Pathology Rent Police

As an accountant specialising in assisting medical practitioners, I am concerned about the unfair playing field and potential intimidating and questionable legality of the Government’s new initiative to protect big pathology business against small practices with a new data kick back monitoring system, when the there are no clear rules for enforcement or ethical brakes in the system.

Uneconomic Clauses are dangerous!

A key concern is the systemic risk from an event e.g. a pandemic. We are aware many practices have ignored good advice to have commercially sustainable legally binding leases to be prepared. Clients of Health and Life who have used our updated templates have less to be concerned.

Some practice owners over a nice dinner may have naively decided at the recommendation of a provider to exercise less scrutinity (keep their advisers at bay and save time and costs) and use their ‘template’ lease arrangements.

Our key concern are the risky “úneconomic” clauses that are embedded in these lease agreements. What this means for many is a 3 month termination notice may be served because of insufficient referrals are being made to the pathology labs collection centre. We do not recommend such clauses as they may also imply a kick back arrangement.

Such clauses are a concern with the Health Insurance Act. They made be viewed as an economic inducement and not a permitted benefit. This may attract significant penalties and prosection. This is why we recomend well prepared templated commerical terms and conditions to protect the practice.

The real problem is for some uncontrollable reason referrals drop. This significant source of income that ususally covers the rent an overheads for many practices could force the practice into severe financial distress.

Many have borrowed heavily and for the long term for a new building and infrastructure. This may push the practices business model over the edge to insolvency. Typically we see this where doctors are paid 70% of their bulk billed gross fees in an expensive new fit out.

Should this happen expect patients to leave with their doctors if the practice is suddenly forced to reduce bulk billing.

What is market value?

The definition of market value is clear and has been tested: that it requires a willing buyer and willing seller. So how do you prove you are being paid 20% above market value and have committed a crime, when both parties are independent and the victim is a billion dollar corporate claiming that they been excessive overcharged for rent by a three-person general practice?

It sounds ludicrous but taxpayers’ money is being wasted, despite this issue having been heavily debated and resolved in 2009. The corporate pathology companies keep trying to legislate profits for themselves.

They already enjoy special protection from kickback laws by being listed companies. This cynical attempt to earn lazy profits at taxpayer’s expense is very disappointing to see.

For an analysis of the issue, see

GP practices in govt crosshairs over pathology rents

choice_paradox1Increasingly corporate medicine, where legally profits are placed before patients, has become the norm. Smaller practices are facing ever-increasing challenges as Big Government and Big Business do deals, as it is more convenient to deal with a few players than many.

As a result, patients are losing their freedom to choose the type of services they want. Less competition means fewer services and the patient becomes less empowered. It is always better to be a big fish in a small pond.

This unhealthy cocktail, of pathology laboratories, also owning general practices that are also listed on the stock exchange, gives them unprecedented special privileges.

For example, they can never be prosecuted in engaging in a kickback arrangement because they vertically own the supply chain from GP to specialist.

permitted

This can breed unprecedented overservicing that the taxpayer ultimately pays for because they can afford to bulk bill, providing no out-of-pocket services to patients. The greater concern is they are not subject to any clinical scrutiny or penalty, unlike your local doctor, who you trust to act in your best interests. Currently only 25% of practice in Australia are practitioner owned. There will be reduced incomes for doctors as the corporate environment dominates.

patients before profitThe effect of this, combined with the Healthcare Homes program in which payments are now made to doctors and practices, is that doctors may suffer significant job security and remuneration loss if they do not comply with those corporates’ financial goals which are in conflict with doctors’ professional responsibility to their patients.

To make matters worse, they will not be held responsible for any clinical adverse events and malpractice issues (legal action against them would be intimidating). The safest protection for doctors is to work for practices that are practitioner-owned and well run where doctors have an economic and professional influence on the practice. As a doctor, you are better off working in a practice where you are a big fish in a smaller pond that is ethical and you can at least have a debate on patient care and not just on Key Performance Indicator’s.

I am concerned the Government at the last election, was pressured and in effect ‘blackmailed in the consulting room’ to change the pathology rent laws by the corporates without a proper public debate.

In any case, the corporates’ efforts to try to regulate rents is legally not enforceable. The Labour Government in 2007 failed to achieve this, after conducting a thorough assessment. This current Government also needs to ‘do their homework’. See the following article:

Pathology Deal Blackfire

https://www.healthandlife.com.au/wp-content/uploads/2016/01/0.-Pathology-Articles.pdf

It annoys me personally that we continue to waste taxpayers’ money on this issue as the corporates publicly cry poor on one hand and on the other, boast significant pathology profits (for example, see 2017 Primary Healthcare’s latest annual report). I believe the Federal Government, taxpayers and patients are being played as fools.

ebit

Primary Healthcare 2017 Annual Report

  1. ACCC – in the scope of reviewing path providers

Is the conduct of the pathology labs exposing medical practices to serious penalties? The pathology rent data will also show if there exists price fixing amongst pathology providers and whether there is unconscionable conduct. A Freedom of Information request for the data, after the data is in, would help to determine this.

GP practices in govt crosshairs over pathology rents

See Unfair contract terms and Price fixing

  1. Should corporates decouple their general practices from their specialty practices since they are conflicted?

This would reduce unnecessary red tape, and the need to monitor for over-servicing and the need for more policing laws. The free market that is open and transparent needs to prevail and we do not want a ‘too big to fail’ corporate-dominated healthcare system like the banking industry. There is safety in competition.

Currently, Government policy is engendering an oligopoly ‘whipping board’ for corporates to beat the Government for more taxpayers’ money without any scrutiny. As the saying goes, once you let them in you cannot get them out. Patients too will suffer from our apathy in not raising this concern with our local Member of Parliament.

  1. Practices should consider running an education campaign aimed at their patients to educate them on the issues.
  2. Contact us if you require any further information at pa@healthandlife.com.au or 1800 077 222.

Your Medical Records Exposed… Confirmed!

