New Ways To Manage Your Vet Practice With FinancialsPresentation Transcript
New Ways to Manage Your Veterinary Practice with Financials Mark J. McGaunn, CPA/PFS, CFP® President MJM Financial Advisors, LLC 114 Turnpike Road, Suite 107 Westborough, MA 01581-2861 phone: (978) 405-3133 e-fax: (978) 776-2609 e-mail: [email_address] web: www.mjmfa.com
Who to Blame
Key Performance Indicators
Financial Strength Index
The Great Number Deluge
How healthcare organizations use financial data greatly affects current and future operational and financial performance. Two schools of thought:
1st school- Managers ask, “What’s the number?” If bad, they ask “Whose fault?” Organization’s focus only on bottom line.
2 nd more successful school led by Leaders who say, “Now that we have the number, what proactive ideas can we implement based on it?”
Lots of Responsibility
Veterinary practice owners and managers responsible for tracking projects, initiatives, clinical outcomes, policies, and procedures.
Data “deluge” causes owners to lose focus and fail to keep strategic thinking aligned with their veterinary practice's long-term vision.
Great strides in information collection and distribution, but
Significant improvements in decision-making value of that information not realized.
Bad Tech Solutions Not Better…
Technology often just simply delivers more, irrelevant or inappropriate data quicker.
Great practices demand timely, relevant data.
Jack Welch, former General Electric CEO, had worldwide operating results delivered to his desk by day 5 of each month.
Much smaller businesses have trouble with 30 days.
Use Your Data
Knowing how to read financial statements and understand the information within them is often the difference between prosperity and just getting by.
Time-honored question asked by every healthcare professional is:
“ Are we making money?”
Know Your Stuff
Veterinarians who don't carefully read such financial outcomes measurements run risks much as they would in failing to read medical outcomes carefully.
Your financial statements are key diagnostic tools for managing the veterinary practice, tracking revenues and expenses, identifying financial problems, and ultimately increasing everyone’s compensation.
You have to know the basics. The 3 financial reports used to monitor an organization’s financial health are:
Income statement-lists revenue, expenses, and residual net income for specified period of time,
Cash flow statement-tracks operational, investing, and financing cash flows, and
Balance sheet-indicates veterinary practice’s degree of solvency and ownership equity
Basis of Accounting
Most healthcare-practice CPA's utilize "cash basis" method of accounting. Cash basis shows what’s been collected and what’s been paid.
“Accrual basis” presents income that’s earned (not necessarily collected) and expenses incurred (not necessarily paid).
Both relevant for tax purposes. Accrual basis must be used for those practices where inventory a material income-producing factor.
Income Statements (P&L)
Of the three financial statements, P&L most adept and flexible device for monitoring practice’s financial health.
Most practices should review P&L review these at least monthly.
In addition to reporting patient income, employee costs, and overhead (office and medical expenses), income statements can even breakout incremental costs for various ancillary services (QuickBooks class system).
Comparisons & Budgets?
Income statements augmented by footnotes can explain to practice owners major deviations in revenue and expenses compared to previous periods.
Checking against a well laid out budget (that already incorporates these timing issues) can show that no extraordinary management is needed.
Budgets are not meant to be punitive tools.
When studying your costs, remember that there are two general categories: fixed or variable.
Fixed costs remain the same regardless of volume. They include rent, insurance and utilities.
Variable costs, such as medical supplies, fluctuate with volume.
Recognize, however, that variable costs vary differently.
i.e. medical supplies have a close relationship to volume, but staffing may vary in steps.
Important to recognize in budgeting, as well as in developing strategy.
BEFORE printing out financial statements to review:
Make sure all deposits, checks, and credit card charges have been entered to month end, and
Make sure all checking and credit card accounts have been reconciled
Then print out reports and use for analysis!
And it won’t mess with your tax planning!
Simple QuickBooks Format
You should modify your QuickBooks ® chart of accounts to incorporate the AAHA chart of accounts format. No longer sold in healthcare version.
