned about their workers contracting the virus, lack of protocols, lack of safety equipment, and lack of a plan by state and federal legislators.
There are a few important topics we wish to address on behalf of our physician practices and medical groups regarding the pandemic COVID-19.
1. Many of our clients participate in ACOs. ACOs that participate in the Medicare Shared Savings Program are concerned they will be on the hook for penalties and won’t receive shared savings this performance year because of Coronavirus cases. The COVID-19 outbreak may drive up Medicare beneficiary spending this year, affecting the benchmark used to determine savings and losses in the program. The benchmark uses historical Medicare spending in addition to current performance year spending.
• According to a CMS spokesman, “The Medicare Shared Savings Program has policies in place to account for unexpected rises in Medicare beneficiary spending that have historically been used for natural disasters. The CMS can mitigate shared losses and calculate quality scores differently for ACOs affected with such issues. The agency implemented such policies for ACOs affected in performance year 2017 by Hurricanes, as well as the California wildfires.” The CMS spokesman also said it’s important to note healthcare providers in ACOs are part of the Medicare fee-for-service program, which has made special coverage considerations for Coronavirus such as testing.
• CMS recently announced relief for clinicians, providers, hospitals and facilities participating in quality reporting programs in response to COVID-19: Due to COVID-19, the Centers for Medicare & Medicaid Services is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for upcoming quality measure reporting and data submission deadlines for the following CMS programs:
MIPS/ACOs (Provider Programs)
2019 DATA SUBMISSION: 1. 2019 data submission deadline has been extended from March 31, 2020 to April 30, 2020. 2. MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year.
2020 DATA SUBMISSION: 1. At this time CMS is evaluation options for relief around participation and data submission for 2020
Post-Acute Care (PAC) Programs:
2019 DATA SUBMISSION: 1. 2019 data submission for Oct. 1, 2019 – Dec. 31, 2019 (Q4) is optional. 2. If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate).
2020 DATA SUBMISSION: 1. Data from Jan. 1, 2020 – June 30, 2020 (Q1 – Q2) DOES NOT need to be submitted to CMS. 2. Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Jan. 1, 2020 – Sept. 30, 2020 (Q1 – Q3) DOES NOT need to be submitted to CMS.
2. President Trump has declared COVID-19 a national emergency. Hospitals have activated there emergency response plans – have you and your physician practice? What protocols have you put in place? Accommodations for staff and patients? You must demonstrate some level of due diligence in assessing patient health and ensuring the safety of patients in your waiting room or you may be liable for not doing anything to protect your patients!
See recommendations below from the PBCMS in the event a patient with suspected COVID-19 seeks care:
a) Follow the CDC’s patient assessment protocol for early disease detection. If a patient calls to schedule an appointment for an acute respiratory illness (e.g., fever, cough, and difficulty breathing), he or she should be screened appropriately for COVID-19. The CDC strongly recommends that practices do not turn patients away simply because a patient presents with acute respiratory symptoms.
b) Practices should consider developing front-door and office signage that informs patients who are exhibiting any of the PUI evaluation criteria (e.g., presenting symptoms, recent contacts, and/or travel history) to notify facility personnel. Consider giving a quick questionnaire to patients upon check in, and include this information on the practice website, also.
c) In some communities with the potential for community spread, the CDC recommends exploring alternatives to face-to-face triage during visits if screening can take place over the phone or via telemedicine.
d) If presenting symptoms, travel history, or patient contacts are suspicious, immediately isolate patients coming into the office in a designated exam room with dedicated patient care equipment. A back entrance may be utilized, if available. Since most medical offices don’t have negative pressure airflow, a spare bathroom with negative exhaust fans may be an option in the medical office setting instead of a regular exam room. The CDC provides guidelines for environmental infection control in healthcare facilities
e) Once suspected patients are inside the facility, instruct them to put on a face mask, utilize tissues, practice good hand hygiene, and dispose properly of any contaminated protective equipment/tissues in a designated waste receptacle.
f) Follow Standard, Contact, and Airborne precautions including gloves, gowns, protective eyewear, and NIOSH-certified N95 respirators that have been properly fit-tested. This applies to all healthcare staff interacting with patients.
