What is a CFO?

EPISODE NOTES

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Jonathan:

Welcome to the Tooth & Coin podcast, where we talk about your adventure of being a dental practice owner. In these episodes, we're going to be talking about problems that you will likely face as a practice owner, as well as give an idea about actionable solutions that you can take so that you can get past this problem in your practice. Some of these concepts are really big ones. Some of them are very specific, but we hope that these episodes help you along with your journey.

Jonathan:

Now, a very important piece for you to understand is that this is not paid financial advice. This is not paid task or legal advice. We are not your financial advisors. We are not your CPAs. This is two CPAs talking about informational and educational content to help you along with your journey. It's a very important piece for you to understand.

Jonathan:

Another thing that you need to know is if you enjoy today's content, join us on the Facebook group. So we've got a Facebook group that is active with dentists that is going to have content talking about what we're talking about today, to continue the discussion. Agree with us, don't agree with us, have a story to tell, have something to share. Join us in the Facebook group. If you go to Facebook and you search for Tooth & Coin podcast, click on it to join it and be able to join us there.

Jonathan:

Finally, if you need some more help, we're developing a list of resources that are going to be centering it around our topics of discussion, to be able to help you a little bit more than what the content is doing. So if you'd like access to that, whenever it becomes ready, all you have to do is text the word toothandcoin T-O-O-T-H-A-N-D-C-O-I-N to 33444.

Jonathan:

Again, that's toothandcoin, all one word, no spaces, to 33444. Reply with your email address and we'll email you instructions on how to get into a Facebook group, as well as add you to a list to be able to send you those resources when they're available and if they're available, we'll go ahead and send them to you as well. So onto today's episode. I hope you enjoy it.

Jonathan:

Hello, ambitious dentist. So today we are talking about the CFO role in dental practices. One of the things that I talk to about, a lot of dentists about throughout all of my conversations is what a CFO is, what they do, how they are aligned with your business. Do you even need one? I'll be honest with you. There's a lot of confusion in the dental industry around the function of a CFO, what CFOs do and is your CPA your CFO? Is that who it is?

Jonathan:

There's a lot of misconceptions about it and Joseph and I are going to talk about that today. So if you didn't listen to the first episode, this is episode number two. On the first episode, we outlined a bit about what the podcast is going to be about. In this episode, we're going to talk a little bit more about that CFO role and what it is, how it works and things like that.

Jonathan:

Joseph was actually the CFO of a medical company that was in the services space and had a lot of success. Seeing that business go from around $3 million a year in revenue upwards to almost eight figures in revenue. So he's got a lot of insight to this and I'm going to be asking him and interviewing him on this topic. So Joseph, why don't we start with that. Let's start with what is a CFO and what do they do?

Joseph:

Great question. Thanks. So when we think about different roles inside of the organization, I think most people are familiar with a CEO and could probably even tell you what a CEO is, a chief executive officer, and you may have heard terms thrown around like C-suite. When we talk about C-suite, what we're talking about is all of the team leads that have C at the beginning of their name.

Joseph:

So you may have a CEO, you may have a CMO, a chief marketing officer. You may have a chief operations officer or COO, you may have a chief compliance officer. So the CFO is the chief financial officer of an organization. So I think that's first and foremost, as you look at the traditional C-suite has three seats, a CEO, chief executive officer. Basically the one that is spearheading everything, the CEO has the vision. They typically are the owner of the practice, owner of the deal.

Joseph:

You're going to have a chief operations officer. So somebody that makes sure that the operations of the company are out there and then you've got the chief financial officer who are making sure that all of the money works. That's as simple as I can break it down. What are your thoughts when you think about what a CFO is, Jonathan?

Jonathan:

Same. The financial side, the F in there which obviously stands for financial, not the other F, it is there to talk about money. It's talking about the numbers. Talking about the ways in which that business has measures and manages its money in terms of the way it's coming in and the terms of the way it's going out. Definitely that's what most people think about when they think about CFOs. What I find in small businesses though, is that there's not always room for a CFO. So the owner usually takes on in smaller businesses.

Joseph:

I think first and foremost, you got to have cash to run a business. You can't pay payroll on an IOU. So at some form or fashion, you've got to have somebody that is managing cash. So that is cash that comes in the business. That's cash that comes out of the business, that comes in and goes out lots of different ways. It may come in through a line of credit, a beginning working capital draw.

Joseph:

It may come in through patient sales and collections. It may come in through credit card transactions, and then it's going to go out by writing checks, paying credit card bills, paying employees, all of those different things. So first and foremost, a typical owner of a small practice is going to be the one that's making sure that the cash comes in and the cash goes out. At the basic, most simplistic level, that's the first role that people are doing.

