Financial Reporting for the Medical Practice

Medical Group Management Association

Healthcare Financial Managers’ Association

Your Presenters

Chris KeefeCFOMetro Imaging

Sharon SagarraControllerRadiologic Imaging

Consultants

Preview Volume Collection/reimbursement A/R Productivity Financial statements

Who is your audience? Doctor/CEO Doctors/owners Doctors/non-owners Management Staff Bank Outside accountant

What are the Hot Buttons? Volume Collection % Physician productivity Billing expense Staffing expense Others?

Volume Reporting

Volume by Type of Service

Month Year-to-date Prior YearQty Charges Qty Charges Qty Charges

Office visits-new 20 3,000 18,000 108,000 86,400 69,120 Office visits-established 150 11,250 67,500 405,000 324,000 259,200 Consults 50 7,500 45,000 270,000 216,000 172,800 Surgical 25 25,000 150,000 900,000 720,000 576,000 Office Procedures 25 7,500 45,000 270,000 216,000 172,800

270 54,250 325,500 1,953,000 1,562,400 1,249,920

MONTH Site A Site B Site C Site D TOTAL

1999 Avg 0 1037 972 1430 3,438

2000 Avg 340 700 646 852 2,290

J an-01 496 815 750 1063 3,123Feb-01 539 706 701 959 2,904Mar-01 617 824 747 2218 4,404Apr-01 577 712 721 1075 3,085

May-01 641 758 748 1110 3,257J un-01 612 712 728 989 3,040J ul-01 610 719 682 995 3,005

Aug-01 711 797 757 1111 3,375Sep-01 607 758 635 948 2,947Oct-01 798 811 731 1153 3,493

Nov-01 706 788 757 961 3,211Dec-01 632 694 674 994 2,993

2001 Avg 629 758 719 1131 3,236

J an-02 770 881 759 1132 3,542Feb-02 730 760 719 1182 3,390Mar-02 769 862 762 1183 3,575Apr-02 837 884 799 1256 3,776

May-02 867 818 817 1218 3,719J un-02 814 747 736 1081 3,377J ul-02 863 848 779 1124 3,613

Aug-02 976 847 794 1155 3,771Sep-02 841 874 759 1072 3,545Oct-02 1020 950 883 1190 4,041

Nov-02 945 847 832 1068 3,690Dec-02 929 860 830 1026 3,644

2002 Avg 863 848 789 1140 3,640

Exam Comparison

Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 SummaryCT 240 280 300 300 300 340 380 300 350 370 340 380 3,880 GI/GU 90 80 80 95 80 100 75 75 75 75 50 75 950 Mamm 480 580 550 500 450 550 500 450 500 440 400 380 5,780 MRI 150 180 180 180 160 190 190 180 200 180 180 150 2,120 Specials 20 20 50 35 35 30 40 25 30 40 20 30 375 US 250 250 300 300 275 275 275 250 300 300 275 300 3,350 X-Ray 600 550 600 650 550 550 700 625 800 700 700 775 7,800

1,830 1,940 2,060 2,060 1,850 2,035 2,160 1,905 2,255 2,105 1,965 2,090 24,255

Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 SummaryCT 175 200 200 250 200 200 250 200 250 200 200 250 2,575 GI/GU 125 100 100 100 80 90 100 90 90 90 90 90 1,145 Mamm 450 500 475 475 475 450 500 400 500 450 450 450 5,575 MRI 150 200 175 175 175 150 200 175 175 175 150 175 2,075 Specials 20 20 20 20 20 20 20 20 20 20 20 20 240 US 250 200 275 275 250 250 250 225 250 250 250 250 2,975 X-Ray 550 500 550 600 500 500 650 600 750 600 600 700 7,100

1,720 1,720 1,795 1,895 1,700 1,660 1,970 1,710 2,035 1,785 1,760 1,935 21,685

MI Sum: Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 SummaryCT 37.1% 40.0% 50.0% 20.0% 50.0% 70.0% 52.0% 50.0% 40.0% 85.0% 70.0% 52.0% 50.7%GI/GU -28.0% -20.0% -20.0% -5.0% 0.0% 11.1% -25.0% -16.7% -16.7% -16.7% -44.4% -16.7% -17.0%Mamm 6.7% 16.0% 15.8% 5.3% -5.3% 22.2% 0.0% 12.5% 0.0% -2.2% -11.1% -15.6% 3.7%MRI 0.0% -10.0% 2.9% 2.9% -8.6% 26.7% -5.0% 2.9% 14.3% 2.9% 20.0% -14.3% 2.2%Specials 0.0% 0.0% 150.0% 75.0% 75.0% 50.0% 100.0% 25.0% 50.0% 100.0% 0.0% 50.0% 56.3%US 0.0% 25.0% 9.1% 9.1% 10.0% 10.0% 10.0% 11.1% 20.0% 20.0% 10.0% 20.0% 12.6%X-Ray 9.1% 10.0% 9.1% 8.3% 10.0% 10.0% 7.7% 4.2% 6.7% 16.7% 16.7% 10.7% 9.9%

