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Physiotherapy bill format for Building services

hello there I'm not sure if you guys can hear me I think you might have to unmute yourself but maybe just give me the heads up if you can hear me or not perfect thank you I've got another minute or so so we will just wait on to see if other people are joining us okay thank you Mark I'm reading a message that there was another set another seminar set up okay so seven o'clock we've got some people there in attendance it's certainly something that people can jump into um can you confirm with me whether you can actually see the um PowerPoint presentation perfect I'm going to go back to the presentation mode then and we will go from the top when I'm in the presentation mode and it's likely my it capabilities I cannot see the chat so I would encourage people to unmike themselves and just ask a question or if for whatever reason you can't see what I'm presenting please stop me I'm sure there is a way that I could one second let's see if I can set this up so I can just get people to admit on their own okay well we're just going to have to go with it here hopefully everyone is in attendance because as soon as I'm here for whatever reason I've lost my chat function okay welcome um I'm Jackie sinkeldam I'm the senior partner at aramosa Physiotherapy and my goal today is to give you our personal experience when it comes to creating a business plan so uh of course I did a two Science degrees at human kinetics and my physiotherapy degree and I started my own business so I'm definitely an entrepreneur but I am not an accountant um what this talk is going to look like it is absolutely drawing from my personal experience with submitting business plans over the last 25 years um as mentioned I um I'm open to questions at any time and please unmute yourself to ask those questions just to reinforce that I have no formal accounting training although my accountant likes to remind me that I seem to want to know all of the details and uh it is definitely important to always uh bring your questions to professionals like lawyers and accountants okay so um you know when we think about a physiotherapy practice of course I'm thinking of Private Practice uh whether that's Orthopedics or neuro or even different pediatric clinics are opening now in the communities that we're in so we're regulated health care providers that are providing physiotherapy services for money and you know I think it's important for uh everyone to realize whether you're working for a private practice clinic or you're thinking of opening your own that you can talk to pretty much any person um that is in the um sorry just beeping again in the service industry and you will be able to get very good um advice from people because although we're providing a physiotherapy service um we are definitely in the service business so that old saying the client needs to come first I think is still very important in our business however we do have to marry it with the idea that we are providing a health care service so you know a lot of sometimes maybe the tactics that are used in the general service business aren't always transferable into our business so we're here to talk about a business plan and I think the biggest uh question you have to think about is where you're going to get the money to start this physiotherapy practice um you know perhaps you're bringing your own personal uh financing in perhaps your um having money lent to you from Families my experience is definitely with borrowing from the bank and we've always been very successful with that borrowing um and the ability to service those loans very successfully so I'm here to share the information that I provided to the banks over the years to get the financing needed to not only start but to grow our business to where it's at today so I went to the bank so I think it's really important and um I did a little bit of Googling because I wondered what uh the basic kind of information on the internet would say when it comes to developing a business plan and there is no doubt that in your business plan intro letter or in your section of your business plan you want to talk about what you think makes yourself different so of course this could be your personal strengths it might be your standard of care you know in comparison to the research that you've done in the community it could be your unique population that you're treating definitely could be the geography of where you're actually proposing that your clinic is placed um and when you know all of the above you'll really have a good sense of who your consumer is which will absolutely drive your marketing plan and for those that are listening next week I'm going to talk a little bit about marketing um but you do still need to have um that overall plan laid out for your business plan for the bank so this is a very old to see if this was still available but there's lots of This research available I like to look at this data anytime we're going to a new City so I'll go to the Chamber of Commerce or the BDC and I have some of those resources at the end of the presentation and I like to look at what does the population look like um in the area that I'm moving to so this is in Guelph this is obviously old from the 2016 data but it does give us ideas on the actual population of the city and you know it actually breaks it down by ages as well so you know we were we were and we continue to open with the exception of our Women's Health clinic that is very much targeted to women we do have General Orthopedic practices of all ages but you