g) Limit staff exposure to suspected patients, with the exam room door kept closed. Maintain records of staff-patient contact, i.e., who was assigned to work with the patient, either in a log or in the medical record. Any unprotected occupational exposure by staff members should be assessed and monitored.
h) When there is a reasonable presumption that a patient may have been exposed to COVID-19, contact the local or state health department regarding patient testing, and for locations designated to triage suspected patients so exposure is limited in general medical offices. Suspected cases must be reported to applicable local and state health departments.
i) Once the patient exits the room, conduct surface disinfection while staff continues to wear personal protective equipment (PPE).
j) Provide information on the virus to the patient and close contacts, including how to follow infection-control practices at home, such as in-home isolation, hand hygiene, cough etiquette, waste disposal, and the use of face masks.
3. Healthcare providers are concerned about the scarcity of PPE, testing kits, protective gear, medications, prescription delays, and COVID-19 copay issues, among other concerns. New York has been one of the states hit the hardest by the Coronavirus outbreak, yet suppliers are struggling to make testing for the virus widely available, with local officials estimating it could take weeks more to reach peak testing capacity. Cases in New York continue to climb as they do around the country. The Defense Production Act will help with marshaling critical supplies, as will the $2 Trillion dollar stimulus package that would inject several billion into the hospital system just passed by Congress. Dr. William Valenti, Chair of MSSNY’s Infectious Diseases Committee, discusses the current Coronavirus outbreak in a March 11th podcast here: https://www.buzzsprout.com/51522/2982079.
An unidentified flaw in test kits distributed by the federal government in February, which gave some false results, has set the country back; boosting testing is crucial disease experts say, to assess the scope of the U.S. outbreak and identify where it is spreading most rapidly. 1.5 million test kits were to already be available by the end of last week, but progress has been slow due to regulatory hurdles at the federal and state level (even thought the FDA is now granting regulatory authority to the states), as well as logistical and technical challenges, and supply chain issues. There is a critical shortage of the physical components needed to carry out tests: extraction kits to isolate viral RNA from specimens, reagents that determine whether Covid19 is present in the sample, and a lack of test swabs.
4. Have you considered implementing telehealth if you haven’t already? What about offering immunity enhancing services or products, vitamin infusions etc.? With respect to telehealth services, The AMA has made recommendations to the CMS for provisions that were included in the first supplemental spending bill passed by Congress. “We have urged CMS to substantially expand its coverage of patient-physician telephone conversations. Telehealth services should also be extended to ongoing care needs unrelated to COVID-19 during this time of “social distancing,” which is particularly relevant to elderly Medicare beneficiaries who are most at risk of severe complications from exposure to the virus. In addition, we have recommended a solution to CMS about currently inadequate ICD-10 diagnosis coding for COVID-19.”
This week the Trump administration announced it will temporarily expand telehealth services under Medicare to cover such interactions at the same rate as in-person visits and allow the suspension of certain HIPAA requirements so doctors can provide services with their personal phones. A range of providers will be able to deliver telehealth services, including doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers. Visits using the telehealth services will be considered the same as in-person visits and will be paid as if the patient were seen in the office. This expansion of Medicare telehealth services will continue for the duration of the COVID-19 public health emergency.
5. In the midst of the crisis Florida lawmakers passed sweeping legislation to expand the roles that pharmacists play in the state’s health-care system, including allowing pharmacists to test and treat patients for the flu and strep throat and treat people with chronic medical conditions, including arthritis, asthma, chronic obstructive pulmonary diseases, Type 2 diabetes, HIV, AIDS, obesity, or “any other chronic condition” adopted in rules. This may be helpful as the healthcare system continues to become more and more overwhelmed with COVID-19.
Concurrently the Florida Senate and House backed a bill that allows advanced practice registered nurses to provide primary care independently of physicians and for certified nurse midwives to work autonomously. The final version of the Advanced Nurses Bill was something of a compromise between the House and Senate. For instance, the bill doesn’t include independent practice for physician assistants or certified registered nurse anesthetists.
6. Additionally, the IRS advised that high-deductible health plans (HDHPs) can be used to pay for 2019 Novel Coronavirus (COVID-19)-related testing and treatment, without jeopardizing their status. This also means that an individual with an HDHP that covers these costs may continue to contribute to a health savings account (HSA). As stated in Notice 2020-15, health plans that otherwise qualify as HDHPs will not lose that status merely because they cover the cost of testing or treatment of COVID-19 before plan deductibles have been met. As in the past, any vaccination costs continue to count as preventive care and can be paid for by an HDHP.