6.4% 12.8% 14.8% 8.7% 8.8% 22.6% 9.6% 11.4% 10.8% 17.9% 11.6% 8.0% 11.9%

Difference from Actual to Budget

Current Year Scans Performed

Current Year Budgeted Scans

0

5

10

15

20

25

30

35

Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03

Average Scans Per Workday

CT GI/GU Mamm MRI Specials US X-Ray

IMAGING CENTERS TOTAL EXAMS RENDERED

0

500

1000

1500

2000

2500

Nov-01 Dec-01 Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03

Current Yr Previous Yr

HOSPITAL EXAMS RENDERED

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Nov-01 Dec-01 J an-02 Feb-02 Mar-02 Apr-02 May-02 J un-02 J ul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 J an-03

current year previous year

Monitoring Collections, Reimbursement, Billing

Performance

Receipts by DOS

MatchingCharges Receipts Coll %

OCTOBER 50,000$ 39,057$ 78.11%NOVEMBER 55,000$ 43,013$ 78.21%DECEMBER 60,000$ 47,055$ 78.42%J ANUARY 2002 40,000$ 30,421$ 76.05%FEBRUARY 45,000$ 34,478$ 76.62%MARCH 60,000$ 45,946$ 76.58%APRIL 55,000$ 42,644$ 77.53%MAY 50,000$ 38,485$ 76.97%

GHP Collections by Site ALL SITES

Site A Site B Site C Site D TOTALS

CHARGES - SERVICE DATEJ ANUARY - 2002 $53,075.49 $34,544.36 $57,095.54 $41,344.25 $186,059.64FEBRUARY $48,861.30 $37,314.34 $65,228.92 $47,198.45 $198,603.01MARCH $56,478.44 $41,802.95 $62,588.72 $44,273.65 $205,143.76APRIL $54,019.65 $46,835.33 $75,586.60 $45,399.05 $221,840.63MAY $51,610.20 $36,490.52 $70,143.50 $46,591.75 $204,835.97J UNE $47,215.25 $35,797.40 $51,582.15 $47,133.15 $181,727.95J ULY $46,278.42 $44,427.55 $60,086.15 $42,396.20 $193,188.32AUGUST $46,118.60 $47,093.95 $55,452.50 $55,894.35 $204,559.40SEPTEMBER $45,027.98 $37,894.00 $63,207.54 $44,287.05 $190,416.57OCTOBER $55,084.55 $44,647.15 $65,096.30 $56,475.55 $221,303.55NOVEMBER $46,877.30 $55,041.25 $43,747.60 $56,157.80 $201,823.95DECEMBER $48,828.65 $38,075.40 $52,542.05 $50,725.70 $190,171.80

TOTAL BILLED CHARGES $599,475.83 $499,964.20 $722,357.57 $577,876.95 $2,399,674.55

PAYMENTS (less refunds) **

J ANUARY - 2002 $34,893.00 $21,176.83 $34,193.36 $26,729.95 $116,993.14 62.88%FEBRUARY $31,696.75 $24,581.77 $41,546.83 $30,574.83 $128,400.18 64.65%MARCH $36,581.31 $25,659.37 $37,608.55 $28,173.50 $128,022.73 62.41%APRIL $32,640.24 $26,929.04 $45,959.26 $28,319.96 $133,848.50 60.34%MAY $32,900.82 $20,721.23 $40,659.09 $29,939.75 $124,220.89 60.64%J UNE $29,754.61 $22,588.28 $32,166.70 $29,012.34 $113,521.93 62.47%J ULY $30,454.22 $25,920.34 $39,411.78 $26,343.16 $122,129.50 63.22%AUGUST $29,134.43 $27,529.36 $36,438.68 $34,788.16 $127,890.63 62.52%SEPTEMBER $29,117.23 $23,714.29 $40,516.32 $27,712.14 $121,059.98 63.58%OCTOBER $35,211.77 $27,835.43 $38,381.07 $33,679.29 $135,107.56 61.05%NOVEMBER $29,560.71 $30,928.99 $26,364.26 $33,697.10 $120,551.06 59.73%DECEMBER $32,998.77 $23,539.50 $33,977.87 $31,855.99 $122,372.13 64.35% TOTAL PAYMENTS $384,943.86 $301,124.43 $447,223.77 $360,826.17 $1,494,118.23 62.26%

GROSS COLLECTION RATIO 64.21% 60.23% 61.91% 62.44% 62.26%

NOTE: Unprocessed charges included.