As I predicted in February 2016, your personal health record is being exposed, with or without your full knowledge. The Federal Government’s new $2bn national patient electronic health record system rollout is at full throttle.

This potentially means others have electronic access to your mental health, drug and alcohol abuse, sexually transmitted disease, domestic violence, and other sensitive information.

Do I opt out?

We have a saying’ ‘if in doubt opt out’. Indeed, you may wish to do this, but only after you have thoroughly researched how this may affect you or a loved one.

If you have any doubts, you need to opt out now before the three month deadline or an automated record will be created for you.

If you do opt out your records will not be deleted if you have opted in by default or with your permission – see Opt-out e-health records won’t be deleted

No warning?!

The Australia Card has arrived, amid controversy. It can give insurers, the ATO, researchers, police and Courts access to your personal information for up to 130 years: see My Health Record still not worth its $2b investment.

Our primary concern is the lack of a national TV, radio and print media campaign informing patients about the card and its implications. This is putting unnecessary pressure on your family GP.

The current system has its challenges so we are still not clear how useful or safe it is for anyone to use. Concerns include, and are not limited to, the fact that your health record may be open to misinterpretation. There are no internationally accepted and commonly agreed guidelines on how this data is collected and used. This is a fundamental flaw.

Currently, no internationally accepted and commonly agreed guidelines exist anywhere in the world. We question the quality and validity of the information collected: see No peer review for more information. Consideration of the quality and validity of the information collected would have been a useful starting point before spending $2bn on software programmers.

            This affects you! – what should you do next?

Every person in Australia is affected by this.

We recommend that you tell your doctor or practice whether you want your Government to have access to your records. Some key questions you should ask:

  1. What is the benefit?
  2. What are the costs and risks?
  3. Who is ultimately responsible if there is a privacy breach?

Make sure you confirm everything in writing before you decide. Also put your request in writing.

Forward this email to your local practice.

Now is the time to stick to your regular local General Practice if you want to ensure control of your sensitive patient records. Can you imagine having to contact all the GP’s you have visited in the last 2 years?

The bottom line is your local GP is being provided Government grants to upload your data. This comes at a significant cost particularly if you pay nothing to see your doctor.

What should practices do next?

            Practices need to have a position

Practices should offer patients a choice. It is an opportunity and not a problem. It is tempting, due to the long Medicare Freeze on patient rebates, to play catch up and proactively encourage patients to give permission to upload their records.

To avoid a patient backlash, you should consult patients first. Some may in fact take offence and complain that they were not consulted, or they may take other action, regardless of whether it is your fault or not. Be proactive and run your own education program.

Use the media reports as a new opportunity to encourage patients to remain with the practice and maintain continuity and convenience.

          Step 1 -Do your homework

Practices need to prepare some stock standard answers for patients for use in waiting rooms, in-house TV message boards, websites, messages on hold, emails and any other communication devices. Texting all patients may be a good option.

Practices need to confirm the medico-legal implications of the information they give and consult their insurer in relation to any concerns in writing.

For more information visit My Health Records Frequently Asked Questions.

            Step 2 – Decide whether to offer a fee paying opt out solution

There is a significant, new, compliance cost associated with consulting every patient in a practice. An annual $20 opt out administration fee per patient to offset this cost could be appropriate.

Practices have an economic dilemma.

The Medicare freeze has put pressure on practice sustainability. This is the thin edge of the wedge. It has been mooted for all General Practices that in 2018 the current PIP grant criteria will be completely replaced, with the number of patient medical records uploaded as being the primary criteria.

Introduce a $20 annual opt out administration fee

You may, as an alternative, ask your patients to pay an annual $20 ‘opt out’ administration fee to the practice to cease uploading their medical records. This revenue should go towards replacing the loss of any PIP grant funding. This will enable practices to maintain their bulk billing profile and reduce the impact on the quality of services offered.

To gauge how patients may react, we conducted a quick straw poll with interesting preliminary results in our February 2016 article called Your Private Medical Condition Exposed.

Below are some results from the poll:

poll

If you would like more people to vote on this issue, share this article Your Private Medical Condition Exposed. We will report the results, or you can see them live.

The take home message is that patients should not be forced to opt in or out, until they feel the system is safe and it is worthwhile to opt in.

HEALTH AND LIFE IN THE MEDIA

  1. Tax nightmare looms healthcare homes May 2017
  2. Disease challenge April 2017  – the need for standardsLyme
  3. David Dahm’s innovative solution to prevent ‘bullying’  international healthcare standards and his views on the ethics board was cited in the American Journal of Physicians and Surgeons December 2016Perspictive
  4. David is interviewed on top practice tips you can implement.1o lessons
  5. How can we teach and monitor trainee doctors better? Is it sustainable to spend $70m to recover $13m for rorting Medicare? There is a better way to prevent this. Does the nature of Medicare audit activity interfere in the doctor patient relationship? Why are there no commonly agreed clinically relevant standards?accussed
  6. Other Medical Observer articles by David DahmMO
  7. Past Interviews and Articles

VIDEO’s ON DEMAND – New Video Releases

We have a library of our cutting edge seminar presentations made around Australia. Armchair Medical have made this initially available free. (We received no commissions or payment for this service).

If you are interested in clinical and non clinical topics, Armchair Medical offer a low cost subscriber option. They offer excellent and timely advice tailored for time-poor people.

These are the latest topics and practical tips that you may find useful.

  1. Practice Automation  – work smarter and not harder. It is cheaper, improves quality and makes life less stressful for everyone.Practice Automation
  2. The-business of healthcare: hippocrates v hypocrisyhypo
  3. The Perfect Practice– Key Performance Indicators.kpi
  4. Risky Patient Billing – why you cannot get a straight answer on Medicare Billing item numbers, and why there are no commonly agreed clinical standards. But there is a new solution; one supported by your peers and influential people working in Government and healthcare. risky
  5. AAPM – a fair go.  A revolutionary new vision for healthcare. A practical solution to the problems in your local and international health care system.Fairgo
  6. Doctors and staff contracts, and optimal business structures (these videos have proved very popular)comtracts
  7. All David Dahm Armchair videosdds videos
  • New offer to our subscribers.
  • If you are interested in the latest high quality clinical and non-clinical topics, Armchair Medical offer a low-cost subscriber option. They offer excellent, practical and timely information tailored for time-poor people.
  • We are pleased to announce for Health and Life subscribers only a generous free trial and offer.

