All right, so for my last talk of the day, I will begin with two polling questions. So we can have the questions now. The first question is, has your practice recently performed internal or external strategic analysis? Interesting. So mostly, there has not been any strategic analysis. All right, next question. Has your practice done any financial forecasting and planning recently? All right, that's interesting. So the next talk is actually going to be about these two topics, about the strategic analysis and the financial forecast. Practice viability, nuts and bolts. The goal of this talk is to go over the strategic planning, financial planning, and briefly over the post-COVID recovery and how to tackle some of those changes that have happened since the pandemic. Strategic planning, by definition, it is a process of assessing a changing environment to create a vision for the future, determining how the organization fits into the anticipated environment based on its institutional mission, strengths, and weaknesses, and then setting in motion a plan of action to position the organization accordingly. In strategic planning, you actually look at your goals for next several years. It is important to have a strategic planning so that you can make a plan. All the organizational plan is based on this strategy, how to achieve that goal, which is in the future. It is vital for any practice or organization to have strategic planning because that's what enables you to create your own future and carve a way to reach that future. It creates a proactive approach rather than being passive and waiting for things to happen. In our organization, in our practice, every few years we have a strategic planning retreat where all of us sit together and go over what our goals are, what do we want to achieve, and how we want to change things to achieve those goals. And it is very important to create that pathway because that's what determines a lot of things that you want to achieve. Earlier, we talked about KPIs and practice matrices. They are dependent on what your strategic planning is because unless you have a goal to achieve, you cannot create your matrices, you cannot create your KPIs. For strategic planning, there are various tools available that can be utilized for analyzing the condition, situation, and organization. But for any medical practice, it is important to not only analyze the organization's internal structure but also the environment, which is external. So SWOT analysis is a useful tool that can be used by any practice. As far as the internal factors are concerned, you have to look at your strengths and then, of course, at your weaknesses so that you can correct them. Similarly, when you analyze the external factors, there comes the opportunities where you can expand, where you can have your bigger footprint, and the threats that can affect your practice and how to deal with those threats. So SWOT analysis gives you a comprehensive way of not only analyzing your own organization but also your competitors and the environment in which you are situated. For internal analysis and assessment, you can look at various factors that includes your service performance, how good the service is being provided, whether it is satisfactory, patient satisfaction is good or not. Similarly, the staff resources, whether you have enough staff available, they are trained well or not. Utilization trends, like we mentioned in the practice matrices that utilization of the schedule, utilization of your resources available is an important KPI that can be used for analyzing your internal assessment. Similarly, financial performance also needs to be analyzed, and there are various KPIs that can be used to assess your internal assessment. These all were mentioned in the previous talks for the revenue cycle management as well. Facilities and equipment are also your internal resources that needs to be seen, whether they are financially feasible, changes that need to be made in them. And the distinctive or distinguishing characteristics of your practice, how you differentiate yourself, what is different in your practice that makes it more attractive for anyone looking at it. When we come to the external analysis or assessment, you have to look at your market changes, which are your referral patterns. As I mentioned earlier that monitoring your referral patterns as a GI practice is extremely important because that can, you can foresee the changes coming in the market, whether be it change in the referral pattern, change in the insurance patterns, and all these factors affect your practice. Similarly, the trends of your demographics, changes in the population, changes in the economy, closure of a plant nearby, all these changes in the economy affect the practices. Similarly, the changes in the technology, how the new technology is being implemented in the healthcare or in the GI practices all over. You have to look at your competition, whether there are new providers coming in town, hospitals have hired new physicians, which is going to affect the private practice close by. So, all these factors are the external factors, which could be threats, which could be opportunities. There is a practice close by that has closed, so you want to expand your footprint. So, all of these things come into the external assessment of, for the strategic planning. Coming to the financial planning, this is quite distinct from your strategic planning. Financial planning could be part of the strategic planning because it encompasses everything what an organization or a practice is going to do. In a financial planning, it is a process where you formulate your financial operations to meet the long-term goals of the organization. So, this is being reviewed more often than your strategic planning. Here, you