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.
Dealing with physician burnout – why is it so prevalent for so many practitioners in medicine in this new millennium?
Being a physician is a demanding job with serious responsibilities. Add to that the fact that patients are often chronically ill, sometimes treatment doesn’t work, and occasionally patients die — that is a heavy burden to bear in addition to a daily workload, rounds, running your practice. But what exactly is burnout, how prevalent is it, and why should the medical community be concerned?
Studies define burnout as “a syndrome consisting of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, which is primarily driven by workplace stressors.” Recent research shows nearly half of practicing physicians in the U.S. experience burnout at some point, with those at the front line of care reporting the highest rates.
Leading drivers of burnout include excessive workload, imbalance between job demands and skills, a lack of job control, and prolonged work stress. Not all of the reasons for burnout are work-related. A physician may have significant issues regarding his or her own health or their personal life. Generally, the three symptoms of physician burnout are exhaustion, cynicism and doubt. Exhaustion isn’t just physical, but can be mental, emotional, even spiritual. Cynicism, or depersonalization, is sometimes dubbed “compassion fatigue.” And doubt, of course, is wondering why you bother.
Burnout in physicians has been linked with lower work satisfaction, disrupted personal relationships, substance misuse, depression, and suicide. Burnout can result in an increase in medical errors, reduced quality of patient care, and lower patient satisfaction. Burnout is responsible for reduced productivity, high job turnover, and early retirement.
Kevin MD reports that more than 51% of physicians attribute burnout to excessive administrative burdens and bureaucratic duties, among other things like long hours, a constantly shifting health care system, and dealing with a built-in level of failure.
A recent article in Medical Economics suggests that simple tweaks in day-to-day tasks, workflow shortcuts, and running your practice more efficiently can ease stress and create a more positive experience for both physicians and patients. There’s a bit more to it than that.
First, as a physician you have to admit that you have normal human needs, will occasionally display vulnerability, are not a machine, and have the right to say “NO” when workload becomes impossible. There should be no shame or stigma about needing help, never wait till you are overwhelmed, exhausted, and stressed, before reaching out for assistance. Don’t blame yourself or let cultural norms, chaotic office conditions and a broken hospital system lead to your burnout!
Second, remember depression and burnout aren’t necessarily the same thing — but they often overlap. Take steps to avoid burnout and, if you feel yourself slipping over into depression, get help.
Third, the solution entails more than getting some sleep, meditating, exercising regularly, learning to say no, and better time management skills. The ultimate answer might be fixing the broken health care system. Studies show that burnout is a problem of the whole health care organization, rather than individuals. It requires structural changes and an organizational approach like changes in schedule and reductions in the intensity of workload, improved teamwork and leadership, communication skills training, changes in work evaluation, enhanced job control, and increasing the physician level of participation in decision making.
With all of that in mind, here are Fuoco’s five to thrive, self-healing strategies to stave off burnout:
1. Sometimes you just have to say “no.” It’s impossible to say yes to everything. Before answering, always ask yourself: Will it lead to more balance in my life or create unwanted imbalance? Will it take away from time with my family and friends? Will it enhance my career? What aspect of being a physician do you enjoy the most and feel you’re best at? Try to focus on that and say yes to more of what you enjoy doing.
2. Accept that you have limitations just like everyone else. Physicians can’t always help or save every patient. It’s impossible to predict or anticipate every possible medical outcome. Sometimes you won’t get to finish every item on your to-do list because you are juggling so many balls (or patients) at once. Develop coping techniques that work for you so you can accept it, and move on.
3. Develop a strong support system. Whether it’s a spouse, friend, colleague, or trusted business advisor, everybody needs someone who will listen. Work on building a team, and better communication and collaboration whether at the office, or in the hospital (even at home).
4. Slow it down. The business plan might call for spending 15 minutes with a patient and moving on, but don’t stress about being so efficient. Slowing down, and taking a few extra minutes out of your schedule when needed to listen, will benefit not only the patient, but you too.
5. Learn to be flexible. Adapting to change is tough and it seems the practice of medicine is changing dramatically every day. Balance is hard to achieve, and stress as well as busy schedules are part of any career. Maybe “survival of the fittest” means most able to adapt to change. Being open and receptive to new ideas and ways of doing things is a positive way to work and live.
