Cyber thieves don’t physically grab your keys or force an entry into your home, but the damage they do to your organization can be just as consequential. If your nonprofit becomes the victim of cybercrime, it could suffer a blow to its reputation that’s impossible to overcome.
 
So it’s important to assess your risks of data breaches carefully, and implement effective security policies and procedures. This will put you in a better position to protect valuable financial and personal data about donors and other constituents.

Are you a sitting duck? 

Nonprofits generally have limited administrative personnel and often lack dedicated IT staffers. They also typically have smaller budgets for technology solutions such as firewalls, antivirus programs and intrusion protection. It’s no surprise, then, that the nonprofit sector is one of the most frequently compromised by hackers. 
 
Your nonprofit’s network probably contains a wealth of data to entice hackers — for example, donor information, including names, addresses, credit card numbers and bank account information. Also coveted by cybercriminals are personnel data, such as employee Social Security numbers and direct deposit information, and accounting records related to payroll, payables, banking, investments and other financial functions.
 
Hospitals and other nonprofit health care organizations that collect and store patient data, including medical records and insurance information, are particularly vulnerable. Colleges and universities also are popular targets because of their multiple networks and many users — that includes students who participate in risky online behavior such as illegal file downloading.

Is your defense strong enough? 

Most nonprofits are already familiar with protections such as firewalls and antivirus programs. And as long as you keep your programs current and download updates as soon as they become available, you can count on some measure of cybersecurity. 
 
But your defense strategy should extend to include policies and procedures, such as data-handling rules. Overworked staffers may neglect to weed out old files, but it’s important to provide procedures for disposing of sensitive data that’s no longer needed. And key data and systems should be backed up regularly and stored in a safe offsite location. Because nonprofit employees often share responsibilities, be sure to create accountability for specific jobs.
 
Training for staffers, volunteers and board members is critical, too. For example, your network’s users should be made aware of such issues as e-mail scams and “social engineering,” where criminals manipulate people into volunteering passwords and other information. Also educate your employees about the proper use of laptops and mobile devices.
 
Finally, consider taking proactive steps against an attack by hiring a “white hat” hacker. This consultant uses the latest techniques to test your network and devices for holes so that you can plug them.

Are you up for a fight?

Of course, a robust cybercrime-fighting program takes time and at least a small bite out of your nonprofit’s budget. Convincing your board that such expenditures are necessary may be tough.
 
Increasingly, nonprofits are creating technology committees led by tech executives or other knowledgeable board members. If your board lacks tech expertise, make recruiting someone who understands the need for cybersecurity — and how to achieve it — a priority. Your tech committee might be tasked with creating policies, determining budgets, evaluating software and products such as cyber liability insurance, and planning how your organization would respond to a cyber attack.
 
If your tech committee plans to act as first responders to a cybersecurity incident, be sure to include a public relations expert in the group. The timing and wording of communications can significantly affect how the media and your organization’s stakeholders respond to an event.

Thwarting cyber thieves

Unfortunately, cybercrime will continue to threaten organizations of all types, including nonprofits, for the foreseeable future. Make sure that your organization is doing all that it can to thwart cyber thieves. 

Generally, one of the requirements for maintaining a corporation’s existence (and the liability protection that it affords) is that the shareholders and Board of Directors must meet at least annually. Although most people view this requirement as a necessary evil, it doesn’t have to be a waste of time. For example, in addition to being a first step in making sure the corporation is respected as a separate legal entity, an annual meeting can be used as an important tool to support your company’s tax positions.

 

Besides the election of officers and directors, other actions that should be considered at the annual meeting include the directors approving the accrual of any bonuses and retirement plan contributions, and ratifying key actions taken by corporate officers during the year. It is common for the IRS to attack the compensation level of closely held C corporation shareholder/officers as unreasonably high and, thereby, avoiding taxation at the corporate level. A well-drafted set of minutes outlining the officers’ responsibilities, skills, and experience levels can significantly reduce the risk of an IRS challenge. If the shareholder/employees are underpaid in the start-up years because of a lack of funds, it is also important to document this situation in the minutes for future reference when higher payments are made.

