#205 Your Practice Can Be Profitable and Still Run Out of Money

A practice hired a provider in January. The hire was right and she was generating revenue from day one. By March the practice was sixty thousand dollars short and could not make payroll, because nobody had modeled what cash looks like in month two when you are carrying a full salary and the claims are still in the pipeline. This episode builds the model that would have caught it, and it is not the binder kind. 

In this episode: 

•  The seven moments when a practice actually needs a financial model 
• The six components that matter, and the ones you can skip 
• How to calculate net revenue per visit and why everything else depends on it 
• The cash flow projection that shows what a profit and loss statement cannot 
• Break-even, translated into a daily schedule number 
• The five numbers each seat in the practice needs to see 

RESOURCES FROM THIS EPISODE 

1. Practice Financial Health Dashboard (free Excel workbook) 

The workbook version of the model in this episode. Revenue per visit, the fixed and variable expense split, a 24 month cash flow projection with the payment lag already built in, and the break-even math. You enter your numbers, it does the arithmetic. 

eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd 

2. The RECOVER Diagnostic (two minutes) 

A short set of questions about how your practice runs. At the end you get a read on where the revenue is leaking and which fix we would put first if it were our practice. 

eligibility.natrevmd.com/recover-quiz-lp 

3. Protecting Your Visits From Downcoding (free live session, Wednesday August 26, 4:00 to 5:00 PM CST) 

Stephanie Hilliard, CPC, on keeping visits from being downcoded and documenting medical decision making that supports a successful appeal. Every registrant gets the physician toolkit: the 90-Second MDM Note Builder, the Is This Really a Level 4 annotated casebook, an EHR SmartPhrase starter pack, the MDM or Time decision card, and the Hidden Work reference. 

eligibility.natrevmd.com/em-downcoding-webinar 

4. The 30-Day Revenue Recovery Plan (free PDF) 

If the model says the practice should be fine and the cash still is not there, this is the first month of fixes we run, sequenced so you are not repairing six things at once. 

eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan 

SYSTEM 1: WHEN A PRACTICE ACTUALLY NEEDS A PLAN 

Four triggers, not a continuous ritual. Starting the practice, adding a provider, opening a second location, adding a service line, seeking financing, a partnership or buy-in, and a sale or transition. The one owners skip most often is adding a provider, because the hire feels like a revenue decision. In the first sixty to a hundred and twenty days it is a cost decision: the salary starts on day one, the claims do not pay for thirty to forty five days, and full schedule utilization takes another sixty to a hundred and twenty days after that. 

SYSTEM 2: THE SIX COMPONENTS THAT MATTER 

The clinical model sets the ceiling on revenue. The revenue model converts capacity into cash through payer mix and net collection rate. The expense structure separates the fixed floor from the variable layer. The cash flow projection makes the payment lag visible month by month, which is what reveals a profitable practice running out of money. The break-even analysis turns the whole model into one daily schedule number. And the KPI dashboard is what keeps the plan alive after it is built. 

SYSTEM 3: WHAT MAKES IT A DECISION TOOL 

Three scenarios instead of one, and the downside case is the one that sets your reserve requirement. Stress tests on every assumption, because knowing which ones are high-sensitivity is how you know what to watch after launch. And an operating translation, so the model becomes three or four numbers each person in the practice can act on rather than a file nobody opens. 

THE CALCULATION, WORKED IN FULL 

Net revenue per visit $130.63 net revenue per visit 

Break-even, for a practice with $180,000 in monthly fixed expenses: 

$180,000 / $131 net revenue per visit = 1,374 visits per month 

1,374 / 22 working days / 2 providers = 31 visits per provider per day to break even 

THREE ACTIONS THIS WEEK 

1. Calculate your net revenue per visit.  

2. Calculate your break-even visit count. Total fixed monthly expenses divided by net revenue per visit, then divided by working days and providers. That is your daily target. 

3. Before any significant decision this quarter, sketch a 90 day cash flow. New expense from day one, revenue with the payment lag applied. If the balance goes negative, you now know the reserve required to fund through it. 

