Practice Assessments

Medical Records
Collection Techniques
Purchasing/Inventory Control
Patient Flow
Recall Systems
Telephone Equipment and Use
Staffing Patterns
Insurance Processing

Practice & Liability Consultants will perform a comprehensive Practice Assessment for you. This assessment will encompass all areas of practice. Your major areas of concern will be emphasized.

The areas typically covered in the Practice Assessment are:

• Establish or Review Budget Projections
• Management Reporting System
• Analyze Revenue/Expense/Net Income – Compare to Benchmark Norms
• Analyze Accounts Receivable Ratios
• Analyze Physician Compensation/Income Distribution Formulas
• Determine Physician Staffing and Scheduling
• Analyze Physical Lay-Out
• Establish Appropriate Staffing Patterns
• Back Office
• Front Office
• Hours of Operation
• Personnel Issues
• Cash Flow Considerations
• Insurance/Managed Care Contracts
• Fees and Charges
• Medical/Dental Records
• Computer Systems
• Telephone and Communication Systems

A comprehensive written report summarizes the findings and recommendations of Practice & Liability Consultants. Our Practice Assessment Report is frequently 35-50 pages in length. Practical, cost-effective solutions along with forms are provided for problem areas that have been identified. Frequently, several options will be provided, with the benefits/costs of each option summarized. Practice & Liability Consultants strongly believe that follow-up is important for you to obtain the full value of any practice assessment. Included as a part of the Practice Assessment are two follow-up visits, at quarterly intervals, to assure that you are on target with your implementation goals. Clients not located in the Bay Area have the option of telephone follow-up or in person follow-up. Airfare is additional. Any problems with implementation that have arisen can be discussed at these meetings.

Managed Care Contract Negotiation

PPO Rate Analysisservices02
Cost Accounting
Marketing And Negotiating

Managed care and in particular, capitation contracting, requires knowledge of utilization and costs of providing medical services. Our financial expertise can assist the physician prior to contracting to determine expected profitability. Frequently, we are hired after contracts have been obtained to determine whether contracts are profitable or should be eliminated.

Services include:
• Comparison to Medicare rates
• PPO Rate Analysis
• Expected utilization
• Carve outs
• Contract terms
• Cost Accounting

With capitation where revenue is fixed, delivery of medical services involves knowing how much it costs to deliver each CPT service physicians provide under the contract. This is essential to know the profitability of the contract. Determining costs of delivering services also benefits the practice with PPO contracts to avoid discounting fees below cost.

• Activity Based Cost accounting techniques are utilized.
• Time flow studies to determine labor costs
• Analysis of materials costs
• Contribution to overhead costs

Marketing and Negotiation: Being excluded from contracts, IPAs or networks can decimate a practice when managed care comes into an area. Being proactive to obtain favorable contracts benefits the physician practice.

Services include:
• Development of marketing materials for the practice or group
• Marketing presentations to Managed Care Organization

New Practice Establishment

They don’t teach you the business skills to run a company in medical school.
Our services make business easy, helping providers open, expand, and improve successful practices that they are proud to own.

Utilizing our “New Practice Decision Grid”
Most medical training programs do not feature sufficient business management curriculum, resulting in graduates who are ill equipped to establish a practice from scratch. Practice & Liability Consultants can assist in establishing the systems and staffing to assure a smooth functioning medical office for a physician who wishes to start a new practice.

A summary of tasks to be assumed would include, but not be limited to:
• Determination of a practice location
• Assistance with purchase of equipment
• Establishment of bookkeeping, medical records, scheduling, and telephone systems
• Establishment of personnel policies and procedures
• Establishment of accounting, expense, and budget control functions
• Recruitment of staff and training
• Implementation of marketing and patient relations techniques
• Overall management and control to assure a smooth functioning office and a healthy financial status

Our 20 page New Practice Decision Grid outlines all the detailed tasks it takes to establish your practice. This provides an organized countdown or time line of tasks which need to be accomplished before your practice opens. The New Practice Decision Grid is also available for purchase as a separate product.

Website and Marketing Materials Design
Practice and Liability Consultants also offers fully custom website design and maintenance, professional logo, print and marketing material designed to help your practice present a professional image. Click here for more information.

Insurance Credentialing
Practice and Liability Consultants can handle your insurance credentialing and contracting process from start to finish. Having us to handle the process for you allows you to focus on your practice, without spending hours filling out forms and making phone calls. Click here for more information.

Insurance Contracting Negotiation Services
We offer physicians contract negotiation services that will increase revenue for your organization. Most practices never negotiate contracts and accept what the insurance company offers. Insurance contracts have evergreen clauses which mean they continue to roll over year after year, which translates to practices missing out on an additional 5-15% in revenue. Successfully renegotiating your managed care contracts can yield to an increase on revenue for most organizations. Click here to learn more.