can start to see even from your marketing and your program development and your niches you know the age group of the people that are in the cities that you're going into equally as important is looking at employment because again depending that on the type of Clinic that you're running you know we are running a general orthopedic clinic so we're going to pull from lots of different Industries so we go we could see the types of industries that were in the city and you know that also gave us an idea of how many people would have extended health benefits which is you know really a big way that people fund their Physiotherapy so again you can all kinds of different information that you can pull and I think the bank wants to know that you've done that research so you know being able to speak to the demographics in the communities that you're going to is very important so again this looks at specifically thinking about benefits and the type of businesses um you know certainly education and government we know that you know those type of businesses are always going to have extended health benefits and some of the other companies you might not know with certainty but you can um you know make some guesses as to who may have access to insurance so still thinking about the niche you know maybe this is what we have put in our business plan uh plans is looking at summarizing so for Us location was always a very uh big decision maker in where we put a clinic so um in the example of Guelph we looked at a population base that is actually one of the highest income categories so our first Clinic that we opened 25 years ago when we looked at the demographics of the people living in the area at that time it was one of the highest income categories and knowing that we're a service that people are paying money for or need to have employment that likely have benefits it makes sense to think about um people's income levels in the area we also were um very sensitive too we didn't want to open a clinic and have to compete against someone right out of the gate so we definitely picked an area where there wasn't another physiotherapy clinic in fact there were no other Allied Health so there are examples of a lot of clinics that will open in close proximity to maybe a chiropractor or a massage therapist but for us we wanted to approach it with a little bit more of a safety net that we would be the only Allied Health provider in that area we needed it to have a mixed clientele because we were not exclusively a pediatric clinic nor were we exclusively a geriatric clinic so we wanted to be able to pull so our original Guelph Clinic was across the street from a high school so we knew we were going to be able to Target some of those younger age groups we were in a busy Plaza that had free parking that was a big thing for us and can continues to be a big thing that we look for there are certainly lots of examples of clinics that are in paid parking and sometimes that is just the way the city is everyone's paying for parking so maybe the clients wouldn't think that that would be a deterrent um we looked for anchors like Grocery Stores um our ongoing joke is that we follow Tim Hortons around but we wanted to find uh anchors that would make it more convenient for our clients to attend physiotherapy so if they were coming twice a week for physio and they could also get their groceries at the same time then they'd likely be more compliant with treatment and we looked for some accessibility so that we were on a bus route so this was all things that were highlighted in our Niche summary of our business plan to our bank so what or where would you want your location so this is our example of our allora Clinic which actually started off across the street in a typical type Plaza um because it's a small community there weren't the same type of anchors however there's still a Tim Hortons that you have to drive by and this particular Clinic we actually got the traffic info for how many cars went through our intersection so we had some very good demographic um details that we could show the bank that we were positioning ourselves in a very high visible area Lucky For Us the land across the street uh became for sale so we bought that land and we built our own building which um was also a great investment and an opportunity to consider when you think about business plans so um we're talking about location so we've given some good highlights around things about your Niche and about anchors and now we're going to talk about space you know I think that in my experience anyway the bank um appreciates the thought that goes in with how much square footage that you are assuming and why so this is an example um from our Georgetown clinic so we were looking for 1800 square feet we run programs like pelvic Physiotherapy and concussion management that and Massage Therapy that absolutely require closed rooms so we needed to think about that closed rooms also gives the ability to incorporate into your business plan the potential to develop passive income um are you an exercise based Clinic certainly in Orthopedics I hope so because there's lots of evidence to support that so how much gym space are you going to be looking for which is your reception area look like are you going to dedicate any space for different Revenue sources like a retail store or other um complementary Revenue sources a retail store for us is something that we tried and for the amount of product that we sold we realized pretty quickly would be would better to dedicate that space to treatment area and simply have a wall that had products rather than having