Use the coupon ‘healthlife’ and you will receive 33% off and so only pay $16.75US/mth Here’s the direct link http://www.armchairmedical.tv?code=healthlife

Do you find trouble in interpreting the MBS item numbers? We need your feed back…

medicareIf you want to know why you have trouble interpreting the MBS (Medicare Benefits Schedule),  here is why you cannot get a straight answer- the answer is nobody knows. It is time this issue was fixed, so we need to hear from you, regardless of whether you are a doctor or a practice manager.

As you may have read or heard, we were involved in one of the most important news stories of the year. We got involved because over the past few decades we have been concerned about the lack of openness and transparency in the way practitioners and practices are educated as to how they should be billing under the Medicare Benefit Schedule, and in the lack of written commonly agreed clinically relevant guidelines for practitioners, which can result in practitioners being prosecuted for alleged billing irregularities.

svaes 2017

Medicare’s current position is…

current

Source:Billing accurately under Medicare

But clinical research into what the commonly agreed accepted guidelines reveal that none actually exist or there are significant problems with the current approach. see British Medical Journal of Australia, Volume 7, Issue 10, STANDING Collaboration: a study protocol for developing clinical standards

So is it fair to prosecute doctors for not getting in right when the system does not work? Japan is the only country we have found so far that has national commonly agreed clinical guidelines, so it is indeed possible.

Professor Bill Runciman who endorses our efforts to establish an international healthcare standards and ethics board, which would set guidelines, makes the following conclusion, which has significant financial and medico-legal implications.

He states…

Runciman

Source: To reduce fatal medical errors look to the world of accountancy.

In 2011 a Federal Senate Professional Service Review hearing (which were involved with) was held to look into the issue but nothing has come of it and nothing has been done since.

Consequently today we are saddled with many bullying, intimidation, unfair and unethical practices. Patients are getting unnecessarily hurt and a lot of money is being wasted. In fact, there is a simple solution, one that seems to have so far have missed by national clinical leaders and the medical profession.

Since it affects your health, we want to open this debate up to the you as practitioners, and to taxpayers and the general public to decide how practitioners provide care to you. Please let your local member of Parliament know and share this information.

Watch these three videos for an in-depth understanding of what the problem is and how you can solve it.

This video shows that practice managers at a national practice manager conference earlier this year, have (nearly unanimously) indicated there is an ongoing and serious problem see  Practice Managers expressing MBS item number concern video.

doc

Please complete this five-minute survey – the best response will receive a bottle wine! We will forward this information to the Health Minister.

 

Time to change to a proactive Accountant/Adviser?

Start off on the right foot with an experienced, future proof accountant/advisor who cares for your practice/business and will help you work.. on the fun stuff too!

This article will help you find the right accountant for you. Asking the right questions is more important than asking for the right answers.

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Financial security – Start with the end in mind and keep asking great questions

Ultimately your accountant/adviser should offer you financial security advice that not only manages your financial and tax affairs, but helps you work well, eat well and sleep well. And remember – if you do not understand something, do not be afraid to keep asking questions. If you can’t do this with your current advisor, then it is time to find another one.

Your greatest debt in life is a future one – your retirement. Owning your own practice is the fastest way to reach this goal of a financially secure retirement, provided you use careful planning.

There are three sets of questions you need to ask:

  1. Is your current accountant the right fit for you? What do you want? What do you need? Do you need to better manage your practice better?
  2. Do you have a significant problem or opportunity?
  3. How to find a great accountant?

     1. Are they the right fit for you?

Do you know what you want and need? Will your current adviser get you to your end game?

As we and our businesses or practices change, so does our relationship with our advisors. Our needs are different at different stages, for example when we are growing the practice, compared with when we are anticipating retiring.

You can only begin start to work out what you want when you know what it is you need. Have your advisers been proactive in finding the perfect solution for you – or are they too busy to care?

  1. Do you have a significant problem?

First identify if you have a problem. There are many excellent advisers out there. Some are happy with just doing your tax return. After all that’s a big part of what accountants do – the numbers. But they are more than just bookkeepers who do numbers. Real accountants and practice professional advisers do much more.

     3.How to find a great accountant!

Like doctors, not all accountants are the same for good reason. In the end you have to trust them and believe they are doing what you need. So how do you know the difference between a good and a great accountant?
Start by asking the right questions and stop looking for the right answers.

Does the cheapest mean the best value?

Cheap may feel better in the short run but can really hurt in the long run if, for example due to an audit, you lose what you thought was always yours. Eat well and sleep principle must always be followed. You must trust but verify in writing what your advisers verbally tell you.

Dodgy accountants?

accountants daily

In a new report that should concern every accountant and/or practice owner, the ATO just announced that tax agents are not doing a great job. You, as a client of your accountant,  are exposed to more scrutiny than you may think.  Budget priced tax agents tend to have a higher risk profile that can expose you risks such as an ATO audit. As with any professional you use to perform a service for you, you can opt to pay a lower price.

However, this does not necessarily mean it is better value for money – it simply means you may not have paid them enough to ensure they have been thorough in preparing the accounts for you. Before making a decision to use their services, you need to ask them how they go about doing your accounts. They should be able to show you.

How interested and specialised are they?

It is personal as well as professional.

A professionally qualified accountant and adviser is supposed to PROACTIVELY help you so that, in the end, you eat well and sleep well.

At Health and Life we provide free no obligation and untimed assessment of your practice. Why? Because we are confident we can provide a benefit.

We believe we do not deserve your work if we cannot communicate our value to you in writing before you join.

It is an important long term relationship for both of us. You are not a transaction; we treat you the way you like to be treated.

