8/6/2019 EXPLORING THE PATH OF PRIVATE PRACTICE M EET YOUR MEDICAL PRACTICE PARTNERS A LEXANDRA K OHRS J EREMY B URROUGHS CARR H EALTHCARE B ANK OF A MERICA P RACTICE S OLUTIONS R EALTY P RACTICE M ANAGEMENT T RACK L ECTURE 1 : E XPLORING THE PATH OF PRIVATE PRACTICE – 10:15 AM -11:45 AM L ECTURE 2 : G UIDE TO T RANSITIONING STRATEGIES – 1:15 PM – 2:45 PM M EET THE E XPERTS B REAKFAST & L EARN : 7:45 AM B OOMER R OOM Q & A S ETTING Don’t miss out on your opportunity to ask the real estate and banking experts any question. We will start with most common questions and provide an open platform for a panel discussion. Come have breakfast with us on try to stump the experts! P RACTICE O WNERSHIP T IMELINE 1
8/6/2019 S HOULD I S TART A P RACTICE F ROM S CRATCH ? Positives Negatives • Build a practice the way you want it built • Stress of building, managing and running an office • Normally a fast growing company and developing area (less/no competition) • No patient base • New equipment and fixtures • You have to deal with growing pains, i.e. staff, billing, benefits, pay plans, • Hire and train your own staff using your scheduling, to name a few, business and service philosophies • You will have to continue your current • Patient selection matches your personality employment until the practice can support strengths and weaknesses itself W HAT DOES THE PROCESS LOOK LIKE ? S TART U PS 2
8/6/2019 D O YOU HAVE YOUR START UP TEAM ? Banker Insurance Business Office Equipment Contractor Space Finder Maintenance Doctor Medical Specific Technology Accountant Rep Equipment HR Specialist Consultant Marketing Investment Lawyer Website Design 7 S HOULD I B UY A N E STABLISHED P RACTICE ? Positives Negatives • CASH FLOW! • You are buying someone else’s philosophy, flow, treatment planning, staff training, • Have a patient based already established systems, etc. • Possible loss of patients in transition • Staff understands their roles and are trained • Existing staff salary is already established • The practice has been marketed and • Staff may resent new owner and leave the maintains a consistent flow of new patients practice • Established insurance relationships • The equipment and office may be old and worn which will require additional economic investment W HAT DETERMINES THE PRICE ? Practice Specialty Cash Flow Revenue Trend Expenses • Hiring/firing employees • Staff wage costs • Adjusted overhead costs Last Cosmetic Update Technology • Digital X-Ray • Computer systems 3
8/6/2019 W HAT DOES THE PROCESS LOOK LIKE ? A CQUISITIONS D O YOU HAVE YOUR ACQUISITION TEAM ? Banker Insurance Lawyer Marketing Practice Website Broker Design Doctor Space Investment Finder Medical Specific Equipment Accountant Specialist 11 D O YOU HAVE YOUR EXPANSION TEAM ? Banker Insurance Lawyer Marketing Contractor Website Design Doctor Space Finder Investment Medical Equipment Specific Specialist Accountant 12 4
8/6/2019 T HE F INANCIAL P IECE • Credit worthiness • Capital (liquidity) • Character (financial position) • Capacity (cash flow) • Collateral (business) 13 Getting your credit in order - Your Credit Bureau file includes - Trade lines and accounts: How are Credit Scores calculated? Payment History 15% Credit Useage 31% Inquries 14 - Public record and derogatory information : Account Types Age of Accounts 10 30% - Hard vs. soft inquiries - Contact information, employment history, aliases & notes 14 #1 D EBT Q UESTION - W HAT IS GOOD AND BAD DEBT ? STUDENT LOANS CREDIT CARDS HOME REVOLVING LINES AUTOMOBILE OF CREDIT 5