** Payments reported for month in which service was rendered.

Reimbursement/Collection/Mix

January 1 through September 30, 2002 January 1 through December 31, 2001Mix Charges Allowable Coll % Mix Charges Allowable Coll %

Missouri Medicare 12.0% 1,000,000 580,000 58.00% 13.0% 1,500,000 945,000 63.00%Missouri Medcaid 1.0% 75,000 30,000 40.00% 1.0% 150,000 63,000 42.00%Blue Shield 15.0% 1,200,000 780,000 65.00% 14.5% 1,600,000 1,008,000 63.00%

Commercial:Aetna 1.0% 75,000 51,000 68.00% 1.0% 100,000 68,000 68.00%Auto 0.2% 5,000 4,250 85.00% 0.1% 3,000 2,550 85.00%Cigna 1.5% 100,000 65,000 65.00% 1.6% 150,000 99,000 66.00%

Etc.

GROSS ** NET ** MONTH GR CHARGES CHARGE ADJ NET CHARGES NET RECEIPTS COLL COLL

(post date) (post date) (deposit date)

10/00 $151,683 $571 $151,111 $2,71911/00 $202,986 $31,860 $171,126 $65,94712/00 $248,591 $59,104 $189,487 $98,658

00 TOTAL $603,260 $91,535 $511,725 $167,324

1/01 $279,161 $90,538 $188,623 $151,7832/01 $309,428 $92,930 $216,498 $165,9123/01 $355,102 $102,865 $252,237 $177,5024/01 $370,694 $121,705 $248,990 $230,7855/01 $398,112 $120,499 $277,613 $246,680 6/01 $357,773 $148,970 $208,803 $229,776 7/01 $357,093 $138,243 $218,850 $266,280 67.7% 108.8%8/01 $307,964 $133,536 $174,428 $255,600 68.4% 109.7%9/01 $403,261 $107,285 $295,977 $166,130 65.0% 101.7%

10/01 $443,918 $141,096 $302,823 $290,480 68.1% 108.3%11/01 $470,619 $163,951 $306,669 $243,328 67.5% 108.1%12/01 $380,021 $145,100 $234,920 $270,038 65.7% 103.9%

01 TOTAL $4,433,148 $1,506,718 $2,926,430 $2,694,295 67.1% 106.8%

1/02 $381,185 $166,735 $214,450 $243,758 63.2% 100.0%2/02 $410,803 $150,816 $259,987 $238,982 63.3% 100.1%3/02 $422,591 $141,967 $280,623 $230,113 62.5% 99.3%4/02 $515,958 $176,799 $339,159 $297,446 62.8% 101.0%5/02 $366,012 $154,548 $211,464 $235,923 63.7% 103.6%6/02 $412,017 $151,637 $260,380 $258,310 58.9% 92.7%7/02 $677,829 $170,337 $507,492 $318,927 61.7% 98.1%8/02 $559,630 $234,205 $325,425 $378,742 65.6% 109.4%9/02 $513,703 $204,617 $309,087 $345,350 64.6% 107.1%

10/02 $513,349 $206,421 $306,928 $350,543 64.5% 103.0%11/02 $582,780 $154,063 $428,717 $273,457 63.4% 100.1%12/02 $629,043 $230,341 $398,701 $377,763 63.8% 111.0%

02 TOTAL $5,984,899 $2,142,486 $3,842,413 $3,549,314 63.2% 102.1%

** BASED ON PREVIOUS 8 MONTHS WITH A 2 MONTH LAG.

Collection Rates

CONTRACTUAL COURTESY UNCOLLECTIBLE COLLECTION

PERIOD TO DATE 12/02 ADJUSTMENTS DISCOUNTS WRITEOFFS AGENCY W/O'S

Site A $269,401.30 $1,499.69 $617.30 $14,870.59Site B $105,243.98 $0.00 $1,484.46 $20,941.69Site C $154,272.79 $34.02 $854.12 $7,554.81Site D $2,539.00 $0.00 $27.70 $108.68Site E $43.70 $0.00 $3.75 ($56.23)

TOTALS $531,500.77 $1,533.71 $2,987.33 $43,419.54

YEAR TO DATE 2002

Site A $3,813,069.38 $26,397.08 $23,828.57 $202,777.80Site B $1,411,656.67 $1,566.70 $12,952.56 $233,243.97Site C $2,115,604.99 $2,759.82 $17,423.30 $114,655.80Site D $27,948.07 $0.00 $780.20 $1,762.02Site E $65,727.85 $188.45 $4,145.46 $22,188.00