Practice Valuation & Brokerage Services

services04Valuation of Practice for Purchase / Sale / Buy-in
Negotiation of Terms
Expert Witness & Litigation Support

Practice & Liability Consultants will perform a valuation of your practice to estimate its financial worth in today’s changing healthcare marketplace. Valuations or Appraisals are needed for the following:

• Sale of the practice
• Buy-out of partnership
• Buy-ins to partnership
• Mergers to equalize assets
• Sales to integrated delivery systems, practice management companies, management services organizations
• Property tax or insurance
• Divorce Valuation

The comprehensive written report outlines the factors and methodologies used in arriving at the final recommended figure. The valuation consists of an on-site review and analysis financial of information. A written report is provided with the rationale for valuation. We also provide a comparison to norms by specialty. The reports are produced in both bound and unbound formats to provide a mechanism for distribution to potential buyers. Advice on structuring the sale or purchase and negotiation of terms can also be provided. Assistance in acquiring legal services can also be arranged through our network of experts.

Medical Practices USA, a joint venture between Debra Phairas and Gary Ware, provides practice brokerage services to the medical community throughout the United States. Medical Practices USA assists sellers of practices and buyers seeking practices. In addition to practice brokerage, Medical Practices USA provides a full range of appraisal and practice management consulting services.

If a sale or partial sale is contemplated, we will:

analyze the market value
along with you, determine an asking price
market the practice
screen responses
negotiate the transaction with the buyer
manage the development of all necessary documents (sales contract, covenant to not compete, promissory note, security agreement, etc.)
guide the parties through the transaction, including explaining due dilligence
coordinate all escrow and legal services for the parties
perhaps most importantly, we take the burden of the sales process off your shoulders so you can concentrate on your practice

For more information, please visit:

Financial Analysis

Expense Analysis
Overhead Reduction
Budget Development
Management Reports
Fee Structure Productivity Analysis

Practice & Liability Consultants can analyze the practice financial information to determine if additional revenue is needed to support practice expenses, if expenses are within norms or can be reduced. We have access to practice benchmark comparison data for all specialties and use this as a guideline to determine how to increase gross revenues or decrease practice expenses that can result in increased net income for the physician.

Our services also include:
• Pro forma revenue and expense projections to:
• Establish a new practice
• Obtain bank loans
• Merge practices or form new groups

Budget Development:
• Working capital
• Capital expenditures
• EXCEL spreadsheet for future use by the office manager
• Preparation of Management Reports to Monitor Practice Financial Health:
• Accounts Receivable and Collection Ratios
• Profit Loss Reports

Productivity Analysis:
• Specialty specific
• Office hours worked
• Office visits per week/per year
• Hospital visits
• Surgical procedures per year

Hospital Physician Recruiting Support

Practice & Liability Consultants is the perfect choice for assisting hospitals with physician recruitment support due to reputation, proven experience and expertise with a solid track record for establishment of new practices, merging new physicians into existing practices, ability to successfully work closely with physicians, and provide excellent documentation for demonstrating community need to provide recruitment assistance. Knowledge of Stark laws regarding physician recruitment and hospital loans is our forte.

A. New Recruit Joining an Expense Sharing Practice or Joining a Group Practice:
• Proforma revenue and expense comparison spreadsheet to demonstrate viability of bringing in an associate and to inform hospital of recruitment expense for overhead share, breakeven point and dollar outlay for support.
• Documentation to support Hospital Recruitment Community Need
• Charges, Adjustments, Collections, Line Item Expense/Overhead ratio, Net Income comparisons to national and local benchmark norms for the specialty.
• Accounts receivable ratio analysis with comparison norms
• Staffing ratios – Payroll to gross collections ratios by staffing type and Full time equivalent ratios per staffing type
• Recommendations to improve all of the above financial, productivity and staffing ratios
• Valuation of practice tangible and intangible assets
• Recommendations for structuring an incentive program for the associate and structuring any buy-in to the practice
• Summary session with the practice to discuss improvements
• Advice to practice for successful long term arrangement including terms of employment or expense sharing
• Credentialing for insurance plan participation if needed

B. New Recruit Establishing a New Solo Practiceservices05
All of the above plus:
• Provision of a Capital Budget for startup equipment, furniture, computers and medical instrumentation
• New Practice Establishment utilizing our NEW PRACTICE DECISION GRID with steps to start a practice from scratch.
• Advice, task assignment, timelines and monitoring.
• Consultation to establish all practice systems such as medical charts, telephone, scheduling, back and front office procedures, Medicare

• Compliance, Personnel Policies and Procedures, OSHA Compliance and risk management.
• Insurance plan credentialing and follow-up
• Interview and assist with hiring office staff

Personnel Management

Personnel Policy Development
Morale Building
Hiring and Interviewing
Complete Personnel Manual

Successful personnel management is an art and science just like medicine. Knowledge of management science and theory as well as experience in “the art” of personnel management is what sets Practice & Liability Consultants apart from other consulting and recruiting firms. Personnel Policy Development utilizing our generic personnel policies and procedures manual developed by nationwide experts who are human resources consultants and attorneys, our firm can provide the peace of mind to the practice to protect physicians from typical employment liability. This product can be customized for the practice or purchased as a generic manual.

