Practice Manager of the Month

Categories: Practice Manager of the Month

The HST team is about “professionals dedicated to the success of medical practices.”  Each month, we recognize a practice manager who shares our passion and success in doing this, and provide you her or his advice.

Melissa Ross
Premier Care for Women

What do you enjoy about your job?

I enjoy talking with patients and working with people, I like trying to help patients make their visits easy and enjoyable.

Prior to Premier Care, Melissa  was a Practice manager for a previous OB/GYN and MFM group.  Two  she offers about being a successful practice manager are to “Listen to patients and your staff, your staff are the actual people who are living in the trenches they a great with coming up with ideas to help with flow etc….  It always helps the patients.”   Melissa also follows advice she got from Tanya Mack, “I have known her for over 14 years and she has always said listen to what people have to say.”

Dr Eva Arkin, MD added this about Melissa. “Melissa is a dedicated manager at Premier Care for Women now for 18 months.  She has stepped into a large practice and has organized the staff and the management of the day-to-day running of the office.  She certainly has encouraged the staff in many ways and keeps up the morale on a regular basis.  The staff appreciate her managerial skills and always look forward to her monthly newsletters.  She is always trying to seek ways of being fiscally prudent.  She has organized the staff and has created a pleasant and stable work environment.”

When You Can’t Hire High-priced Marketing Experts, Fractional CMOs Provide Wholesale Value

Categories: Articles

As the marketplace and your customers become increasingly sophisticated, “outsourced Chief Marketing Officers (CMOs) offer small- and medium-sized practices both high-level marketing counsel and the resources to execute marketing plans without paying six-figure salaries.

In what other ways can a fractional CMO bring value to your practice? As objective, third-party advisors, fractional CMOs provide:

  • strategic insight into how to reach your short- and long- sales and business objectives.
  • knowledge of and experience implementing effective marketing tools.
  • recommendations for marketing vehicles that are best suited for your practice and industry.

The primary financial benefit of engaging a fractional CMO is reduced overhead costs. Engaging fractional CMOs when needed or on a project basis can save your business monthly expenses associated with employing full-time marketing professionals. Also, if your practice’s business is seasonal in nature, you can retain outside marketing counsel just prior to and during peak times and cut back during quieter months.

A Harvard Business Review blog post from earlier this year takes a more focused look at the role of today’s CMO, whether an employee or an outsourced company, one step further. The article examines the value of CMOs and how they are increasingly driving the strategies for practice technology. It states that CMOs who are focused primarily on digital marketing efforts, “…have the self-awareness and the confidence to take bold action even when the context has shifted beyond their sphere of influence and scope of expertise. That is leadership.”

Fractional CMOs are inclined to push the envelope, which is a distinct advantage for companies that are experiencing little or no revenue growth, are traditionally risk averse, and/or employ leaders who resist change. Taking risks and getting out of your comfort zone are necessary qualities companies should look for in marketing leaders.

During your practice planning sessions, consider whether utilizing a fractional CMO could help you optimize your marketing strategy and execute digital campaigns that advance your practice’s leadership.

As the digital marketing agency for B2B and B2C clients who have limited marketing staff resources, NicheLabs is a fractional CMO, trusted advisor and results-driven service provider.  For more information, please contact Hal Schlenger at or 770-335-0077.

As we continue to feature digital marketing advancements, connect with us on Facebook, LinkedIn or Twitter to receive alerts when new information posts, or subscribe to our monthly newsletter to read summaries of our weekly posts.

Health Care Reform Review and Commentary

Categories: Articles

I don’t eat breakfast much, but when I do, my favorite place is the Sandcastle in the Village on St. Simons Island, Georgia. However, every time I eat there, I have a dilemma. All I really want is 2 eggs, toast and bacon. This runs about $5.25, but they also have this wonderful breakfast buffet. I mean it is really good. As many eggs as you want, 5 kinds of meat, grits, hash browns, corn beef hash, 4 kinds of juice, waffles, pancakes. I mean really good. The buffet costs $7.25 only $2.00 more for all that choice and bounty.

