Sample of Sunder Vision Solutions Practice Assessment Analysis report

1. 1
XYZ Institute
Practice Assessment
Analysis
Prepared by:
Steven Sunder, BS
December 1, 201_

2. 2
The GAP is the difference between where
you are and where you want to be.
This Practice Assessment is the first step to
bridging the GAP.
The key to any partnership is delivering
real business value.
My goal is to provide you with individual
solutions that are workable and practical.
The GAP

3. 3
Bridging The GAP
1. Strategic Business Planning
3. Information Technology
2. Operations
There are 5 key areas to bridging the GAP
4. Productivity
5. Financial Improvement

4. 4
 Strengths , Weaknesses, Opportunities and
Threats aka SWOT Analysis
 Business Plan
 Key Performance Indicators (KPI’s)
 Annual Budget
 Marketing Plan
 Accounts Receivable/Collections
Strategic Business Plan

5. 5
Operations
 Human Resources
 Implement Employee Handbook
 Job Descriptions
 Electronic Time Tracking System
 Benefit Management
 New Hire Screening Process
 HIPAA Compliance
 OSHA Compliance

6. 6
Operations
 Practice Management Processes
 Standard Operating Procedures
 Checks and Balances
 Financial Management
 Accounts Receivable/Collections Management
 Fee Schedule
 Medical
 Optical
 Expense Reduction Initiatives
 Cost of Goods Management
 Patient Flow
 Patient Satisfaction Survey
 Patient Demographics
 Frame Board Management
 Vendor Agreements

7. 7
Information Technology
 Practice Management System
 Electronic Patient Charts
 Reduced Clerical Errors
 Electronic Appointment Tracking
 Automated Export to Patient Billing
 Electronic Insurance Claim Submission
 Electronic Appointment Reminder
 Electronic Recall System
 Electronic Product Notification
 Electronic Medical Records
 Electronic Medical / RX Records (required by 2014)
 Eliminates Data Entry Time
 Improved Coding and Billing
 Eliminates Paper Charts

8. 8
 Practice Communication Systems
 Automated Patient Notification via 4PatientCare
 Intranet
 Phone System
 PC Network
 Automated Daily Data Backup
 DataHealth
 Electronic Order Submission
 VSP Interface
 VisionWeb for Non-VSP orders
 Increased order production time by 1.5 days
 Check Real Time production Status
 Online Contact Lens Ordering
 Network Recommendations
 To be assessed
Information Technology

9. 9
Provider Productivity
 Care Team Model
 Care Team Benefits
 Quality of Care
 Leverage physicians
 Quality Time with Patient
 Enhanced Continuity of Care
 Diagnosis
 Evaluation
 Treatment plan
 Superior Medical/Surgical Eyecare Delivery System
Technician
XYZ EYE INSTITUTE CARE TEAM
Physician
Unite
Clerk
Technician

10. 10
The GAP
Industry Benchmarks Analysis
As a Rate to Gross Revenue
Industry XYZ Eye Institute Variance +/-
Practice demographics 65+ 40% 23% -42%
Healthy Range
Revenue Average per MD $600K-$900K $600,000 $560,647 -7%
Average Patient Encounters per MD
5,000-8,000 5,000 4,448 -11%
Revenue per Encounter $120-$180 $120 $126 5%
Patients seen per Hour 5+ 5 3.2 -36%
Cataract Surgery Yield 18-25 18 2 -87%
Number FTEs per FTE MD 5-7 5
Optical
Cost of Goods Sold 27% 64% 139%
Capture Rate 60% 60% 32% -47%
Average Rx Sale $275 $181 -34%
Iventory Turns 3-4 times per year 3 1.1 -63%
Expenses
Support 22%-32% 22% 20% -9%
Facility 8%-11% 8% 11% 40%
Marketing & Promo 4%-6% 4% 11% 187%
Medical Supplies 2% 1.00% -50%
Office Supplies 2% 1% -40%
Professional Liability Insurance 1% 0.95% -5%
Net Revenue
Total Physician Income divided by
Total Net Collections 30%-40% 22%
New Patient Ratio 12-24% N/A
Aging Healthy Best
Aging Days Range In Class
0-30 40%-60% 75% 54% -28%
31-60 20%-30% 15% 23% 56%
61-90 5%-10% 5% 9% 78%
91-120 5%-10% 2% 5% 154%
>120 5%-10% 3% 25% 733%
Notes:

11. 11
 Improved Productivity via Practice Communication
Systems
 Electronic Recalls: 500 charts, recalls generate 125 visits @ encounter fee of
$180? (180 x 125 = $22,500) with a capture rate of 50% = 63 sales at $275 avg. sale
($17,325) generates a calculated projected increase in revenue of $39,825.00!
 Electronic Appointment Reminder
 Electronic Product Notification
Productivity
Hours Wages
Monthly Savings 21.5 $290.25
Annual Savings 258 $3483.00
Assumptions
1. Average 5.0 hours per week calling patients
2. Based on blended rate of Optician hourly rate
Hours Wages
Monthly Savings 34.4 $516.00
Annual Savings 412.8 $6,192.00
Assumptions
1. Average 8 hours oer week calling patients