EPISODE BREAKDOWN 

00:00 The hire that nearly broke a practice 

00:40 What a business plan actually is 

02:30 System 1: the four triggers 

08:00 System 2: the six components that matter 

09:30 Net revenue per visit 

13:00 The cash flow projection 

15:30 Break-even as a daily number 

18:00 System 3: three scenarios 

19:30 Stress-testing assumptions 

21:00 The five numbers each seat needs 

23:00 What to do this week 

Transcript

SPEAKER_00 0:05

A practice hired a new provider in January. Three months later, they were short on payroll, and money wasn't coming in as fast, and the schedule wasn't full enough in order to cover their benefits. One of the worst things that can happen within a practice is for you to bring on a new provider, bring on a new service line, yet not have enough to meet payroll and not have planned for the expenses and be short when it comes to a revenue shortfall. So today we're going to talk all about business plans. Welcome to Nat RevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signorelli, founder of Nat RevMD. Let's get started. So today we're going to talk all about those different uh parts about a business case, when you need a business case, and actually what to include in a business case. For those of you who know me well, I am a physician executive. I have been doing business cases for over 10 years in the healthcarecare world. And I think that these are the bread and butter in order for you to own a business, for you to run a business, if you're managing a business, this is what you can bring to your executive leadership team to say, hey, these are the things that I've already reviewed. These are the recommendations I have. This is the time that it's going to take for an investment to be paid back. And our profitability on a new service line, a new building, a new provider, whatever it is that you're doing, anything new? So I want to outline a framework for business plans in general. So when we think about our personal life and we think about spending money, I think we all recognize okay, if I'm buying a new house, you think about budgeting and understanding, okay, what is that return on investment? And we're very cautious about those dollars. But when it comes to business, I feel like we've not always been taught how to really structure a way to think about a new service, a new product, a new provider, or even assess the ROI you're getting on your current providers. Today we're going to talk about just when you may need a business case and then how and what to put in the business case, and a little bit about the numbers that you need to know behind the scenes in order to build out that business case. I want you to think about looking at your current expenses, whether that's from a provider perspective, supply perspective, service, really assessing each one of those and thinking through do I really need this? And should I have had a business case in order to have this current vendor? So even if you're not going through a new phase, you could still apply this business case framework to things that you currently have. Do I have a service line that I'm not quite sure? Is it making money? And today with AI, it's so easy to build out a business case with some simple prompts that you can really understand what current state looks like. And I think it's really easy for us to think, gosh, I feel like my practice is really busy and we could use another provider. Or I feel that I should open up another business location, you know, 30 minutes away because I've got a lot of patients that are coming in from that area. And if I had another location, I could capture more market share. I want to encourage you to think about feelings and putting numbers on paper instead of going with a gut instinct on this. And I think that when I've seen business cases go wrong, whether that's in the hospital world or even in the practice side of things, it's really when there's a true lack of business plan that's been created and actually running with the specific numbers that are in your practice. It's easy to go, well, I think I'm getting paid $150 a visit. So I'm going to use that round number. So I want to encourage that as we go through this discussion today, that we're not just using estimates that you think are accurate, that you're actually pulling volumes, pair mixes, and, you know, provider reimbursement, actual reimbursement, not theorized reimbursement, so that you can understand the bigger landscape of how your actual numbers play into a return on investment. One other thing is that if you are looking to bring on x-rays or lab testing or another vendor service, that vendors will always paint the picture to be rosier than it is. So they will say, well, yeah, you'll get, you know, $3,000, you know, per test that you run. And I'm I'm talking about expensive, you know, genetic tests. But the vendor's telling you that, but you have to recognize that there's going to be a portion of that that you're going to get less than that $3,000. And so you've got to ask the hard questions when a vendor comes to you and you're working through a business plan that, you know, is that, you know, where do you get those numbers? Where how do you base that number? And how can I expect my actual numbers to look? And so when you press vendors, they can tell you, oh, well, that's the Medicare number. Oh, okay, that's Medicare's reimbursement. You know, do my fee schedules look better than Medicare or worse than Medicare? And