too much dedicated square footage um again thinking about location we we talked about this a little bit about who are your competitors or who are people that could heighten your exposure so if you're looking at other physio clinics um what I like to look at and there's certainly no science or math but seems to have worked well for us is I like to look at how many dentists there are in the community so I will figure out ratios of dentist per population because dentists also pull from extended health care benefits so people have dental coverage they're probably going to have physio coverage and I'll get an idea as to what that data looks like I have other markers that I look at for example in cities I might look at how many medical doctors there are relative to how many physiotherapists there are in that Community as well so I will start to see trend and that helps me make a decision as to whether the market would warrant adding an increased physio exposure we've talked a little bit about um Cairo for us we are a very manual therapy based clinic so it doesn't make sense for us to position ourselves right next door to a chiropractor when we will be competing for a market that's pretty similar around low back pain patients but if you're not a manual therapist and you're a very exercise based then you know perhaps that actually gives you increased exposure um and that's what we have looked for when we think about some other things like we like to be side we like to be beside gyms or Pilates studios because they we can develop good Partnerships with them and you know we have a very nice uh way to refer people out into community-based programs likewise with our women's health clinics you know if we can position ourselves to be close to midwives Obstetricians or other community groups that attract moms or young families those can be synergistic so all of this is what I would be outlining in my business plan when I'm talking about my location I've already talked a little bit about the secret sauce looking at the different ratios again I can't give you any guarantee that my ratios mean anything but they seem to be working for me okay the bank's going to want to know what what are your expenses going to be and we're going to talk about that in a little bit more detail but rent is likely in my experience the second biggest expense you're going to have next to your employee wages so one thing to be thinking about and this was certainly not really something I understood well when I was writing my first business plan is when you're looking at rent you're always going to have a base rent plus some type of an additional rent often that additional rent is referred to as cams which stands for common areas and maintenance fees sometimes it's called tmis which stands for taxes maintenance and interest but either way you're paying it so often when something's advertised as in this case it would say 21 dollars a square foot plus twelve dollars cam the cams are actually typically not a fixed cost because they represent the cost of maintaining the plaza and they will vary and we've we've had years of lots of snow and at the end of the year you got an extra bill from your landlord for the extra snow removal but in any event suffice it to say the current landscape for rent in sizes that we typically go in are not that cheap so we're paying about 33 dollars a square foot so if you picture that 12 by 12 ceramic tile that's every step is 33 dollars um most of our clinics that are servicing a three to four physio Clinic um open 7 A.M till 8 P.M or about 1800 square feet so using that math you know you're looking at 59 000 plus HST which is often a number that people forget about when they are predicting their expenses so cash flow wise you're looking at an annual expense of about sixty seven thousand dollars a year so you want to think about that when we talk about the two really important pieces of a business plan being your profit and loss and your cash flow this is definitely a big cash flow pull whoops terms of the lease uh often people will want to go into a situation where they're not committing the next 10 years of their life most new businesses probably are looking for a five-year lease I haven't seen a lease signed in for anything less than five years in a long time because we have a different level of experience and confidence we're usually going in with a 10-year lease because if we negotiate a 10-year lease we can try and keep better control of this base rent and there is some value to landlords when you're signing longer leases it actually is more favorable for them with their own potential personal financing of the plaza so you can tend to be a bit more aggressive when you're negotiating your base rent when you're signing longer leases always always always make sure that you have an option to renew you don't want to get to the end of your five or ten years and find out your landlord has decided someone else is going in that space you want that option to renew and I always ask for exclusivity Clauses so I definitely ask for physiotherapy but I also ask for massage therapy Cairo naturopathic medicine I try and ask for as much exclusivity so that I have the opportunity to bring those people into our practice versus seeing them go in the plaza and likely experience some gains because of the traffic that we bring in um always think about negotiating rent free periods which will help your initial cash flow especially if you're having to do considerable leaseholds most landlords will give you what's called a fixturing period which you may not pay any rent or you might only pay the