Makes practice to practice comparison easier.
It is not necessary for you to re-create the wheel in your endeavors of practice-to-practice uniformity.
AAHA Chart of Accounts Balance Sheet
Assets-Current, Fixed & Other (100 Series)
Liabilities-Current, Long-term (200 Series)
Equity (300 Series)
-Corporations (C or S)
-Equity for Partnerships or LLC’s
-Proprietor’s Capital (Sole Proprietorship)
AAHA Chart of Accounts Income Statement
Income (400 Series)
Cost of Goods Sold (500 Series)
Operating Expenses (600 and 700 Series)
Other Income & Expenses (800 Series)
Income Taxes (900 Series)
Measurement must incorporate key factors in developing measures that:
Extend throughout entire practice..
Tie into practice overall strategic plan.
Have consensus as to relevant and appropriate factors.
Based on both internal and external factors.
Empower employees, not stifle them.
Allow systematic review, and
Encompass each operating division in a veterinary practice.
Franchisors have utilized benchmarks to highlight financial strengths and weaknesses in store-to-store and intra-store measurements.
True progressives utilize intra-entity benchmarking and metrics to measure their progress (if already > average).
Financial metrics are typically only a component.
Customer Service s/b measured in all aspects.
How can we be cutting edge?
Your Primary Competition Is..,
What relevant benchmarking data are available to assess performance?
Comparative benchmarking data are crucial to the success of any reporting systems.
Ideally, a practice should have some comparative reference points to evaluate how it is doing with respect to its primary competitor- itself .
Key Performance Indicators
Quantifiable measurements that reflect the critical success factors of an organization.
They reveal a high-level snapshot of a practice’s financial and operational status.
Before Key Performance Indicators are selected, vital to identify what the practice’s goals are, which are in turn dependent upon its mission and owners.
KPIs act as a measure of progress towards these goals.
Whatever they may be, KPIs must be critical to the success of the practice.
Application of Key Performance Indicators provides practice owners with a high-level, real-time view of the progress of a practice.
Combination of reports, spreadsheets and charts.
Revenue figures, trends, or any long-term consideration which may be essential in gauging the health of the practice.
Should not only reflect the organizational goals but also be quantifiable .
To be valuable it must be accurately defined and measured.
A KPI may meet the criteria of reflecting the organizational goal, which may for instance pertain to being the most popular company.
However, since a company’s popularity can not be measured or compared to others, therefore the KPI would be useless.
Considerations regarding how a KPI is to be measured should also be established in advance .
Definitions as to exactly how the indicator is to be calculated and whether it is to be measured in dollar amounts or units should also be specified.
Moreover, it is imperative that the organization then sticks to these definitions from year to year in order to allow for annual comparisons.
Indicators can include:
quality of care
marketing and development
internal veterinary practice procedures; and
employee, patient, and DVM satisfaction.
The process of converting raw or numerical tabular data into a graphical depiction is known as “data visualization”.
One of the main goals of data visualization is to support decision-making through the use of properly designed graphical representations of information.
Visual Trends Inspire
For most operations managers, trending data and exceptions to those trends are much easier to understand when they are presented visually.
Information presented in a visual format allows decision-makers faster perception of patterns or problems that they may not have anticipated.
Ultimately, they can make valuable conclusions more readily.
KPI - Dentistry
Common approach to measuring financial performance basically little change from capital-intensive operating styles of 20th-century industrial companies.
Old model doesn’t sufficiently account for the contributions of talented, highly motivated employees that more often than not, are the new basic source of integral practice wealth.
Somehow, the component of “people” seems lost in the healthcare practice equation.
Other Industries Global management consultant McKinsey & Company reports since 1997 30 largest worldwide companies (market cap) have seen their profits per employee rise dramatically. 5 year reward system trend in leading US financial planning firms now centered on fixed-based structures, leading away from variable-based because return on labor statistics were a wild card (IA Mag.)
