What’s Your Threshold?

Categories: Articles

Thresholds, what are they and why do they matter to practices?

If you said, “thresholds are a strip of wood, metal or stone forming the bottom of a doorway”, well…. you’d technically be right, but I’m not talking about that kind of threshold.

No, I’m talking about time (or count) thresholds as they relate to inbound calls in your practice. These are pre-planned values that are used as part of key performance indicators (KPIs) to benchmark against internally, and ideally to trigger operational processes or employment of resources to positively influence the overall delivery of patient experience.

Why it Matters

These threshold levels can be very important in assessing a practice’s service level. At the most basic level, we all know what happens when calls take too long to be answered, right? They hang up. Thresholds in this example can be setup around your longest wait time in queue for your current interaction to help ensure a minimal amount of calls/patient interactions go unanswered before a predetermined amount of time passes, and they are abandoned.

When used properly, thresholds can be a fairly accurate early indicator of when calls are likely to be abandoned. The key is having the tools to analyze, continually, if your thresholds continue to make sense. Is it a threshold that is helping to keep abandoned calls to a minimum? Reporting & Analytics software can help you leverage your data to determine when thresholds should be set and adjusted to make sure calls are answered before the average call is abandoned.

What About the Patient

Another way to think about thresholds is from the perspective of your patient: Thresholds are great when used as a KPI, (Key Performance Indicator) but ultimately, they are there to ensure a better experience for your patients. They should be used to trigger interventions within your practice to minimize wait time, ensure the right skilled resources available for your call volume to certain skilled queues, etc. Remember, if a call waits too long it likely means worse than an increment against your Abandoned Calls %… it more than likely translates to a lost appointment or a future mutually beneficial relationship with that patient.

How About an Example?

You’re a practice Manager. It’s been a busy Monday morning and you are constantly putting out fires. You look away from your dashboards to answer some emails or talk to a coworker. Your team is busy, and the calls are coming in faster than they can be answered, we’ve all been there. You’re quickly approaching your configured threshold limits and there’s a chance you miss the visual warnings and alerts that are telling you something is wrong. Fortunately, with proper tools like Brightmetrics software you’re able to configure audio alerts in addition to the visual alerts that tell you when calls are approaching your threshold. This will allow you and your team to proactively manage and redistribute workloads to get the calls answered before you exceed your service levels.

But Wait, There’s More!

And if you’re a Real Time Dashboard user, thresholds can play a pivotal role in how you provide top notch patient service. If you’re trying to deliver the best experience for your patients, it’s likely that your dashboards are the first thing you look at in the morning and the last thing you see before you leave; your eyes are always on them.

And because we know you’re busy and want your data easily digestible, thresholds can be configured to be highlighted in On-Demand Reports in a visual format so you can quickly see the calls that exceeded the predetermined threshold and why it might have happened.

For questions on how your practice can take advantage of these types of Reporting and Analytics tools, contact Paul Mancini with Clear Choice Telephones at 678-387-3200 or paul@clearchoiceinc.com



Assessing Telehealth ROI

Categories: Articles

Telehealth has been a buzzword lately in the healthcare industry. With all this talk about how telehealth can help improve the quality of care and overall revenue for your practice, there comes the point when it merits serious consideration. The real question is, “How do you track your Return On Investment (ROI) from implementing telehealth systems.”

Unfortunately, calculating ROI for telehealth systems is different from practice to practice. Luckily, Manatt Health Strategies has been working on a solution. Manatt did a case study on one rural healthcare organization and one more urban healthcare organization to determine who to decide which factors should be included to define the ROI from a new telehealth system. They identified four different institution types that have unique considerations they should consider. (Table 1)

Along with these clearly defined institution types and unique considerations, there are seven general considerations that every healthcare organization should look at when deciding how to determine their ROI. Each of these general considerations has a vital aspect they test, but you have to think critically and ask the right questions to see their value. First, Patient Acuity Mix, Cost Savings, and Reimbursement or Contract Revenue all have to do with the revenue stream of your healthcare practice. By analyzing the changes in these three considerations, you can determine how your telehealth system has impacted your revenue. Next, New-Patient Volume and Patient Retention reflect how your patients are responding to your telehealth system, potentially how telehealth is enhancing the quality of their care. Last, Technology, Program and Program Management, and Staffing help define costs and staffing requirements of your telehealth system. These directly impact the overhead of your practice. Comparing these three segments to one another can give you a clear view of the ROI for the telehealth system and where you need to think about improvements.