cams while you're applying for permits and having your contractor set your space up and you always will want to try and ask your landlords to pay for the leasehold improvements they obviously own the building and you know the fixtures are Theirs to keep um most leases will say the fixtures are Theirs to keep um so you want to try and recover that cost that has changed in my experience where in the beginning 25 years ago the landlord paid for all of the leaseholds um whereas now we're really only getting smaller percentages paid for I haven't heard from anyone do I need to go back and check the chat or just have a quick peek everyone good okay okay so this is um this is actually our Georgetown Clinic that um we moved to a bigger location right before covid so it was kind of a tricky time for us but it was advertised at 29 a square foot plus 921 cams uh we noted that this space had been unoccupied for four years it was in a well-anchored plaza it was just bigger than our space um so we were moving down the street so it was very easy for me to go in and sign a 10-year lease and be confident that we were going to be successful so that helped us in the negotiations so after we did secure the lease and I'll share some of those details the other thing to think about from a cast full of standpoint standpoint and your business plan is that we did have to give them a fifteen thousand dollar deposit um to actually uh reserve the spot to secure the space so as I said this it was advertised at 29 a square foot um because we were going in and signing it a 10-year lease this is what we offered them that we'd start off at 27 and we'd go up so we're finishing in the year 2030 at 30 50. which was really interesting because the current space that we were in we were already at 29 a square foot and he had proposed to us that he wanted our rent to go up by six percent every two years and we could not physically grow anymore in that clinic we had run out of space so this was a really good strategic move that I could also include in my business plan so even though we had to um pay for those leaseholds to be redone I could demonstrate to the bank the point in time it at which our rent savings um paid for our leaseholds because I went in she deeper than what I was currently at in my other lease space so the bank definitely likes to know about your rent um in this particular case when we're going to talk about you know some equipment costs that will be part of your um requirements for the bank but I was able to negotiate that after we finished our leasehold so we still had to have the cash flow to pay our contractors we did receive a 25 000 reimbursement back from our landlord so it's it's always good to you know start high ask them to pay for everything and you know see what sort of response that you get from them so again a bit of a summary um of your marketing plan we talked about this right at the beginning this will be part of your business plan so understanding your Client List where your clients are coming from that probably reinforces your location the community relationships and Partnerships the age group and any key marketing niches that you have so um we're going to go into a lot more detail next week at the talk but this is just an example of what would be in my marketing summary lets the bank know all of the different Target markets that we have um and you know in our actual formal marketing plan we would have more detailed analysis as to what some of our strategies are but this is just to give you guys a bit of a layered approach that certainly would illustrate to the bank that you have a strategic marketing plan in place Okay so in the business plan you've talked about your strengths you've talked about your location you've talked about you know your client needs you've talked about your marketing plan now you have to get back to like how much money are you asking them for the for um potentially starting this clinic so you have to think about the equipment that you need um and I will share maybe on the chat after I did do a quick Google search and one of the companies that does Supply a lot of physio supplies had a pretty um good starting point if not exhaustive equipment list so it gives you a bit of a rough idea but you're going to need you know your clinical equipment like your plants and whatever modalities whatever exercise equipment that you're going to have but you're also going to need all of your office equipment as well because sometimes we can you know forget that we actually have to still have office and charting room equipment your leaseholds you know the leaseholds can be incredibly exhaustive depending on the space that you're going into that Georgetown Clinic that I talked to you about when I went to look at it the floor was basically gravel so we were doing everything um expensive pieces of the leaseholds that it's nice when the landlord has included them is the rooftop HVAC which controls your heating and air conditioning you know we like to try and ask that to be included because the size of it is very specific to the unit so it should be included and if it's already there you'll want to make sure that your lease notes that it's in good working order because they can be quite expensive and other than that you know you most people are paying to run the venting and things like that to exactly where they need so your fixtures are usually from floor to ceiling sometimes people forget forget about the signage that outside sign can be quite pricey and depending on the Plaza that you're going into and what your landlord will approve um they they do vary considerably