look at your finances on a more short-term basis rather than on the long-term strategic goals that you have. Financial forecast is the part of this financial planning where you assume, where you just look in the future and see how, okay, how it is going to be like. Because it is an important part of the planning to have some idea how things are going to be in the next few months, one month, two months, three months, up to 12 months. Of course, there are going to be some unseen things. I mean, no one knew in January of 2020 that what will happen in March, April, or May. But still, these are events that you cannot predict, but yet you have to make prediction based on what you have right now. So, you review your current situation, then you look at your anticipated revenue and expenses over time and make a prediction. Similarly, now we know that we will have some resurgences of COVID-19. There will be some times or months when there will be some increased cases. There will be decline in the patient population. So, for those possible situations, you can have a contingency plan at that time from the financing standpoint. From the financial planning standpoint, breakeven analysis is an important tool that should be utilized for every practice. A breakeven point is where the practice or the endoscopy unit is neither losing money or making money. So, they are at a neutral point. And it is very important to know that point because it is useful to determine at what point you are going to make any profits. With the COVID-19 pandemic, we saw that there was a sudden decline in the number of the procedures and the number of the patients coming in. And whenever there is increased cases, there is an issue with the number of patients that are going to show up. But if you do not have that analysis available, you can lose money just by the increased cost. So, as long as you know how much work you have to do, you have to curtail the cost according to that. As I mentioned, breakeven analysis is an important tool from a business standpoint that can help in improved decision-making, be it how many patients you have to see every week, be it the number of staff you need in your practice. It can also help to plan how much funding is needed or when you need to go out to get funding. A very simple example is that during the peak of pandemic, there was a sudden drop in the number of patients showing up in the practice. If you have to make a decision that how many procedures or how many days you want to keep your ASC open, you have to have a breakeven analysis. This can help you to make decision like, okay, you probably just need to keep your ASC open for only two days and do this number of procedures in those two days and keep it closed for the rest of the week so that you can reach a breakeven analysis rather than keeping it open for five days a week, which will increase the cost for the practice. Similarly, if you know your breakeven analysis and you can go out to get better pricing for all the supplies you have. It also helps you to determine what your revenue targets are and get some benefits in improving the overall cost and the fixed expenses of the practice as well. So this is a simple formula for the breakeven point, which is the number of patient visits or the procedure required to reach the breakeven point and it equals the fixed cost divided by the revenue per visit or procedure minus the variable cost. As you can see, based on this formula, there are four ways to improve your breakeven point and bring it down. You can increase prices, which basically is trying to get better insurance contracts. And if you know your breakeven point, you can work proactively on this as well. Similarly, increasing the volume, of course, will improve your breakeven point as the fixed cost. If fixed cost is not changing, just increasing the volume will help. But if you improve your fixed or variable cost and decrease them, it will also help to get your breakeven point at a better level. This is a graphical representation of what I just explained earlier about the breakeven analysis. So, initially, you can see on the y-axis is the revenue and the x-axis is the number of encounters. Initially, because of the fixed cost, you have the loss unless your revenue reaches that point, which is the breakeven point. And then after that, you continue to incur profit and it keeps going up as your fixed cost is most likely going to stay the same. It's your variable cost will change, but mostly this is much less than your fixed cost. So, once you bypass or cross the point of breakeven, then your profit, of course, goes up. And once you have this analyzed, you can look at various factors here, which I mentioned earlier in the previous slide, of the volume and the fixed and the variable cost, and by working on these, you can improve your profit. In the next few slides, I'm going to talk about various ways how the practices can help to get the patient volume and the finances better and improve them, especially since the COVID-19 affected these two factors quite a bit. First of all, telehealth. Telehealth has been a big change that has happened since the pandemic. Prior to that, it was not available all over. It was not paid for in normal situations, but now it is. So, we need to evaluate and make use of this one thing, that in-office versus telehealth and where there are patients hesitant to come into the offices should get telehealth options so that they can be – this facility can be used. Similarly, the new processes should be established where in the triage it can be seen that where in-office visit is necessary or should be done or where the telehealth facility can be used to improve the number of the patient volume. Similarly, new messages are to be created, especially on the practice website, that