Remember – all I wanted was 2 eggs, bacon and toast, but I always rationalize getting the buffet. I end up spending more than I intended, and end up paying for a lot of stuff I don’t need or want (or even eat). I end up eating way more than I wanted (or needed). It ruins the rest of my day.

The cost of the buffet is based upon average consumption – and I am a small eater. I pay a lot for what other people are eating. What would happen if a lot of really hungry people were allowed to at eat the buffet for free (because of a special government program)? Now, I am paying for what they eat through taxes. Also:

  1. Average consumption at the buffet would go way up (these are hungry folks).
  2. This would cause the average cost of the buffet to go way up (for me as well – as I must still pay my share for what others are eating – and extra taxes).
  3. The line would get rather long – delaying my meal.
  4. Ultimately, the buffet would run out of items – including stuff I would like (or need) to eat.

Now, imagine the restaurant saying the buffet was the only choice – no al a carte. AND, only certain items were available on the buffet – not all there is now.

*****Welcome to the future of healthcare in America *****

While doing research for this paper, I read all I could get my hands on. My perspective was from the initial objectives for Reform. Remember those? Provide broader access to healthcare for the “uninsured”, and to lower the cost of healthcare for all. Even at the beginning of our year long journey, I thought those two objectives were at odds with each other, but like most Americans, I moved forward in faith that these disparate objectives might somehow be reconciled to one another.

As I read the words of the Patient Protection and Affordable Care Act (PPACA) Bill, I can’t help but wonder when our elected leaders lost total sight of the ultimate objectives. Neither of the primary outcomes will be achieved. From my viewpoint, we are left with an incredibly complicated set of rules, taxes, exceptions, and more twists and turns than the lines at Disney World.

In order to understand my interpretation of “Health Reform” more appropriately termed “Health Insurance Reform”, it would be instructive to establish my understanding of how this was all supposed to work. You have heard this from me before, but I will reiterate here in order to establish a proper framework for what follows.

Principles and Characteristics of Insurance:

  1. On a Macro level, insurance is a mechanism wherein many people pool their risks by paying a relatively small amount in order to cover the claims of the few that actually experience the event which they paid to insure themselves against.
  2. On a Micro level, insurance is “exchanging an unforeseeable, unbudgetable, financially catastrophic event into a series of affordable payments” (premiums).
  3. Insurance is typically used to protect against infrequent, but intense claims. Think of your homeowner’s insurance policy. I have paid my insurance premiums for years and years, and have never filed a claim. However, if I need it, a homeowner’s insurance claim is likely to be a big event.
  4. The price of insurance is predicated upon the risks in the pool and the overall claims arising from these pooled risks against which the insureds have paid their premiums.
  5. Ultimately, insurance is not a product – it is a “cost plus” service. The insurance company gathers funds from the members of the pool and pays out to those few with claims. Of course, the insurance carrier should also perform services that will help to impact claims costs. The carrier adds the cost of its overhead to the total claims for the year (including a “safety margin”), discounts these costs for earnings on any reserves previously established and this becomes the premium for the coming year.

Healthcare vs. Health Insurance:

Now, we come to “health” insurance. Prior to the early 1990’s, in Atlanta, we looked to the insurance carriers to provide “insurance”. There were no physician visit copays and relatively few prescription drug cards (those having arisen in the late 1980’s). Insureds did not engage the insurance company at all for physician charges, only for hospital-based claims (inpatient, outpatient surgery, advanced imaging, etc.). The insurance company was there for facility based charges, and for physician charges that exceeded our deductible. Deductibles during these years were commonly higher than deductibles today as they were for catastrophic coverage.

With the advent of Health Maintenance Organizations or HMO’s, it was decided that insureds could drive care into the discounted networks if we added a “Healthcare” component to the mix, and thus were born physician copays. After 1990, “Healthcare” and “Insurance” were merged to create Health Insurance. No longer did you need to pay your deductible up front, but rather, for $5 (initially), you could see a network doctor. Of course, at this time, drug card copays also flourished.