Practices can redesign their own internal financial performance approach and set goals for an intrinsic return on intangibles by also incorporating greater attention to both:
profit per full-time employee equivalent (FTE) &
the number of FTE employees
rather than placing an intense focus on profits, returns on invested capital (ROIC), and return on equity (ROE).
New Practice Metrics
Do Homework Before Move? 89% 68% 49% ROL Client moved to new practice building in 2005-staffed up for expected demand
Other Uncommon Metrics
Avg. Unit Cost per Visit
Avg. Occupancy Cost per Visit
Actual Profit Per Active Client (not avg.)
Calculate Financial Impact Of Negative Variances Examine Numbers Convert Numbers to Ratios Observe Trends Compare to Benchmarks
Boring But Effective 2 2 6 Complaints 8 22 21 New Patients $9,887 $18,225 $6,122 Checking Balance $10,222 $11,212 $10,492 Payroll 11 16 21 Surgeries 185 211 225 Pt. Visits April 17-24 April 9-16 April 1-8
Presenting Dashboard Data
"Dashboard" reporting used more in all industries to keep owners and managers focused on critical areas that affect overall performance of the organization.
Dashboards allow you to effectively communicate your philosophy to your entire practice.
Low cost, strategic approach enables you to translate a practice’s vision and strategy into implementation.
Can create visually interactive financial scorecards to help you monitor both your key financial and non-financial metrics and ratios.
Help employees at all levels monitor individual performances and align their performance against practice goals.
Instill a culture of responsibility and accountability for results.
Practice Cockpit Indicator
Remember, it's that 15-year strategic financial plan that serves as both the:
foundation for financial decision making
framework against which we measure our financial performance.
We suggest developing a “ one-sheeter ” Dashboard to organize pertinent practice information to be reported on a minimum monthly, and preferably weekly, basis.
Developing a Dashboard
Keep it concise and easy to use. Report can be a combination of line and bar graphs, run charts, instrument gauges, and diagrams.
A well-drawn Dashboard has basic guidelines:
The practice’s major critical success factors should be included.
Comments should be used where necessary to assist in interpreting the information.
Measures should be compared to targets and benchmarks.
Focus on looking at and explaining variances from both targets and benchmarks.
Use trend analysis so readers can visually see long-term patterns.
Clear definitions should be published.
Visual appeal shouldn’t be a “bonus”.
Proper use of color constitutes an important function in well-designed Dashboards.
Practice Cockpit Indicator
As healthcare financial leaders, we can perform key management tasks to assist in the application and analysis of financial data:
Get it right.
Get it soon.
Make it useful.
Get it to decision makers.
Make active decisions with the data.
Robert Kaplan and David Norton developed in 1997.
Process integrated strategy execution, performance management, and facilitated organization learning.
Kaplan argued traditional benchmarking based on production and financial indicators provided limited insight into business’s key strategies and that comparisons were generally made to the average of a group of practices.
Balanced Scorecard approach helps practices develop primary goals directly from a mission statement, practice vision, and defined critical business strategies to implement all 3.
Approach takes a pulse of:
financial and non-financial measures of your practice,
its leading and lagging indicators,
employee and patient satisfaction, and
short- and long-term strategy.
Kaplan utilizes a strategy map (Scorecard) to develop a practice’s key strategies.
Shows cause and effect linkages between various parts of strategy.
Represents an attempt to enhance the value of information and to exploit IT capability to deliver true value to decision makers.
Perfect for situations such as lack of focus or direction, a new strategy, or a need to achieve practice alignment to a common vision.
How Scorecards Help?
Balanced Scorecards state that:
Reporting should be available on those key performance indicators truly affecting veterinary practice performance, and
Data is irrelevant if it cannot be utilized to improve veterinary practice performance.
Show Concepts Clearly
Balanced Scorecards present data in a visual format, allowing both a:
High level review of goal attainment and
Drill down ability
to monitor status against predetermined practice objectives.
You can incorporate your “15 year” strategic plan to everyday practice operations management.