then make that range in terms of reimbursement so that you're not painting a return on investment or a business case based on a rosy picture that you get as realistic as you can. Today we're gonna talk about the different areas that you build out of business case, like what triggers would cause a business case to need to be built. And then we're gonna talk about some of the frameworks of how to build that business case. And then over the next couple of weeks, we're gonna talk about different things, whether it be about lab testing and should you bring in lab testing, what does a business case look like with lab testing, all the way through how to build a business case for different scenarios? So if you haven't already subscribed to our channel, please, please do. It sends you a reminder when we've got new episodes. Also, you can also subscribe to our newsletter, which gives uh more detailed information and toolkits. So that head on over to our website, natrevmd.com, and there's a subscribe button way at the top. So that's just a way for you to get information when it comes to releasing new toolkits or things that are going on. All right, so let's talk about those specific moments in a practice that would require a business case. And these should be the triggers in your mind so that you know, okay, I need to sit down and create something. And if you are a practicing physician, maybe you've got office manager or maybe a part-time CFO, a fractional CFO or a controller, please sit down with them so that you can share your expectations around new services, new benchmarks, new providers, new facility, anything that you do that is new. And I would even encourage any new vendor that you're doing. What is the current state? What is the anticipated end goal? And then how long is it going to take you to get to that end goal? And are there investments necessary so that you can calculate what that return on investment is? So, this really the goal here is that we're reducing financial risk within your practice so that you don't wake up with a facility location that's not making enough money or provider that's not covering themselves. And now you're stuck in a negative profit perspective for months on end. Now you may have certain positions in your office that you already have recognized are going to be negative, but they're there because they're taking a load off of a physician. So we see this in the OP world with nurse midwives, where they may not be covering for themselves, but at the end of the day, they're reducing call for physicians. And so that's a different benefit. So you just need to really outline what are those benefits and what am I, what are, what am I able to take out of our profit in order to make sure that that is a service we have for our physicians or our patients, et cetera, on a monthly basis. So obviously, first you're opening a practice for the first time, but worth mentioning. So if you're listening to this and you're like, I really want to start my own practice, okay, let's sit down and create a business case so that you really understand what are all of the expenses, what is an anticipated average reimbursement on a per visit perspective. So that may be $150 for primary care, maybe more than that if you're a sub-specialist. Reach out to other colleagues of yours and GMA. And there's many different sources that are helpful in order to gather an understanding of what you can expect on a per patient basis so that then you can build backwards, you know, what your pay is, what a new provider's pay is, really taking into account expenses that you have for your current location. So you're gonna want to pull in, you know, all of the different expenses, get quotes for all of that, pull together, okay, how many patients do I think I'm gonna have on month one, two, three, and model that out for the, you know, really that first 12 to 18 months. And then at what point in time am I going to become profitable? And then how do I add expenses, i.e., staff, only when certain volume thresholds happen so that you continue to build a practice that is sustainable and profitable, and that you are really thinking through those volume thresholds so that you don't overextend yourself when it comes to staffing, technology, uh, AI tools, vendors, service vendors, so that you have a clear path forward of okay, here are the expenses. Here I'm gonna increase expenses as I increase volume. And here's what I model out those expectations. And what's really interesting is you could even think to do that when it comes to marketing. So it's really thinking about what level of profitability do I need to be at? How many patients do I need? And then what are my mechanisms in order to increase that volume so that I can back into those goals? So that's probably the most obvious one. Um, the second is going to be adding a physician, a provider, a mid-level, you know, nurse midwife, whatever it is, is then to really ask, okay, where do we currently stand from a volume perspective? And we'll talk more in a minute about the actual business case and what to pull together. But think through the, you know, provider business case as a way for you to understand where are you currently today with volume? How much more volume do you need to cover that physician? And then how much more volume do you need to cover to make that a profitable position? Because there's different ways you can bring on a physician. And it may not be always a profit-driven discussion. It may be, hey, I