in price um I don't know if you remember from the picture of that allora clinic but we put that pie line pylon sign out there and it was thirty thousand dollars so they are certainly not cheap so when you're asking the bank for money you're thinking about office clinical equipment leaseholds and then you have to think about like you're going to need some cash for operational setup as well so every utility company is going to want deposits um your Payment Systems payment system machines um and you know some of some budget for that initial marketing campaign that you have highlighted as well so this is all going to be cash requirements that you have to decide are you asking the bank for that money or not so the bank likes to use um some language so the first thing is capital needs and capital needs are typically defined by um the definition that it's usually over a thousand dollars something whether it's a desk or a piece of equipment and it's something that doesn't deteriorate over a period of time so theraband is not a Capital Equipment because it obviously gets used and you know over a period of time it's no longer there so the bank's not going to finance your theraband um typically my bank I would lump I would ask for all that initial inventory of acupuncture needles theraband tape all of that I did try and put in the capital needs and um depending on the time and the year that we are opening a particular Clinic sometimes I would get some financing for that initial capital um often the bank will want cosigners um it particularly if you are not bringing any of your own money to the table so um sometimes you don't have to bring your own money way back when in my case um I owned a house that had some Equity so I did have to leverage my house so I basically signed a document to the bank that said if things went South they wouldn't get all of the equipment and my house so there are ways that you can try and keep your personal assets I would of the equation it usually means actually showing to the bank that you're bringing a percentage of cash to the business transaction uh definitely always think about shopping around even amongst the standard Banks of you know TD Bank Montreal RBC those uh those Banks because they often will change what how they Define their health care platform so we've switched banks now three times over 25 years so we're originally with bank Montreal um that we had some Capital boring that at the time would have been at prime plus three and a half percent and RBC introduced a health care platform and physiotherapists were included on that Healthcare platform and the borrowing was prime plus half a percent so we were able to move to that bank and all of our Capital Loans were then at prime plus a half a percent which was a significant savings for us so do you do the shop around and the BDC um BDC I believe that's a short they can also offer some creative financing as well so this is what the bank really wants to see when it comes to numbers so you need to know the difference between a cash flow and a profit and loss so when we think about um really either one of those if we want to talk about a cash flow to begin with a cash flow statement if you Google it is really just a um minor all on Excel sheets they're nothing fancy but it's a prediction of how much cash is going to be coming in every month and how much cash is going to be going out that is not really the same as a profit and loss because a profit and loss the top part of your profit and loss statement is definitely about income but your income isn't always the same as the cash coming in on a monthly basis because some of your income if it's coming from third party funding sources like perhaps a motor vehicle accident insurance company or the wsib insurance board you might not get paid in the same month that you delivered that service so the cash flow is your prediction of what are you actually going to get paid for in that month and what are the bills that you have to pay for in that month where's the profit and loss is all of the income that got booked to that month and then the loss part of or the bottom part of the profit and loss is all of the expenses that are associated with that particular month so you'll have your income minus your expenses which will definitely give you whether you're ahead of the game or not the interesting difference that again I learned a little bit the hard way is when you look at a profit and loss and you look at your expenses for example if you borrow money and you know your I would Hazard to guess if you're borrowing money for leaseholds and equipment for a typical orthopedic clinic you're probably born between 250 and 300 000 dollars when you borrow that you have to make a monthly loan payment the bank obviously wants to get paid the portion of the loan payment that shows up on your profit and loss is only the interest so you can only deduct from your income the um interest but on a monthly basis the actual true money leaving the clinic is the whole loan payment so you'll start to see the differences between the cash flow statement and the profit and loss the cash flow statement is really what the bank wants to see because they want to make sure that you have enough money coming in to actually pay your bills the profit and loss will show them you know on paper what is going to be your Breakeven point so um that gets a little bit kind of accounting um background and I will show you some examples so the the not the hard part but you know what I would challenge you to be thinking about is how do you determine how much money is coming in of course you