Accountants are highly and uniquely specialised.

advice

Accountants can only help you this if they specialise in your vocation or profession. Many try to be a jack of all trades and are instead a master of none.

For over 25 years we at Health and Life have specialised only in healthcare, and for a reason. We are not distracted with servicing other industries that are not relevant to our healthcare clients. We are not conflicted in our advice and do not spend our time generating financial planning commissions for loans and investment products that you may not need.

A professional adviser has a duty of care to put your own best interests forward and not theirs  (see our article Who do you trust?)

We are here to build up your primary wealth generator and purpose in life, that is your practice. Your trusted accountant/adviser is a key adviser and must be at all times on the front foot of this issue. Why? Because your practice is you life’s main engine room. For yourself, and the people you care about the most, it puts food on the table and a roof over your heads. Importantly, for practice owners, it is also your superannuation. It will most likely be the single biggest financial contributor to your retirement.

How do you test your adviser?

einsteinGenerally, you can tell this at the first meeting. As yourself, is this person thinking originally or are they simply copying somebody else’s idea? This is important because unfortunately the devil is in the detail and where expensive mistakes arise. This is not your fault. You need to ask the right questions before getting the right answers (it can be difficult, but it must be done).

A good advisor should be:

Honest and candid. An experienced adviser can have a mature discussion on not what you want but what you need. They should be able to tell you what you could be earning and not just what you are earning.

They should act with integrity and not have conflicts of interest such as working for one owner and the group practice at the same time. This breeds discontentment. Favouritism or professional bias towards an owner is poor for morale. A professional adviser has a duty of care to put your own best interests forward and not their own (see our article Who do you trust? )

Experienced and well trained. They should be experienced specialists in your occupation or vocation. They should not be not a jack of all trades and a master of none. They should not be many things to many people but to one thing – your profession or vocation.

litigation_disputeThis means you gain maximum value both in time and money because they immediately understand your unique situation: things that are critically important to you like a SIP, PIP, a SWOPE, care plans, Equipseps, My Health record, corporates, local competition and the impact of it on you or your practice.

They also understand, and can help you understand, the big picture. They can discuss vision, strategy, business models and structures, key performance indicators and most importantly on how to run the practice i.e. governance explained in simple and practical terms.

Too big to change or care. Yes, big practices have large resources but they can become impersonal. They find it hard to change, especially in this time of technological disruption. You end up paying for it as they continue to use old systems and processes. Their advice becomes outdated and redundant at a time when you need to future proof yourself and your practice.

What should you look for in an accountant?   

One that can future proof and grow your practice!

its ok

Declining profitability is a feature in many healthcare practices. See our article Is unprecedented competition for patients hurting you?

All practices must generate a sustainable profit. At some stage you may want to sell it, so it must be attractive to a purchaser, such as staff member. You would not invest in BHP shares if it kept making a loss or was experiencing declining profits.

Succession planning is a process and not an event. You don’t want to suddenly retire, for ill health or some other reason, and call your adviser and ask them to find a buyer immediately. In this case you probably will not find a buyer  unless you are happy with a fire sale. Furthermore, nobody wants to join the Titanic, new part owners are more likely to buy if there is a steady transition and had at the wheel.

Is unprecedented competition for patients hurting you?

  • Unprecedented competition and Medicare freezes have eaten into most practices’ bottom lines. What can you do about it?
  • Too afraid to reduce bulk billing? Afraid of losing patients?
  • Increase marketing but turnover still not be good enough?
  • Cut costs to the bone? When do you stop?
  • What should you do next?

At Health and Life, we specialise in healthcare, especially in General Practice.

The signs, many of which we predicted from our national benchmark series,

have arrived. Many practice owners are concerned:

  1. Income has either has flattened over the last two years or has declined by up to 2.5% p.a
  2. Many face unprecedented local competition since patients now have a lot more choice and instant access to a doctor is the new norm
  3. Costs have increased, with inflation running at 2 to 3% p.a. Many practices have already cut costs to the bone and can cut no further.

Losing profitability is harming patient care. There is less money available to improve services or pay down debt to improve facilities.

What should you do next – increase marketing, reduce bulk billing or cut costs further?

1. Increase marketing?   If there is no big change in the services offered, then increased marketing of the practice is going to be a waste of time and money.

Instead of marketing to new patients, consider marketing new or existing services to your current patients. Why? It is easier and they already trust you. Ask them to introduce a friend to the practice and provide an incentive as a way of saying thanks. Target mothers and you will get the others. They look after Mum, dad, the spouse and the kids.

            Perception is reality…first impressions are critical.

If the practice looks run down, has old magazines in the waiting room, the waiting room itself needs a fresh coat of paint, the staff are not well trained and presented, and the doctors are always running late.. then you have a serious problem. Take a hard look at yourself and see what others see. How do you compare with your competition? Is this why patients are drifting away?

Review all your ‘moments of truth’ when patients have real contact with your practice. Everything – from your mobile app website to the paint on the walls – needs to be looked at. Patients demand convenience and there is a lot more choice available at their fingertips if you cannot be there all the time.

2.Reduce bulk billing? Your accountant may simply recommend you increase your consultation fee. It is true that you may lose up to 20% of your patient numbers. However, your profit is not likely to change or remain in free fall. Remember patients become more careful when they spend their own money. They are more critical but loyal and value continuity. This stops declining fee growth. You could opt to gradually reduce bulk bulling, but past experience shows the fall in profits will continue.

Medicare Audit

A problem may arise when one doctor in the group is reluctant to reduce bulk billing. They either fear losing patients or are concerned for their patients; often they are not confident of the quality of the services they provide their patients. They will use excuses such as ‘only greedy doctors charge a fee’. The truth is often that they fear losing patients to competition.

Not handled carefully, herd mentality in the practice may mean that other doctors in the practice fall into line. But reducing bulk billing and charging increased fees is achievable when everyone is on the same page from the outset and believes in themselves and the practice.

3.Cut costs

How do you cut costs and not reduce quality any further?

