Examine your cash flow inputs. The place to start your cash flow analysis is to determine where you generate your revenues.

CASH INPUTS

Let’s begin with examining the cash inputs and some trends that impact your ability to generate revenues.

1. Revenues from Services and Procedures are derived from:
   1. Patients directly- this is increasing and patients will be required to pay more of the costs.
   2. Insurance companies have increased their premiums and deductibles because of increasing costs and Obama-care requirements.
   3. Medicare is paying lower fees, increasing the payment times and challenging more of the services and procedures and their submitted costs.
   4. Medicaid is not offered in all States and is part of Obama-care.
   5. Employers are reducing or eliminating coverage and increasingly moving toward “health savings plans” and avoiding the penalties of Obama-care by moving employees to “part-time” status, which is not covered under the legislation.
2. Tax refunds. Taxes at all levels are increasing and practices are trying to avoid overpaying and so refunds are decreasing.
3. Consultation and second opinion income– Healthcare practices, hospitals, clinics are increasingly merging and consolidating and so they have more resources to provide consultation and second opinions from their own staff and not using outside individuals or organizations. Therefore this type of income is likely to continue to decline.
4. Publications and Teaching- Social media and the increasing number of healthcare blogs and articles are increasing. In most cases there is no compensation paid for these and so the income derived is declining.
5. Other income. There are an increasing number of practices and organizations that are now providing healthcare products and consumables that provide supplementary income. Many practitioners have aligned with the companies that produce and market these products and some have signed franchise agreements.