need to take time off of my plate. I need to cut back two days a week. And so I need to bring somebody on to cover those days. And that may not be a profit discussion, but you've got to have those discussions with yourself or with your leadership team so that if you're a practice doing $400,000 a month and you want to bring on a new provider, what is the goal with that provider? Is it to, you know, allow you to step back and do more CEO stuff, or is it to cover a wait list that you have? Maybe you've got wait lists for the next two to three months. And so you're trying to, you know, bring somebody on to cover that wait list. How long is it going to take for you to cover their salary, their overhead? We've talked about this before, all of those components to where that position is profitable, where you're not paying out of pocket for that physician's salary benefits, malpractice, et cetera. Every position that you have should be bringing on some sort of revenue generating or profit generating opportunity. And again, that that could mean it's giving you more time to run the business. So you're not having to hire somebody external for that. Or it could be, I need to actually get those patients seen. I need to get more patients seen. And so you've just got to really lay out that and then lay out the expenses. And we'll talk about the components of a business case here in a minute. So the third is opening up a second location or whatever number of locations it is that you're opening, and really thinking through, okay, the cost to do that. Do I need to lease a new space? What's any construction that I need to do to get a building where it needs to be in order to do that? And then really thinking through, okay, realistically, what does the volume need to be to cover the expenses of the salary of those staff, the fixed expensive of actually running the build the building? And then how long can you does it is it gonna take to get there? Now, one of the big things with opening another location is just really having the model define the break-even visit volume. And so you're gonna really want to step out how long it's going to take to reach that volume on a realistic ramp. And so you can compare that to a current location, you can compare that to a waiting list that you already have created, and then really the understanding around total cash requirement until that hits. You know, a second location that breaks even in nine months means that you're funding the expenses for nine months of overhead before that breaks even. And what happens if that doesn't hit? And then how are you tracking on a monthly basis the volume threshold and the marketing input of patient leads or new patient visits in order to ramp up and hit that target? And I'm a big believer that if you're not measuring these things, then it's not going to be monitored. Really important so that you don't get stuck with a location or a lease that is not going to be successful. Now, the fourth is going to be bringing in a new service line. And this is really important. So say you want to bring in X-rays. So say you're in urgent care, you want to bring an X-ray, or say you're an OBGYN office and you want to bring in an ultrasound machine and you want to insource those or lab testing. So any lab testing, you're going to want to build out a business case to really understand, okay, what is my anticipated volume? What volume am I, you know, sending out today? If I insource that, what are all of the expenses that are going to be incurred for bringing in that service? And then what is my reimbursement capabilities? And how do I match that with payer mixes and current reimbursement? Some of this will be a little bit of a guess guessing game, but you can leverage vendors to help support this discussion. You can leverage, like, say, if you are bringing in x-ray, you know, those vendors who are supplying the x-rays will be able to provide some information around uh test reimbursement, same with lab tests. So, say you're bringing in some point of care urinalysis testing or respiratory testing, those sorts of things should be able to be supplied from the vendor who's giving you that equipment. And again, just want to make sure you really understand their assumptions so that you don't paint a rosy picture that's not realistic. All right, so let's transition and talk a little bit about the actual business plan itself. So, business plans can be as complicated or as simple as you make them. And as someone who's had to make some very complicated business plans in my life and in my career, I think simple scales for this scenario. So if you're a private practice, you're bringing on a provider or service line. I don't think you need to make a business plan with 10 or 12 different sections. I think you can have a very simple business plan, but allows you to get to a discussion around return on investment is the the end goal here. How long is it gonna take if you bring something in or you bring a provider, a secondary location, an ancillary service to where that then becomes profitable? And so that's your return on investment, the the time at which it's gonna take for you to get to a break-even point and then setting up metrics to measure every single month so that then you recognize are you hitting those metrics? So things like executive summary or a market analysis or competitive landscape, an operational plan. I mean, some of this can get really complicated. And some of those may matter if you are