This gave rise to two systemic problems:

  1. Routine healthcare does not meet the essential definition of insurance. It is not unforeseeable – as we know children (or ourselves) will need some level of routine care each year. It is not unbudgetable (routine preventive healthcare services cost less than a $100 – even today). While routine healthcare may be inconvenient or irritating, it is not financially catastrophic. If insurance is a cost plus service, why are we paying the insurance company to process $100 claims (at a cost of $125), rather than expensing this directly? Of course this anomaly was exacerbated by a tax code that made the extra cost tax deductible – and by a robust economy.
  2. Routine healthcare is not an “infrequent” event. It can almost be “daily”. Insurance companies then had to get into the “claim processing” business in addition to being in the risk acceptance business. Routine preventive healthcare services required enormous increases in personnel, technology, etc. As such, the administrative overhead increased dramatically.

At BenefitStrategies, we believe we need to go back to looking to the insurance companies for insurance and go back to personal responsibility for routine healthcare issues. However, having someone else pay for our colds and flu symptoms is imbedded in our system. Further, we cling to unrealistic (unsustainable?) out of pocket limits. If we then add defensive medicine (due to tort law suits), improvements in technology, and mostly a system that provides services to all while only charging the few, it is no wonder American Healthcare is in a mess.

I have long been a proponent of health care reform. With 15 – 20% of the population having access to healthcare without paying into the system, it is no wonder that health insurance premiums have skyrocketed over the past 20 years. Add the 30% of the population covered by Medicare and Medicaid (which do not pay their fair share either), and it is hard to solely blame insurance companies for the cost of insurance.

So, health care reform was intended to address 2 issues:

  1. Get more people “insured”. The current legislation does not get more people insured (remember the definition of insurance – paying into the system and receiving benefits?).The current legislation merely lets people that were getting free healthcare at the emergency room seek free healthcare at the physician’s office (or ER if they so choose).If these folks could not afford insurance now (or chose to not buy it), they are certainly not going to pay into the system in the future. If the Congress was concerned about the “uninsured”, why do these folks have to wait until 2014 to be covered? How many unfortunate folks will die before 2014?
  2. Lower the cost of insurance. The Administration would suggest that getting more people insured will lower cost. Do you think the new entrants to the insured roles are healthier? Are they less healthy than those that sought health insurance (and had to be healthy to get it) currently? If we add millions of “less healthy” folks to the risk pool, and they still do not pay into the pool, how are costs going to go down?

Provisions that suggest costs will not go down include but are not limited to:

  1. Insurance companies can no longer underwrite insureds, but can only price their products based upon the (inflated) claims. Rates can no longer be based upon age. Do you think premiums for a 60 year old will go down? Or do you think premiums for the 25 year old will go up? But this is OK, because the 25 year old can pay a $95 fine and not buy insurance until needed. This is cheaper than an $1,800 annual premium.
  2. We are removing pre-existing limitations. Good for the insured, but costly for the risk pool when the unhealthy pay fines to the government until they are seriously ill and only then join the risk pool – and with no pre-existing limitations.
  3. Preventive care will be covered without any cost. Good for the insured, but expensive. Further, those not inclined to “get a physical” still will not – as the plan will pay unlimited amounts to fix them when they get sick.
  4. No internal limits on services. Good for the insured, but costly, as there are no restraints on unnecessary service (except perhaps rationing).
  5. I won’t go into the impact on waiting lines, etc. as the patient load for physicians’ increases exponentially.

Finally, until we address the overall health characteristics of our nation, claims will continue to skyrocket. Obesity and Diabetes is pandemic in this country and until we get the Cheetos out of their hands, nothing is going to change. Currently, 70-75 cents of every dollar spent on health care is spent on treatment of a preventable disease. Preventable diseases are those associated with a well-researched and widely accepted set of modifiable health risk factors (nutrition, weight control, exercise, cholesterol level, blood pressure, etc.).