 

The directors should also specifically approve all loans to shareholders. Any time a corporation loans funds to a shareholder, there is a risk that the IRS will attempt to characterize all or part of the distribution as a taxable dividend. The primary documentation that a distribution is intended to be a loan rather than a dividend should be in the written loan documents, and both parties should follow through in observing the terms of the loan. However, it is also helpful if the corporate minutes document the need for the borrowing (how the funds will be used), the corporate officers’ authorization of the loan, and a summary of the loan terms (interest rate, repayment schedule, loan rollover provisions, etc.).

 

A frequently contested issue regarding a shareholder/employee’s use of employer-provided automobiles is the treatment of that use as compensation (which is deductible by the corporation) vs. treatment as constructive dividends (which is not deductible by the corporation). Clearly documenting in the corporate minutes that the personal use of the company-owned automobile is intended to be part of the owner’s compensation may go a long way in ensuring the corporation will get to keep the deduction.

 

If the corporation is accumulating a significant amount of earnings, the minutes of the meeting should generally spell out the reasons for the accumulation to help prevent an IRS attempt to assess the accumulated earnings tax. Also, transactions intended to be taxable sales between the corporation and its shareholders are sometimes recharacterized by the IRS and the courts as tax-free contributions to capital. Corporate minutes detailing the transaction are helpful in supporting a bona fide sale.

 

As you can see, many of the issues raised by the IRS involve the payment of dividends by the corporation. (The IRS likes them — the corporation doesn’t.) To help support the corporation’s stance that payments to shareholders are deductible and that earnings held in the corporation are reasonable, corporate minutes should document that dividend payments were considered and how the amount paid, if any, was determined. Dividends (even if minimal) should generally be paid each year, unless there’s a specific reason not to pay them — in which case, these reasons should be clearly documented.

 

These are just a few examples of why well-documented annual meetings can be an important part of a corporation’s tax records. As the time for your annual meeting draws near, please call us if you have questions or concerns.

 

Make no mistake; dentistry is one of the most overhead-intensive professions. According to Dental Economics Magazine, overhead as a percentage of practice revenue runs upwards of 73 percent for the average American dentist. 

Untamed, this “cost of doing business” can take a big bite out of net profits, making practice owners feel they are not earning enough for their efforts.

Of course, you could ramp up production. But that requires working harder. 

Or, you could take steps to tame your overhead. Here, the idea is that a dollar saved in practice expenses is a dollar earned. With that in mind, consider how you can reduce costs in these key expense categories:

Supplies – If you look, you’ll probably find the overhead beast lurking in your supply room. Are you using disposable safety glasses and bite blocks for X-rays? Supplies that can be sterilized and reused might be a more cost-effective alternative. At the same time, review supply costs in terms of a desired percentage of production. For example, if you want to keep dental-supply costs within a range of 4 to 5 percent — and you produced $30,000 last month — your cost of supplies should not have exceeded $1,200. Use $1,200 as your target amount for the next month, and track your progress.

Lab Costs – Cost isn’t the only factor in working with a dental lab. The critical question really is whether the lab provides quality products that you don’t have to send back for adjustment again and again. Likewise, are the lab fees reasonable in terms of the revenue you generate for the procedure?

Staffing – Nothing drains overhead like poorly performing staff. Make sure you’re getting value for the salaries you pay. That starts with investing time and money in the training your staff needs to perform at the top of their game. You can also look at shifting some portion of salary (which is a fixed overhead expense) and making it a variable, performance-based expense. With a production-based bonus system, for example, salaries increase only when staff members work harder and more efficiently.

Occupancy — Are you paying rent at a reasonable rate for your location? With communities and demographics changing so rapidly, it might be smart to only commit to a lease for 5 years or less — and negotiate for extension options. At the end of the lease you could determine if the location of the office is still attractive. 

The bottom line is that when you cut overhead, you increase your take-home profit — day after day, year after year. Take the time to review your financial statements and analyze overhead costs at least quarterly and annually. 

Contact our office today for help in getting a handle on your current practice overhead, as well as establishing target overhead percentages. 

