The Physician Assistant Business Owner Richard O’Bringer, PA-C

1. The Physician Assistant Business OwnerRichard O’Bringer, PA-C ASAPA Spring Conference 2011

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

3. Disclaimers • This is a Commercial Presentation • Physician Assistant owner for 7 years • Not an Attorney or CPA • This is not legal or tax advice • Shared experiences • Overview • Monday morning www.PAassist.net

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; • Social Security number • TIN of an approved corporate entity • PA UPIN Number • 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? • True • False

7. Pre-test question #3 Which type of corporation is “double taxed?” • S-Corp • C-Corp • LLC • 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 PA’s

9. Getting Started Incorporating hiring firing payroll bookkeeping litigation corporate compliance billing liability contracting sales invoicing inventory insurance taxes marketing asset protection business plan

10. Spirit of an Entrepaneur “This just might work and I think I’ll try it” “The journey of a thousand miles begins with a single step” ~ Buda “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 – PA Ownership • 4/1/2002 - CMS expands employment & ownership opportunities. PA’s 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) • SS# vs. TIN • Some states restrict PA ownership to 49% (varies) • Doc must own 51% • Avoids conflict of interest • Review laws in your state • Consult with 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. Creating a Business Plan Do you need a “Formal” business plan? Ask your bank first, it’s free advice SBL , SBA, Chamber of Commerce – free resources

14. Incorporating5 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

15. 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.

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

17. 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”

18. 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

19. Incorporating • Why should you incorporate? • To bill Medicare • Tax Benefits • Liability – asset protection • When should you incorporate? • Personal income level above $150,000 - $200,00 advantages vs. obligations

20. 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 do • Must offer other employees same • Can require three year eligibility

21. Tax Benefits • Vehicle paid for by corp. • Lease VS Purchase • Meals with employees & contractors 100% deductable • Otherwise 50% deductable • Other Expenses • Caps: gifts, student loans, office, travel, marketing, advertising, promotions, events, FUN!

22. Independent ContractingDefinition 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?

23. 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

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

25. Corporate Compliance - Obligations • Business License • Annual Corporate Filing – List of Officers • Annual Officers Meeting & Minutes • State Sales Tax – File Forms • Federal Posters • Work Comp Insurance - $500 / yr for 2 people • self? home office? 1099 contractors? travel? • OSHA • Safety Manual • Annual Log of Accidents • Injury Report (C4 form)

26. Sales & Marketing

27. Sales & Marketing • Like leads to trust • Trust leads to new business • Laughter leads to new business • First impressions strike an emotional cord

28. Connecting

29. Results

30. Results

31. Procter & Gamble stock rises

32. Be yourself, be likable

33. Make the connection • Harvard Business Review • Rule of 6 • Create encounters - no pressure • Be yourself • Build the relationship • Reason to return

34. Make the connection • Sound Bite (30 seconds or less) • Initial Presentation • Keep it simple and to the point • Questions, concerns, & objections • All are signs of interest

35. Leadership

36. 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

37. Engagement

38. Engagement 25.56 0.0

39. Strengths Engagement Track Performance Outcomes • Productivity • Profitability • Customer Satisfaction • Employees Turnover • Safety Measures

40. 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?

41. Employee communication • Employer evaluations • Fostering open communication • Asking questions • Reflective listening • Understanding employee needs • Benefits

42. Strengths Engagement Track Changing course • Identify • Change • Grow

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

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

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

46. Post-test question #3 Which type of corporation is “double taxed?” • S-Corp • C-Corp • LLC • LLP

47. 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

48. Thank You For Attending www.PAassist.net