8/6/2019 B UYING VS R ENTING B EFORE A P RACTICE ? PURCHASE Do you KNOW Does it RESPONSIBLY EXACTLY MAKE MORE -keep short and where you will SENSE to long term plans in purchase or start purchase or rent? mind a practice? K NOW T HE L ENDING O PTIONS Specialty Lenders Local Banks SBA Seller Financing Term Rates Pre-Payment Fees Down Approval Personal Residential Approval Time Payments Flexibility Guarantees Guarantees Life Disability Malpractice Insurance Insurance Insurance S UCCESS T IPS • Develop your “Why”…Why am I doing what I’m about to do? - The “Why” becomes your driving force behind your decision • Create an experienced TEAM - Successful Opening, Speed & Savings (Time and Money) • Have a plan - Know exactly what you want to do - Commit to the plan - Execute the plan with your TEAM • Develop a project list - Organize and prioritize your “To Do” items Identified issues that are coming (ahead of time) Reduces stresses – by being proactive vs. reactive • Don’t take shortcuts • It’s never too early to start looking at your options -Work on Personal Situation if Need be -Find the right space/ practice takes time 18 6
8/6/2019 M OST C OMMON P ITFALLS • Not becoming a practice owner sooner • Location - Poor visibility and signage - Trying to negotiate your own lease terms - Poor demographics • Financial/Budgeting mismanagement • Practice Homework • Lack of marketing • Not hiring the right staff • Non Compete concerns • NOT HAVING THE RIGHT TEAM IN PLACE L ECTURE 2 : G UIDE TO T RANSITIONING STRATEGIES 1:15 PM – 2:45 PM M EET THE E XPERTS B REAKFAST & L EARN : F RIDAY , 7:45 AM B OOMER R OOM Q & A S ETTING Come have breakfast with us on try to stump the experts! Bank of America, N.A. provides information from speaker topics for your discussion and review purposes only. Please consult your tax advisor, as neither Bank of America, its affiliates, nor their employees provide legal, accounting and tax advice. AR: AR9SRJ9D 35428 The Path of Private Practice Session 1 7
8/6/2019 Types of Real Estate Transactions • Start-Ups • Lease Renewals • Expansions • Relocations • Additional Offices • Purchases (Land/Building) • Practice Transitions The Importance of Real Estate to Your Practice Second-Highest Expense • Your office is typically the second- highest expense after payroll • After years of lease escalations, most offices are significantly overpaying for their lease • You typically get only one chance every 5-10 years to reduce this expense. Don’t Miss the critical opportunity! How does real estate impact your practice? 8
8/6/2019 Commercial Property types • Office (condo/ stand alone) • Retail • MOB • Hospital Campus • Land/New Construction Pros and Cons • Signage • Exposure • Access • Parking • Synergy of Other Tenants • Costs • Natural light/windows • Amenities Understand Your Lease Type • Full Service, Modified Gross, or NNN • Base Year vs. Expense Stop • What is a CAM? • Utilities and Janitorial Included? • Office park fees 9
8/6/2019 Everything is Negotiable (almost…) • Lease rate and annual escalations • Build out period • Improvement allowance • Free rent • Signage, Parking, Exclusivity, etc. Purchase vs. Lease • Is it always better to own? • How does it affect your cash flow? • Short term vs. long term • Principal pay-down and equity • Tax implications • Exit strategy Leverage Your Opportunity Through Representation 10
8/6/2019 Negotiation Strategy Appropriate timeframe • New Lease or Purchase: 9-12 months • Renewal: 12 months • Land Purchase: 18-24 months • Practice acquisition: 30-60 days Negotiation Strategy (Cont.) Posture is mandatory • Understand what is really at stake • Renewal Scenario Negotiation Strategy (Cont.) Whoever has the most viable options wins • If the landlord believes you can’t move or aren’t willing to move… 11
8/6/2019 Key Players and Their Roles • Real Estate Broker • Lender • Attorney • CPA • Architect • Equipment and Technology • Contractor Closing • Real estate dramatically impacts your practice • Understand the market and your top options • Maximize your opportunity through representation • Create a team of trusted professionals Jeremy Burroughs 405-410-8923 jeremy.burroughs@carr .us 12
Recommend
More recommend