Determining how much a business should pay its owners is never easy. You’ve got to consider a variety of factors, including just what form (salaries, benefits, stock) that compensation will take. You also need to ensure your approach will hold up under IRS scrutiny.
 

Balancing act

 
Let’s start with the basics. Compensation is affected by the amount of cash in your company’s bank account. But just because your financial statements report a profit doesn’t necessarily mean you’ll have cash available to pay owners a salary or make annual distributions. Net income and cash on hand aren’t synonymous.
 
Other business objectives — for example, buying new equipment, repaying debt and sprucing up your office — will demand dollars as well. So, it’s a balancing act between owners’ compensation and dividends on the one hand, and capital expenditures, expansion plans and financing goals on the other.
 

Dividend double-taxation

 
If you operate as a C corporation, your business is taxed twice. First, business income is taxed at the corporate level. Then it’s taxed again at the personal level as you draw dividends — an obvious disadvantage to those owning C corporations.
 
C corporation owners might be tempted to classify all the money they take out as salaries or bonuses to avoid being double-taxed on dividends. But the IRS is wise to this strategy. It’s on the lookout for excessive compensation to owners and will reclassify above-market compensation as dividends, potentially resulting in additional income tax as well as interest and penalties.
 
The IRS also monitors a C corporation’s accumulated earnings. Generally similar to retained earnings on your balance sheet, accumulated earnings measure the buildup of undistributed earnings. If these earnings get too high and can’t be justified as needed for such things as a planned expansion, the IRS will assess a tax on them.
 

Other business structures

 
Perhaps your business is structured as an S corporation, limited liability company or partnership. These are all examples of flow-through entities that aren’t taxed at the entity level. Instead, income flows through to the owners’ personal tax returns, where it’s taxed at the individual level.
 
Dividends (typically called “distributions” for flow-through entities) are tax-free to the extent that an owner has tax basis in the business. Simply put, basis is a function of capital contributions, net income and owners’ distributions.
 
So, the IRS has the opposite concern with flow-through entities: Agents are watchful of dealer-owners who underpay themselves to avoid payroll taxes on owners’ compensation. If the IRS thinks you’re downplaying compensation in favor of payroll-tax-free distributions, it’ll reclassify some of your distributions as salaries. In turn, while your income taxes won’t change, you’ll owe more in payroll taxes than planned — plus, potentially, interest and penalties.
 

Red flags, higher taxes

 
Above- or below-market compensation raises a red flag with the IRS — and that’s definitely undesirable. Not only will the agency evaluate your compensation expense — possibly imposing extra taxes, penalties and interest — but a zealous IRS agent might turn up other challenges in your records, such as nonsalary compensation or benefits.
 
What’s more, it might cause a domino effect, drawing attention in the states where you do business. Many state and local governments face budget shortages and are hot on the trail of the owners’ compensation issue and will follow federal audits to assess additional taxes when possible.
 

Other interested parties

 
Other parties also might have a vested interest in how much you’re getting paid. Lenders, franchisors and minority shareholders, for instance, could think you’re impairing future growth by paying yourself too much.
 
Plus, if you or your business is involved in a lawsuit, the courts might impute reasonable (or replacement) compensation expense. This is common in divorces and minority shareholder disputes. In these situations, you’d be wise to consult an attorney early in the compensation decision-making process.
 

Best practice

 
The best practice in owners’ compensation is to see to it that you’re being fairly compensated — and that you’re in line with industry figures. Avoid red flags, and your decisions should be able to withstand outside scrutiny. 

Adapting to the times – Estate planning focus shifts to income taxes

Until recently, estate planning strategies typically focused on minimizing federal gift and estate taxes, with less regard for income taxes. Today, however, the estate and income tax law landscape is far different. What does this mean for estate planning? For many people — particularly those who expect to have little or no estate tax liability — it means shifting their focus to strategies for reducing income taxes. 

Changing estate tax law

For many years, the combination of relatively low estate tax exemption amounts and high marginal rates could easily devour more than half of an estate’s value. Popular estate planning techniques often had income tax implications, but in general any income tax consequences were eclipsed by the estate tax savings.