Jonathan:

I agree. Usually the person who is the owner or ends up being the dentist, they basically have to be all three of those things. They've got to be the CEO, they've got to be the COO and they've got to be the CFO. In that CFO role, they've got to make sure that the money going in and out is going to the right places and that there is something to manage and there's things happening.

Jonathan:

So it's this unique problem that is in the dental industry, that you have to be all of these things in this organization. Now, pretty much every small business has that problem. Obviously I'm the CEO, CFO, COO of Tooth & Coin but I have other people that help me with those things, but I haven't always had those people because we haven't always been as big as we've had.

Jonathan:

So we've had to grow people into those positions as our company has grown and evolved and things like that, but in terms of that small dental practice owner, you mentioned you got to have cash and you got to move those things in and out. What is it that you see in the dental space, being the dentist are doing, maybe even unknowingly as CFOs? What is it that they're probably, whenever they're thinking about their practice at night, they're probably doing in terms of like what a CFO would normally do for you?

Joseph:

Great question. So I think that a lot of them are trying to figure out top line revenue which when we talk about top line revenue, what is the amount of services that have been delivered? We can measure revenue a couple of different ways. As someone comes in the practice and as they get a treatment and they get a cleaning, they get an exam, once that service has been performed, you are owed that money.

Joseph:

So that could be one way that we measure revenue. One of the ways that you can pull that out is pull that out of your practice management software. So they're trying to get an idea of how much revenue is generated. So the next piece of that, that I think that a lot of practice owners are looking at is how much cash is coming in the door?

Joseph:

So there are certain times that 100% of the service that you provide turns into cash the same day, or within a couple of days, if somebody writes you a check, brings you cash or pays with a credit card. So there's not often a lag time between those. What is most common is that there is a lag time between when the service is performed, when the revenue is generated and when the cash actually comes in the door. That's where there's often a difference in timing.

Joseph:

That timing, if you've got a great front office billing person, that's billing and pushing claims out the door, that may just be five days between the time we send it to the PPO insurance company and the time that an EFT shows up into our bank account. We may have patients that are paying us out a month to month to month.

Joseph:

We may have somebody that pays in full with care credit, or with a credit card that turns into money in the bank account within a couple of days. So all of those things, I think that small practice owners are trying to get their arms wrapped around all of these different things as money comes in the door, as revenue is generated. Then what they're trying to do is they're trying to figure out, okay, did I make enough money this month to pay rent, to pay my people, to pay my supply bill, to pay my lab bill, and hopefully to pay myself?

Joseph:

So if I'm set up and I've got payroll running out, hopefully I've generated enough cash coming into the practice to cover all of those expenses. Then at the end of the day, whatever is left over, it depends on who you talk to, but we'll just call it profit. Profit is the simplest way of doing that. As the money came in and the money went out, do you have more money in your bank account today than you did 30 days ago? Then I would call profit.

Jonathan:

So try and get some type of an understanding of how they're making money in practice from revenue to expenses, and then eventually paying themselves and profit and things like that. All within the responsibilities of that dental practice owner, who also is generating production and revenue every day, and managing employees, doing the marketing, doing all the different things that go along with their business. So, with that in mind, what was it that you saw whenever you went to your ... When you started your role as a CFO?

Jonathan:

Again, I could see many of my practices, and many of our clients here at Tooth & Coin are having the same issues as the business that you got into at the time that you got into it as the CFO. Around that $3 million in revenue mark, you got a lot of practices that are around that level, half a million, a million, 2 million, 3 million, but $3 million mark.

Jonathan:

They get to be pretty busy in a small business. So what is it that you saw whenever you walked into that business in the first day in the role of the CFO, that really just hadn't been done that needed to be done from a CFO perspective. Because again, that owner of that business couldn't do everything. There's just no way that you could have that type of skill set to be able to do everything on your own.

Jonathan:

There's a reason there's a million employees at Bank of America. The CFO there is not ahead of every financial element. The CEO doesn't do all the COO and CFO and all the other roles and things. There's reasons why there's more than one person doing all of these things. So what was it that you walked in at day one, your becoming a CFO from the smaller medical business to grow into where it was?

Joseph:

Sure. I think the first thing I noticed is the wild swings and cashflow. It wasn't a matter of, we had the same exact amount of money that would come in every month and every day and we were pretty product heavy. So we had to spend quite a bit of money to provide these specific devices and services before we ended up actually delivering the service. So as you're paying your lab bill, as you're paying your supply bill, there's all these huge outflows that go, and they don't always match up with your revenue perfectly.

