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Presentation on theme: "T HE P HYSICIAN A SSISTANT B USINESS O WNER R ICHARD OB RINGER, PA-C ASAPA Spring Conference 2011."— Presentation transcript:


2 D ISCLOSURES Stockholder - Zimmer Holdings Stockholder - Cardo Med INC COM Stockholder - Pfizer INC President / Owner – Richard OBringer, PA-C, a prof., corp. dba - Advanced Surgical Associates. Member / Owner – Axis Surgical, LLC (ortho implant distribution distributorship)

3 D ISCLAIMERS This is a Commercial Presentation Physician Assistant owner since 2004 Not an Attorney or CPA This is not legal or tax advice Shared experiences Overview Monday morning

4 Learning Objectives Communicate PA rights & responsibilities of incorporating and billing Medicare Analyze basic options for incorporating Analyze tax benefits and cost analysis of incorporating Develop business plans, corporate compliance, HR, resources, & leadership Create sales and marketing strategies, trends, and tools

5 Pre-test question #1 Physician Assistants can bill Medicare independently, and be paid directly from Medicare, ONLY using their; A. Social Security number B. TIN of an approved corporate entity C. PA UPIN Number D. Through their physicians UPIN

6 Pre-test question #2 A distribution from your corporation does not need to be reported to the IRS as income? A. True B. False

7 Pre-test question #3 Which type of corporation is double taxed? A. S-Corp B. C-Corp C. LLC D. LLP

8 Who We Are Advanced Surgical Associates offers PA first assist surgical services to surgeons. Our services are free since we bill insurance directly Actively expanding and recruiting PAs

9 Getting Started in Business Incorporating hiringfiringpayroll business plan corporate compliance billing bookkeeping taxes liability asset protection contracting sales marketing invoicing inventory litigation insurance

10 Spirit of an Entrepaneur This just might work and I think Ill try it The journey of a thousand miles begins with a single step ~ Buddha Beginning is half done! ~ Confucius

11 Is Ownership Right for You ? Independent Contracting Offer PA services hourly, per-diem, other ? Consulting ? Independent billing Negotiate collection split with doc ? Four walls Clinic, other ? Tax benefits

12 Federal Law and PA Ownership 4/1/2002 - CMS expands employment & ownership opportunities. PAs permitted up to 99% ownership interest in approved corporate entity that bills Medicare program. Any other person own 1% (spouse, family member, friend, business partner) TIN vs. SS# Some states restrict PA ownership to 49% (varies) Doc must own 51% - Avoids conflict of interest Review laws in your state Arizona has no such restrictions Non-medical entity can own 49% Consult with AAPA, State Academy & attorneys who know how to structure Ownership VS Compensation VS Physician Supervision PA owners still have physician supervision per state regulation Education helps to reassure control and compliance

13 PA Ownership in Arizona A medical practice in Arizona may be owned by a professional corporation, a professional limited liability company or certain other types of entities. Arizona law permits PA ownership of such entities or co-ownership with physicians. A corporation may elect professional corporation status for the purpose of rendering professional services within two or more categories of professional service, unless the combination of professional purposes is expressly prohibited by a licensing law of the state applicable to one or more of the professions in the combination or by a licensing authority with jurisdiction over one or more of the professions in the combination. No such limitation exists precluding PAs and physicians from co-owning a professional corporation. Similar rules apply to professional limited liability companies. Under recent revisions to Arizona corporate statutes, up to 49% of the shares of a professional corporation or of the equity interests in professional limited liability companies may be owned by non-licensed persons or entities.

14 Creating a Business Plan Do you need a Formal business plan ? Check with your bank first, its free advice SBL, SBA, Chamber of Commerce – free resources

15 Incorporating 5 Common Mistakes 1. Incorporating without getting the advice of a good CPA 2. Thinking the corporate veil gives you unlimited liability protection. 3. Operating without proper local business licenses 4. Not filing periodic paperwork or taxes as required 5. Incorporating without sufficient capital or revenue stream

16 Options for Incorporation S-Corp Single tax – Individual only Pass through entity Pass-through taxation means that income of the corporation is not assessed corporate taxes. Instead, the income or losses of the corporation are distributed among the individual shareholders in direct proportion to their ownership or investment in the company. Income or loss is then claimed on the individual tax returns of the shareholders as personal income, and it is taxed at a much lower rate than the Corporate tax assessment.