TOTALS $7,434,006.96 $30,912.05 $59,130.09 $574,627.59

Writeoffs

A/R Trends

Accounts Receivable Reconciliation

Mar-02 Apr-02 May-02 J un-02 J ul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 J an-03 Feb-03

Beginning A/R Balance 2,188,678 2,085,661 2,112,960 1,773,926 1,989,141 2,120,598 2,011,553 1,939,614 1,813,869 1,862,802 2,095,244 2,202,723

Gross Charges Billed 1,162,220 1,325,200 1,021,562 1,190,417 1,357,536 1,284,357 1,229,266 1,239,828 947,244 1,311,873 1,268,014 1,224,736

Adjustment to Charges * (650,670) (640,388) (688,975) (492,676) (602,545) (747,108) (646,007) (680,962) (446,593) (533,034) (601,414) (586,449)

Net Collectible Charges 511,550 684,812 332,587 697,741 754,990 537,248 583,259 558,865 500,651 778,838 666,600 638,287

Gross Receipts (573,598) (628,710) (615,611) (449,010) (577,611) (605,186) (613,565) (637,190) (409,459) (506,345) (506,384) (533,298)

Refunds/Returned Checks 3,676 4,933 105 9,376 2,846 8,450 2,807 5,287 20 3,133 4,355 8,481

PPO Participation Fees 7,444 3,178 2,937 2,642 1,817 2,621 3,047 42 5,035 1,989 2,239 2,744

Net Receipts (562,478) (620,598) (612,569) (436,992) (572,949) (594,115) (607,711) (631,861) (404,404) (501,224) (499,790) (522,073)

Uncollectible Write-offs ** (52,089) (36,915) (59,052) (45,534) (50,585) (52,178) (47,487) (52,749) (47,314) (45,173) (59,330) (49,777)

Ending A/R Balance 2,085,661 2,112,960 1,773,926 1,989,141 2,120,598 2,011,553 1,939,614 1,813,869 1,862,802 2,095,244 2,202,723 2,269,160

* Adjustment to Charges: Medicare/Medicaid/Blue Shield Nonallowed Write-offs, HMO/PPO Discounts & Withholds, Courtesy & Employee Discounts.

** Uncollectible Write-offs: Bad Debt, Charity, Bankruptcy, Deceased/No Estate, Small Balance Write-offs, & Collection Agency Referrals.

Gross Collection Rate: 44.61% (March - Dec Gross Charges compared to May - Feb Net Receipts).Net Collection Rate: 89.08% (March - Dec Gross Charges less May - Feb Adj.To Charges compared to May - Feb Net Receipts).Average Number of days a charge remains in A/R: 47 days.Ending A/R as a percentage of Annual Billings: 15.58%

GROSS CHARGES BY PAYOR

Medicare16%

MKD/IPA0%

Workers' Compensation

2%

HMO51%

Patient1%

PPO/POS/Indemnity30%

Outside Readings0%

NET RECEIPTS BY PAYOR

Medicare11% Mkd/IPA

1%

PPO/POS/Indemnity30%

Workers' Compensation2%

HMO54%

Patient2%

Outside Readings0%

Collections0%

Productivity Monitoring-Physicians

CPT by Physician

Doctor # 1 Month Year-to-date Prior YearQty Charges Qty Charges Qty Charges

99211 20 800 4,800 28,800 23,040 18,432 99212 150 9,000 54,000 324,000 259,200 207,360 99213 50 3,750 22,500 135,000 108,000 86,400 99214 25 2,500 15,000 90,000 72,000 57,600 99215 25 3,750 22,500 135,000 108,000 86,400

etc. 270 19,800 118,800 712,800 570,240 456,192

Volumes for Key Indicators

New Patients Surgical CasesDoc #1 Doc #2 Doc #3 Doc #1 Doc #2 Doc #3

Jan 10 25 2 20 30 5Feb 12 20 1 25 35 8Mar 5 15 4 20 50 10Apr 6 20 3 30 45 12May 8 11 1 35 60 15

# Exams Read per FTEJ an-02 Feb-02 Mar-02 Apr-02 May-02 J un-02 J ul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Average

Hospital A 8012 7195 7743 7792 7987 7374 7878 8055 7755 7835 7274 7478 7,698Clinic 1 0 204 0 0 0 0 0 0 0 0 0 0 204Clinic 2 0 4 0 0 0 0 0 0 0 0 0 0 4Clinic 3 386 356 331 450 394 363 439 394 411 447 377 408 396