Joseph:

So I would see these wild swings in our cashflow. So, as an inquisitive person, if you see wild swings in the cashflow, the first question you're going to ask is why. So the first question I started asking was, "Well, how do we get to deposits into the bank account?"

Joseph:

Well, insurance companies write us checks, patients write us checks, we take credit cards, all these different things. That's how money turns into the bank account. I'm like, "Okay, well, how much did we generate in services last month, for example?" Okay, we'll pull the rapport and we got all the billing done. We got all the services delivered and we would pull the report and they'd say, "All right, well, we did 300,000 this month. That was a great month."

Joseph:

I was like, "Oh, okay. Well, what kind of service was that?" "Well, we did 300,000 this month." I was like, "No, no, no, no. Like specifically, you've got eight lines of business here. How much did you do in each one of those?" They're like, "Well, we can think of those couple of big ones that we delivered. I know that our shoe business was big. We had some big shoe," but it was very clear early on that they were not measuring revenue by line items.

Joseph:

So when you translate that to the dental practice, it's like, well, how many cleanings are you doing? How much hygiene are you doing? How many crowns are you doing? How many are you doing that are implants? It's like, the first thing that you've got to do is you've got to measure what specific revenue pieces you did in each month. So, if we're looking at the month of January, I'm going to say we did X amount on this, X amount of that, X amount on that. Then we as accountants, what we like to do is we'd like to compare.

Joseph:

So I came in and said, "Okay, well, you did 300,000 this month. Well, what'd you do last month?" "Oh, we'll have to go back and rerun that report. We don't remember what we ran. Oh, but we remember that May, of last year was a really, really good month. We should run that month." So it became very clear and apparent that they weren't measuring how the practice was doing month by month by service line.

Joseph:

So that was the first thing. So the first thing I did is okay, why don't we categorize our sales? Why don't we just make it simple and just have three or four different big buckets of sales that are all kind of related and we'll just measure those specific line items, rather than trying to do some kind of procedure code, because the healthcare practice that I was in, we had a thousand different procedure codes. Some of them were the big numbers and some of them were the small numbers and there's all these add-on codes for these additional things.

Joseph:

So it's like, I don't want to look at a revenue by code line item because I've got a thousand codes that we use in the course of the month. Why don't we break that down and summarize that into three or four different ones that we can measure? Why don't we look at that for this month versus last month versus the month before, and let's figure that out. So the next thing that I figure out, I get in there and I'm like, "Okay, so that number of 300, tell me what that number is? What makes up that number?"

Joseph:

They pulled it up and I started looking at the individual patients that made up that line. It became very clear that what they were calling revenue was usual and customary. We may refer to that in the dental world as the UCR, the usual and customary rate, or you could just say, that's your general fee. I said, "Okay, well, of this 300,000 that you generated in revenue, is that going to be what turns into collections in the bank?"

Joseph:

They're like, "Oh no, no, no, no, no. Insurances, they all take their discounts." I'm like, "Okay, well, that's probably where we need to start measuring revenue. We didn't do 300,000 revenue. We did much less than that. So let's come up and figure out what's the allowed charge." The next thing that I figured out is that whenever I went into the allowed charge, they had taken a standard discount off of everybody.

Joseph:

So we had, in the business that I was in and we had the Medicare allowed fee. So basically what they did was they keyed in the Medicare allowed fee for every single patient that came through the door. What's the problem with that? Problem with that is not every single patient is on Medicare. We've got Blue Cross Blue Shield, we've got Humana, we've got UnitedHealthcare. We've got TRICARE, we've got a number of these different ones and I'm like, "Well, how do we know what Blue Cross is going to pay us whenever Blue Cross comes in?"

Joseph:

They were like, "Oh, well, we just adjusted off the EOB, or the explanation of benefits whenever it comes in." I said, "Okay. So what you're telling me is whenever we've measured that revenue, we measured it at the Medicare allowed rate, but we're not going to make an adjustment for the Blue Cross rate until next month when they pay the claim or next week when they pay the claim or whenever they decide to pay the claim?" They said, "Yeah, that's what we do. That's when we adjust it."

Joseph:

I said, "So this $300,000 number is not a real number. The $250,000 is not a real number. So why don't we drill in and figure out, well, what are our contracted rates for all of these different insurance companies?" And as you can imagine, Jonathan, they were all different. Blue Cross had a certain percentage off of the Medicare allowed, United had a certain fee schedule that they had determined. TRICARE had something different. We had a workers' comp that would take a percentage off of our usual and customary rate.