Analysis of Staffing Pattern: Practice & Liability Consultants can analyze the present staffing pattern in the practice and recommend changes for greater productivity and utilization of staff. Staff is the largest practice expense category and effective management of staff is essential in today’s medical practice.

Analysis and comparison to specialty norms:
• Full time equivalents to MD
• Staffing expense to collections ratios
• Job descriptions
• Wage levels

Recruiting: Our firm performs recruiting, interviewing and hiring services to free the physician from this time consuming task. Selecting the right staff for the right position is a skill honed over years of experience. Practice & Liability Consultants is particularly skilled at recruitment of practice administrators and office managers. Many physicians are not aware of federal anti-discrimination interviewing questions. Typical recruiting firms charge 25-30% of first year salary. We charge 10-15% depending on the position.

Services include:
• Writing and placement of advertisements
• Postcard notification of receipt of resumes
• Screening of resumes
• Preliminary interviewing
• Interviewing final candidates with physicians
• Reference checks and complete background checks
• Salary and benefits recommendations
• Employment contracts
• Notification to applicants of filled position

Morale and Team Building: Disgruntled and unhappy staff members can cause the practice to lose patients, lose excellent staff members, increase malpractice exposure and cause compliance problems. Rejuvenation of staff morale and effective team building can attract new patients, new referral sources, retain valuable staff and create a harmonious, pleasant work environment.

Services include:
• Interview staff members to determine problem areas
• Summary report to the physicians
• Team building, morale and motivation exercises

Malpractice Prevention Services

Development of Claims Prevention Programs
On-Site Loss Prevention Survey Programs
Seminar Development and Presentation
Audiovisual Materials Development

Our consultants have developed claims prevention programs for many state and national malpractice insurance companies. Highly acclaimed seminars and lectures incorporating claims prevention information, motivational behavioral change strategies, actual claims examples and practical solutions have been presented nationwide for physicians.

Development of Claims Prevention Program
• Program organization including staff, interaction with underwriting, claims and data processing
• Analysis of claims for trends
• Evaluation of existing programs
• Licensing of survey programs, handouts and materials and staff training
• Communication with insured via newsletters, handouts, written materials
• Program implementation
• Evaluation and tracking to assure successful results

Loss Prevention Survey of Ambulatory Facilities and Physician Practice
• Pre-Screening survey
• On-site review of all departments and functions
• Specialty specific risk analysis
• Summary meeting
• Educational session for physicians and staff
• Confidential written report with recommendations to reduce risk
• Seminars and lectures to physicians, mid-level providers, managers, and staff
• Development of seminars based on claims
• Creative handouts and materials to accompany seminars
• Case study summaries for seminars
• Mock deposition and trial formats
• Scripts for patient, doctor, lawyer, claims representative case examples

Lectures on common claims prevention topics including:
• Communication, Patient Relations and Rapport
• Handling Unexpected Outcomes
• Informed Consent, Informed Refusal
• Avoiding Failure to Diagnose, Treat and Refer Claims
• Managed Care Risks
• Documentation, Medical Records, Release of information
• Practice systems- Recall, abnormal results, tracking, referral/consultation process

Individual Risk Assessment Program
• Self study- Home study risk management
• Audio, video, internet programs
• CME test
• Audiovisual Development, video, audiocassette, slide/tape, PowerPoint production
• Award winning video productions – $2,000-$500,000 budgets
• Four camera, live on tape production for seven set video production
• Documentary style interviews of doctors
• Actual delivery on camera as expert
• Concept, script development, casting, direction, editing and production

Mergers/Group Formation

Defining Goals
Terms and Agreements
Distribution Formulas

In consulting with over 1400 practices of all sizes and specialties, we are familiar with the elements that lead to successful group or partnership practices and the conflicts that can lead to disharmony and practice dissolution. Utilizing this knowledge, we can facilitate the decisions physicians must make on the necessary tasks prior to group formation.

Steps to take:
• Anti-trust review for IPAs or specialty IPAs
• Confidential Interview or Questionnaire to uncover “stumbling blocks” to successful formation
• Identification of “Sacred Cows” as an impediment to merger
• Pension Issues
• Buy-In, Buy-Out and Formulas
• Equalization of assets
• Income Distribution/Overhead Share Formulas
• Pro Forma Revenue and Expense Projections
• Governance, Structure, Voting, Death, Disability, Retirement, Dropping Call
• Space Planning, Renovation or Lease Issues
• Practice assessments to combine office systems
• Staffing analysis to combine staff
• Team building to successfully merge staff
• Promotion to the community and physicians

Expert Witness Services

Qualified Expert Witness in California, Arizona and Washington. Expertise includes Medical Practice/Surgery Center valuations for divorce or shareholder/partner disputes, medical malpractice, medical office risk management, economic loss of income for physicians, hospital loan guarantees, WRVU compensation and practice management. Experience includes: Litigation Support, Depositions, Arbitration, Mediation and Trial Testimony.