What is the difference between making or losing 27k in 15 minutes? That’s just the situation that faced one of my clients. How would that make you feel? What about if it was just loosing the odd £20 now and then? Would you even know if that was happening?

In the healthcare profession, the topic of money is a veritable minefield. Naturally it’s a profession that attracts caring, nurturing people. Nice people who want to help everyone and make the biggest impact that they can to humanity. Highly skilled individuals who are trained in improving the highest assets – someone’s health and wellbeing. I mean who doesn’t want to make sure everyone feels better?

However, in the private healthcare sector there still needs to be a financial transaction, a sale, and for many this can be extremely challenging. These can be broken into three themes that reoccur time and time again;

• The Money Mindset
• Maths
• Methodology

The Money Mindset

Do you know how much you would to earn? Many people don’t even feel comfortable thinking about this question, let alone start working towards improving it. Stories, society and personal experience are just some the beliefs and money is a highly emotive topic.

One of my favourite team training exercises is understanding the mindset of money.

Quick fire round – how would you complete the following;

• Talking about money is ……….
• The value of our service is ……….
• Asking for money is ……….
• Spending money is ……….

Rejection due to finance is a reason given by all departments. By opening up the conversation of our internal money beliefs and how these can affect the conversations in clinics is a great starting place for discussion. In many cases its rather a matter of value or priority and our thoughts and beliefs around money will affect how we respond.

That’s not to say you won’t find yourself in front of someone who could desperately benefit from your services, but practically just can’t afford it, you can still ask for an investment by opening the conversation to what they can contribute.

In the extreme circumstances you still find yourself wanting to financially contribute to care, you could let them know that if they are able to contribute X, you will be matching their investment. Their awareness that you are paying for the additional amount is valuable for you both.

However, please always avoid the word FREE; no service is provided free.

Just because they are not walking out of your practice with a physical item, doesn’t mean there are no costs to deliver. A bankrupt practice is no help to anyone.

It is also vital that all of your clinical assistants receive training; they are your sales team.

Knowing the maths is vital

How many of us have memories of hideous algebra exams or personal finances where we would rather shove the statements under the sofa? The secret is keeping it simple and dealing only with the actual data. Here are just a few of the ways you can increase your money management.

1. Calculate the cost to you to deliver your service This is done by calculating all your current expenses into a weekly or monthly amount. Most importantly including paying yourself! Factor in annual bills, memberships, taxes, training, contingency plans. Average out your adhoc payments – these would include stationery, marketing, uniforms etc. Then when you have the weekly amount for all of the above, divide the number of patient visits by this amount. This gives you a ‘cost to deliver price’. This should be reviewed regularly, and as you get busier, if you’re managing it correctly, your profit margin should be increasing. Using this method can help you set your capacity targets, financial budgeting and it’s fantastic information to understand when you are tempted to lower your value.
2. Care plans, packages or memberships These are a fantastic way of rewarding loyal customers, increasing retention and creating financial stability. The trap here is setting the discounts on a percentage that sounds enticing not on the actual financial data. You are not competing with the January sales of the high street here. Let’s assume you decide on giving 10% off a block of 10 sessions you will need to know; a) the cost to deliver the treatment and b) the cost of discounts when applied to the cost to deliver.

10 treatments @ £30 each = £300

10% discount on 10 treatments = £30

If the cost to deliver was £25 per treatment then the discount would leave £2 profit per session. Play around with the options. Would selling 2 packages of 5 with a 5% discount be a better option? Can you reduce the cost to deliver? How many people leave after only one or two sessions and what impact could this have on retention?

3. Increasing cash flow This can come from many sources. What is the value of the stock you are holding? What is the petty cash used for (and are you the responsible person for the never balancing accountability sheet)? What is the value of outstanding invoices (particularly if you are dealing with third parties?) When was the last time you reviewed your suppliers? Without making any alteration to your prices or capacity you can increase the money in your account.

So remember the practice with the missing 27k? Sadly for them, this figure came to light when reviewing the annual figures. After many sleepless nights of wondering why the increase in services could lead to less in the bank, they came to the most obvious conclusion; there must be some fraud or theft afoot. A deeper look showed a quite different story.

In the previous year they introduced care plans. The care plan offered a 20% discount on a course of care paid for in advance Sounds great! But, as we just mentioned, why did they decide on 20%? Because it sounded like a good number; missing puzzle piece number 1. The discounts had no data foundation of treatment cost vs profit to calculate the discount. This obviously brought about fantastic success and they incentivised the team in the promoting and selling of care plans; missing puzzle piece number 2. There was no measure of how the increased patient visits or the lifespan of the existing patients effected the clinic. As the finances were not part of the teams goals, and their focus was to increase the sales and keep customers happy, all the data went sitting unnoticed for a year; missing puzzle piece number 3. The final missing puzzle piece was that over the year operational costs had risen. In failing to link the daily activity to the bigger picture, the practice was actually in the simple equation of less in and more out. So why was the account so much lower than the previous year? Simple maths.

To find the missing amount we simply calculated the number of patient visits by the amount that would have been generated if they had paid full price and then calculated the amount that they were now actually paying per visit once the discount was applied. We then compared the annual operational figures from the previous year and right there before us the “missing” money was found.

Introduction of packages, blocks of care and memberships are a fantastic idea. Giving less transactional conversations, more repeat care and ultimately better results for the customer, just make sure they are working for you.

Method in the Reconciliation

The final area is being able to track and account for the pennies. Software systems are a fantastic way of easily tracking this data but need to be used along side the right cash up system or checking tools. Simply use them as a way to show what your delivered services are. This should then match what you have physically taken for the value of your services on a daily basis. Busy clinics should be checking the balance throughout the shift to save hours looking at the end of the day. Again, make sure the team are well trained to find and resolve discrepancies. It’s important to make sure that these reports also match the bank account, this can be done on a weekly or monthly basis. It’s amazing the amount of discrepancies that occur at this level, technology is not fool proof.

For financial reporting and legal requirements it wise to invest in expert help. Interview accountants and bookkeepers to find the right person to support and educate you in your money management. Make this part of your budget and plan regular communications. They are working with you not for you.

This article is in no way meant as financial advice. There are so many elements to improving your financial health these are just some of the practical practice management tools used. It might sound cliché but setting a strong financial foundation will not only help set valuable targets but will ensure you can avoid many of the financial pitfalls and stresses.