Joseph:

So one of the things that I've always subscribed to is the Pareto principle or the 80/20 rule. So I was like, okay, why don't we 80/20 this thing. What 20% of our payers make up 80% of our revenue? So obviously to go through, we had hundreds of contracts. To go through hundreds of contracts and trying to get all of those fee schedules immediately ready, that would have taken months.

Joseph:

So I was like, why don't we just take the top 20% of our payers, the ones that pay us the most money and why don't we go ahead and make sure that that is correct inside of our billing software so that we were able to get to an allowed fee. The other thing that I figured out was that the Medicare allowed fee changes every year. Some years it goes up, some years it goes down. I'm like, "Well, what's that Medicare allowed fee?"

Joseph:

They were like, "Oh yeah, we loaded that in a couple of years ago." I'm like, "Okay, we should probably upload the current Medicare allowed fee. We should probably upload the current Blue Cross Blue Shield fee." Because one of the things is that as your accounts receivable people have money that's coming in the door and they have an EOB, we should know and expect to know what Blue Cross is going to pay us for this specific client, for this specific line item and if they pay us different, we need to know about that.

Joseph:

We need to investigate that, we need to follow up on that and say, "Well, is it because they paid us incorrectly? Is it because this is a Tennessee Blue Cross Blue Shield versus a Texas Blue Cross Blue Shield?" What are these differences that are inside of this? So I think that was where it first started was we need to start measuring revenue.

Joseph:

We need to start measuring revenue. We need to record it. We need to be measuring it month to month. We need to figure out what is revenue and it's obviously not your usual and customary. I was having this conversation with the dentist the other day. I said, "What was your production for the month of January?" She said it was $30,000.

Joseph:

I said, "Okay, well, tell me more about that number. What is that number?" She's like, "Oh yeah, that's the UCR." I said, "Okay, you understand that the UCR is not what your insurance company is going to pay you that you're in network with?" She was like, "Well, yeah, that's not the right number." I was like, "Okay, well, the first thing we need to do is we need to figure out what are you generating."

Joseph:

Because her question to me was how much can I afford to spend on you know, this next thing or this next loan, or can I hire another employee or can I increase my salary? Can I take a draw? Is my rent too high? She started asking these questions. I said, "Well, the first thing we got to figure out is how much money is coming in the door and how much revenue is coming in the door."

Jonathan:

There's usually a reason that revenue is the first thing on a profit and loss, because it's the first thing you're supposed to be able to know about. I find a big misconception inside of the dental space is that the CPA equals the CFO. When I try and tamper expectations with all of our clients is that, look, there is a lot more to revenue than just that first line item. Whenever you file a tax return, you file income. Sometimes you have a cost of services or whatever it is that you put down there as well, but revenues is a one line on the tax return, but it's much more than that. So would you say that's a fair statement to say that one of the jobs of the CFO, one of the responsibilities of small dental practice owners in their role as the CFO is to understand their revenue?

Joseph:

Absolutely. I think that's got to be where it starts. It's got to be where it starts because we got to understand ... So we've got to put expense models together and figure out how much we can afford based on our revenue. Obviously your revenue is going to fluctuate month to month, year to year. I'm looking at financials in January. Financials in January look a lot better than December. Why is that? Well, we took a week off for Christmas to New Year's.

Joseph:

So January, we worked full month. February will probably be shortened because we've got crazy snow storms that have hit the United States and people have been shut down for a week. So there's always going to be some fluctuation of revenue, but it's got to start with that. So then if we can figure out, well, what's a general rolling average that we can forecast out for revenue, then we can break that down per month and we can say, "Well, what did we do in July of last year?"

Joseph:

"Well, July is always a great big month for us, but it never is quite as big as August. August is so big because the kids are coming back to school. They want to get all their dental work before they go back to school. So August is always a big month in dental. March is always a big month in dental because of spring break."

Joseph:

So then we can forecast that stuff out and understand what our revenue's going to look like so that we can build our expense models based upon that. I think that's a big thing for CFOs is, people like to talk and use the word budget all the time. They're like, "We need a budget."

Joseph:

I'm like, "Well, we need a forecast is what we need." How many patients came in the door last month? How many of those were new patients? What percentage of that? What was the percentage of each one of the different service line items? So can we expect that to come back? If it's a hygiene client, are they going to be expected to come back in six months?

Joseph:

Well, we had X amount coming in January. That means that we know that we're going to get a certain percentage of those to come back in July and we can look and compare that and say, "Okay, well, what percentage of hygiene clients actually keep up with every six months?" Okay, well, it's not 100%. We wish it was 100%, but it's not 100%. Is it 90%? Is it 80%? Is it 50%?