Keep in mind that this is just two case studies from one healthcare strategy group, and as telehealth becomes more widespread, more refined systems to calculate the ROI of your telehealth system will begin to show up. Don’t get lost in the data and remember that the ROI of your telehealth system should always be defined by unique considerations for your specific practice. Only you and your patients can determine is telehealth is helping or hurting your practice.

By: Mike Jann
Medicus IT


Spotlight: Stephen Bradley

Categories: Team Member Spotlight

Family – married? Children? Pets? Married w/three children – all under the age of 3. They certainly keep us busy.

Where did you grow up? Interests as a child? What did you want to be “when you grew up”? Peachtree Corners, which makes me a true Atlanta native. We regularly traveled for sporting events so I still enjoy a good tailgate today. Was never attracted to any industry – just enjoy meeting and learning from new people daily.

What college did you attend? What did you study? Best memories of those years? UGA. Undergrad was Political Science. I later went on to earn an MBA as well from UGA. Undoubtedly, my best memories are the times spent with friends, both in class and around campus. Especially game days.

Where in Atlanta do you live? What brought you here? Dunwoody. I’ve always lived in Atlanta. My wife and I previously lived in Brookhaven but recently moved to Dunwoody after having children.

Hobbies? Any charity or philanthropy? Traveling and golf. Sporting events. Most charitable time spent supporting our church and its outreach programs.

If money were no issue, what would you do with your time? Focus more time to hobbies!

Favorite food? Worst food? Fried chicken. Nothing in particular but no sweet tooth here.

Cook or clean dishes? Cook.

Favorite sports team(s)? Favorite book? Favorite movie? UGA Dawgs. I enjoy reading about current

events over novels. Tombstone is my favorite movie.

Furthest you’ve ever traveled? Best trip of life? Furthest – China. Best – traveling/hiking in Alberta.

Speak any other languages? Nope.

Mountains, beach, or staycation? Mountains.

Role model in your life? My parents.

What is one tidbit of information about you we wouldn’t expect? I can spin a basketball on my finger for a long time.

A US airport is the latest place to ban plastic water bottles

Categories: Articles

It’s just the beginning of fixing the airline waste problem.

By Terry Nguyenterry.nguyen@voxmedia.com  Aug 21, 2019, 4:40pm EDT

Since the advent of air travel, airlines and airports have provided passengers plastic-wrapped items to be used once and tossed away. Rather than make the switch to sustainable goods and packaging, which tend to be heavier than plastic, the aviation industry has kept at this — and annually generates millions of tons of plastic waste.

In recent years, however, sustainability has grown into a larger talking (and selling) point for customers, who care about green travel options. On August 20, 2019, the San Francisco International Airport (SFO) started banning plastic water bottles smaller than one liter from being sold at concession stands, lounges, restaurants, or vending machines. It’s the first major airport in the US to issue such a policy, a step toward its goal to be a zero-waste hub by 2021.

Each guest that comes through the airport produces roughly half a pound of trash, an airport spokesperson told CBS News, and around 10,000 bottles of water used to be sold daily. San Francisco International already requires vendors to provide certified compostable utensils, food service accessories, and reusable cups.

As progressive as that sounds, there is a caveat: The plastic bottle policy only applies to water (not other beverages like seltzers, juices, or sodas), and doesn’t affect how airlines independently serve passengers. Airport vendors will still be able to sell water in presumably single-use aluminum and glass containers, which are arguably not much better for the environment.

Plastic water bottles have a notorious reputation in our waste-obsessed world: They’re flimsy, disposable, and most likely won’t be recycled, since research shows that only 9 percent of plastic waste ever generated are reused. They’re also manufactured from petroleum, which is extracted by oil drilling.