Contact Us:Does your medical practice need a check-up for Coronavirus? We can help keep your practice healthy during the economic downturn due to Coronavirus. We can discuss the short- and long-term impacts on your business operations and the right steps to take now to minimize your risk. Do you have business interruption insurance? We have ideas how you can be proactive and revise your original 2020 business plan.
Our November client in the spotlight is Marciano Family Optometric and owners Drs. Mark and Brandee Marciano. Both are board certified optometric physicians who met during their fourth-year externship, and made a dream come true when they married and then built an optometric practice together that is now the leading provider of optometry services and vision care products in the greater West Palm Beach area.
“We believe life is all about your vision,” has been their motto since opening their doors in 2005. Dr. Mark Marciano has been practicing since 1999 and performs comprehensive eye exams and specializes in the management of ocular disease; including, cataract, glaucoma and refractive surgeries. Dr. Brandee Owens Marciano has also been practicing since 1999 and has extensive training in the co-management of refractive surgery and in pediatric eye care. She performs comprehensive eye exams and specializes in contact lenses, vision therapy and ocular disease management.
Marciano Family Optometric offers vision examinations to families from the young through the young at heart and specializes in the diagnosis and treatment of a wide array of eye diseases, conditions, and problems. It is their mission to provide the best eye care services possible, using only the most advanced, state-of-the-art diagnostic technology and eye care products available. They and their entire staff are committed to educating patients and providing high-quality, personalized eye care. The office is located at 1788 North Jog Road, West Palm Beach, Florida. Appointments can be made by calling 561-242-1200. More information on products, services, and staff, can be found at www.drmarciano.com.
Marciano Family Optometric has some exciting news to share, the addition of their new second location “Marciano Family Vision Associates” is on the way! Mark and Brandee purchased the practice of Dr. Michael Haugen located at 11380 Prosperity Farms Rd., in Palm Beach Gardens. Renovations are almost complete, state-of-the-art diagnostic equipment is being installed, and they anticipate opening Marciano Family Vision Associates in early December.
You may recognize Mark from his photo because he also serves as a Palm Beach Gardens City Councilman. Mark is also a Senior Trustee to the Florida Optometric Association. Both doctors are very involved in their community and the Society of Optometrists, they have both served as Past President of the Palm Beach County Optometric Association. Mark and Brandee live in Palm Beach Gardens where they are raising their two sons.
TFG is proud to provide Drs. Mark and Brandee Marciano, and Marciano Family Optometric, with a customized range of accounting services as part of our “new financial dialogue.” Become a part of the Fuoco Group and TFG Health client family, and enjoy the benefits of our expertise. We are more than just accountants, we are trusted business advisors that will beat your expectations.
Like everyone else, doctors are concerned they are not saving enough money to retire on. However, there are many factors that set physicians apart from the average American trying to plan for their retirement. First, due to their grueling schedules doctors have less time than the average individual for financial planning.
Second, the cost of regulation and compliance is growing and that is increasing business expenses and disrupting cash flow. Third, reimbursements are decreasing and that negatively impacts income. What else distinguishes doctors from other folks hoping to safeguard their financial future? Plenty! Here is why healthcare professionals and clinicians need more than the general investment advice found on Google and in newspaper and magazine articles:
It takes more time to establish their healthcare practice. Medical school, residency, and fellowships – a doctor’s career takes longer to get started, and it takes longer for their medical practice to become established. Add to that early retirement due to burnout and the staggering amount of student loan debt, it’s no wonder there is less time to save what’s needed for retirement.
Higher income may require more complex investments. Tax efficient investing is a priority for physicians who traditionally make higher incomes, and often juggle brokerage accounts, Roth IRAs, life insurance and annuities, and outside retirement plans. It is important to consider tax-advantaged and tax-exempt investments and know how to access funds in the most efficient way during retirement.
An asset protection plan is needed. Medical malpractice lawsuits loom large and doctors in every profession need to plan ahead for the possibility of an adverse event as well as for disability. Income and retirement savings need protection, and long term care must be considered. A risk assessment is needed and an insurance audit for yourself and your family as well as for your practice.