Joseph:

Well, if it's 50%, we've probably got some things that we need to work on with our front office staff to make sure that we're confirming appointments, whether they were doing all the things that you guys know that we do in order to make sure that people are coming in for their six month checkups, but we can start forecasting and start getting a picture of what things are going to look like from here on out.

Joseph:

We can say, "Okay, well, if revenue, this month is $30,000, but our goal is $50,000 and we know that we're projecting that next month is going to be $40,000, we know that we've got 10,000 that we got to make up. So where are we going to make that up? Is it going to be new patients?" All right. So let's say that it's going to be in new patients. How many new patients do we need? How many of those are going to be hygiene patients versus emergency patients versus some more complex procedures that we're running specials on?

Joseph:

So these are all the things that when you try to get a handle on your top line revenue and get a handle of the money that the business is generating, these are things that are all going to project out so that you figure out what you're going to do money-wise moving forward.

Jonathan:

So you mentioned a lot of strategic game plan that was coming up. To me, it's like, step one, understand revenue. Step two, create a baseline of what it is we know is happening currently and then step three, would be to design some type of a game plan to effect those numbers, to try and create something around those things.

Jonathan:

So like you said, maybe it's that where we find that our deficiency is in our hygiene recall rate. Do we have enough of our patients coming back in for hygiene after they come in for the first time? Do we have enough people to getting back on the schedule today compared to whenever they come back in the future? Or do we let too many people just walk out with our unscheduled treatment?

Jonathan:

How many treatment plans did we do today and how many of those were actually on the schedule? Did we have a conversion issue? Understanding those different components after you have a bigger picture idea and understanding of that revenue allows you to start optimizing and influencing those numbers. So is that what a CFO's role is or is the CFO's role to influence those numbers or is it to unearth those numbers?

Joseph:

So I think it's both. I think a great CFO is going to do both. I think that if you look at the accounting world, one of the things that's tough about the accounting world is we're always looking backwards in time. We're looking at what happened last month, what happened last year. We're generating a tax return four or five months later after the year's closed. So, if you're trying to figure out what you're going to do with your business in May of a year, but you're waiting on last year's tax return to get done or last year's books to get done, you're always looking backwards.

Joseph:

I think the best CFOs that are out there do a combination of both. Number one, they're reporting the results in a way that'll help us understand the past, but they're also looking at all of the different pieces that we know that are going to happen in the future.

Joseph:

We're going to take some projections. We're going to make some assumptions. We're going to look forward and try to figure out what is life going to look like moving forward. Then we say, "Okay, life looking forward. If I take the snapshot of it today, that's not where we want to be. So let's figure out where we want to be. Why don't we create some goals around this? Why don't we create a monthly goal? Why don't we create a daily goal? If it's a number of new patients that are coming in, how many new patients should you be getting per day?"

Joseph:

Then we can start to influence those numbers and we can say, "Okay, we know that where we're at today is X. We want to be at 2X of where we are. What's the plan to get there." So that is where I think good CFOs are able to really, really hone in on a practice and really help you move forward and help you project to the future and make good, smart business decisions and influence those decisions and help your team understand how they influence those decisions.

Jonathan:

So how would it be, again, this is, this is a question that I get a lot is do you think that a CPA, someone who works as a CPA for a dental practice, that that CPA should be the CFO of that company?

Joseph:

I just think that it's got to be a lot more granular than that. As CPAs, we're typically reconciling banks daily, weekly, monthly. We're looking at financial statements, we're trying to get everything to tie out. We're doing everything that we can to make sure that the books are right, which is a very important part of your financial picture is understanding what your books look like. But I don't think that CPAs are equipped to be out there and to be in your practice to know like, well, how many confirmation calls did we have on patient schedules today?

Joseph:

Okay, well, we can track that. We can get it in the software. We can create all these different systems that are out there, and then maybe the CPA can look at that, but I think that that's outside of the CPA's role just because we don't have access to all that. We don't have the boots on the ground.

Joseph:

Now, if you have a full-time CPA that works in your office, many practices do. Huge, huge practices. Once you get to several, several millions of dollars, you're going to have a controller onsite that's going to help you out with some of this stuff. Maybe they're going to have a CFO on site once they get to that 10 or $15 million mark so that you can do that. But if you're a CPA and you're working with 20, 40, 50, 100, 200 clients, there's just no way that we can project all of that granular detail out in order to to do that and to fulfill that CFO role. That's certainly my opinion anyways.