While glass and aluminum certainly seem more sustainable (both can be recycled again and again), manufacturing cans and bottles out of these materials, not to mention shipping them, requires lots of fuel, according to Grist’s Umbra Fisk. Completely banning single-use disposables — or even all plastic bottles, in this instance — would be a radical step for the airport, but could lead to a number of problems. It could cause confusion for passengers not aware of the policies, and according to SFO’s spokesperson, there are not enough non-plastic alternatives for teas, juices, or sodas.

In comparison, San Francisco International’s push to completely ban plastic water bottles seems positioned to actually reduce waste. (Now if only it could do the same for plastic Coca-Cola bottles or aluminum La Croix cans!) But conscious change, especially in a space thousands of transient people pass through daily, happens slowly.

San Francisco International Airport (SFO) started banning plastic water bottles smaller than one liter from being sold at concession stands, lounges, restaurants, or vending machines. It’s the first major airport in the US to issue such a policy, a step toward its goal to be a zero-waste hub by 2021.

Added by article submitter:

First it was plastic straws, now its plastic water bottles. It might be time to start thinking how we can all do our part. There are tons of options when it comes to re-usable tumblers, simple plastic ones and stainless versions with vacuum sealed interiors to keep liquids either hot or cold. All can be imprinted with a company logo. Now that we know for sure passengers will be carrying something other than plastic bottles through the airports, it might as well be some sort of device with YOUR logo on it.

Sheila Fox-Lovell

Shandy Creative Solutions



Is Your Company at Risk for Occupational Fraud?

Categories: Articles

As a business owner or Managing Partner with a large corporation, you want to trust your employees, and this includes upper management, as well. You interviewed, tested, and helped train the best candidate available who eventually became a part of your business. After roughly 16 months, you find yourself looking at a case of Occupational Fraud. How did this happen? Oversight. Weak internal security accounts for almost half of the fraud instances.

According to the “Report to The Nations: 2018 Global Study on Occupational Fraud and Abuse,” publication, 2,690 real cases of occupational fraud were reported from 125 countries in 23 industry categories with $7 billion total losses. Small businesses generally suffer the brunt of monetary losses in  an approximate period of 16 months per case. Employers need internal controls and a trained resource for prevention. An internal audit is generally a good place to start and this can be done by an independent third-party source such as Stellaris Group Human Resources in Roswell, Georgia, by a CPA firm, or by management.

It’s difficult to know where to even begin to start when it comes to preventing occupational fraud in the workplace, but with a few steps you can ensure your company can be safe:

  • Have a system in place where employees can anonymously report or tip you off that someone in the company may be stealing from you in one form or another. Internal tips are the number one method of detecting occupational fraud over other methods and accounts for approximately 40% of the cases reported.
  • An Internal Audit is another way to detect someone who may be cooking the books or outright stealing from you. Some signs might include an employee showing up at work all of a sudden with an expensive new car or wearing designer clothes that you are certain are outside of their salary range.  Or maybe they are having financial problems such as too much debt or a gambling problem. The reasons are endless.
  • Conduct a Management Review and delegate. Preventing one person from managing all of the accounting responsibilities such payroll, accounts payable, receivables, bank reconciliations, financial statements, etc. These responsibilities should be shared among several employees in order to prevent the temptation of occupational fraud.

Overall, implement a Hot Line for employees, vendors, and competitors to tip you off if they suspect fraud. Have a good anti-fraud plan in place. Small businesses suffer greater losses because they sometimes lack the resources larger corporations have in place. If you do not have a Human Resources department, hire one to independently review your current anti-fraud plan for recommendations or guidance.

Dawn Stastny, SPHR, SHRM-SCP is the Managing Partner and Founder of Stellaris Group, LLC. To learn more about Human Resources Outsourcing and Consulting, connect with her at 678-935-6001 or by email at Dawn.Stastny@Stellaris.Co




Spotlight: Bill Steuer

Categories: Team Member Spotlight

Family – married? Children? Pets?

Wife and 3 girls- 16,14, and 11.(yes, I have an 11 yr old!)

Where did you grow up? Interests as a child? What did you want to be “when you grew up”?

Clearwater, FL and Daytona Beach, FL. Loved all sports especially  anything on the water. Really never had a specific career/job in mind, but my aptitude test in high school had me leaning towards sales and as a lawyer. I took the easier path and less education requirement 😉

What college did you attend? What did you study? Best memories of those years?