Society at large is beginning to understand the long- and short-term consequences of poor lifestyle choices which brings me to the biggest problem with this Health Insurance Reform: Lifestyle Behavior is the single greatest determiner of health status which remains wholly unaddressed by the current healthcare reform legislation. Consumerism in healthcare is about behavior change—people taking personal and financial responsibility for their health and wellness. A better way of saying this is:

“Nobody spends somebody else’s money as wisely or as frugally as he spends his own.”
Milton Friedman, Economist and recipient of the 1976 Nobel Memorial Prize in Economics

In summary:

In the beginning, our system was a brilliant conception. However, it went wrong in the early 1990’s, and we have inherited an entitlement culture and have paid the insurance companies too much to do which they are ill designed to do. Then, Federal and State regulation added to the problem (Georgia mandates 138 healthcare items that have to be covered by insurance – whether or not the employer wants it covered). Ultimately, it has been access to healthcare without having insurance that has tipped the system over the edge. We now have more people taking from the system than we have paying onto it.

This version of health reform fails to address any of these issues, and will not achieve either of its primary objectives. In fact, I believe this bill is the result of a failed effort to install a single government based single payer system.

As this concept was politically untenable, I believe the bill as passed intends to destroy the insurance company based system altogether over the next 3 – 5 years, so the government can make a case for taking the whole arrangement over. If you think not, note the sections of the law that require Insurance Companies to pay out 85% of premiums in benefits. This leaves 15% gross margin with which to run their business. Could you do that? From where will funds come to establish claim reserves? To invest in technology? To cover their employee and equipment (and benefit) costs?

By 2012, the Director of Health and Human Services is empowered to decree what plans will be available for purchase, what rate increases will be allowed (we already have a Federal “rate increase regulation” Board being established), and it would appear that the system of fines and taxes established is disconnected altogether from healthy outcomes.

When the “exchanges” are established, there will be little incentive for employers to maintain health programs on behalf of their employees. It will be permissible to provide “fairness vouchers” or pay the fines and tell employees to get their own insurance. In the beginning, this will be cheaper. However, the cost will be paid somewhere, somehow. If the employer payroll tax is going up, employers will (rightly) decide to not pay this AND support an employer paid option.

I have attached a “best efforts” summary of the Health Reform Provisions and mandates and their impact on employers, individuals, and insurance companies. There are a lot of questions that remain, and a lot will not be known until the Director of Health and Human Services decides what is best for us.

About the Author: Carl C. Schuessler, DHP, DIA, GBDS is the Managing Principal of BenefitStrategies, LLC. an Insurance and Employee Benefits Brokerage and Consulting firm. We specialize in Insurance, Risk Management and Employee Benefit Consulting. BenefitStrategies helps improve your cash flow, save money and retain top talent with well-structured employee benefit and financial planning solutions. With more than 20 years of experience in employee and executive benefits consulting and financial planning experience, he guides large firms, privately held companies and executives through the challenges of evaluating planning opportunities. We pride ourselves on our ability to be creative in designing innovative, optimum plans and helping companies and individuals make the most of their financial resources.


For more information:
Carl C. Schuessler, Jr., DHP, DIA, GBDS
Managing Principal
BenefitStrategies, LLC. • 2776 Ridge Valley Rd. • Bldg. 100, Site. 150 • Atlanta, GA 30327
Direct (404) 941-5519 • Mobile (404) 277-7852 • Fax (928) 833-2265

Windows XP and Office 2003 Put your Practice at Risk after Apr 8, 2014

Categories: Articles

We would like to provide an update as it relates to the ‘end of life’ of Microsoft Windows XP and Office 2003. There has been a lot of buzz recently and it has been getting a lot of publicity in the news, generating many questions, prompting us to put together this information.

Windows XP was released August 2001; before Facebook or Twitter was even introduced to the world. Microsoft will end support officially on April 8, 2014 for Windows XP and Office 2003. Additionally, many Internet Explorer (IE) applications will be moving to and requiring Internet Explorer 9.0 to function; this is also not available with Windows XP. We have all grown to love Windows XP and these technology changes make a large impact to us all and preparations need to start occurring for anyone who has and uses Windows XP in their businesses today.