Now that has changed. For one thing, since 2001, the federal exemption has grown from $675,000 to $5.45 million. And, unlike before 2013, the exemption isn’t scheduled to drop in the future. In fact, it will continue to gradually increase via annual inflation adjustments. Estate tax rates have also decreased significantly, from 55% to 40%. And the 40% rate has no expiration date.

For many people, this new gift and estate tax law regime means federal gift and estate taxes are no longer an issue.  

Income tax matters

At the same time that potential gift and estate tax liability has disappeared for many, individual income tax rates have increased. In 2001, the top federal income tax rate was 39.1%, substantially lower than the top federal estate tax rate of 55%. Now the top income tax rate has grown to nearly as high as the current top estate tax rate.

Taxpayers with taxable income of more than certain annually adjusted levels (for 2016, $415,050 for single filers, $441,000 for heads of households, and $466,950 for joint filers) are now subject to a 39.6% marginal rate. 

Capital gains rates also have increased. Currently, the top rate is 20% (up from 15%) — 23.8% for taxpayers subject to the Affordable Care Act’s 3.8% net investment income tax (NIIT). It applies to certain net investment income — including dividends, taxable interest and capital gains — earned by taxpayers whose modified adjusted gross income tops $200,000 ($250,000 for joint filers, $125,000 for separate filers). The NIIT thresholds aren’t annually adjusted.

Fortunately, many estate planning strategies are available that can help reduce income taxes. Consider the family limited partnership (FLP). A properly structured and operated FLP allows parents to shift income to children or other family members in lower tax brackets by giving them limited partnership interests. But watch out for the kiddie tax, which can undo the benefits of income shifting if you transfer FLP interests to dependent children under the age of 19 (age 24 for certain full-time students).

Tax basis planning

The heightened importance of income taxes also means that there may be an advantage to holding assets until death rather than giving them away during your life. If you give away an appreciated asset, the recipient takes over your tax basis in the asset, triggering capital gains taxes should he or she turn around and sell it. 

When an appreciated asset is inherited, on the other hand, the recipient’s basis is “stepped up” to the asset’s fair market value on the date of death, erasing the built-in capital gain. So, from an income tax perspective, there’s an advantage to retaining appreciating assets until death rather than giving them away during your lifetime.

For those with large taxable estates, however, this advantage may be outweighed by estate tax concerns. From an estate tax perspective, it’s preferable to remove appreciating assets from your estate — through outright gifts or contributions to irrevocable trusts — as early as possible. That way, all future appreciation in their value will be shielded from estate tax. 
If your net worth is safely within the estate tax exemption, retaining assets until death will minimize the impact of built-in capital gains on your heirs. Alternatively, if you want to share your wealth with your children or other family members, consider using an estate defective trust, which provides current income to your beneficiaries without removing the trust assets from your estate. (See below under “Have your cake and eat it.”)

Charitable planning

Higher income taxes can also have a big effect on charitable giving strategies. If your estate plan includes charitable bequests, for example, it makes sense to fund those bequests with assets that otherwise would generate “income in respect of a decedent” (IRD).

IRD is income that a deceased person earned but never received, such as IRA or qualified retirement plan distributions. Unlike other inherited assets, which are income-tax-free to the recipient, IRD assets can trigger a significant tax bill. But you can avoid these taxes by donating the assets to charity.

If your estate is within the exemption, it’s preferable to make charitable gifts during your lifetime. This is because, if you have no estate tax liability, charitable bequests won’t yield any tax benefits. But lifetime donations can generate valuable income tax deductions.

Do the math

Identifying the right estate planning strategies for you and your family is in part a matter of running the numbers. Projecting your income and estate tax liabilities — including state as well as federal taxes — will help you determine whether it’s better to focus on reducing estate taxes or income taxes.

Have your cake and eat it

Intentionally defective grantor trusts — also known as income defective trusts (IDTs) — have long been a popular tool for reducing estate taxes. These trusts ensure that assets are removed from your estate while the trust income remains taxable to you. If, however, your estate is well within the $5.45 million gift and estate tax exemption — so that you’re more concerned with reducing income taxes — you might consider an estate defective trust (EDT).