The answer will be clearer if you recognise you have a problem. The solution may come from looking outside the practice.

2For many local family general practices, there has been a permanent increase in competition. As generous pathology rents start to dry up, many new clinics with high overheads will find their business models may start to falter. The oversupply of GPs from the training programs has also provided patients with a lot more choice of GPs.  The faster you see patients the less loyal they are to you or the practice. So bulk billing is great but it does not buy loyalty and patient continuity. Your service delivery model has to (and patients need to be) educated as to why you can provide a more relevant and caring service compared to the doctor next door. This is where the real opportunity lies.

Healthcare practice owners or wannabe owners should ask themselves

  • Using your mobile, can you run the business aspects of your practice from your local coffee shop?
  • Are you happy with your current trusted adviser?
  • Are they advising you on the most cost-effective and the best systems to help you run your practice so people will buy what you have?

If your adviser is not keeping up and proactively letting you know, they are leaving you

behind, especially if you want to recruit and retain the next generation of

practice/business owners and keep a competitive edge.

Clients on average sell a 10% interest in their practice between $150,000 up to

$300,000, with a 30% pre-tax return p.a.

We are not a little different, we are totally different to your current adviser…

At Health and Life, we are proud to announce we have re-engineered how we operate

and use the latest systems and technologies. Many of our clients use these systems to simplify how they work. It provides them with an unprecedented competitive edge. We are now ready to share this with you see A Powerful New Way to Manage Your Practice.

Who are we?

Health and Life are national leaders in the healthcare industry. We have over 25 years of

unique experience and solutions. As well as being a registered tax agent, David Dahm our

founder and CEO, has been an accreditation surveyor for over 10 years. This unique

experience demonstrates the breadth and depth of our commitment to the healthcare

industry. With over 450 national media interviews we are viewed

nationally as experts in our field.

Most importantly we are not ‘johnnies come lately’ or ‘copycat advisers’. We have

innovated many of the latest nationally market tested practice management ideas you

see in the health space today. We offer our nationally multi-award winning clients a winning, competitive edge and we can offer the same quality of service to you.

We provide;

  • Templated optimal legal and business structure, agreements and sustainable practice business and tax models;
  • State of the art practice systems that actually work and integrate with each other;
  • Clearly presented and timely graphical monthly management reports with automatic warnings when your key targets for success, compared to other practices, are missing the target – and what to do next;
  • Ways to be fairly rewarded  for your efforts and the risks in owning a practice; and
  • Peace of mind – we provide conservative but extremely cost-effective solutions that will protect your long-term financial security.

Most importantly we provide you with peace of mind; you practice will thrive and you can eat well and sleep well.

Are we competitive?

monalisatable

Yes, we are extremely competitive… for these reasons.

You as our client will not deal with junior or inexperienced advisers at Health and Life. We know and understand how to navigate the many

‘hidden’ issues to a complex problem. It is more than just book-keeping or numbers….

We are here to protect your financial security for your sake and for the people who you care about.

We are affordable. The benefits to you

from savings on tax, finding alternate sources of income or by simply operating efficiently

using cost-effective cutting edge technology pays back the cost of

our advice many times over.

The more knowledge and information your adviser can

provide you, the more you know, and the lower the risk and greater the return. We are akin to having a GPS in your car. You get to your end destination far

quicker, safer and cheaper.

Car GPS

We can provide a free confidential assessment of your practice and you will immediately

notice the difference.

Why use us? To solve a recurring and complex problem…

Financial concerns?

Loss of patients?

Staff morale?

Poor systems and communications?

IT problems?

Practice sustainability?

Corporatisation?

einstein

As we explain in our article ‘how to future proof your practice or business’ we recommended you start with working with an experienced future proof accountant/adviser. We have over 25 years of national experience as health care tax accountants and practice advisers with over 1,200 clients.

            Content and Context is king..!

context

There are three things people want in life…

  • To look after their loved ones;
  • Acquire and keep financial security;
  • more time.

We can empower you to have all three.

To start with, recognise that if your practice/business is not growing, then it is dying. Ask yourself is your revenue or are your patient numbers organically growing by 10% per annum? If not, why?

Recognising you what type of assistance you need is the next step. The next step is to decide who you’ll obtain the assistance, and how and why should you use them.

We hope this article will help you find a future-proof accountant/adviser to help you along your journey.

What to look for in a trusted future proof accountant/adviser?

Does how much you pay make a difference?

It is hard to find great advice. It is not always the case that more you pay the better the advice, but the more your advisor knows that makes the real difference.

Conflicts of interest

Make sure the advice is not conflicted and declared, then make an informed decision. For example, many accounting firms offer financial planning. This generally means commissions are paid to them directly in exchange for a lower accounting fee. Are you comfortable paying your accountant more interest over the lifetime of your home loan? Are you sure you were provided with the correct advice in writing? It may cost a little more but it will save you, in the long run, should there be any doubt.

As a firm, we do not support these types of arrangements, as they are in conflict with our professional associations’ ethical positions.

Do the advisers care about you and do they have the necessary experience?

First, start with your principal adviser’s personal experience and their personal interest in

your success. A great adviser will only work with a client where there is the right

fit. They will tell you, at the first meeting and without fear or favour, what you need to know and they will put it in writing, at no charge or obligation. We certainly do.

Where there is no care there is no concern, no matter how experienced or

qualified the person is. Furthermore, the origin of any piece of advice is critical – unreliable hearsay information could be fatal especially in a big decision.

A good adviser will act on facts and not just on feelings. Over the 25 years we have been operating in the healthcare industry, we have seen how it only takes one moment for an advisor to make a little mistake that cannot be undone due to either ego and ignorance, and it can cause great emotional and financial distress. It could be the wrong person, supplier, finance, system or practice that was bought or sold for a ridiculous price.

In a hyper-competitive market, mistakes can be less forgiving. People are used to instantaneously voting with their feet. You no longer get second chances.