Jonathan:

I agree. I see a lot of it because I speak to Dennis every week and it's not uncommon for me to hear someone say one of two things. One being that I need a CFO and they think that they need a CFO because they need someone who's going to help with all of these things. Then we can start digging into it and it's like they're doing three, four, $500,000 a year in revenue. Or even all the way up to say a million to $2 million a year in revenue.

Jonathan:

I need a CFO because I need someone who's going to do all of these things for me. Completely get an understanding of my revenue, which just for the listeners out there, that means we're going to have to understand your production philosophies, we're going to have understand the way that you view dentistry, the way that you view your patient care.

Jonathan:

As you dentists know, every other dentist is going to be different. So every CFO is going to have to understand that about you as the provider, as well as any other providers in your office. The way that we do that as data people is, we look at the production procedure code, service mixes, things like that, to be able to see what that looks like, but that's on a very high level.

Jonathan:

If we were to be the CFOs for you, that would be what we would have to do from a provider standpoint, for us looking at our provider level. What I tell most of these people is, "No, you don't really need a CFO. You just need more production right now. You need more revenue, you need to do more dentistry or have more patients," and that's basically all I can tell you.

Jonathan:

That's exactly what a CFO would tell you if they were to be engaged with you right now is, "We don't have enough revenue, we don't have enough production and we don't have enough patients." There might be some small problems that that person could uncover, but the amount of money you would have to pay someone to be able to do that, to uncover those problems would be a negative value compared to what they find, because you'd be paying them a whole bunch of money because it takes a whole lot of time to understand all of these elements for every business.

Jonathan:

While dentistry, yes is an industry and single office owner practices are similar in nature, they're all different. They're all different nuances and things like that and most of that nuance comes from the provider, the person that is doing the production.

Jonathan:

So I completely agree that the CPA role is not designed around this and the cost structure is not designed around this. If we're charging someone say a $1,000 a month for accounting, bookkeeping, tax planning, tax prep, projections, keeping updated on all the things that are going on in the dental ecosystem from a financial perspective, we don't have the ability to be able to make sure that Susie in the front is entering in the production correctly into the computer. That's not what we're engaged to do. The amount of money that we typically are getting paid for that, we don't have enough time in the day to be able to be helping with those types of things.

Jonathan:

So it then falls back on the dental practice owner to do those things, unfortunately. So I completely agree. It's, CPA does not equal CFO. I guess that's the point I'm trying to make with that, is that people sometimes think that they're the same person. It's a very specific subset. It's a different skillset, number one, and number two, it's not typically what you're paying your monthly fee for whenever you're seeing these people come in.

Jonathan:

So I mentioned earlier, there's two things. The first one was the person I'm talking about. They need a CFO and I don't think they really need one, and the second one is that they'll have already had a CFO and they'll be looking for someone new, which is the reason they're talking to me and I'll look at the work that's been done and it's literally just CPA work that's been done. It's not CFO work.

Jonathan:

So it's what you're saying here. It's financial statement analysis is all that that CFO is doing. To me, financial statement analysis, yeah, your CPA can help you with financial statement analysis. Almost every CPA can do that. I'm asking this to you, Joseph.

Joseph:

Yeah, absolutely.

Jonathan:

So every CPA can help you with financial statement analysis. Financial statement analysis is like one line item of things that CFOs do out of hundreds of things the CFOs do. So CPAs can help you with financial analysis, which is the things we talked about. The way that our firm does that is through a management report that we send out every month, where we're calculating out and are rolling quarterly averages and doing overhead analysis and things like that, but that just is the overall picture of the results of the practice.

Jonathan:

It is not the granular detail of, we did, say, three times more crowns this month than we did the month before. That does not exist on a financial side, on the traditionally prepared financial statement done by a CPA firm. So a lot of times what I'll tell people is lean on these softwares that can pull these data elements out of their practice management softwares, like Dental Intel is really good. Practice By Numbers is really good and they can do some of these practice management data calculations for you, but don't lean on your CPA for those things because we're not traditionally trained for those types of roles.

Jonathan:

A lot of the times what I tell people is that CFO role, we can find the problems, but we can't usually find the solutions if we're not in that practice every day. So you're paying a lot of money for someone just finding problems. Whereas in this industry, to me, if you're a smaller business, you have to be paying a practice manager consultant to find and fix those problems a similar amount of money. So when is it to you that a dental practice should consider having an outsourced CFO or a CFO and just in general, that is not that owner of that business.

Joseph:

I think that all the stuff that you're hitting on definitely says to that. So the question is, we're dealing with dentist who are very, very intelligent people. They're all very entrepreneurial because they went out and started their own practice, or they're thinking about starting our own practice and want to start their own practice.