THE Florida State University, business school and Hospitality Administration (hotel & restaurant). FSU was a great place to get an education and have a great social life. One summer I studied abroad with our Hotel & Restaurant faculty and got to live in Switzerland for 7 weeks. During this time we traveled all across Europe as well as classroom time 3 days a week. Really a fantastic experience.

Where in Atlanta do you live? What brought you here?

Dunwoody. Married and bought a house in Decatur which was fun. As we added kids, we wanted more a family-type community and moved to Dunwoody. We live less than a mile from the JCC where my kids and I do a lot of sports, working out and volunteer activities, and can easily get to highway.

Hobbies? Any charity or philanthropy?

I love basketball and staying fit through exercise and cross fit-type movements.

As for charities, I have a few passions and for a variety of reason- probably like how most people are drawn to their charitable giving.

  • Ian’s Friends Foundation (IFF) : My middle daughter was in kindergarten with Ian Yagoda and we learned about Pediatric Brain Cancer and how it is the leading cause of death in children after accidental death. This led to our support and involvement over the past 10 years and a bond to the entire Yagoda family. Fast forward to today, IFF raises over $1.3mm every year and has invested in many types of Brain cancer stem cell research.

Just this year, the FDA has Fast Tracked one of the investments IFF made for a specific treatment for inoperable brain tumors called the “monorail”. Where they can take an inoperable brain tumor and moved to an operable area.

  • Save A Child’s Heart (SACH) : This is an organization in Holon, Israel that I had the pleasure of visiting in 2018 as part of a “mission” of sorts. This group is based inside of a hospital where it utilizes the common operating and recovery rooms for children who have congenital heart disease at No cost to the families. Ironically, this organization does Not treat children of Israel since Israel utilizes a Universal Health Care system and offers “free” healthcare. The organization serves children from undeveloped nations such the Congo, Ethiopia, Zanzibar and Gaza. Religion and Nationality have no bearing on who get helped, it is based solely on need.

In 2017 we started a local chapter to help raise awareness and funds to support the group.

If money were no issue, what would you do with your time?

Spend more time volunteering in the community, as well as helping others network/connect to further their businesses and concepts.

Favorite food? Worst food?

Like most people I love all that is not good for you, like pizza, Italian, etc. I do like Mediterranean a lot too. Reality, I try to eat well most of the time and definitely cheat along the way. I am a fan of Red wine and many bourbons.

Cook or clean dishes?

I am more of a “cleaner “ these days, but there was a time I would cook frequently.

Favorite sports team(s)? Favorite book? Favorite movie?

FSU Seminoles ; grew into a Falcons fan and now, like most locals , Atl United.

Furthest you’ve ever traveled? Best trip of life?

All over Europe  and again to Normandy France for the 50th anniversary of D-Day (1994); and any trip with my family

Speak any other languages?

Barely speak English!@

Mountains, beach, or staycation?


Role model in your life?

Several : Father, best friend, and uncle

What is one tidbit of information about you we wouldn’t expect?

With 3 girls, I am one of the best at blow drying and straightening hair!

‘Ban the Box’ is Most Likely Coming Soon to an Employer Near You

Categories: Articles

According to the National Employment Law Project (NELP), three-fourths of the U.S. population lives in a community that has banned the box. This leads to the question of “Can you legally ask an applicant if he or she has ever been convicted of a crime or involved in any illegal criminal activity,” during a job interview?

The answer is both “yes,” and “no.” It’s complicated. Can you legally include this question on a job application where an applicant has to click the box regarding having a criminal background? Currently you can—in *some states and municipalities, based on private or public entities.

**On the Public Level, over 150 counties and cities and 35 states (at the time of this writing) have initiated the “ban the box” movement in an effort to allow job candidates a fair chance of becoming employed. Depending on the state, county, or municipality’s laws, the candidate may not be questioned about his or her criminal background until later in the hiring process, generally after a firm offer has been made, or sometimes after a second interview where the question may be asked or a criminal background check may or may not be performed (again, this depends on your state or local laws).

**In the Private Sector, 18 counties and cities and 12 states (at the time of this writing) have extended the fair-chance laws to ban the box among them. This is all in an effort to give a potential employee a chance to prove to the employer that he or she is qualified for the position. In the past, most employers would look at the check mark in the box, and make a snap judgement based solely on that and move on to the next applicant before a fair chance was given.