have to make a guess on how many new patients that you're going to see on a daily and a weekly basis and you also have to make a guess or an estimation of how often are you going to treat those people and for us when we had to make that decision of what was our best guess as to how often we were going to treat those people we actually just looked at the research studies that you guys are seeing on a regular basis if you look at a study on shoulder pain or back pain and you look at the actual study how often did they see people in that study in order for them to expect a clinical change most studies I think you're going to find dosage is going to be somewhere between two and three times a week or six to eight weeks that tends to be a clinical window that is often used in research studies so on the high end three times a week over eight weeks would be 24 treatments on the low end two times a week over eight weeks would be 16 treatments so you could be looking at numbers like that if you took the time to do some investigation of the companies in your area you can often find out what their actual coverage is for Physiotherapy and while there are going to be some exceptional plans for physiotherapy most insurance companies annually tend to cover somewhere between five and eight hundred dollars which if you divide by your expected treatment B is definitely not going to provide 16 or 24 treatments so then you have to start to think about well how many treatments would I need to actually produce a clinical change and help people meet their health care goals so when you're predicting your income you know you are making your best guess and I feel that that guest should be reflective of clinical practice versus making income goals and then forcing your clinical practice into those income goals because it is a health care service we want to deliver a good physiotherapy service so we want to make sure that the income goals that we're setting are reflective at minimum as to what we're seeing in the literature um so that's how I come up with income and number of visits that we would potentially expect someone to be seen on the expense side of things from a cash flow perspective what are all the bills that you're going to be paying on a monthly basis what are all the expenses that are going to show up on your profit and loss these are a few rent and your wages will be by far your biggest percentage of um expenses so you'll want to make sure that you're collecting the money as quickly as possible so that you can be paying your hopefully paying yourself or your other professional and administrative supportive staff um okay so um we talked about this a little bit already the first thing that you need to do in either case for a cash flow or profit and loss is Project your income so we talked about all of this um there's the profit and loss will give you what I call paper profit paper profit is not always the same as real cash in fact it rarely is the same for the reasons that I spoke of because the cash flow will be looking at specifically the income that you truly collect where's the income on a profit and loss may not be the income that you're truly collecting and of course the expenses that are showing up on a cash flow are the true expenses that you're seeing money leave the clinic um whereas on the profit and loss the expenses are really just the expenses that are allowed to reduce your income ing to cra um so that's an another good uh the uh draw like if you're a self-employed physio starting your own practice you're not going to be on a payroll so there's not going to be a true expense because if you're self-employed or you're in a general partnership essentially if you're not on a payroll and the only way you're going to be on a payroll is if you choose to incorporate your company off the get-go which we can talk about um but that's the only way that you could be on a payroll otherwise any wage that you take as far as the government is concerned is just to draw on the profit that shows up on your profit and loss so again if you know that to pay your own personal bills you need to take a thousand dollars a month you will never see an expense line on your profit and loss that says a thousand dollars a month so you will have to account for that draw on your cash flow analysis so simply put cash flow is always about cash in cash out and I think that I would like to show you what those look like how we doing everyone's still there are you sleeping or any of the chat any questions so far no we're good okay so I'm gonna stop sharing that presentation and we will share examples of cash flow so there are probably great templates of about this um I'm just going to go back here I'm I'm a bit perplexed as to why I can't see both someone is typing can you guys see the Excel sheet yes okay perfect thank you okay so um this is uh a older um an older version of um it's old data so the assessment being all of this thing is very archaic but you can see that we made an estimate that we were going to see 30 patients a month so that's approximately five new patients a week what were we going to charge people for that assessment that was 70 what about um we were we were a clinic that was going to see all spectrums of funding sources there are definitely clinics out there that are opting out of MBA and wsib um you can see what the fee for an MBA assessment is and you might think well that's a lot more than the regular private assessment until you see the paperwork that comes with that um so this was going to be uh our estimate of how much assessment income so you can see that we saw said on