Clinic 4 1162 751 695 633 721 691 635 757 627 1062 997 1369 842 TOTAL 9,144 6.50 FTE 1,407

Hospital B 3890 3706 3767 3700 3934 3501 3644 3718 3643 3843 3608 3598 3,713

Clinic 1 61 36 39 37 52 59 52 60 60 78 43 49 52

Clinic 2 319 261 274 307 215 270 186 244 237 323 265 274 265 TOTAL 4,029 2.00 FTE 2,015

Hospital C 5275 5059 5137 5172 5228 4918 5633 5427 5278 5510 5003 5176 5,235Clinic 1 62 82 72 76 47 58 44 58 52 74 59 78 64Clinic 2 148 100 142 154 147 133 117 123 141 169 141 127 137

TOTAL 5,435 2.50 FTE 2,174

Imaging CentersLocation A 2358 2363 2365 2512 2436 2161 2247 2310 2143 2379 2135 2051 2,288Location B 1669 1437 1524 1597 1633 1472 1557 1587 1517 1765 1663 1659 1,590Location C 1896 1520 1723 1768 1635 1493 1696 1693 1748 1899 1693 1720 1,707Location D 1926 1460 1538 1674 1733 1628 1725 1951 1682 2039 1889 1858 1,759Clinic 1 364 393 331 343 345 282 293 328 274 343 282 316 325Clinic 2 422 412 430 519 471 415 466 438 428 521 396 383 442Clinic 3 92 96 95 91 104 75 87 82 94 100 88 70 90Clinic 4 5 34 38 68 45 55 50 33 26 40 35 17 37

TOTAL 8,237 5.00 FTE 1,647

Work RVUs # of Rads RVUs per Rad

Hospital A 53,274.43Clinic 1 4,985.39Clinic 2 254.30Clinic 3 74.47Clinic 4 1,696.91Clinic 5 2,254.07TOTAL 62,539.57 6.5 9,621.47

Hospital B 27,768.65Clinic 1 147.64Clinic 2 82.94TOTAL 27,999.23 2 13,999.62

Hospital C 23,973.30Clinic 1 229.52Clinic 2 115.02Clinic 3 751.96TOTAL 25,069.80 2.5 10,027.92

IMAGING CENTERSSite A 14,380.84Site B 12,285.53Site C 10,445.85Site D 10,024.75Clinic 1 912.76Clinic 2 440.00Clinic 3 630.00Clinic 4 1,108.80Clinic 5 1,043.70Clinic 6 1,504.03TOTAL 52,776.26 5 10,555.25

Work RVUs per FTE Radiologist by Site

Productivity Monitoring-Staff

Hours % Exam HrsExam Weights Worked CT GI/GU MAMM MRI SPECIALS US XRAY TOTAL to Hrs Worked

Staff 1 16.25 1.00 0.75 8.00 - 0.75 - 6.27 16.77 103.20%Staff 2 135.25 39.00 2.25 11.50 49.00 - - 27.72 129.47 95.73%Staff 3 139.00 17.00 6.75 19.00 70.00 0.75 - 16.83 130.33 93.76%Staff 4 16.75 - 0.75 - - - 12.18 2.97 15.90 94.93%Staff 5 8.25 - - - 8.00 - - - 8.00 96.97%Staff 6 99.00 7.50 2.25 18.50 29.00 - - 24.09 81.34 82.16%Total 414.50 64.50 12.75 57.00 156.00 1.50 12.18 77.88 381.81 92.11%

Staff Productivity

Overtime Monitoring

Employee Name Loc 8/31 9/14 9/28 10/12 10/26 11/9 11/23 12/7 12/21/02 OT HrsEmployee 1 06 2.50 3.25 0.75 1.25 0.50 0.25 0.50 9.00Employee 2 06 0.50 1.75 1.00 1.00 1.50 1.75 0.50 8.00Employee 3 06 0.75 2.25 0.75 0.25 0.25 1.25 5.50Employee 4 06 0.50 0.25 0.75 0.50 1.50 3.50Employee 4 06 2.00 0.25 2.25Employee 5 06 0.00Employee 6 06 0.25 1.00 1.00 3.00 0.50 0.25 1.50 7.50

0.75 5.75 2.75 11.75 2.75 2.25 3.25 1.75 4.75 35.75

Tardy Monitoring

Employee Name Loc 01/05/02 1/19 2/2 2/16 3/2 3/16 3/30 4/13 4/27 5/11 5/25 6/8 X Tardy Tardy MinEmployee 1 08 3 2,3 3 1 1,1 2,1,1,2 1 2 1 1 24 41Employee 2 08 1 1 4 5Employee 3 08 1 2 2Employee 4 08 1 5 4,2,7,7 1 4 1 12 40Employee 5 08 4 57Employee 6 08 31,3,2,5 2,2 1 4,4,1,2 1,3,5 12 25 67