First and foremost, with Microsoft ending support and security patches, this will make XP computers more vulnerable to attacks and malware, even if these devices are not connected to the internet and are connected to a private network. Because of the end of security patches, after the end of support date, XP will no longer be an acceptable as part of your practice’s HIPAA compliant solution.
Many software vendors have already released that they will be requiring Internet Explorer 9 in future versions which is an additional reason why XP computers will need to be retired.

Upgrading the operating system OR replacing the XP machines will need to occur to protect the security of your systems and to meet basic HIPAA security compliance. Some computers may have hardware capable to run and upgrade to Windows 7. If the hardware is not powerful enough for the Microsoft upgrades, we recommend to pull, shred the hard drive, and recycle the old PC; replacing it with a new computer running Windows 7 Professional or Windows 8 Professional.

Many computers may have a Windows 7 Professional license running XP and can be upgraded. This can be checked by looking at the top of the computer at the Microsoft certificate of authenticity which will provide the version of the license.

Below are a few links from Microsoft which include so of the above mentioned dates and support.

Practice Manager of the Month

Categories: Practice Manager of the Month

The HST team is about “professionals dedicated to the success of medical practices.” Each month, we recognize a practice manager who shares our passion and success in doing this, and provide you her or his advice.

January Practice Manager of the Month
Debbie Olmos, ENT of Georgia

What do you enjoy about your job?

I enjoy working with people and in particular, with employees, vendors, and mentors. I get pleasure when our team has done a great job or when we have worked on a great deal that increased efficiency or reduced cost to the practice. Another thing I enjoy is seeing employees grow by training them, teaching them, and empowering them to make decisions.

In 2004, we were installing a new practice management system. We were migrating from Unix to Windows. One employee had never used a mouse before and now she is very so comfortable with technology. It is rewarding to see people grow personally and professionally.

What is your greatest accomplishment in your current job?

My greatest accomplishment is associated with one of the largest projects we’ve ever under taken – evaluating and installing the EMR system in use today. We were able to install a new system across sixteen locations without losing one dollar in billing revenue and we had no trouble whatsoever in our claims clearing house. I attribute this very smooth transition to detailed planning. A key reason for no disruption was our one-office-at-a-time implementation approach because it ensured that we worked out the kinks along the way.

What were you doing prior to your current job?

I was the administrator for a pediatric surgeon in New York. I started out as a data entry clerk and collector and moved my way up to become the practice administrator. When I started, we had one office and one doctor. When I left, we were at three doctors and two offices. I learned how to manage multiple physicians and locations from this experience.

What 2 tips can you offer your colleagues about being a successful practice manager?

First, I try not to make quick decisions. I like to ponder the information for a short while to make sure I carefully evaluate the information. I think it is important not to react too quickly. Secondly, I think it is very important to develop a good team and don’t be afraid to roll up your sleeves and help them. It is critical to understand the processes and to make sure that I know what it’s like to walk in my team’s shoes.

Who gave you advice about being successful and what was his/her advice to you?

My mom has always been my role model. She was an administrator for an anesthesiologist group. She led by example. It was her example that helped me to form my managerial philosophy to stay calm, be patient, and be thorough.

What hobbies or special interests to you have?

I love to travel – anywhere from Disney World to Malaga, Spain

Lump Sum Distributions vs Pension Plans

Categories: Articles

The Markets

If you found holiday songs or Beatles tunes humming through your head last week, it may have been your subconscious processing world and market events.

Over the river and through the woods/To Grandmother’s house we go… Janet Yellen, current Vice Chairman and nominee to be the next Chairman of the Federal Reserve System, testified at her confirmation hearing before the U.S. Senate’s Committee on Banking, Housing, and Urban Affairs on Thursday. Her comments were widely interpreted as indicating that current stimulus measures will remain in place. This made investors happy and helped push global stock markets higher.