A long term exit strategy is essential. Transition models can include selling your practice and all related assets outright or a partial sale of the practice assets only while retaining ownership of hard assets, such as the building and land, which can generate ongoing income.
Job security is a myth. Group contracts are not always renewed by facilities, and some physicians are being replaced by mid-level providers to contain costs. Leverage that physicians once had as a unique and powerful brand is fading. Even a doctor who is the head of a department or a key faculty member is subject to the whims of a large bureaucracy or big corporation just as much as the rest of us these days. And as the economy goes (or the insurance provider) – so goes the elective surgeries. Medicine is not recession proof.
Spending habits are hard to break. Lifestyle choices can be difficult, but budgets work for a reason. Financial goals need to be aligned with spending and financial habits like saving.
Financial planning for physicians is a specialized area of practice that requires an understanding of the unique financial challenges facing doctors today. Healthcare practitioners need to take a wellness approach to their financial health and that includes an annual financial check-up! Do you have access to adequate resources for emergencies or opportunities? A comprehensive financial plan for a physician from residency to retirement would include:
• Financial Statements, • Income Tax Planning, • Insurance and Asset Protection, • Debt Analysis and Management, • Budget and Cash Flow Management, • Tax Efficient Investment Planning, • Business Loan Procurement, • Employee Benefits Planning, • Retirement Planning, and • Estate Planning
Contact the healthcare experts at TFG – we are more than just accountants and tax experts, we are medical practice consultants and business advisors. We understand your struggles with variable income, compliance issues, payors, and the changing landscape of medicine. Take advantage of our 20+ years of experience whether you are a physician, surgeon, chiropractor, dermatologist, dentist, podiatrist, pharmacist or other niche healthcare provider.
Becoming a partner in a physician practice or dental group is a dream come true and comes as the result of goals setting, sacrifice and an investment of time and self. It can also be a cauldron of financial complexity.
Be prepared. Although partnership can give you a voice in how the medical group is run, job security, and additional income, it comes with complications. Partners assume the risk in the practice, but those who are entrepreneurial and productive can realize success, even in a smaller partnership. There is no silver bullet or one size fits all approach, but here are the major landmines to be mindful of:
1. The Buy In: Some groups have you buy in with dollars, other have you buy in with time served. The difference between what you earn and what you’re paid goes toward your equity share in the group. That might include part of a building, some medical equipment, goodwill, and a share of the accounts receivable. Negotiate your partnership contract. Have built in compensation increases for reaching revenue goals or cost-saving benchmarks, as well as increases to keep pace with inflation, etc.
2. The Additional Expenses: A step up the ladder comes at a price – now you will be responsible for the personal expenses that the practice paid on your behalf prior to partnership including health insurance, malpractice insurance, Social Security and Medicare taxes. Set up an HSA to pay medical bills and contribute to it as a retirement vehicle, it is triple tax free. You won’t have withholding, so consider making quarterly estimated tax payments. You may get paid on a K-1.
3. Shared Business Costs: Be aware that as a partner, you will now share in costs of running the practice whether administrative, operational, or related to insurance, taxes and financial fees, etc. Some of the practice expenses will be variable and some fixed, some will fluctuate based on how many patients you see and how much revenue is generated. This also means your income will variable.
4. Financial Complexity: The more you make, the more you pay in taxes. Tax minimization strategies still exist and there are business structuring options available – tax reform legislation now provides a deduction of up to 20% for pass-through entities on qualified business income.
5. Retirement options: Often there are additional retirement savings options and investment plans available to partners, now is the time to consider contributing up to the annual limit. Whether early retirement is on your mind or not, you need to plan now to exit the practice later. Estate planning alone will not protect your family, but Business Exit Planning will protect your financial future.
Contact Us: Making partner is a significant life event! It is a great time to review your financial situation. Make a budget, look at your insurance, plan your investments, and put together an asset protection plan as well as an estate plan. As mentioned in the article It is also a good time to have a review of business structure and tax situation with your Fuoco Group CPA. Congratulations! Becoming a partner can bring financial complexity, but your TFG professionals are here to help you reap the rewards.