Biller Productivityaccts edit per hour worked accts edit per hour worked accts edit per hour worked accts edit per hour worked

5/18 - 7/06/02 07/07 - 10/13/02 10/14/22 - 01/22/03 1/20/03 - 02/28/03

Employee 1 7.96 10.64 13.57 16.11Employee 2 6.99 7.12 6.63 8.8Employee 3 13.19 14.66 14.47 10.8Employee 4 8.18 8.84 8.16 8.86Employee 5 3.48 5.15 4.63 5.85Employee 6 10.88 9.34 9.49 12.26Employee 7 7.51 8.59 7.2 7.45Employee 8 3.59 10.03 7.71 8.6

Financial Statements

Chart of Accounts MGMA Chart of Accounts MGMA Cost Survey Outside Accountant’s Chart of

Accounts

Cash vs Accrual Cash is easy Tax basis Docs understand

it Expenses

fluctuate Impact of doc’s

vacation

Accrual is more work

Must estimate net revenue

Rev & Expenses matched to proper period

Malpractice spread out

Modified Cash Best of both worlds Spread large expenses Book depreciation Flexible Easy

Contractual Allowance Can be difficult to estimate How do you know when it is right? How long does it take to collect

every penny? Changes every year

Timing of Financial Statements When should your F/S be ready?

On the first? 10 days after month-end 15 days after month-end 25 days after month-end

Impact of Physician Comp Your physician compensation

formula can drive your F/S format Expenses by doctor:

Car, CME, travel, Dues, Licenses Their nurse, their staff, their space…..

Separate cost centers for each doctor?

How far do you go?

Financial Statements Samples

Basic Income Statement

Dec-02 % of Cash Dec-01 % of Cash Jan-Dec 02 % of Cash Jan-Dec 01 % of CashReceipts Receipts Receipts Receipts

Charges 200,000 150,000 2,400,000 1,800,000

Cash Receipts 120,000 100.0% 90,000 100.0% 1,440,000 100.0% 1,080,000 100.0%

Expenses Salaries 30,000 25.0% 22,500 25.0% 360,000 25.0% 270,000 25.0% Payroll taxes 3,600 3.0% 2,700 3.0% 43,200 3.0% 32,400 3.0% Retirement plan 4,500 3.8% 3,375 3.8% 54,000 3.8% 40,500 3.8% Health insurance 3,000 2.5% 2,250 2.5% 36,000 2.5% 27,000 2.5%Total Staff Expense 41,100 34.3% 30,825 34.3% 493,200 34.3% 369,900 34.3%List all other expenses 18,900 15.8% 14,175 15.8% 226,800 15.8% 170,100 15.8%Total Expense 60,000 50.0% 45,000 50.0% 720,000 50.0% 540,000 50.0%

Income before Phys Comp 60,000 50.0% 45,000 50.0% 720,000 50.0% 540,000 50.0%

Physician Comp 60,000 50.0% 45,000 50.0% 720,000 50.0% 540,000 50.0%

Net income - 0.0% - 0.0% - 0.0% - 0.0%

Income Statement to Budget

Dec-02 % of Cash Budget % of Cash Jan-Dec 02 % of Cash Budget % of CashReceipts Receipts Receipts Receipts

Charges 200,000 150,000 2,400,000 1,800,000

Cash Receipts 120,000 100.0% 90,000 100.0% 1,440,000 100.0% 1,080,000 100.0%

Expenses Salaries 30,000 25.0% 22,500 25.0% 360,000 25.0% 270,000 25.0% Payroll taxes 3,600 3.0% 2,700 3.0% 43,200 3.0% 32,400 3.0% Retirement plan 4,500 3.8% 3,375 3.8% 54,000 3.8% 40,500 3.8% Health insurance 3,000 2.5% 2,250 2.5% 36,000 2.5% 27,000 2.5%Total Staff Expense 41,100 34.3% 30,825 34.3% 493,200 34.3% 369,900 34.3%List all other expenses 18,900 15.8% 14,175 15.8% 226,800 15.8% 170,100 15.8%Total Expense 60,000 50.0% 45,000 50.0% 720,000 50.0% 540,000 50.0%