12. 12
 Online Contact Lens Ordering
 Electronic Ordering and Status Verification
Productivity
Hours Wages
Monthly Savings 3.6 $52.20
Annual Savings 43.2 $626.4
Assumptions
1. Avergae 6/10 of an hour per CL order
2. Average of 6 CL orders per month
3. Based on blended rate 0f 50% split Optician / Tech
4. Zero overhead with product delivered to patients home. Clinic receives monthly utilization check
Hours Wages
Monthly Savings 9.2 $131.10
Annual Savings 110 $1,573.00
Assumptions
1. 10 miuntes per RX for non-VSP order
2. Wages based on blended rate of Opticians

13. 13
Productivity
 Recommended Utilization of Technician
 Pretest
 Phoria Testing
 Visual Fields
 Auto Refract
 Keratometry
 Confrontations
 Pupil Testing
 Amsler
 Color Testing
 Visual Acuity
 Blood Pressure
 Health History
 Patient Ocular History
 Patient Ocular Surgical History
 Patient Surgical History
 Patient Health History
 Family Ocular/Health History
 Contact Lens Insertion /Removal Training

14. 14
 Purchasing Power
 Laboratory Costs
 Frame Costs
 Medical Supplies
 Office Supplies
 Accounts Receivable Aging
 Increased Cash Flow
 Through weekly Accounts Receivable aging reconciliation and management
The Commercial Law League of America published the precise correlation between the age of the receivable and the chance of collection:
Period of Delinquency
Aging Collection Likelihood
1 month 94%
60 days or 2mths 85%
90 days or 3 mths 74%
120 days or 6 mths 48%
>120 days or 9 mths 43%
1 Year 27%
2 Year 14%
Financial Improvement
A/R Aging (Insurance and Patient) as of October 2008
Practice Current 31-60 Days 61-90 Days 91-120 Days Over 120 Total
MEI $36,081 $10,227 $5,078 $3,614 $18,111 $73,112
49% 14% 7% 5% 25% 100%
Best in Class
Benchmarks 75% 15% 5% 2% 3%

15. 15
Financial Improvement
Summary
 Increased Cash Flow
 Achieve $180 per patient encounter
 Achieve frame inventory of 2x’s in 2009 with a goal of 4x’s by 2010
 Reduce current frame inventory to achieve 2x’s turn in 2009 [recommend 400 - 500 ophthalmic
frame inventory]
 Perform daily claims cleaning
 Submit electronic claims on weekly basis
 Adopt DirectContactLenses.com
 Frame Board Management
 Expense Reduction Initiatives
 Decrease Cost of Goods to 27%
 Align with ELOA and Lensco [directcontactlenses.com]
 Align with Europa International and Classique Eyewear
 Decrease marketing expense
 Design, develop and implement internal marketing plan
 Adopt and implement MEI Community Alliance program with weekly staff penetration in
community
 Increased Revenues
 Revise fee schedule
 Medical and Optical
 Increase surgical demand/procedures
 Implement Community Alliance program
 Achieve 60% optical capture rate
 Optical average Rx sale of $275.00
 Increase contact lens sales

16. 16
Financial Improvement
Summary
 Potential Cost Reductions
 Electronic Appointment Reminder $6,192.00
 Electronic Product Notification $3,483.00
 Online CL Ordering $626.40
 Electronic Ordering Verification $1,573.00
 Cost of Goods Reduction $25,777.00
Sub-total Potential Cost Reduction $37,651.40
(potential bottom line savings)
 Potential Revenue Increase
 Optical Capture Rate of 60% [39% to 60%] current annual 2008 projection of 351 sales. New 540
$52,250.00
 Electronic Recalls $39,825.00
 DirectContactLenses.com $400.00
Sub-total Potential Revenue Increase $92,475.00
Current 2008 Revenue Trend $560,647.00
Total Calculated Increased Revenue $92,475.00
Aggregate Annual Potential Revenue $653,122.00
Methodologies:
 Cost of Goods: Current 2008 trending at 64%, goal is 40%. 2008 Sales trend $107,406.00 x 24 point reduction = $25,777.00
 Optical Capture Rate 2008 trend is 39%, goal is 60%. Increase by 53.84% over 2008 trend.
 DirectContactLenses.com: 2008 contact lens trend 6 per month. No overhead with this business model where MEI receives
monthly revenue of controlled retail and cost. I.E., retail Accuve 2 $21.00, cost $15.50 = $5.50 revenue per box.