In the United States, the Dow Jones, S&P 500, and NASDAQ, all appear to be headed toward milestones. The Dow is nearing 16,000, the S&P is closing in on 1,800, and the NASDAQ is approaching 4,000.

You say you want a revolution/Well you know/We all want to change the world… China’s third plenum of the 18th Central Committee, which also is being referred to as a blueprint for reform, a reform manifesto, and the Decision on Major Issues Concerning Comprehensively Deepening Reforms, is ambiguously phrased, according to The Economist. However, it appears to encourage:

“…Experimentation in everything from trading rural land to the freeing of controls on interest rates. Barriers to migration will be further broken down and the one-child policy relaxed. A widely resented system of extra-judicial detention, known as laojiao (re-education through labor), will be scrapped.”

China’s leaders also promised to elevate the role of markets in the economy. That news helped push Shanghai Composite Index higher last week.

HAVE YOU BEEN OFFERED A LUMP SUM DISTRIBUTION? Not too many employers offer pension plans anymore. You know, pension plans. The kind of retirement plans that employers used to offer; the type where employees generally didn’t contribute and the benefits they received in retirement were determined by their salaries, length of employment, and other factors.

If you’ve ever worked for a company that had one, it’s possible that the offer of a lump sum distribution may be headed your way. If you accept a lump sum distribution, you’re choosing to receive a pile of cash today instead of monthly or annual pension payments in retirement. Basically, you’re agreeing to take responsibility for investing the money and generating a stream of income during retirement so your employer doesn’t have to do those things.

Why are companies offering lump sum distributions? The Pension Protection Act of 2006 (PPA) established new accounting rules. Companies with pension plans must recognize their plans’ funded status on their balance sheets each year. Since balance sheets are scrutinized by analysts and investors, and lots of pension plans are underfunded, companies decided it was time to take action.

How underfunded are these plans? A Wilshire Associates report cited by Reuters found the difference between the amount that S&P 500 companies will owe to retired workers and the amount those companies have set aside to pay retirees is more than $1.5 trillion. How much is that? Well, if you took one trillion one-dollar bills and strung them end-to-end, the chain would stretch further than the distance from the earth to the sun!

Anyway, having an underfunded plan became a corporate finance headache. Two-thirds of companies that have pension plans are trying to limit the effect of those plans on their financial statements (69 percent) and cash flows (58 percent), as well as reduce the overall cost of their plans (41 percent), according to a recent Towers Watson survey. CFO Research in collaboration with Mercer said employers plan to do this by:

  • Adopting more conservative investment strategies
  • Transferring pension obligations to insurance companies by purchasing annuities
  • Offering lump-sum payouts to retired and current employees

In many cases, accepting a lump sum payout rather than having income from a pension may have a significant impact on your retirement.

Think About It

“The average 401(k) account balance fell 34.8 percent in 2008, then rose from 2009 to 2011. Overall, the average account balance increased at a compound annual average growth rate of 5.4 percent over the 2007-2011 period, to $94,482 at year-end 2011… The median 401(k) account balance (half above, half below) increased at a compound annual average growth rate of 11.5 percent over the period, to $42,082 at year-end 2011.”

— Employee Benefit Research Institute, June 2013 [12]

How Do You Know if You Need to Restore Your Pluck?

Categories: Articles

If you are full, well-rested and financially strained, you survived yet another Thanksgiving holiday. As we begin December and look ahead to January, we shift our focus to 2014 planning.

Keith Finger, a B2B marketer and NicheLabs partner, shared his thoughts with us, which we would like to share with you. In his post, Keith highlighted the importance of tapping customers and prospects to for valuable insights into both what we are doing well and what elements of our marketing approaches need tweaking.

How do you obtain reliable, external input? NicheLabs welcomes you to share your thoughts on this topic one-on-one, as well.