Income before Phys Comp 60,000 50.0% 45,000 50.0% 720,000 50.0% 540,000 50.0%

Physician Comp 60,000 50.0% 45,000 50.0% 720,000 50.0% 540,000 50.0%

Net income - 0.0% - 0.0% - 0.0% - 0.0%

Trend Report – 12 rolling months

Oct01 Nov01 Dec01 Jan02 Feb02

Expense

5000 · Salaries 150,000 160,000 180,000 150,000 150,000

5020 · Payroll Taxes 22,500 24,000 27,000 22,500 22,500

5100 · Business Meetings 20 20 40 20 107

5115 · X-Ray Chemicals 1,000 1,200 1,000 1,100 1,500

Trend Report – Income Stmt

INCOME STATEMENT THRU DECEMBER 31, 2002 MONTHLY TREND REPORT

31-Jan-02 28-Feb-02 31-Mar-02 30-Apr-02 31-May-02 30-Jun-02 31-Jul-02 31-Aug-02 30-Sep-02 31-Oct-02 30-Nov-02 31-Dec-02 TOTAL------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------

Revenue------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------

Total revenue 925 919 825 891 954 740 840 930 949 953 733 773 10,432------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------

Gross profit 925 919 825 891 954 740 840 930 949 953 733 773 10,432

Operating Expenses

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total operating expenses $217 212 276 243 305 220 195 264 236 339 276 376 3,159

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Net income from operations 708 707 549 648 649 520 645 666 714 614 457 397 7,274

Other Income & Expense------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------

Total other income & expense 3 0 0 1 0 0 6 0 1 0 0 -10 2------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------

Earnings before income taxes 711 707 549 649 649 520 651 666 714 615 457 387 7,276------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------

Net income (loss) $711 707 549 649 649 520 651 666 714 615 457 387 7,276=========================================================================================================================================================================

Net Profit per FTEJ an-02 Feb-02 Mar-02 Apr-02 May-02 J un-02 J ul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Average

Hospital A 230,678 222,054 231,487 164,913 192,104 243,536 264,666 230,945 156,336 205,228 194,437 207,081 $211,956Clinic 1 0 10,624 0 6,913 5,969 6,568 12,938 6,215 0 0 5,864 6,257 $5,112Clinic 2 12,768 12,025 10,700 12,255 11,792 10,780 12,862 10,763 736 0 0 0 $7,890

TOTAL $224,958 6.50 FTE $34,609

Hospital B 75,559 108,075 116,174 41,615 129,136 84,993 93,948 94,037 53,396 88,121 89,633 52,893 $85,632Clinic 1 0 0 10,559 0 0 12,143 2,597 2,364 0 5,630 0 6,484 $3,315Clinic 2 1,140 712 668 888 1,066 888 1,082 1,096 1,408 778 886 0 $884

TOTAL $89,831 2.00 FTE $44,915

Hospital C 120,899 130,833 102,702 111,448 124,896 138,862 124,730 155,230 93,609 123,786 99,257 131,574 $121,486Clinic 1 491 1,358 940 594 439 825 271 730 384 757 671 1,084 $712Clinic 2 1,079 1,645 1,689 1,024 1,599 1,743 1,239 1,680 1,507 1,720 1,709 1,303 $1,495

TOTAL $123,692 2.50 FTE $49,477

Imaging CentersLocation A 44,465 60,828 47,652 45,029 53,742 55,404 50,626 57,104 47,973 61,113 63,443 56,106 $53,624Location B 58,694 69,213 69,553 57,227 73,550 70,854 67,491 72,293 51,601 83,983 81,050 73,838 $69,112Location C 66,827 83,717 71,842 63,646 80,636 82,399 80,811 79,288 69,135 88,676 86,762 89,274 $78,584Location D 48,324 62,464 49,544 54,245 66,975 79,536 72,524 73,614 57,426 79,330 78,283 75,290 $66,463Clinics 2,837 3,910 4,270 4,819 1,195 1,014 6,161 4,134 1,235 1,575 20,337 1,353 $4,403

TOTAL $272,186 5.00 FTE $54,437

Balance Sheet How do you use it? Balance sheet ratios:

Debt to equity=Total debt/equity What equity?????

Current ratio=Current assets/current liab

12 Month Trend Report – Balance Sheet

BALANCE SHEET THRU DECEMBER 31, 2002MONTHLY TREND REPORT

31-Jan-02 28-Feb-02 31-Mar-02 30-Apr-02 31-May-02 30-Jun-02 31-Jul-02 31-Aug-02 30-Sep-02 31-Oct-02 30-Nov-02 31-Dec-02------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------

Assets

Current Assets

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total current assets 324 481 403 391 414 315 430 595 687 750 649 518

Fixed Assets

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total fixed assets 230 248 249 251 251 252 252 253 247 242 237 191

Other Assets

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total other assets 9 9 9 9 9 9 9 9 9 9 9 9

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total assets $562 737 661 651 673 575 691 857 943 1,001 895 718