Our sole objective is to help your healthcare practice grow so you can support your patients’ needs. You outsource the hard and complex stuff to us, so we can conveniently simplify it for you. As you know it is hard to unsay or undo anything in this new digital world where first impressions count.

Does your accountant/adviser provide you with proactive and holistic advice?

So how do you know you have the right accountant?

You instantly know they are experienced and know a lot about your industry if…

In the first five minutes you know they know a lot about your industry. On their website, they have a proven track record. They are proactive in finding strategies to help you grow your practice. They know when the numbers do not look right and what to look at. For example, they understand what a Pip, Sip, SWOPE, Home Care or bulk billing is. You are not getting billed for having to research yourself things they should know. Furthermore are aware of industry benchmarks such as the going rates for pathology, pharmacy rents, contractor percentages and productivity benchmarks like average fees and costs per patient. At Health and Life, we work nationally so we see and hear most things that a local adviser might miss such which practices are failing to maximise their Government grants eligibility.

Did you know successful GP practice owners earn from 95% up to 160% of their gross billings or have a 30% net operating profit margin? Ultimately if you can sell your practice it is worth something, but the secret is in the numbers. These do not lie.

Real-time context and knowledge is power. This provides you confidence and a competitive edge.

They use the latest and cost-effective systems and  technology and to get rid of

the stuff you do not like

Unfortunately, like a freight train, it only takes one little thing to derail everything.

A future-proof adviser uses and recommends the latest systems and templates for employment and contractor contracts that integrates with your business model and legal and taxation structure.

They will do everything to get rid of the boring and repetitive stuff and reduce silly errors.

Especially in cloud bookkeeping, automation has come a long way. Now it is extremely cost effective and convenient and getting even better as time goes on. For example, you can now automate your staff rosters and they can even chase up your staff for you.

Many of our clients that have converted to cloud accounting, and it is a pleasure to see how well they are financially doing, and in real time. When times are tough at least they know how tough, and know when to do something about it. They are in a timely position to change their financial scoreboard. If they are not sure they know when to pick up the phone and get some help. It is extremely convenient for both the practice and their advisers.

The reality is, it too late, in an hyper-competitive market, if you have to wait 18 months after the financial year for your accountant to produce key information that you could receive instantaneously.

We like to know how we are going early so we can take timely and corrective action.

There will always be a need for an accountant to help you become financially literate in helping you interpret and make sound decisions based on your strategies you want to implement and monitor. Furthermore, you need them at BAS and tax time and for those big decisions, in addition to handling the odd journal entry so the numbers make sense.

Ultimately you want a future proof adviser/accountant to provide a one-stop shop

free of conflicts that can look beyond the numbers. They should be able to explain things simply without fear or favour. There needs to be mutual trust or the relationship will not work. Finally, they should be able to provide you with timely and relevant advice which is easy to follow. You must feel safe and confident that their advice has been well researched and tested.

If you are not having fun in your practice or business maybe it is time to change.

Let us at Health and Life start taking care of you so you can take care of yourself!

Unfortunately, you have to spend some money to make a lot later for your retirement. Understanding your practice is an investment and not an overhead is a good starting point.

If your practice is not growing or succession planning is not of interest you may be happy with your existing adviser.

But if you are still curious to read on and use this as a checklist. Remember at all times there is no point in spending good money on advice and not following it. It is like paying for a diet and still eating junk food on the side. You need to mentally commit as well to the change process.

What makes a great accountant and business/practice adviser?

1.They must provide you with a financially competitive edge and peace mind now!

They must make you money and provide ethical ‘cradle-to-the-grave’ advice.

Competitive advantage advice must go beyond the numbers and the structuring of your affairs.

A great accountant should, in one meeting, be able to fearlessly but respectfully identify financial opportunities to increase your income and reduce unnecessary costs and risks, with a view to succession planning. This benefit should far outweigh their fees.

If they are confident in their advice (as we are), they will do this, for free, in one meeting by asking the right holistic questions – and not just give the right answer. They must believe and have confidence in, their advice.

A great accountant should give you a competitive advantage with real-time market intelligence, that it is not generic advice or catchy taglines promoted in glossy brochures. The size of the firm or number of staff will not save you from poor advice.

The more you pay does not guarantee you the best advice. Cheaper is not always better, especially if this advice is conflicted with long-term commissions on loans and financial products.

They need to demonstrate they are a firm committed to your industry. We at Health and Life can because for over 25 years, we have been operating nationally in the healthcare sector with over 1,200 clients. We have developed many solutions and unique template agreements and software, that other firms have tried to copy across the nation.

2.  Cost-effective, fast access to knowledge is power!

This is just one reason (apart from controlling your own destiny) why you should consider owning a practice.

The keys to success are the right shared vision, strategy, business model and governance to set to realistic key performance indicators.

A great accountant gives you time to work on the business (where the greatest gains are made) and not in it. We have templated cost-effective proven processes that will allow you to achieve this.

So it is important to understand your position before you embark blindly on a new project. Why reinvent the wheel, when market proven templates exist?

It is hard and can be expensive to reverse the wrong move. First impressions count whether it is an employee who is involved, a supplier, a client/patient or customer, a potential owner or the bank.

How can we do this?

For over 25 years we have built and worked for a unique national network with key influential stakeholders in healthcare from the media, professional bodies, health practices, and the Government. We also participate fearlessly in, and influence, key public policy and debate. This provides us with an unprecedented insight into your future when it comes to providing the latest advice.

From signing your tax return or assessing the value of a new practice, we are across the detail on how to achieve your ultimate goal. Our hands-on founder David Dahm has the knowledge and practical first-hand experience of setting up and running a successful practice. Unlike many other firms, we use the very same tools that we recommend.

We know where you are heading, we can take everything into consideration. We combine this with the largest and longest longitudinal real-time financial and non-financial benchmarking database in Australia. So we realistically know where you could and should be.

All this knowledge and experienced disseminated in templates, videos and regular free advice saves you a lot of time and worry so you can focus on what you do best.