trying to get funding for a second location or you're trying to get again a loan. Typically, you're gonna have to become or put together something more complicated. Or if you're starting a practice for the first time in a certain area, that may mean you are having to do more of a market, a market landscape or market analysis so that you understand what your competition is and the likelihood of success. For today, we're gonna talk just, you know, run of your mill, six different components that typically work for most business cases. And the first part of this is the operational model. So before you can do the financial projections, you're gonna want to know and define what it is that you're looking to do. So this is about defining the services that the practice is going to offer, how many providers you're actually gonna be bringing on, how many days a week are they actually going to be working? What is the capacity per provider? So this is the operational framework by which you're gonna use and build a financial case. So operations comes first. You really want to think, okay, what it is that I'm trying to do, what are my goals? Why am I doing this now? And then really the details on the day-to-day aspects for this specific, you know, situation that you're building, right? So if it's a provider, you're bringing on a new provider, okay, what kind of patients are they gonna see? How many days a week are they gonna work? What kind of patient volume do I expect them to be able to handle at, you know, normal capacity, right? At end state, right? Is that 20 a day? Is that 40 a day? And and then what hours are you gonna be using that physician, for example? And so that is going to be, you know, the operational plan. So if it's a lab test that you're bringing in, why are you bringing in that lab test? What is the current problem you're trying to solve? Is it a revenue problem or is it a turnaround time problem? Right. So you've got to think through, again, what is the problem I'm trying to solve with anything that you're doing within your in your business? Because otherwise, if you're not clear on the problem you're trying to solve, then you may go down a rabbit hole of trying to get something to be profitable when in reality you're just trying to take work off of your plate. So you've got to define what good looks like and again, the problem you're trying to solve. If you're bringing in a new service line, x-ray or lab test, that may be a very different problem you're trying to solve. That may be a profit thing you're trying to solve, or that may be a bottleneck or a clinical thing that you're trying to solve. You know, you don't have the right information in order to treat the patient. And that's a different discussion. You may be okay with just breaking even versus you're trying to gain profit. Okay, what is that profit margin that you're going after? Is it 20%? Is it 30%? Same with bringing in a physician. You may be bringing in a mid-level so that you can then go do more surgeries. Well, then that case, you may be okay with just breaking even or having a 10% profit margin versus a 40% profit margin. And so you've got to think about why you're doing something in order to craft the next steps. So the second part of this is the revenue model. And this is what takes that operational plan and puts it into numbers. And this is where you may be thinking, okay, I am not a number person. I don't like numbers. This isn't a fun part. That's fine. But you as a CEO needs to find somebody who is that person. Or say you are the COO or a manager in a practice, you've got to start thinking through, okay, who's gonna sit with us to build this out? Maybe you've got the great idea, but getting a business case and putting the numbers together is not what you're great at. That's okay, but you've got to find somebody who is. So the second part of this, that revenue model, the financial piece, is what takes, you know, all of that and puts it into numbers. So that talks about, so say, for example, you're bringing on a new provider. That's what talks about the number of visits that they're gonna see on a per day, per week basis. What is your average current reimbursement per visit? Is it expected to be the same, or is it a mid-level where we expect, you know, a 15% drop in in them in their fee schedule, just depending on, you know, sometimes mid-levels get 85% of the fee schedule compared to a physician. What is your payer mix? What is your contracted rates? What is your actual reimbursement? Because just because you're contracted with that, depending on your, you know, billing billing efficiency, you may not be getting that. And so really being able to step out your estimates of what the rosy picture is, how that compares to what you currently have going on today. So, say, for example, you're bringing on a new provider and you expect them to see 20, 25 patients a day. But when you look across your practice, nobody is seeing 20, 25 patients a day. They're all seeing 15 patients a day. So then that question becomes, okay, are they really capable of seeing that? Am I really going to be able to fill their schedule? Or do I have a no-show problem? Or am I just not efficient enough to be able to see 25 patients a day? And then you end up not making an ROI or break-even situation for two times as long as you had hoped for. So you've got to kind of have a range of expectations. So this calculation part is really going to be what matters most because then it allows you