So, what does happen when a potential employee applies for a position and you are genuinely interested in them, only to discover during a criminal background check that he or she has a criminal record? This is up to you. According to a *“SHRM” article dated November 12, 2018, “The dilemma for HR and hiring managers lies in finding the balance between giving applicants with a criminal history a chance to be evaluated on their qualifications and being liable for negligent hiring.”

As the ban the box movement progresses, and it is, things can get even more complicated for employers and the hiring process. It’s a little-known fact that this movement has been around for the past 20 years, but it is gaining momentum as time goes by. These days, more than ever, Human Resources has their work cut out for them, and if you don’t currently have an HR department or someone certified in HR at your disposal, it is imperative that you seek out a reputable HR company like Stellaris Group in Roswell, Georgia.

Stellaris Group is well-versed about Government Compliances, Recruiting and Hiring, Employee and Labor Relations, and day-to-day HR management. If you need to know what you can or can’t do as a business owner or an employer, you can count on Stellaris Group to keep you in the know.

Dawn Stastny, SPHR, SHRM-SCP is the Managing Partner and Founder of Stellaris Group, LLC. To learn more about Human Resources Outsourcing and Consulting, connect with her at 678-935-6001 or by email at Dawn.Stastny@Stellaris.Co



CMS and The Office of Civil Rights takes another step in enforcing HIPAA activities by launching “ASETT”

Categories: Articles

The new program is called ASETTAdministration Simplification Enforcement and Testing Tool.

This is a web based platform is for individuals or organizations to file complaints for potential non-compliance with the non-Privacy/Security provisions of HIPAA. CMS is making an effort to make the “whistle blowing “ process easier for the general public. A streamlined process to allow patients to report what they feel is a violation or misstep with their PHi and the like.

The ASETT system securely captures demographic information about the complainant and the filed-against entity, as well as details of the alleged violation, and any supporting documentation provided by the complainant and the filed-against entity. When filing a complaint, the complainant has the option to remain anonymous to the filed-against entity.

Complainants are urged to provide as much detail as possible to justify and support the allegations, and to ensure that accurate contact information is provided for the filed against entity (full names, titles, phone numbers, and email addresses). Each complaint is reviewed for validity and completeness to ensure that it can be processed.  The site offers Tips to assist the accuser in documenting their compliant. (ie. Add Supporting Attachments to support your complaint. Test Transactions to support Transaction violations)

Once the contact information for the complainant and the information against entity is verified and validated, CMS will officially open a complaint. CMS will contact the filed-against entity by phone/email to notify them of the allegations and to advise them that a letter will be sent with complaint details and a request for follow-up. This exchange permits the filed-against entity to evaluate the information, conduct an internal investigation, and either dispute the allegations or develop a response indicating how the issue will be corrected.

The correction can be done either immediately by their staff,  or through a process outlined by a formal Corrective Action Plan (CAP).

The CAP is created out of performing a Security Risk Assessment and documenting those items that need to be addressed/mitigated. CAPs are considered a “working or live” document since it should be referred to and updated throughout the year. Just about any audit that a covered entity will be faced with will include the delivery of a current Corrective Action Plan.

One of our services includes examining a covered entities current CAP (and Risk Assessment), to help them better understand those how to mitigate those specific risks, and help them prioritize with a plan forward. If you need additional information, feel free to contact us at www.gsgcompliance.com  or 877-270-8306.

You can find more information about the ASETT web based tool with the link below.


Healthcare’s number one financial issue is cybersecurity

Categories: Articles


The cost of a healthcare breach is about $408 per patient record and that doesn’t include the loss of business, productivity and reputation.

Tuesday July 30, 2019

By:  Susan Morse, Senior Editor, Healthcare Finance


Cyber attacks affect the finances of every hospital and insurer like no other.

“I’ve seen estimates of over $5 billion in costs to the healthcare industry annually,” said Lisa Rivera, a partner at Bass, Berry and Sims who focuses on healthcare security. “That’s enormous and is not going away.”