An EDT is essentially the opposite of an IDT. It’s designed so that the trust income is taxable to your beneficiaries while the assets remain in your taxable estate. From an income tax perspective, an EDT provides two significant benefits. First, you can use it to shift income to beneficiaries in lower tax brackets, reducing your family’s overall tax burden. Second, it allows you to share some wealth with your beneficiaries now without losing the benefits of the stepped-up basis at death.

 

Reposted from AICPA Insights, January 25, 2016 Post by James B. Jordan, CPA, CGMA

Contributions – whether by cash, check, or online giving – are the lifeblood of faith-based organizations. Many do not realize how often these donations get into the wrong hands.

There are primarily two types of theft that occur in faith-based organizations –larceny and skimming. Larceny occurs after the money has been counted, deposited, and recorded in the books of the organization. Skimming occurs when donations never get logged in the books; that is, they go missing before ever being recorded. It is the counting and depositing process that opens the organization up to skimming, and that is where fraud can be most difficult to detect. 

Faith-based organizations need to take steps to ensure that contributions make it into the bank in the first place. 

Read the full article  here

Stay on top of filing and reporting deadlines with our tax calendar! Our tax calendar includes dates categorized by employers, individuals, partnerships, corporations and more to keep you on track. 

2016 Tax Calendar_Quarter_2

The Financial Accounting Standards Board (FASB) has issued its long-awaited update revising the proper treatment of leases under U.S. Generally Accepted Accounting Principles (GAAP). Accounting Standards Update (ASU) No. 2016-02, Leases (Topic 842), will affect entities that lease real estate, vehicles, equipment, and other assets. The standard requires these entities to recognize most leases on their balance sheets, potentially inflating their reported assets and liabilities. 

Background

According to the FASB, most lease obligations today aren’t recognized on the balance sheet, and transactions often are structured to achieve off-balance-sheet treatment. A 2005 U.S. Securities and Exchange Commission (SEC) report estimated that SEC registrant companies held approximately $1.25 trillion in off-balance-sheet lease obligations. As a result of these obligations being left off balance sheets, users of financial statements can’t easily compare companies that own their productive assets with those that lease their productive assets. 
 
To address this issue, the FASB launched a joint lease accounting project with the International Accounting Standards Board (IASB) in 2006. The joint project was unsuccessful, however. The boards couldn’t agree on how to report leases on the income statement and decided to issue separate standards. The IASB issued its standard (International Financial Reporting Standards 16) in January, and now the FASB has released its own standard.

Impacts on lessees

Currently, entities that lease assets (lessees) account for a lease based on its classification as either a capital (or finance) lease or an operating lease. Lessees recognize capital leases (for example, a lease of equipment for nearly all of its useful life) as assets and liabilities on their balance sheets. But they don’t recognize operating leases (for example, a lease of office or retail space for 10 years) on the balance sheet. Such leases appear in financial statements only as a rent expense and disclosure item.
 
The new standard will require lessees to recognize on their balance sheets assets and liabilities for all leases with terms of more than 12 months, regardless of their classification. Lessees will report a right-to-use asset and a corresponding liability for the obligation to pay rent, discounted to its present value. The discount rate is the rate implicit in the lease or the lessee’s incremental borrowing rate.
 
The recognition, measurement and presentation of expenses and cash flows arising from a lease by a lessee will continue to depend primarily on its classification as a capital or operating lease:
The standard requires additional disclosures to help users of financial statements better understand the amount, timing and uncertainty of cash flows related to leases. Lessees will disclose qualitative and quantitative requirements, including information about variable lease payments and options to renew and terminate leases.
 
These changes may have additional repercussions for lessees. Entities with significant leases may incur costs to educate their employees on the proper application of the new requirements and financial statement users on the impact of the requirements. They’ll need to develop supplemental processes and controls to collect the necessary lease information. 
 
The reporting changes could affect financial ratios and, in turn, have implications for debt covenants. They might also lead to higher borrowing costs for lessees whose balance sheets look weaker with their operating leases included. Entities could consider buying instead of leasing, because they’ll end up with similar leverage on their balance sheets from either transaction.