Cost effective – rosters Governance, efficiencies and strategy  and performance reviews

Future proof

Messy spreadsheets and reports. So you have a financial dashboard

Competitive advantage

3. Unprecedented cost-effectiveness and efficiency

You save the most money in efficient and effective system. This improves staff productivity by 40% and morale by 100%.

This dramatically improves recruitment and retention as the new generation of staff members want to work with the latest technology that gives them flexibility and convenience.

4. We provide you with a cost-effective, easy to understand daily mobile real-time  financial update on how you are going

Reliable monthly numbers prove your strategy and vision is right and whether you are on track.

 Work with the latest and smartest cost-effective technology and processes

Do you want to focus on the fun stuff..?

Did you know you can.

Remove emails, following up people;

Automate the most tedious, boring and repetitive tasks from preparing rosters, chasing staff by SMS;

Automate  bookkeeping with 98% accuracy, and scanning and filing documents;

Get rid of messy spreadsheets when calculating service provider/doctors percentages that link to their contracts;

Move your server out of the office;

Use extremely low cost IT all available 24/7 on your mobile phone or tablet or Ipad device that improves staff productivity by 70% and save you up to $70,000 p.a.

Some other information you may find useful  How to choose the right accountant.

5. Does local matter? Not anymore and may do more harm than good

Does it matter whether your accountant is local or national? Once upon a time, it did. Not anymore. Local accountants are great but they can be conflicted if they are acting for your competitor.  However, if they are not local they probably are not specialised enough to understand the nuances and opportunities of your practice.

The end of the mining boom has seen the rise of many ‘Johnny-come-lately’ accountancy firms that state they do doctors tax returns. They produce glossy brochures, and they often sponsor conferences.

However, their advice may be tied to lifetime training commissions on your home loans and financial planning advice. At Health and Life, we do not operate like this, because this advice is biased and is aimed at earning fees for them, and not returns to you.

Contact us for a free no obligation consult to know more at www.healthandlife.com.au, email pa@healthandlife.com.au or 1800 077 222 anywhere and anytime.

A Powerful New Way to Manage Your Practice…!

In a world that is already going through major changes due to technological advancement, the business of healthcare is evolving to meet the demands of a new fast-paced culture. Today, we want everything immediately, and this has created opportunities for optimisation in the world of healthcare. Will you be ready to ride with these changes, or will you fall behind to outdated healthcare systems and practices?

21st
[vimeo 248424223 w=640 h=360]

The Millennials run the world..?

In the world of healthcare, there are a major demographic changes taking place. The baby boomers are retiring and the group that will make up the bulk of the next workforce, the millennial generation, has arrived. As a result, the culture of healthcare is changing dramatically.

Now it’s official — millennials officially passed Generation Xers as the largest generation in the U.S. workforce. Commonly described as people born in the early 1980s through the end of the millennium, millennials are comfortable with both the old school, analog age and the new digital world as well.

Millennials are often described in a negative context by people of older generations, but from my experience as an employer of many millennials, there are many positive traits in this new workforce that go beyond the derogatory stereotypes.

You Need To Be Ready for the Millennial Workforce

With millennials dominating today’s workforce, you really can’t afford to ignore the impact this workforce is having, and will continue to have, on healthcare.

Driven to make an impact, millennials are ambitious and goal-oriented. The healthcare profession as a whole tends to balk at embracing new technologies, but millennials have no such reservations. They love new technological advancements, such as the cloud, that offer flexibility and more efficient ways of performing healthcare tasks.

We believe millennials will accelerate the widespread adoption of technology into the world of healthcare, which will, in turn, contribute to changes in the way key healthcare providers interact with their patients.

Hierarchical office-bound systems and older management models are definitely not appealing to this incoming workforce. These twenty-somethings are not interested in outdated systems and dull restrictions. So it’s time to loosen up and welcome this tech-savvy group with open arms because there really is no way to avoid the millennials. And if you hope to continue to survive into the future as a healthcare provider, your practice needs to accommodate this changing workforce.

So consider giving your employee benefits a more contemporary appeal, with more flexible hours, and adopting the latest technology, which, for many millennials are more attractive than pay raises. Look at it from their viewpoint: would you rather be working with mobile technology or pushing pen to paper? Ringing in the changes will take time; this is a process and not an event. It will take time to gently change your focus and bring others along for the next big and rewarding investment in your practice.

Moving healthcare to the Cloud

Start with cost effective automated bookkeeping and no email communications.

For cost effective and great examples on how to manage your practice better watch this videoCar GPS

We predict by the end of 2019, more than 80 percent of small- and medium-sized practices will be using cloud software, starting with cloud accounting software. Why? It’s inexpensive, user-friendly, and incredibly convenient for both accountants and their clients. The main challenge for practitioners is to find an adviser who is not threatened by this technology and who is prepared to share and embrace all the efficiencies you need now to remain competitive.

At Health and Life, we are experienced using cloud technology. It works for us, and it will work for you. Aside from the efficiency benefits that the cloud brings to your practice, it also demonstrates that you are a practice that is open to new ideas that can optimise older strategies. This is essential if you want to attract millennials and prepare yourself for the new age of healthcare.

You have probably already heard about or used online accounting services like Xero and Quickbooks, but these are not the only options available. More and more practices are taking their accounting and systems such as SMS staff rostering to the cloud in order to meet their unique requirements.

There are many other great ways to take advantage of this new, more efficient cloud computing space. For example, you can have a no email environment. This eliminates unnecessary meetings and poor communications that lack context or are hard to follow. All solutions are conveniently available on your mobile phone or tablet device.  For more great ideas see Practice Automation  – work smarter and not harder. Practice automation is fun, cheaper, improves quality, staff morale and makes life less stressful for everyone.

Practice Automation

Practice Automation video

What about security?

Passwords

Security, or lack of it, is a major issue in most practices. For example, in our experience, many practices continually re-use the same password, or share around a password, one that is not frequently changed. This is a big security problem. Much tighter security and cost-effective systems like Last Pass simplify this and tighten controls. It is especially convenient when a staff member leaves or joins and you need to be able to instantly stop or grant access to multiple software programs. It is also great for practice IT accreditation.