17. 17
Key Performance Indicators
XYZ Eye Institute
Monthly Revenue and Productivity Trend analysis 200_
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Trend
Clinic Gross Revenue $53,345 $23,505 $50,908 $44,962 $54,799 $107,911 $67,467 $78,906 $64,560 $0 $0 $0 $45,530
Medical Revenue $0 $0 $0 $0
Operational Days 19 21 21 24 21 21 22 21 21 23 19 21 21
Average Daily Revenue $2,808 $1,119 $2,424 $1,873 $2,609 $5,139 $3,067 $3,757 $3,074 $0 $0 $0 $2,151
Variance From Average $657 ($1,032) $273 ($278) $458 $2,988 $916 $1,606 $923 ($2,151) ($2,151) ($2,151)
Rate 31% -48% 13% -13% 21% 139% 43% 75% 43% -100% -100% -100%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Trend
Net Margin $7,530 ($23,408) $1,599 ($7,629) $8,189 $46,636 $1,258 $4,130 $6,740 $0 $0 $0 $3,754
Operational Days 19 21 21 24 21 21 22 21 21 23 19 21 21
Average Daily Net Margin $396 $1,115 $76 $318 $390 $2,221 $57 $197 $321 $0 $0 $0 $177
Variance From Average ($219) ($1,292) ($101) ($495) $213 $2,043 ($120) $19 $144 ($177) ($177) ($177)
Rate -123% -729% -57% -279% 120% 1152% -68% 11% 81% -100% -100% -100%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Trend
Productivity (Visits) 55 117 115 127 202 218 216 230 233 276 179
Operational Days 19 21 21 24 21 21 22 21 21 23 19 21 21
Average Daily Productivity 3 6 5 5 10 10 10 11 11 12 0 0 8
Variance From Average (6) (3) (3) (3) 1 2 1 2 3 4 (8) (8)
Rate -66% -34% -35% -37% 14% 23% 16% 30% 31% 42% -100% -100%
285
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Trend
Provider Revenue per Encounter $208 $208
Operational Days 19 21 21 24 21 21 22 21 21 23 19 21 21
Variance From Average ($208) ($208) ($208) ($208) ($208) ($208) ($208) ($208) ($208) $0 ($208) ($208)
Rate -100% -100% -100% -100% -100% -100% -100% -100% -100% 0% -100% -100%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Trend
COG's $2,568 $8,041 $9,464 $8,346 $8,073 $4,816 $5,356 $5,891 $3,899 $0 $0 $0 $4,705
Operational Days 19 21 21 24 21 21 22 21 21 23 19 21 21
Variance From Average $2,137 ($3,337) ($4,760) ($3,642) ($3,369) ($112) ($652) ($1,187) $806 $4,705 $4,705 $4,705
Rate 45% -71% -101% -77% -72% -2% -14% -25% 17% 100% 100% 100%
Rate to Revenue 5% 34% 19% 19% 15% 4% 8% 7% 6% #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Trend
Scripts Filled 25 27 37 31 35 41 33 38 30 54 35
Revenue $8,595 $8,255 $16,016 $10,335 $9,197 $10,666 $9,384 $11,120 $12,776 $11,062 $10,741
Operational Days 19 21 21 24 21 21 22 21 21 23 19 21 21
Variance From Average ($2,146) ($406) $5,275 ($406) ($1,544) ($75) ($1,357) $379 $2,035 $321 ($10,741) ($10,741)