17 Options for Incorporation C-Corp Taxed at two levels – Double Taxation o Pays tax on its corporate income o Then, distributes profits to stockholders who pay income tax on those dividends o For companies looking to go public

18 Options for Incorporation Limited Liability Corp (LLC) Better for smaller businesses More flexible than Corporations May be owned by non-US citizens May be owned by a Corporation or another LLC Unlimited shareholders Different levels / classes of ownership Less taxation (individual assessment only) Offers more asset protection – limited

19 Options for Incorporation Limited Liability Partnership (LLP) Separate legal entity May own property – sue / be sued Liability Protection for all General Partners from claims against the LLP Liability Protection for the LLP from claims against a General Partner Partner dividends are reported on the partners personal tax returns No date of termination is required in the Partnership Agreement

20 Incorporating Why should you incorporate ? o To bill Medicare o Tax benefits o Liability – asset protection When should you incorporate ? o Personal income level above $150,000 - $200,00 advantages vs. obligations & cost

21 Tax Benefits 25% of income tax deferred into; SEP-IRA max $49,000 / year 401K max $54,500 / year 50yo catch up provision Able to borrow up to 50% of value More structure & cost to establish & maintain Independent Contractors, 1099 can also deduct Must offer other employees same Can require three year eligibility

22 Tax Benefits Vehicle paid for by corp. Lease VS Purchase Meals with employees & contractors 100% deductable Otherwise 50% deductable Other Expenses – (some have caps) Legal, travel, malpractice, office, marketing, advertising, promotions, events, FUN!

23 Independent Contracting Definition 1099 / sole proprietor - interchangeable terms True independence ? Who dictates hours / schedule ? More than one revenue source ? Multiple clients ? State law requirements ? Stand alone – biz cards, sub-contractors, multiple locations ?

24 Tax Obligations Independent Contractors, Sole Proprietor, 1099 must pay their own portion of FICA (Social Security & Medicare) 5.65% FICA 5.65% is paid by each side (employer & employee) 0.5% Modified business tax 0.08% Federal Unemployment $7,000 / year cap 3% state unemployment $27,700 / yr cap (Nevada) Add 11% to your compensation to offset Distributions = profit i.e. taxable income (shell game myth) Payroll Yourself; W2

25 Pay your taxes Follow the rules & be careful looking for loopholes

26 Corporate Compliance - Obligations Business license Annual corporate filing – list of officers Annual officers meeting & minutes State sales tax – file the forms (zero out) Work comp insurance - $500 / yr for 2 people self ? home office ? 1099 contractors? travel ? provide - federal posters, background checks, safety manuals, other ancillary services OSHA safety manual annual log of accidents injury report (C4 form)

27 Sales & Marketing

28 Monday Morning Tools Like leads to trust Trust leads to new business Laughter leads to new business First impressions strike an emotional cord Video – is sales really this simple and fun?

29 Making a connection with your audience

30 Facebook Fans Increase

31 Sales Increase

32 Procter & Gamble stock rises

33 Be yourself, be likable



36 How do you make the connection? Harvard Business Review Rule of 6 Create encounters o Frequency is what matters o Repeated exposures No pressure Be yourself Reason to return Building the relationship is the goal, not sales or referrals

37 Make the connection Sound bite (30 seconds or less) Initial presentation Keep it simple and to the point Frequency of information, not volume o TV commercial Questions, concerns, & objections All are signs of interest

38 Leadership

39 Strengths Engagement Track Benchmark study of 65 high performing teams Journal of Applied Psychology Dr. Jim Harter, Gallup Organization Dr. Frank Schmidt, University of Iowa

40 Employee Engagement


42 Strengths Engagement Track Performance Outcomes Productivity Profitability Customer satisfaction Employees turnover Safety measures

43 Building a productive and engaged team Communication is key Do you know what is expected of you at work ? Do you feel that your opinions count ? Do you feel someone at work cares about you ?

44 Strengths Engagement Track Changing Course Identify Change Grow

45 Communication Seek first to understand, then to be understood. ~ Stephen R. Covey The 7 Habits of Highly Effective People

46 Summary Get started Incorporate Enjoy tax advantages and follow the rules Sell your idea Develop sound bite Be likeable Create encounters Foster communication Engage and empower your organization & your people

47 Post-test question #1 Physician Assistants can bill Medicare independently, and be paid directly from Medicare, ONLY using their; A. Social Security number B. TIN of an approved corporate entity C. PA UPIN Number D. Through their physicians UPIN

48 Post-test question #2 A distribution from your corporation does not need to be reported to the IRS as income ? A. True B. False

49 Post-test question #3 Which type of corporation is double taxed ? A. S-Corp B. C-Corp C. LLC D. LLP

50 Resources Available on our Website


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