Some helpful resources for our physician clients in New York and Florida include:
New York Resources from the Medical Society of the State of New York Committee for Physician Health: http://www.mssny.org/cph/
As you work for the health of your patients, the professionals at Fuoco Group work for our physicians’ financial health. If you are worrying about cash flow, internal controls, staff and equipment issues, perhaps the prescription is customized accounting and financial services from a CPA firm well versed in physician medical practices. Our “New Financial Dialogue” includes a 360 degree business advisory program designed to take the burden off you and your physician partners because worrying about costs, reimbursement, margins, operations and finances shouldn’t be keeping you awake at night!
Contact us today – offices in New York, Long Island, and South Florida.
Here’s our Rx to protect and enhance your bottom line so you can spend more time practicing medicine and taking care of patients:
1) Hire Better – This will save you money in the long run as having to replace staff is expensive in many ways and bad employees can cost you patients. You wear a lot of hats in your practice, but remember that patients spend a great deal of time in front of your employees so make sure they are technically skilled, but also compassionate and personable. The more your staff can do, the less time you have to devote to tedious tasks, and you might just help your stress level as well as your financial statement.
2) Don’t Be Afraid of Change – When your practice stagnates so does your bottom line. Embrace technology that streamlines daily tasks, billing, processes, patient intake and records, etc. In the end it saves time, and makes compliance and collections easier. On another note, be aware of tech trends that are changing the status quo such as telehealth and telemedicine – there may be financial opportunities there as well as a way to better serve patients!
3) Look Beyond Reimbursement – What insurers and other payors, including the government, are willing to reimburse is not controlled by physicians, and we have already seen how $$$ for quality vs procedure has shifted the financial landscape. Focus instead on internal costs which you can control. Focus instead on proper coding and compliance to avoid penalties.
4) Better Billing – Train staff to increase time for revenue producing activities, code and bill accordingly, and reward staff for opportunities seized to streamline activities and avoid waste/duplication.
5) Toot Your Own Horn – You can easily grow your practice by figuring out what is special about your brand or medical niche and then marketing that. If you are not ready for a facebook page, at the very least make sure all your online profiles are accurate, and your website is visible and accessible. Join a local medical society or professional organization and network with other doctors or large employers in your area who can refer patients to you.
6) Avoid Burnout – You are the practice leader as well as the healer. You can’t do either well when you are seriously fatigued. Remember exhaustion is mental, physical and emotional. Know your limits, when to slow down and when to ask for help. Communicate, build a team, re-evaluate scheduling and workload, delegate where possible, and accept your limitations.
CONTACT US: Perhaps it’s time to consider an accounting ally in the healthcare industry with single or multiple physician practice expertise whether internist, specialist, surgeon, chiropractor, podiatrist, dentist, etc. In addition to tax and accounting services, our new financial dialogue includes a 360 degree business advisory program. All designed to take the burden off you and your physician partners because worrying about costs, reimbursement, margins, operations and finances shouldn’t be keeping you awake at night!
Doctors face a variety of legal risks every day: malpractice, fraud, waste and abuse. These actually surpass the risk of malpractice and tax liability. But physicians participating in federal health care programs can and must minimize those risks, because failure to do so exposes them to severe criminal, civil and administrative penalties, as well as tarnishes their reputation and impact reimbursement. Here are some simple steps that can help you take control:
1) Review the red flags for fraud:
• Billing for services not rendered. • Billing for a non-covered service as a covered service. • Misrepresenting dates of service. • Misrepresenting locations of service. • Misrepresenting provider of service. • Waiving of deductibles and/or co-payments. • Incorrect reporting of diagnoses or procedures (includes unbundling). • Over-utilization of services. • Corruption (kickbacks and bribery). • False or unnecessary issuance of prescription drugs.
Disputes often occur due to concerns about the adequacy of a provider’s documentation or the level of supervision over a service. Generally the provider is a repeat offender! Unfortunately it is assumed that physicians and their staff know all the statutes, regulations, and CPT codes, memorize the manuals, national and local coverage determinations, bulletins and fee schedules applicable to their claims. When participating in federal health care programs and government money is at stake, ignorance is not a defense. So what else can you do?
2) Create a culture of compliance. Be committed to compliance with education and training, random auditing, and detailed documentation. Let violators in the office know they will be held accountable and let “whistle-blowers” know there won’t be retaliation. Getting compliance right is a competitive advantage for your bottom line.
4) Attend to problems quickly. Compliance problems not detected or those ignored for a lengthy period of time will attract government attention and lead to large penalties.
5) Budget for compliance. Providers should ensure that adequate resources and time are devoted to compliance activities. Legal or consulting advice may be beneficial in developing a compliance plan and procedures, doing an audit or investigating non-compliance issues.