Joseph:

So they've got that grit and grind about them to figure all of this stuff out. I really don't think that it's something that they can't handle on their own. I think that it really boils down to time. Do you have the time to devote to this? Do you have the resources, the manpower that you've got in your office to help you out with it? At the point where you're doing dentistry five, six days a week, and you're busting at the seams and your schedule's full, that's probably time that you can probably hire somebody else to do that.

Joseph:

I certainly think a lot of startups can benefit from having an overall plan and just kind of having some goalposts to operate on to help them out with that, but I don't know that there's actually a magic moment where you say, "I need to outsource a CFO." Certainly as the practice grows, if you had 50, 60 employees or more, I think that's kind of like the traditional, that's the point where you need to have a CFO.

Joseph:

Once you're probably at probably 25 or 30 employees or more, you probably need to have some kind of a controller in place. Another question is like, well, at what point do you have an HR manager in place? Well probably when you get to about 75 employees. So I say that to say like the businesses that you and I work with, almost all of them are single office, two office, way, way smaller than that.

Joseph:

I think that they'll be able to wrap their arms around a lot of it, maybe with a little bit of coaching and some help on the side from some consultants and some practice analytics, different pieces that they can figure out there and certainly podcasts like ours, where they get a chance to go out and learn, like, what are the things we need to be looking at and measuring?

Joseph:

Okay, well, this is what we need to be looking at. Let's go measure it now inside of our software. We knew that we probably could, but now we know this is what we need to go look at. So I don't know. What are your thoughts on that, Jonathan? That's a really good question. It's probably one that several of our clients hem-haw around about.

Jonathan:

So to me, I don't see much of a reason for a CFO on a practice. From a traditional CFO role, I don't see any reason for a dental practice that's doing less than, probably at a minimum, 2 million a year in revenue. I don't see much of her need for a CFO. The money that you're going to pay for a CFO ... If we're talking dollars and cents here, if you're going to have a CFO, that's actually going to do the work that the CFO needs to do, you're talking like at a minimum, outsourced a day a week, maybe four grand a month, five grand a month is what you'll end up paying that person, if you're lucky.

Jonathan:

So 40, 60 grand a year for, not financial analysis, hopefully it's more than financial analysis, but basically looking for little problems and little tweaks that are going to have ... Let's say it adds a 10% increase to your revenue. That's great. That pays for that, but you got real lucky if that person finds a 10% change. More than likely what they're going to do is they're going to be overseeing stuff and helping set plans and game plans up and things like that.

Jonathan:

I just don't see that creating that much of an impact on that business. Conversely, you get a really good practice management consultant in there that can help you do a better job with your treatment planning or do a better job of turning nos into yeses when it comes to getting patients to accept care. Then that money spent is going to have a much higher impact on your practice from a dollars and cents perspective. So almost like my best financial advice is to not get financial advice from a CFO until you get to a level where the tweaks can be worth that dollar output effectively.

Jonathan:

To me, it depends on the practices and things involved. To me, it's probably at the three to $4 million range and about what you said. Somewhere 25, 30 employees. So for example, you hear about these practices and we have a few practices that are similar to this. That could be if expand and scale, but they'll do $2 million, $3 million in revenue and they'll have 20 or 15 employees.

Jonathan:

So they'll hit the revenue number, but not have as many employees. Those practices, they're probably already doing most of these things already because they got probably really high production per patient. They got really high operatory usage. They got really high efficiency from their employees, probably have really strong protocols in terms of their collections and payments and things like that. So those things are probably already in for those types of offices, but we're talking about is whenever there gets to be a lot of people involved, a lot of revenue and a lot of patients.

Jonathan:

That's, to me, when optimization starts creating an unexpected value that's high enough to be able to pay someone else to come in and help analyze and optimize and strategize around those numbers. So that's kind of my thing. So real rough numbers, but at the bare minimum, 2 million a year in revenue, probably closer to 3 million before you start having that conversation. Then also somewhere around that 30 employee and up mark is where you start having someone that can start doing this for you, or start paying someone to be able to do that for you.

Jonathan:

Real rough numbers, but every situation is a little bit different case by case basis, but that's in general what I would be saying. So we talked about some of the problems today that the dentists are facing is one, an understanding of revenue. Understanding what revenue is, how to analyze it, how to record it, how to you ... See what it is that you're doing.