The Four Views
Balanced Scorecards suggest we view a practice from 4 perspectives, and develop metrics, collect data, and analyze it relative to each perspective:
Learning and growth perspective
Veterinary practice process perspective
Link Measures to Strategy
Balanced Scorecard Elements
Business Vision & Strategy
Four Business Perspectives
For each Perspective there are:
Financial Perspective Customer Perspective Internal Process Perspective Employee Growth Perspective Revenue Strategy Productivity Strategy Compensation Strategy Operational Excellence Pet Need Solutions Client Education Operations Efficiency Marketing Drive Innovation Employee Competencies Technology Infrastructure Responsibility Practice Vision & Strategy
Blank Strategy Map Balanced Scorecard Strategic Theme: Process Improvement Customer Satisfaction Financial Performance Employee Satisfaction Objectives Measurement Target Initiative Statement of what strategy to achieve and what’s critical to its success. How success in achieving strategy will be measured and tracked. Level of performance needed. Key action programs required to achieve objectives.
Customer Perspective - Implement PetCare TV ® & dental education in waiting areas -Document!!! -Develop staff communication plan (DVM, tech, kennel, recept., other) & training 100% DVM recommended follow through (PMR review) Compliance Year 1-45% Year 2-60% Year 3-75% Percentage of patients compliant with semi-annual screenings and recommendations Encourage patient owner compliance with AAHA dental screening recommendations over current 30% standard Initiatives Target Key Performance Measure Objective
Internal Processes Perspective -Functional areas responsible for part of each protocol -Training!!! -Develop staff communication plan (DVM, tech, kennel, recept., other) & training 80% of all practice visits covered by formal written protocol Target Coverage Month 1= 20% Month 2-9=60% Month 10-12=80% # of Protocols Written # of Missed Charges Found on Random Charge Audits Develop diagnostic and therapy protocols for practice to ensure consistent medical treatment and care Initiatives Target Key Performance Measures Objective
Developing KPIs, Balanced Scorecards & Dashboards to measure and evaluate performance can pinpoint successes or problems in a veterinary practice.
Saves valuable energy and efforts on coming to such conclusions.
Practice owners can rely on that information about practice operations and performance in order to act correctly and make good decisions.
A special thanks to Elizabeth Bellavance, DVM (Camlachie, Ont.) for her Balanced Scorecard expertise!
Financial Strength Index (FSI)
Simple measure of overall human hospital financial health is the Financial Strength Index (FSI).
Composite measure of 4 critical dimensions that collectively determine hospital financial health.
FSI implies that hospitals with large profits, great liquidity, low debt, and newer physical facilities are in excellent financial condition.
Conversely, hospitals with poor profitability, low levels of liquidity, heavy debt, and aging physical plants are in poor financial condition.
In a study of human hospitals, four key drivers of financial strength were:
profit (total margin),
liquidity (days cash on hand),
financial leverage (debt to total assets), and
age of physical facilities (accumulated depreciation percentage)
FSI Critical Key Factor is…
Profitability strongest relationship to financial strength.
High-FSI hospitals had greater mix of surgical patients.
Pricing far more important than cost control as a driver of financial strength.
High-FSI hospital fees on avg. 13% higher but costs that were only 2 % lower than those of low-FSI hospitals.
Other FSI Factors
Liquidity . High-FSI hospitals had better liquidity, evidenced by higher values for cash on hand.
Financial leverage . High-FSI hospitals had lower debt.
Age of facilities . High-FSI hospitals had significantly newer facilities and greater rates of investment.
Seek help from CPA or practice management consultant
Decide if you want number crunching or “big” picture analysis.
Set short- and long-term goals for success and growth.
Well-developed financial plans help merge strategy and financial capability.
Management’s mantra-"anticipation, attention, analysis, and action."
Financial performance-currency of an effective competitor.
Mark J. M c Gaunn, CPA/PFS, CFP ® President
MJM Financial Advisors, LLC 114 Turnpike Road, Suite 107 Westborough, MA 01581-2861 phone: (978) 405-3133 e-fax: (978) 776-2609 e-mail: [email_address]