For more about security read this blog.

Back ups

Most practices have an on site server where physical back ups of data or remote back ups are stored – but these may fail. So systems are often backed up offsite with NASA security cleared environments.

We have recently moved to data storage on the cloud. We found it safer, reliable, convenient and cost effective – no more blackout or virus problems.

Once you are in the cloud there are many opportunities to simplify your systems and processes such as automatic rostering and following up of staff, freeing up your valuable staff to concentrate on their tasks.

Electronic signatures

Cloud computing has matured, where even the Australian Tax Office is now moving to the cloud. For example,  for client tax returns who use Xero, the Australian Taxation Office electronic signatures are accepted on tax returns. This is great news when it comes to chasing people for signatures on their annual leave forms, company minutes, employment contracts, contractor agreements, tax returns or anything else you need approval for. This is much better than no signature.

Financial security is your ultimate end game?

bills

Finally, a word about the future.

Your practice or business is an investment, and this applies to investing for your retirement. When it comes time to sell down or sell out it may represent your biggest retirement savings asset. You don’t want to leave your practice with nothing or even in debt.

So it is important to timely invest and protect this, your second most valuable thing in life (after your loved ones). You need to include it in your long term plans. Succession planning is a process and not an event, and it cannot be achieved in one day, so start now.

If you would like to know more, contact us at pa@healthandlife.com.au and/or see our article Time to future proof yourself, start with a future proof accountant/advisor and start focussing on the fun stuff? See Is it time to change to a proactive accountant/adviser?

Why we nearly liquidated our high profile international professional body CPA Australia

accountants dailyDear readers; you are probably wondering why I, David Dahm am involved with this matter. The answer is simple. It has to do with my work in promoting the accounting profession (and issues in the medical profession as well – in particular how the medical and health care professions can reduce fatal medical errors.) After a meeting with Federal Senator Nick Xenophon who was interested in hearing more about my ideas, Senator Nick Xenophon  also raised a concern about CPA Australia.

It has been clear to me for some time, (and I am not the only one), that the conduct of one the professional bodies of which I am member – CPA Australia – has severely embarrassed the accounting profession, despite its international status and high profile

This is the reason why I (with my colleagues) nearly liquidated CPA Australia (see CPA lobby group keeps no confidence on the table.)

dangerous

Taking on an international professional body with a $180m p.a. turnover is not something I would recommend to anybody, without a lot of careful consideration. But that’s we did. Now in the public’s and your interest I want to share with you the full story,. It is a problem that closer to home than you might realise. I believe it’s an inspiring story about doing something positive for the greater good.

What responsibilities does a profession have? Among them is unfailing duty of care to protect you.

As your professional accountancy and advisory group, it is our duty to protect your life savings and act in the community’s best interest. We consider this every time we sign your tax return or provide you with financial advice. We take this role very seriously, not just professionally but personally too.

So when a professional body that is supposed to be watching over us and enforcing high ethical standards begins to falter, and we ourselves do nothing, then something is seriously wrong. For a true professional, doing nothing is not an option. See Ian McPhee’s whitewash on CPA’s Alex Malley era is imminent.

ian

What do you do…

  • When the top end of management of your professional body starts using their members’ hard earned and trusted reputations to profit from financial products e.g. loans, shares etc and investment advice?
  • When your professional body, which is supposed to independently scrutinise poor, unethical or unscrupulous advice members may give to their clients, actually profits from this bad advice instead?

In these cases, there is a significant problem.

Global Financial Crisis v.2 breeding a new financial scandal.

This is akin to your family doctor recommending and prescribing you with an inappropriate drug that he or she has a financial interest in. Your doctor profits all the way down the line. There are no checks and balances in place. The danger is, with the accounting profession, you are breeding the next Global Financial Crisis as rival competing professional bodies go down the same path, and consider lowering their standards to meet the competition. (See story on banning all commissions to accountants Accounting bodies resist financial planning reform.) It also explains why for some people, their accountant’s or advisers’ services can be so cheap, if a kickback to the adviser underwrites their adviser’s fees!

Sadly, these arrangements are being copied by other professional international bodies, as these bodies are now global franchises.

We saw a similar problem with the Big 4 Banks. These conflicted arrangements caused enormous family hardship in the Global Financial Crisis. These issues are the subject of a Royal Commission and compensation being demanded into conflicted advice provided by our 4 banks.

The accounting profession is the last bastion of safety

The accounting profession alone, (not even the medical profession) has internationally agreed standards or ethics, which are there to protect your hard earned savings.

Indeed, the accounting profession is the last bastion of protection from these types of predatory behaviour. We need to protect this privileged position we have earned over the decades, and not take it for granted.

Every profession and not-for-profit body can be blinded by glossy brochures and impressive powerpoint slides. Membership apathy leaves us vulnerable to unethical and self-interested Board members and management who seek to quickly profit from your goodwill at the expense of the greater good.

The CPAA Board and management knowingly and wilfully threw the members and the public’s trust in the profession into doubt. They are still doing their best to cover up the truth by silencing members and the community.

Stand up for doing the right thing… or it will come back to haunt you.

It is important to nip these issues in the bud before they become irreversible. We must fight the tendency to say we are too busy or we simply do not think that it affects us, or we cannot affect change.

Where to from here?

It’s not my intention to preach or proselytize. But in life, if you do not stand up for your purpose, your profession and the community, you stand for very little. Your life is empty.

The CPA’s experience is a lesson for all not-for-profit Board members. Do not take your members and the community’s trust for granted. Do not gamble away their integrity and hard-earned reputations. Stay in touch, carefully listen and act.

Right now, the last thing we need is another global financial crisis. That’s why I am proud to be Chair of this courageous group.

For more information read https://www.linkedin.com/pulse/killing-bambi-why-we-decided-provisionally-liquidate-high-camphin

Disclosure: The author David Dahm is a Fellow of CPA Australia and the Institute of Chartered Accountants.