Is Your Marketing Plan a Turkey?
It’s November and hopefully you’ve done some planning for 2014. I’ve found that companies frequently make strategic decisions based on their unique view of reality, and without any external input. Of course, the way we look at our own businesses is vastly different from how prospects and even customers view us.
So how do you get reliable input? Here are some thoughts:
1. Do NOT talk exclusively with customers. They know you and may not give you the candid input you’d receive from non-customer. While customer feedback is important, don’t rely on it exclusively for planning purposes.
2. Do NOT rely on focus groups. It’s all too easy in a focus group for a few outspoken people to dominate the discussion and cause others to stay quiet or change their opinions, even with a good moderator. They’re also expensive.
3. DO talk with companies who are not your customers. This is the best way to get info on unmet needs, perceptions of the marketplace, competitors, etc.
4. Do NOT gather info from prospects you’re also selling to. It’ll make the sales process awkward.
5. DO gather info using one-to-one interviews, conducted by an inquisitive marketer. Find people to interview using LinkedIn and association websites. Send an email asking for their input for research and be sure to state the length of the call and assure them it is not a sales call in disguise.
6. DO interview at least 10 people. Twenty is even better. You need enough info to allow you to see patterns and make some judgments on actions to take. If you get an especially insightful response from one person towards the end of your calling, contact previous respondents to get feedback and confirmation.
7. DO prepare a basic list of questions but don’t read them off like a bad telemarketer. Be conversational. Also, it’s okay to veer off-course and probe particularly insightful responses.
7.5 One more point: hire a facilitator to run planning meetings. You’ll end up with better results if everyone participates and someone doesn’t also have to also run the meeting and log comments.

Comments? Questions? Click reply or drop Keith a note at or contact Hal at NicheLabs or 888-978-9254

You are not Planning to Move but don’t Overlook Your Renewal

Categories: Articles

By Stan Sharp

With new regulations coming from seemingly every direction, the looming implementation of ICD10 and the far reaching effects of the Affordable Care Act practices often overlook a significant source of bottom line savings, their lease renewal. When your practice has a lease which is a year from expiration you should begin the process of planning for a successful renegotiation.
That process involves many of the same elements you consider in looking for new space. You must first examine the clinical needs of your practice at that location in terms of your current needs but more importantly in terms of your needs over the renewal term. Based on that evaluation you must determine if your current space is able to meet those needs. If your current space does not meet those needs you must determine what changes are needed and the cost and practicality of those changes. You will be signing a long term high dollar commitment which will have a significant impact on your practice’s bottom line. Many practices fail to start the renewal process early enough and they fail to consider the renewal as an opportunity to plan for the efficient operation of that location into the future. The renewal gives your practice the chance to consider how changes in healthcare will change the requirements for that particular location in terms of the amount of space needed and in the layout of the space.

To examine your current and future needs you need to begin asking questions.

  • Do you plan to add or reduce the number of providers at that location during the term of the renewal?
  • If you plan an increase or a decrease in the number of providers how will what effect the number of exam rooms, restrooms, and doctors offices needed?
  • What changes should or could be made to the support areas based on the changes to the clinical areas which would necessitate either an increase or a decrease in the space needed?
  • Will changes in your practice change the number of staff needed (either by addition or subtraction) throughout that office?
  • Have equipment changes either in the front office or elsewhere caused the need for a redesign of the effected area?
  • Has the patient base either current or projected changed in such a way as to necessitate the need to re-examine the geographical location of that office?

Once you have asked sufficient questions and obtained sufficient answers you can determine whether your current space can accommodate your future needs both in terms of square footage and layout. This information can then be used to make design changes to your current office and to select alternatives to your current space which meet your current and future needs. The alternatives you select serve a dual purpose. At the end of the analysis one of them may provide a better alternative than your current space and they will provide valuable leverage which you can use in negotiations with your current landlord.

Once you have picked realistic alternatives you should work thru the process just as you would if you were looking for a new space in a new area. You request proposals from your current space and the initial alternatives you selected. Based on a comparison of the responses you will choose one or two of the alternatives as finalists. These finalists are then asked to prepare preliminary floorplans and construction pricing so that each of the finalists can provide an updated proposal which reflects the lease cost and the construction cost for that alternative. Using these proposals and the updated proposal you received from your current landlord, which reflects any proposed tenant improvements, you will negotiate between options to achieve the best possible offers from each. Remember that negotiation is a process not a one time request for terms. After you feel you have negotiated the best terms obtainable from each of the options, including your current space, you compare the options and select a winner. Once chosen you negotiate a final lease document with the winner.