Beyond the cost to find a solution to fix breaches and to settle any civil complaints are fines from the Department of Health and Human Services Office of Civil Rights. In 2018, OCR issued 10 resolutions that totaled $28 million.

The HHS Office of Civil Rights is stepping up breach enforcement of private health information, according to Rivera, who is a former assistant U.S. Attorney and federal prosecutor handling civil and criminal investigations for the Department of Justice.

What officials want to see is that the hospital or insurer has taken reasonable efforts to avoid a breach.

“There is no perfect cybersecurity,” Rivera said. “They say it’s not perfection, it’s reasonable efforts. That’s going to require an investment up-front to see where data is located, and educating the workforce on phishing incidents.”

Also, hospital finance professionals who are relying more on contractors for revenue cycle management and analytics should take note on the security issues involved in sharing this information.

“Every sector of business has attacks, but healthcare is experiencing the largest growth of cyber attacks because of the nature of its information,” Rivera said. “It’s more valuable on the dark web.”

It’s also not easily fixed.

If an individual’s credit card is stolen, the consumer can cancel his or her credit card. But in health records, the damage is permanent.


Despite the number of breaches, healthcare has been behind other sectors in taking security measures. Four to seven percent of a health system’s IT budget is in cybersecurity, compared to about 15% for other sectors such as the financial industry, according to Rivera.

Hospitals are behind because first, it’s a challenge to keep up with the move to more information being in electronic form.

“There’s no hospital that doesn’t have mobile EHR information,” Rivera said. “Then there was this transition with incentives from the government to go to electronic medical records. There were vast routes to doing that without a lot of experience involved in doing it. The push to become electronic began happening with this enormous uptick in cyber attacks.”

Also, the focus of healthcare has always been patient care. The population health explosion also involves the sharing of information.

And consolidation across the healthcare industry can potentially make covered entities more vulnerable to lapses in security during the transition and integration phases.


The number one way to cut costs is to prevent a breach. Once one has happened, hospitals must be able to identify it as soon as possible and then be able to respond to it.

Hospitals should be able to determine where certain data goes off the rail, Rivera said. For instance, large systems doing research have outcome information that may not be within the system of protection.

“You don’t want to learn about a data breach because the FBI saw it on the dark web,” Rivera said. And some hospitals have.

It’s a constant battle of software updates and checks. Criminals are pinging systems thousands of times a day. It’s like locking down doors and windows.

The first thing that’s needed for systems large and small is a risk assessment. This is the first thing the OCR wants to see, she said. Many hospitals use an outside vendor to do the job.

Prices for other cybersecurity measures vary from a software purchase that could be in the millions, to having vendor monitoring.

But the cost of a healthcare breach is about $408 per patient record and that doesn’t include the loss of business, productivity, reputation and the service disruption.

Hospitals can also purchase cyber insurance, which varies in cost and coverage. Some obtain it for purposes of class action lawsuits.


OCR enforcement activity during 2018 demonstrates the agency’s continued emphasis on enforcing violations of the security risk assessment and risk management requirements, Rivera said.

Covered entities and business associates are required to: conduct a thorough assessment of the threats and vulnerabilities across the enterprise;    implement measures to reduce known threats and vulnerabilities to a reasonable and appropriate level; and ensure that any vendor or other organization accessing or storing private health information is security compliant.

The OCR concluded 2018 with an all-time record year for HIPAA enforcement activity. The OCR settled 10 cases and secured one judgment, together totaling $28.7 million. This surpassed the previous record of $23.5 million from 2016.

In addition, OCR also achieved the single largest individual HIPAA settlement of $16 million with Anthem, representing a nearly three-fold increase over the previous record settlement of $5.5 million in 2016. Anthem was held responsible for cyber attacks that stole the protected health information of close to 79 million people.

Article provided by Stephen Bradley

Things to Remember When You Have a Lease Coming Up for Renewal

Categories: Articles

THINGS TO REMEMBER prior to a lease renewal.
1. Create or have a LEASE ABSTACT prepared at lease expiration.
2. Give yourself TIME prior to expiration.
3. Consider ALTERNATIVES to your current space.
4. THINK LONG TERM as well as short term.
5. REVIEW the LEASE DOCUMENT even if you renew.
6. Use the renewal or relocation as a time to RETHINK OFFICE OPERATION.