can help patients to decide what type of visit they would like, especially if the telehealth is available or not and how they can opt for that. The staffing level is similarly a moving target, especially if there is increased number of telehealth in your practice, you might not need that many – that much staff. So – or you need more staff on the phones or more staff needs – staff needs more training for the telehealth. So these things need to be addressed and have to have continuous monitoring. Payroll is one of the biggest expense a practice has. So if the number of the staff that can be managed accordingly, it can help to improve the finances. So it is important to look at the financial benchmarks and KPIs, like payermakes or the account receivable, so that they can be monitored more closely. With the changes in the EM codes and availability of the telehealth visits, you want to make sure that the billing staff is using appropriate codes and the new billing codes. All the rules are being properly implemented. Many times it does take time and effort and sometimes financial resources to retrain your staff if all of the billing is in-house, but it does pay off because there can be substantial losses if the coding is not used properly and there is increased rejection from the payer side. Similarly, the front office needs to make sure that every time the patient is coming in, they are checking their insurance changes. As I mentioned in the RCM talk, that is one of the most important part of the revenue cycle. And with recent changes in the insurance because of the COVID-19, a lot of people have lost their jobs or changed their jobs. You need to make sure that they have appropriate and correct insurance information. You have to look at your obligations, your expenses, and you have to be quite observant of that because of the changes and the fluctuating patient volume. You want to keep an eye on your expenses at this time as the cash flow can be fluctuating with the number of the patient not showing up or increased number of patients coming up later on. So, you might need more supplies. So, you need to anticipate these things at this time. Similarly, you have to have an income recovery plan, especially from a financial standpoint. You should take advantage of any new federal, state, or local financial help program for the healthcare systems as they were available last year. All the society, especially ASG, keep their members in loop by communicating with them whenever these type of programs are available, and there are always webinars about them. So, keep an eye on those communications. Similarly, if needed, you should take out a line of credit from the bank because if you don't survive right now, you cannot do anything later on. But if you survive a tough time, you will be able to recuperate your finances and your revenue later on. Sometimes you need to look at what you owe. So, if you have a loan on your practice and in the last year you have to restructure it and review it, you might have to renegotiate with your vendors, renegotiate the payment arrangements to help the practice. Similarly, you have to renegotiate or review the lease on the monthly payment on the real state of your practice or the endoscopy unit. Given the situation, it is not a bad idea to have at least 45 to 60 days of expense at hand in the bank, and that should be included in your income recovery plan. So, when you're looking at improving the finances, you have to, of course, make a plan to increase the revenue. And the way to do that is to increase your productivity and how you do that, increasing the patient volume, how many patients you see every day, the number of charges, you have to look at the charges you are billing and are they appropriate and according to the service you are providing. You might have to cut down the vacation you have to take, the time off might have to go away. I know that is increasing to the stress level, but as I mentioned earlier, the court survival is not mandatory as well. So, in these situations, you might have to cut down some of the vacation, increase the number of hours you are working in the office. Adding weekends, especially for screening colonoscopies, that can increase your productivity and also entice the patients to come in because they are also going through the same situation. They have to work more, so they don't have to take the day off. Similarly, for provider compensation, you can make a plan to increase the number of compensation. You can make some changes, especially in the situations where because of the COVID, there is decreased revenue. You don't have to give bonuses or decrease the salary for the time being, and especially only for the providers and not for the rest of the staff. And this could be for several months because if you go and make these changes now, that will help the practice to survive. And of course, you can later on recuperate most of it. So, some highlights at the end that if your practice participated in any of the federal programs in the past or any in the future, make sure you understand the program requirements, critically review the practice or endoscopy finances. And the most important part is to continually review them and not just one-time thing because the situation changes. And so, you want to make sure that you know the financial situation and how, where, and how to cut the cost. Similarly, to improve the bottom line, you increase the revenues, decrease the expense, and ideally do both. And develop a well-defined financial plan, forecast. Try to foresee and make assumptions based on your current situation so that you have a better roadmap to navigate these challenges.

strategic analysis

financial forecasting

strategic planning

SWOT analysis

internal analysis

external analysis