18. 18
Key Performance Indicators
XYZ Eye Institute
Projected Monthly Revenue/Productivity Variance Report
Time Frame: October 200_
Number of working days completed: 23
Number of current month working days: 23
Number of last month working days: 21
Eyewear Average Sale: $190
Revenue MTD (Gross) MTD (Gross) MTD MTD
MTD
(Gross)
Monthly
(Gross)
Monthly
(Net) 1
Optical Professional Actual Aggregate Aggregate Projected Projected Monthly Monthly Budget Prior
Practice Revenue Revenue Contractual Loss CL + Adjustments Revenue Revenue Revenue Budget Variance Variance Month Variance Rate
XYZ Eye Institute $11,062 $57,506 ($14,345) ($19,318) $68,568 $68,568 $53,314 $53,314 #DIV/0! $53,314 #DIV/0!
Total $11,062 $57,506 ($14,345) ($19,318) $54,224 $68,568 $53,314 $0 $53,314 #DIV/0! $0 $53,314 #DIV/0!
Per Day $481 $2,500 ($624) ($840) $2,358 $2,981 $2,318 $0 $2,318
Visits Professional E/M Surgery Lasik Cataract Projected Prior
Practice Visits (92) Visits (99) Visits Visits Visits Total Total Month Variance Rate
XYZ Eye Institute 196 45 29 4 3 276 276 276 #DIV/0! Better
Total 196 45 29 4 3 276 276 - 276 #DIV/0! Better
Per Day 8.52 1.96 1.25 0.15 0.13 12.01 12.01 -
#of RX's # of Rx's # Second MTD Projected Projected Prior
Practice Captured Pair Rx Total Total Revenue Month Variance Rate
XYZ Eye Institute 53.5 53.5 53.5 $10,151 53.5 #DIV/0! Better
Total 53.5 - 53.5 53.5 $10,151 - 53.5 #DIV/0! Better
Per Day 2.33 - 2.33 2.3 $441 -
Refractions # of Projected Prior
Practice Refractions Total Month Variance Rate
XYZ Eye Institute 29 29 29 #DIV/0! Better
Total 29 29 - 29 #DIV/0! Better
Per Day 1.26 1.26 -
Capture Rate Capture Projected Prior
Practice Rate Total Month Variance Rate
XYZ Eye Institute 184.5% 184.5% 66.3% 118.2% 178.5% Better
Total 184.5% 184.5% 66.4% 118.0% 177.6% Better
Per Day
A/R Aging (Insurance and Patient)
Practice Current 31-60 Days 61-90 Days 91-120 Days Over 120 Total CL ADJ +/- ADJ PRO $ BUDGET +/- RATE - BUDGET
XYZ Eye Institute $36,081 $10,227 $5,078 $3,614 $18,111 $73,112 Worse $54,224 ($4,973) $53,314 $0 $53,314 #DIV/0!
49% 14% 7% 5% 25% 100%
Total $36,081 $10,227 $5,078 $3,614 $18,111 $73,112 $54,224 ($4,973) $53,314 $0 $53,314 #DIV/0!
Percentage Average49.35% 13.99% 6.95% 4.94% 24.77% 100.00%
Monthly Contractual Adjustment Calculation as a percent of Aggregate AR

19. 19
Key Performance Indicators
Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Gross Revenue $53,345 $23,505 $50,908 $44,962 $54,799 $107,911 $67,467 $78,906 $64,560 $68,568
- Adjustments ($8,145) ($5,316) ($11,358) ($7,635) ($4,584) ($8,453) ($11,827) ($14,061) ($12,993) ($14,345)
Net Revenue $45,200 $18,189 $39,550 $37,327 $50,215 $99,458 $55,640 $64,845 $51,567 $54,988
($40,000)
($20,000)
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
XYZ Eye Institute Revenue Trend YTD 200_

20. 20
Key Performance Indicators
Jan Feb Mar Apr May Jun Jul Aug Sep Oct
Accounts Receivable $37,078 $33,892 $49,410 $60,510 $71,970 $114,684 $93,759 $101,916 $73,277 $73,112
Days in AR 22 45 30 42 41 33 43 40 35 41
0
5
10
15
20
25
30
35
40
45
50
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
days
in arar balance
XYZ Eye Institute 200_ AR Trend YTD

21. 22
Key Performance Indicators
2008 YTD
Industry Benchmarks $80.00
Support Revenue per Hour $38.17
Variance -52%
$80.00
$38.17
-52%
-60%
-50%
-40%
-30%
-20%
-10%
0%
$0.00
$10.00
$20.00
$30.00
$40.00
$50.00
$60.00
$70.00
$80.00
$90.00
revenue p/hour
XYZ Eye Institute
Support Revenue per Hour YTD 200_

22. 23
Key Performance Indicators
$7,921
$8,000
$13,282
$13,344
$13,961
$15,291
$15,383
$20,772
$35,516
$61,655
$73,887
$0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000
Billed
XYZ Eye Institute Insurance Carrier Revenue Stream YTD 200_
ABC
Prime
Medicare
ABC-QUEST
65C Plus
Worker''s Compensation
HMA/PPO
HMA
United Health Care
ABCCare - Claims Department
Medicaid/ACS

23. 24
Key Performance Indicators
Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 YTD-2008
Revenue p/SQ FT $31.38 $13.83 $29.95 $26.45 $32.23 $63.48 $39.69 $46.42 $37.98 $32.35 $0.00 $0.00 $35.37
$31.38
$13.83
$29.95$26.45
$32.23
$63.48
$39.69
$46.42
$37.98
$32.35
$0.00 $0.00
$35.37
$0.00
$10.00
$20.00
$30.00
$40.00
$50.00
$60.00
$70.00
average revenue
per square foot
YTD 2008
aggregate revenue
XYZ Eye Institute
Revenue per Square Foot 200_

24. 25
Key Performance Indicators
18
68
64
93
103
91
9
50
32
81
126
103
2.19%
12.17%
7.79%
19.71%
30.66%
25.06%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
0
20
40
60
80
100
120
140
01 - 09 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59
age and # sold
XYZ Eye Institute Frames Sales by Age Demographic YTD 200_
Patients Frame Sales by Age Percent of Total