to really understand and calculate the time at which you can cover the expenses before you're profitable. So is that 12 months? Is it six months? Is it two years? Obviously, if you're bringing on another location, that may be a longer period in time versus I'm just bringing on another provider and I already have a three-month wait list and I expect their patient volume to be full in three months. So you've really got to map this out month by month so that you can understand what that's going to look like. You can sit there with Claude and have this conversation with Claude and really tell them about you and your practice and have them build out a spreadsheet for you so that then you can put some real numbers into it and then say, okay, help give me a worst case, average case, and best case scenario in terms of a return on investment or breakeven point and really talk through, okay, what is my current profitability on my physicians? And if I'm bringing on a new physician, what is my expectation of profitability for that person? And then what are the expenses of that individual? And then how do I match that to volume and current revenue, revenue numbers so that then I can drive and execute on what my final business case looks like. So one thing that you're gonna want to make sure that you know very well is your fixed and variable expenses for bringing on this new service line, any sort of capital investments, any sort of regular ongoing monthly expenses that you expect to have, and then be able to compare that to the revenue and volume numbers that you've collected. So you can think of expenses on one end. And revenue on the other end, and how long does it take for your revenue to be higher than your expenses so that you can calculate return on investment and your break-even point? We've talked about the operational model, then we talked about the revenue model, which is really about how to convert the operations workflow or plan that you have into numbers. And that's taking things like your volumes, your contracted rates, your revenue per visit, and building out the finances around this. That is where having metrics that you really trust becomes really important. Then you're really going to want to layer on both your expense structure, which is your fixed and your variable expenses. So fixed expenses are going out every month, regardless of how many patients you see. Whereas your variable expenses will fluctuate depending on your patient volume. So think supplies, whereas your fixed rates are things like your lease, your utilities, software, you know, ad minute costs, those are all fixed expenses. You pay for them regardless of if you've got patients in the door or not. Then the next part of the business plan that you're going to want to build out is really around that cash flow projection. So once you know what your goal is, what you're trying to produce. So say you're bringing on a provider and you now have, you know, an expectation around how many visits you expect them to do. Then you're building out the revenue model around, okay, if I expect them to see 25 patients a day, that's this, this many per month. You start to pull together all of their expenses of what it's going to cost you. And then you pull together the potential revenue again in that worst case scenario, average case scenario, best case scenario, so that then you can start to do the cash flow projection of, okay, at this many patients per month, we expect there to be a cash flow of six, or I'm not quite breaking even yet. I'm still having to come out of pocket in order to have a ramp up period, and then model out, okay, at month six or month 12, we expect to be cash flow positive, where we have more patients and more revenue coming in than the expenses of that provider. So that fifth part is that break-even analysis where you say, okay, this is the month that I anticipate having that break-even point so that you know, okay, it's eight months of runway that I need to be able to cover a portion or all of the expenses of this individual. Or say you're doing that with a facility location. Okay, how many months do you need to have saved or have a loan or a line of credit in order to cover the revenue gap that there is for that practice? And then the last is the KPI dashboard. So not always part of the business plan itself, but the business plan you're gonna want to lay out what metrics you're gonna want to monitor every month. And then the KPI dashboard is what you build out afterwards. So, for example, you would build out a dashboard of, okay, here are the fixed expenses I expect, track those. Here are the variable expenses with this service. So with an additional provider, that may not be something you want to have a dashboard on, you could probably wrap that up into your expenses that you're tracking high level for the office in general, and just tracking to when that provider covers both their overhead and expenses, the cost of goods and services, and then also when they start to cover their salary benefits and then monitor for profit. So, in that scenario for a provider, you're going to want to be tracking how many total patients is this person seeing? What is the gap between that and what we need to get to on a monthly basis in order for them to cover themselves, break even, and then hit your cash flow targets, so your profit targets. So then you'll track to that. And if you're under that, well, then what revenue generating activities are you doing in order to