Jonathan:

What does revenue equal, and what does that mean in dollars and cents perspective? Then what does cashflow mean? Then coming up with a game around those things. So one of the things that we're doing on this podcast is we're highlighting problems and then we're going to try and create episodes around how to address those problems. So expect in a future episode for us to talk about these problems and give you different ways, as a listener, to be able to come up with solutions and to be educated in these problems so that you can do some of these things on your own.

Jonathan:

So that is our episode on the CFO role in dental practices. We may do a follow-up episode in the future, but that is the episode for that. So any closing thoughts on the CFO's role in dental practices, Joseph?

Joseph:

I think the dental industry is just a great industry in general. It's something that I'm excited to be out helping dentists. Super, super smart men and women. Very, very, very hardworking. Very entrepreneurial. So a lot of this stuff, at the smallest of the small scales, at the small offices, they'll be able to figure it out. They'll be able to make those decisions internally and as you grow, that's going to be the point where you've got to figure out at what point does it make sense to invest in additional health.

Jonathan:

As a final thought, what are some of the other problems that a CFO can help with? We talked about understanding revenue, we talked about coming up with a game plan and I guess another thing would be to track the success or failures of that game plan. Is that accurate?

Joseph:

Yeah. I think one other things that I think a great CFO will help you out in the dental space with is figuring out what does your insurance reimbursement look like. I know there was a point in time where pick a company shows up and says, "Hey, we want you to be a network with us," let's say at Cigna, "And we're going to offer you X," and that's significantly below what your usual and customary is. So the question becomes, can we afford to take this contract?

Joseph:

It could be United or Concordia, or it could be any number of places. What's that look like? What's the financial impact of that look like? I talked to a client one time that was in the Midwest that was close to an insurance headquarters and they wanted to drop their reimbursements by, I think it was 30%.

Joseph:

I said, "Hey, by the way, we're making cuts. You guys are on the hook for 30%." So then the question becomes, and this is a great CFO question. So what percentage of your patient base does this insurance carrier represent and how much dollars in revenue does that mean per year and if we take a 30% hit in that specific insurance carrier, how does that project out? What this practice was able to figure out was that it would have been a couple of staff members.

Joseph:

I think that the impact of this was like two staff members. So they wrote the insurance company back and said, "We're not going to be in network with you anymore if you continue to say this, because every one of our staff members are important to us and you're taking away two jobs from our practice, and we choose not to do that."

Joseph:

That's a great CFO project to look at. Certainly, there's smaller contracts that you can afford to take bigger losses on and that kind of thing if you wanted to, but I think that understanding insurance reimbursements and your contracts and all those things. Of course, there's always plenty of people that you can outsource, you can do this with, but that's a big CFO role.

Joseph:

What's the impact of this specific contract going to be and how's that going to go? One of the markets that I was in had a big, huge FedEx plant and the FedEx switched insurance carriers and the insurance carriers dropped everybody that was in network. So it was like, oh my gosh, are we going to survive? Because so much of this town's employees ... And it was like, well, let's run the numbers. Let's see.

Joseph:

Well, it turned out that out of, let's say, 100% of the total revenue, only 5% of it was this specific insurance carrier. So I think we're going to be okay. It's not going to be great. It's not going to be helpful, but I think those are great things for CFOs to get a chance to look at for you.

Jonathan:

Cool, awesome. So we will follow up with those in future episodes. Stay tuned to the Tooth & Coin podcast to hear more about the different problems inside of the dental industry, from a financial management perspective that we will be addressing here on the Tooth & Coin podcast. So we thank you very much and we'll see you next time.

Jonathan:

That's it for today, guys. I hope you enjoyed this episode of the Tooth & Coin podcast. If you are going to be a practice owner or a new practice owner, and you're interested in CPA service, head on ever to toothandcoin.com where you can check out more about our CPA services. We help out around 250 offices around the country and we'd love to be able to have the discussion about how we could help your new practice.

Jonathan:

We do specialize in new practice owners. So people that are about to be an owner of a practice they're acquiring, about to be an owner of a practice they are starting up or has become an owner in the past five years. That is our specialty. We'd love to be able to talk to you about how we could help you in your services with your tax and accounting services.

Jonathan:

If you enjoyed today's episode, again, go to the Facebook group. Talk to us about what we've talked about. Join in on the discussion and let's create an environment where we can talk about some of these things so that we can all help each other get through these things together so that this adventure of business ownership is more fun, more productive, and better in the longterm.

Jonathan:

Lastly, if you want access to those resources that we are currently building, just text the word toothandcoin to 33444. That's toothandcoin, no spaces. T-O-O-T-H-A-N-D-C-O-I-N to 33444. Reply with your email address, we'll send instructions in the Facebook group. We'll send you the resources when they're available and we will see you next week.

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