Impacts on lessors

Entities that own leased assets (lessors) will see little change to their accounting from current GAAP. The new standard does, however, include some “targeted improvements” intended to align lessor accounting with both the lessee accounting model and the updated revenue recognition guidance published in 2014 (ASU No. 2014-09, Revenue from Contracts with Customers)
 
For example, lessors may be required to recognize some lease payments received as liabilities in cases where the collectability of the lease payments is uncertain. Users of financial statements will have more information about lessors’ leasing activities and exposure to credit and asset risk related to leasing.
 
Lessors also could see the changes to lease accounting play out in lease negotiations. Existing lessees may seek to modify their leases to reduce the impact of the new standard on their balance sheets by, for example, securing lease terms of one year or less. 

Combined contracts

Contracts sometimes include both lease and service contract components (for example, maintenance services). ASU 2016-02 continues the requirement that entities separate the lease components from the nonlease components, and it provides additional guidance on how to do so. 
 
The consideration in the contract is allocated to the lease and nonlease components on a relative standalone basis for lessees. For lessors, it’s done according to the allocation guidance in the revenue recognition standard. Consideration attributed to nonlease components isn’t a lease payment and, therefore, is excluded from the measurement of lease assets or liabilities.

Interplay with international standards

Many aspects of ASU 2016-02 are converged with IFRS 16, including the definition of a lease and initial measurement of lease liabilities. But there are some significant differences.
 
For example, the IASB opted for a single-classification model that requires lessees to account for all leases as capital leases. That means leases classified as operating leases will be accounted for differently under GAAP vs. IFRS, with different effects on the statement of comprehensive income and the statement of cash flows.

Effective dates and transition

Public companies are required to adopt the new standard for interim and annual periods beginning after December 15, 2018. Nonpublic entities following GAAP will need to comply for annual periods beginning after December 15, 2019, and for interim periods beginning a year later. Early adoption is permitted.
 
The standard requires entities to take a “modified retrospective transition approach,” which includes several optional “practical expedients” entities can apply. An entity that elects to apply the practical expedients will, in effect, continue to account for leases that begin before the effective date in accordance with previous GAAP unless the lease is modified. 
 
The exception is that lessees are required to recognize a right-of-use asset and a lease liability for all operating leases at each reporting date based on the present value of the remaining minimum rental payments that were tracked and disclosed under previous GAAP. 

Act soon if you have extensive lease portfolios

Because of this standard’s long gestation period, many entities have taken a wait-and-see approach to tackling the lease accounting changes. But now that the new standard has been released, entities would be wise to begin their preparations if they have extensive lease portfolios. 

When reviewing financial statements, nonprofit board members and managers sometimes make the mistake of focusing solely on bottom-line figures. But financial statements also may include a wealth of information in their disclosures.

Savvy constituents and potential supporters know this and will examine the notes to your financial statements to gain a sense of how well your organization is pursuing its mission. This means that you, too, need to be familiar with the common types of disclosures and the information they make available for scrutiny.

What’s in your accounting policies?

The summary comprises two sections: a brief description of your nonprofit (including its chief purpose and sources of revenue) and a list of the main accounting policies that have been applied in preparing your financial statements (with a subsection for each specific policy). A policy is generally considered significant if it could materially affect the determination of financial position, cash flows or changes in net assets.

The summary outlines specific policies such as:

The disclosure of accounting policies should describe accounting principles and methods that have been selected from acceptable alternatives, and explain industry peculiarities or unusual or innovative applications of Generally Accepted Accounting Principles (GAAP).

How are your investments performing?

Nonprofits must disclose in the notes a variety of information related to investments, beginning with the types of investments, such as equities, U.S. Treasury securities and real estate. Among other information, the notes must disclose the carrying amounts for each major type of investment, current year income, realized and unrealized gains and losses, and information about how fair value is determined.

Have you had related party transactions?