Liabilities AND Equity

Current Liabilities

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total current liabilities 42 46 31 43 38 41 46 58 41 54 40 74

Long-Term Liabilities

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total long-term liabilities 296 284 273 262 251 240 229 217 206 194 194 183

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total liabilities 338 331 305 306 289 281 275 275 247 249 234 256

Equity

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total equity 224 407 356 345 384 294 416 582 696 752 661 461

------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- ------------- -------------Total liabilities and equity $562 737 661 651 673 575 691 857 943 1,001 895 718

General Ledger AnalysisFOR PERIOD ENDING: 12/31/02

CURRENT PRIOR CURRENT PERIOD PERIOD Y-T-D

SOLVENCY RATIOSQUICK RATIO 2.23 8.44CURRENT RATIO 5.73 12.52

LEVERAGE RATIOSEQUITY RATIO 0.64 0.74DEBT RATIO 0.36 0.26DEBT TO EQUITY RATIO 0.56 0.35

PROFITABILITY RATIOSNET INCOME TO SALES 0.50 0.62 0.70GROSS PROFIT TO SALES 1.00 1.00 1.00OPERATING EXPENSE TO SALES 0.49 0.38 0.30RETURN ON TOTAL ASSETS 0.56 0.51 10.16

RVU ReportSite Site 2 Site 3 Site 4

ExpensesSalary 8.77 7.16 8.47 7.30 Accrued salary 0.07 0.05 0.04 0.19 Payroll taxes 0.74 0.63 0.70 0.59 Insurance-group health & dis 0.44 0.74 0.69 0.57 Pension expense 1.01 0.78 0.83 0.88 Pension fees 0.03 0.03 0.02 0.02

Total Cost of Personnel 11.06 9.38 10.75 9.56 Xray film 1.05 1.00 1.25 1.00 Medical supplies 0.53 0.54 0.90 0.48 Contrast 0.44 0.43 0.36 0.50 License, dues & subs 0.02 0.02 0.01 0.10 Continuing education 0.01 0.01 0.01 0.01 Computer supplies 0.01 0.01 - -

Subtotal expenses 14.62 13.05 14.35 13.44

Cash Flow STATEMENT OF CASH FLOWS

12/02

2002 2001CASH FLOWS FROM OPERATING ACTIVITIES

Net income (loss) 2,546,475$ 2,515,778$ Items not requiring (providing) cash: Depreciation 47,205$ 34,947$ Gain/Loss on Disposal of Assets - 702 Deferred Income Tax - - Changes in: CR Card Receivable 91 (77) Prepaids (maint., ins.) (54,380) (4,664) Due From (16,170) 4,139 Due To 19,012 (16,979) Lease Deposits - (2) Accrued Expenses - - Investments 35 (221) Due to Employees 401(k) 1,564 (2,526) Ins Premiums W/H (683) (265) Accrued Pension 887 (1,003)

Net cash provided by (used in) operating activities 2,544,036 2,529,829

CASH FLOWS FROM INVESTING ACTIVITIESPurchase of property & equipment (34,257) (32,919)

Net cash used in investing activities (34,257) (32,919)

CASH FLOWS FROM FINANCING ACTIVITIESNet borrowings (repayment) on notes payable (47,028) (42,912) Owner payouts (2,485,688) (2,424,364)

Net cash provided by (used in) financing activities (2,532,715) (2,467,276)

INCREASE (DECREASE) IN CASH (22,937) 29,635

CASH, BEGINNING OF YEAR 79,936 50,301

CASH, YEAR TO DATE 56,999$ 79,936$

Sample Reporting for Physician Compensation

Doc #1 Doc #2 Doc #3Net receipts 25,000 30,000 18,000 Other receipts 2,000 5,000 1,000 Total receipts 27,000 35,000 19,000

Direct expenses 10,000 12,000 5,000 Variable expenses 5,952 7,143 4,286 Fixed expenses 6,000 6,000 6,000 Total expenses 21,952 25,143 15,286

Distribution amount 5,048 9,857 3,714

Direct expenses Phys comp &

benefit Prof liab ins Employee salaries Dues,

memberships CME, travel Meals,

entertainment

Rent Marketing Retirement plan Health insurance Auto

Variable expenses Employee salaries Employee

benefits Medical supplies Drugs Physician services Transcription Data processing

Billing/collection Telephone Postage

Fixed expenses Employee salaries Employee

benefits Rent Equipment leases Building maint Property taxes Interest

Equipment maint Legal and acctg Utilities Telephone Depreciation

In conclusion They are your reports – they

should help you do your job For doctors – no errors allowed Use graphs – you can skew them

anyway you want