Planning for your next lease expiration starts early at the execution of the lease. Shortly
after lease execution you should prepare or have a professional prepare a lease abstract. A
lease abstract is synopsis of the most significant terms of the lease including information
on any expansion and renewal options. The information on expansion options will
include the notice that must be given the renewal option and the terms which were agreed
to in the original lease. Use this document as reference for your path as you approach
lease expiration.

Make sure that you start the process early enough so that you will have enough time to
properly evaluate alternatives prior to any notice which must be given for a renewal
option, which is included in the original lease. Don’t create a scenario where you have
too little time to do a proper evaluation all of your available alternatives. As with
anything else, it is always better to have too much as opposed to too little time. If you
start too early you can always slow down but if you start too late the advantage goes to
the Landlord, which is never a good idea. How much time is enough? To figure this out
in your particular situation, estimate how much time you realistically need for each
component of the search, taking into account that this will not be your only activity.
There will need to be 1) time to review your lease abstract to determine the terms
available in your current lease, 2) time to look at the market and assemble good
alternatives, 3) time to tour those alternatives, 4) time to request and receive proposals,
5) time for lease negotiation and 6) time for any buildout, which might be required either
at your current space or at another building of your choosing. In the case of a 5,000 sf
lease space, you should figure on 30 days to review your lease abstract and determine
what options are available. It is a good idea to find five or six options which might work.
Allow a minimum of 30 days to work thru those options which would include doing test
fits on the top two or three options. Efficiencies differ between different buildings and

Take the time or hire a professional medical office broker to find a reasonable number of
alternatives. Once you have identified five or six possibilities, tour those alternatives
paying particular attention to such thing as visual appeal of the building ingress and

egress to and from the building, the total number of parking spaces available in the
building (minimum 4 spaces per 1,000 square feet of leased area but ideally 5 or 5 per
1,000). Parking is the silent killer of a practice. If there aren’t enough spaces it will cause
patients to be late for their appointment, it will create angst on their part as they drive
around looking for a space, further aggravated as they are harassed by staff for being late
to the appointment. They may not complain to the practice but just not come back. Once
you have toured the options, made notes on what you have seen to keep the details of the
alternatives straight. Send out requests for proposal (RFPs) to each, telling them what
information you want. The idea behind an RFP is to get identical information from each
option so that you can make an apples to apples comparison. Remember that despite your
best efforts landlords will always respond in such a way as to accentuate the positive and
minimize the negative aspects of their property. To the extent they are successful, this
makes the job of comparing alternatives more difficult. Once you receive the proposals,
from the options you will want to put the competing buildings on a spreadsheet and
compare them both in terms of their economics and the more subjective issues such as
appearance, ingress/egress and parking.

Concurrent with requesting RFPs you will want to do test fits with the best two or three
options. This will allow you to compare layouts, highlighting their relative efficiencies.
In commissioning a test fit look long term, considering the things which currently work
in your space and those things that don’t. Think long term. Consider the number of exam
rooms? Consider the seating in the reception area. Have the practice consider whether it
wishes to use a “pod concept” where the exam rooms serving a particular doctor, the
doctor’s office and the doctors nurse or nurses are all bunched together in a pod; or the
concept which seems to be more favored in the current changing medical environment
which is to have all of the exam rooms together with the nurses station and have the
doctors all together apart from the exams, using charting stations interspersed among the
exam rooms.

Many practices are content to just sign an amendment renewing their existing lease
without looking back at the original lease. You should always review your existing lease
to become reacquainted with what was agreed 3, 5 or even 10 years earlier. The times are
always a changing, healthcare has changed and will continue to change. Your practice’s
situation has most likely also changed in those intervening years. Management may also
have changed and the direction and focus of new management may be different. For all
these reasons you need to review the original lease with a lawyer and or a real estate
professional to determine how your current space may address the current objectives and

In the case of a satellite certainly, but even in a renewal your office staff may have
grown. This becomes a good opportunity or even a necessity to review aspects of practice
operation. You may decide to tackle this on your own but as you know there are a variety
of vendors who are positioned to look at the various aspects of such a review.

Submitted by Stan Sharp, HealthOne Realty Advisors



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