Constituents may look to the related party transaction disclosure to determine if the not-for-profit is susceptible to conflicts of interest. The note describes transactions entered into with related parties such as board members, senior management and major donors. The description should include the nature of the relationship between the parties, the dollar amount of the transaction and any amounts owed to or by the related party as of the date of the financial statements, and the terms and manner of settlement. Guarantees between related parties also must be disclosed.

What about contingencies?

The not-for-profit must disclose any reasonably possible loss contingencies. Contingencies are existing conditions that could create an obligation in the future but arise from past transactions or events. Constituents may find loss contingencies of particular interest because of their potential effect on financial position and net assets. The financial statement notes must disclose the nature of the contingency and provide an estimate of the loss (or state that an estimate can’t be made). In certain circumstances, gain contingencies also may need to be disclosed.

Examples of nonprofits’ contingencies include:

Contingencies related to noncompliance with donor restrictions also should be included in the disclosures.

What were your fundraising costs?

Contributors, funding sources and regulators tend to be more interested in total expenses by function, such as fundraising costs, than expenses for line items like professional fees, postage and supplies. Nonprofit financial statements should disclose information that allows users to compare the total amount of fundraising costs with the related proceeds and total program costs. If a ratio of fundraising expenses to funds raised is disclosed, the organization also should describe the method used to compute it.

What’s behind the numbers?

Bottom-line numbers don’t always tell the whole story of an organization’s financial health. Board members and management need to follow the lead of their savvier constituents and take the time to read the disclosures so they know the facts behind the figures and can plan for their organization accordingly. 

 

Second in a series

The shift is on as healthcare providers are increasingly being incentivized to provide high-quality care at a lower cost.

Ultimately, the goal is delivery of healthcare that provides patients with:

– the best outcomes,
– from the most appropriate treatment, 
– by the right kind of provider, 
– at the right time, and
– in the most appropriate setting.

Under a value-based payment model, physicians are rewarded for good work — not just good workloads. Current value-based payment models include:

Bundled Payments — One payment is made for the entire range of services provided around a particular episode of care. Payment is typically paid to one entity (e.g., a hospital), which then pays the participating physicians from that bundle.

Shared Savings Arrangements — A physician is rewarded if patients have better-than-average quality/cost outcomes, and is penalized for excessive costs and poor outcomes.

Value-Based Payment Modifier — The Value Modifier provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished compared to the cost of care during a particular performance period. 
 

7 Things to Consider

As providers consider entering into value-based and/or risk-sharing arrangements, they will certainly need to focus on the details. In particular, physicians are well advised to evaluate these critical factors: 

  1. Risk — What is your financial risk exposure? Does the payment model offer protection by limiting your total risk exposure? Just as important, does the plan penalize you for factors outside of your control? 
  2. Reward — Does the contract include appropriate rewards for achievement of performance goals? Will you be given credit for quality achievements outside of stated performance goals?
  3. Distribution — How will bonuses from any shared savings be distributed? Are the shared savings distributed equitably between all of the stakeholders? Any agreement should spell out how allocations will be made to each provider (e.g., through utilization and outcome measurement).
  4. Performance Goals — Are performance goals set at reasonable levels — and can they be achieved within the current care setting? Just as important, will you have the ability to help establish the goals and measurement criteria?  Does the contract allow for innovation in care approaches?
  5. Measurement — Are required tools and processes already in place to accurately measure outcomes, identify at-risk patients and successfully report and monitor quality and cost data? How is that data communicated to the payer? 
  6. Providers — Shared savings and bundled payment arrangements typically cover the entire continuum of care — primary care, acute care and post-acute care services. Are the right providers in place for success? 
  7. Liability — Traditionally, physicians have been able to accept or refuse to treat a patient or a group of patients, as well as choose physicians or other healthcare professionals with which to collaborate. Is there any additional risk associated when participating with other organizations or physicians? Does the contract limit your ability to do what is right for the patient?

The Payment Train Has Left the Station

It is estimated that in the next 10 years, 50 percent of physician compensation will come from value-based care payment models. Physicians who  think through the issues and opportunities now will be better prepared for success in the value-based world. 

Value-based care is a complex issue requiring careful analysis of its potential impact on physician practices. Please look for our continuing blog articles on this topic.