hit those goals in profitability? And I know this sounds like a lot, but I I promise once you do a couple of these, it gets easier. And using AI in order to help supplement the thought process around this can be very helpful. So I have really stressed the importance of not just painting a rosy picture. So just to sum that up again, you'll really want to make sure that you have some high-level expectations of what good looks like when you bring in this service. So whether that's lab tests, x-rays, a new provider, a new facility, what are your volume projections? And let's look at those worst case, average case, best case scenarios so that then you can plan, okay, worst case scenario, I'm having to come out of pocket for six months, 12 months, and then ramp that out so that you know, okay, over a 12-month period, I need to have $200,000 or, you know, whatever the dollar amount is to cover that service before it's covering itself. And that's the piece that I think folks underestimate. You think, oh, okay, revenue will be coming in, but you don't go as far to say, how long will it take and how what is my line of credit? And am I comfortable with running a negative for that period of time? And then listing out the activities you need to do in order to hit those volume targets. Because I think we underestimate the the work effort around covering the needs in order to get that revenue coming in. So we underestimate the amount of marketing we need to do. We underestimate uh what it's going to take to get that physician busy enough. And that's when you get into a situation where you're struggling. And so really modeling this out is going to help you plan. It's going to help you stay on target of the activities you actually need to do in order to hit those targets. So then once you've got your KPI dashboard, you are you've got your worst case, average case, best case scenarios, then you can manage and monitor this on a monthly basis with your team so that you understand if you're moving in the right direction or if you're not moving in the direct direction, what changes you need to make. So action plans to do this week, first, obviously really important for you to have billing metrics and revenue metrics that you can trust. So you're really gonna want to make sure that you know your revenue per visit. So that's the money coming in on a per visit basis. If you are looking at details around a new facility, you're gonna want to look at things like payer mix from the last 90 days. What do you anticipate that being in your new location? You're gonna want to confirm things like your net collection ratio, so the amount of money that you're collecting after contractual adjustments are removed. So that's an important number for you to know. Then you're going to really want to make sure that you understand. You're you're really gonna want to make sure you understand your ability to manage additional cash flow if you're having to cover a certain service or cover capital equipment or cover a physician's salary or cover a location's expenses for X number of months. So that's really what you're gonna wanna come out with is how many months do I have this gap where I'm having to cover the gap? What is the worst case scenario in terms of coverage and what are your plans to manage that? And we see a lot of practices will use a line of credit for that, which is fine. But then you've just got to have a really stringent process around if you're not hitting those targets every month and you're not getting the patient volume we saw it, what are the actions in place that you're going to do in order to hit that? So, last but not least, if you do want to build this out, I really do think working with Claude or another AI tool to help build that spreadsheet, we have already made a workbook around the practice financial health dashboard. It is free and it holds a very important piece to the data that you're gonna need for any business case you do for any reason. And that will be down in the show notes for you to check out. We are also doing a webinar, so coding webinar to be able to go over really how do you proof and prevent documentation gaps so that if payers are starting to do down coding and we have to start submitting those records for the down coding, what is necessary in those notes so that when we send the medical records, you don't get a judgment on a down coding that is upheld. So essentially what we're seeing is payers come in and they'll send back an EOB. So say you build out a 99214, they'll list the 99213, they'll list the 99214, but show it as a zero pay and they'll list the 99213 with your contracted rate. And so we're seeing that as like the automated down code. So they don't even give you a denial. They don't they don't tell you that it's a denial. They just they put a the denial code in there, but they've already paid you for the lower level. And so you're having to appeal these and send in medical records. So it's something that we're seeing not super common, but we are seeing it crop up and we are having to appeal those. So you just want to make sure that you are documenting appropriately for your EMs, which is why we are doing the webinar again. It is going to be August 26th from 5 to 6 p.m. Eastern or 4 to 5 central time. So check those show notes links out of register for the webinar. And as always, if you find this helpful, we would love for you to share with other colleagues in your circle. Hopefully, you guys have a good rest of your week.