6) Use benchmarking. Do not be in denial, big data is being mined by interested parties to find offenders. Be proactive and compare your billing data to similar providers in your area to be sure you are not under- or over-charging or incorrectly coding and providing the proper level of care. Abuse involves substandard, negligent or medically unnecessary practices that increase the cost of health care. Abusive practices often indicate fraud.
Keep in mind that health care fraud and abuse control programs are designed to prevent, identify and prosecute unlawful billings by health care providers and insurers. Health care fraud is a misrepresentation or failure to disclose pertinent information. A false claim involves an intentional false representation that causes the government to pay more than is allowable and might land you with more than a slap on the wrist!
Contact our healthcare team for assistance with this or any other accounting and operational needs. We have a depth and breadth of experience in the healthcare industry whether servicing hospitals, physicians, MSOs, dentists and DSOs, concierge medicine providers, chiropractors and podiatrists, etc. Whether in New York or Florida, call toll free 855-534-2727.
Staying on budget and managing cash flow can be difficult when juggling expenses, collections and reimbursements. A lack an understanding of revenue cycle management can cause internal billing and coding errors, a failure to prioritize patient collections, not properly educating patients about payment policies or not verifying insurance for every patient.
Revenue cycle management is a complex interaction of services, billing codes, benefit analysis, and successful invoicing. Now that high-deductible health plans are more common, reimbursement patterns started shifting and doctors must develop good ways of interacting with patients to encourage payment of their bills. TFG Health Professionals can help you put a financial policy in place. We can design an audit process to help you track delinquent accounts prior to patient visit, and have our accountants analyze financial reports at month end to identify problems. Help and a more profitable practice is just a phone call away.
Is it time for your healthcare practice to have a check-up?
We have solutions to help you protect and enhance your bottom line so you can spend more time practicing medicine and taking care of patients.
Look to TFG Health for advice on: new payment models and care paradigms, revenue builders, cutting expenses, insurance planning, buy/sell agreements, new hiring physicians and mid-level providers properly, maximizing patient collections, preventing fraud in your practice, adding new products and services like telemedicine to increase profitability, Stark Law updates, and more.
Summer barbecues, boats and beaches should not distract you from the business of your taxes. Throughout the year, you take your car in to the mechanic for maintenance – so too should you chat periodically with your financial professionals to be sure you are not missing any individual or business opportunities to minimize your taxes by December 31st. The end of Summer is a perfect time for a mid-year review of your tax return which can reveal money saving ideas and leave you plenty of time to implement new financial plans.
Here are some events that can significantly impact your tax
Change in employment, ie., from private practice to clinical, educational, research or hospital based career;
Marriage or divorce;
Death of a spouse;
Spouse starts to work;
Birth of a child or adoption;
Substantial increases or decreases in income;
Large gains from the sale of assets, stocks or bonds;
Buying or selling of property or rental property;
Starting a practice, acquisition or sale of a practice;
Purchases of medical equipment or other property;
Buying, selling, or re-financing a domicile or vacation home;
Receiving an inheritance;
Substantial investment income or gains from the sale of investment assets;
Imminent retirement or reaching age 70 ½; and
Unplanned withdrawals from an IRA or pension plan.
On your checklist of things to consider should be:
Are you able to take advantage of the 20% of qualified business income (QBI) deduction? Physicians can benefit from the 199A Deduction if their taxable income is below $157,500 for single filers and $315,000 for joint filers. Proper tax planning and restructuring alternatives can help your eligibility.
What does your balance sheet look like? Is your practice’s financial plan on budget, are you managing cash flow, are you feeling the impact of income gains or projecting losses?
Starting a 401(k) or similar retirement plan like a SEP for your practice.
Review withholding and estimated tax payments to avoid paying too much or too little. Two-income families may be more vulnerable to being under-withheld or over-withheld.
If your income is approaching the net investment income tax (NIIT) threshold consider strategies to defer earned income or shift some of your income-generating investments to tax-advantaged retirement accounts.
Have you considered bunching charitable contributions?
CONTACT US: Don’t procrastinate! Life altering events and changes in both your practice and personal circumstances can impact your taxes, don’t wait until tax time 2019 to see the results. With mid-year tax planning, you may be able to mitigate the tax impact of certain events and avoid unpleasant surprises before it is too late, as well as decrease your prepayments and obtain more cash flow. Call toll free to set up a consultation with one of our tax and financial professionals: 855-534-2727.