The process of negotiating between your current space and the alternatives provides critical leverage to make sure that whether you choose to remain in your current space or choose an alternative you have a space that will meet the changing needs of your practice over the renewal term and you have negotiated the most cost effective terms. Too many practices skip this process and as a result leave significant money on the table but with prior planning you can make a positive difference in the outcome of your next renewal.

Stan Sharp is founder of HealthOne Realty Advisors. He can be reached at 770-578-4996 .

Uncertainty Requires Building Energy Reduction

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In the United States, buildings use one-third of our total energy, so therefore building owners need to know and understand the energy consumption of their building due to the high cost of energy and the uncertainty of future energy costs.

This knowledge will also be a benefit to the building ownership in regard to value of the building when steps are taken during design and construction to reduce energy consumption.

The U.S. Green Building Council has developed the LEED (Leadership in Energy and Environmental Design) rating system where a building is designed and built to meet the criteria for the four levels of certification. Those four levels are Certified, Silver, Gold, and Platinum. These rating levels can only be achieved when a LEED’s certified professional is involved with the design and construction of the building. LEED certification takes into account all of the aspects of the building process from site selection, material delivery distances, distance to public transportation, and many other environmental impacts. Should a building owner select not to have his building LEED certified due to the strict requirements and cost impact, he should direct his building design team to incorporate energy saving systems to increase his building value.

The following are some to be considered:

Artificial lighting needs to be selected to reduce heat load of the light fixture. Light fixtures typically produce heat when operating which requires more air conditioning. Reducing the heat load of the light fixture will reduce the air conditioning requirements of the building. Also many of the light fixtures on the market which
produce low heat load are more efficient to operate and have a long lifespan.
New advancements are being made in LED (Light-Emitting Diode) lighting where these systems can be used to reduce energy. In the future LED light bulbs will replace other low efficiency lighting helping reduce energy cost, reduce maintenance, and disposal costs.

Increasing the thickness of roof and wall insulation help to reduce heat or cooling lost through the largest exposed areas of the building. Special attention should be given to the roof area due to the direct exposure to the sun. Also thought should be given to the roofing material selection to increase the reflectivity of the sun’s rays. Thin solar panels are now being developed to be placed on building exteriors to produce electrical currents to help power the building systems. These systems should be ready for building use in the next three (3) to five (5) years.

The exterior glass systems of the building should include an insulated glass panel with reflective coating and a thermal break in the framing system. The reflective glass helps control the heat gain of the building, helping reduce the energy requirements for conditioned air. Thermal breaks in the framing system eliminate the thermal conductivity between the inner air condition of the building and outer building conditions. Another consideration to the glass system design is using reflectors or diffusers to help add natural light but not direct heat gain caused by the sun’s rays. Not too far in the future, we will have “intelligent” glass systems which increase glass reflectivity as the solar gain increase similar to eye glass lens which change from clear to darker as lighting increases.

Another system which should be considered when building a building in the Atlanta area is rainwater reclamation or rainwater harvesting, due to the small drainage basin which servesthe metro Atlanta area. In simple terms, a rainwater harvesting system collects and stores rainwater which falls on the building site for future use. If the building is designed properly, this water can be used in the building for non-potable use such as toilet flushing, cleaning, and landscape irrigation. If stored rainwater is used in this manner, use of city or county water can be reduced by up to 60%. Sunbelt Structures – Use of Efficient Lighting Achieving Medical Practice Profitability

This article only mentions a few of many energy saving systems which should be considered when building a new facility or renovating an existing facility to increase the over-all project value. Should the owner have interest in energy savings and a concern for the environment, he should select a competent architect and general contractor to aid him with the selection of energy saving systems and the cost impact and pay back of those energy saving systems.

by Eric A. Schoppman – Schoppman Company

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