average that we would see people 12 times um I can tell you that that's probably a bit High um from our experience now in private practice we would see probably an average number of 10. so I mean I could change that just to illustrate what that does to the cash flow so we're going to see each one of those 30 new people 150 times at the time we were billing 42 dollars a treatment so we had a um guess on what our treatment Revenue would be and we had some unique programs that we offered at the time so in any event this was what we were aiming for if we got those five new patients a week and we actually saw them but you'll see that this is what we build out but we in that month we have no money like we we don't have any money so when I presented this to the bank that we're already starting in a deficit so at the time our billing practices were that we would build that out to people's Insurance nothing was electronic of course everything took a month before we got anything back so um we had to recognize that that first month of operations that we were not going to have any money in our bank account and we didn't have any money we did not put any money into the business so you'll see that then we went through and gave our best guess at what things were going to cost us and we we knew what our rent was that was one thing that we did know um and you can see that this is going back many many years ago our admin at that time would have worked 40 hours a week times 12 an hour times 52 weeks a year so that was our administrative uh wage for that month you know of course we had Bank charges you have commission fees on credit cards you've got your loan interest of the money that you've borrowed you've got your line of credit interest and that is what we asked the bank for so we asked the bank for Capital borrowing to buy all of our equipment and then we asked for an operational line of credit so right at the get-go we were in debt we had some advertising that we had to account for and this was the draw that we took we the owners took 500 a week to live off of so in that very first month of operations the cash that was leaving the clinic was twenty five thousand dollars and we had no money to offset it so immediately we were in our line of credit by twenty five thousand dollars so then you go through the whole same thing for your next month you know we've increased our expected new patients so we scroll down to the bottom lo and behold we're hoping to earn more income and in this case even this was a bit overzealous in that we assumed we would collect a hundred percent of what we build out um in our business we have a very good collection policy so we actually only write off less than two percent of our income so in the end this was a good estimate but in most businesses they would allow for a bigger margin of what is called doubtful accounts that people don't pay their bills um so in this case we we added thirteen thousand dollars we collected the nine and if you scroll down to the bottom you know we're gonna have we actually you can see that some of those initial startup costs are not included so the cash out wasn't as significant because some of those things we didn't need to re-buy so the second month we're in business cash out for expenses was fifteen thousand dollars but we collected from our clients nine thousand dollars so that means we're actually only going going to be using going into our line of credit by a smaller amount um we did end up getting some money put into our bank account because we knew our landlord was going to be providing some landlord um distributions so you can simplify this now I think based on how you collect your money so I don't want to make this more complicated because this was a little bit complicated based on how we collected our money at that time but in our business now anytime someone comes in for their physiotherapy they actually pay for the physiotherapy on the spot we do direct electronic billing to their insurance company and the next day they're reimbursed from their insurance company whatever that they are going to get reimbursed so if I was to redo this cash flow it would be much more forgiving because that money that I'm billing out I probably have collected 70 percent of it or more depending on how much is MBA and wsib because those funding sources do take anywhere from 90 to 120 days to actually collect so the point of the cash flow is that you're going to keep going through every month of generating how much income that you're going to get so like this is an interesting month um I'm trying to remember what my rationale was for why February we were going to Bill less than January it's probably a shorter month but we went through every month and did our expected income and we went through every month and did our expected expenses so cash in cash out and we could see what sort of cash flow situation you're in so you can see this is the first month that the cash in compared to the cash out actually left us with some real money to pay down the line of credit that we had been building up but then the next month because it's a shorter month our cash in cash out didn't work out so well so it does show you particularly in this method of how we were collecting money that from a cash flow analysis standpoint you're not always going to be in a surplus even though when you look at your profit and loss you may find that you are positive so in this case if you look at the whole year prediction of cash in cash out we've predicted that we were going to Bill 276 thousand dollars in total Billings and these are the totals for all of the not necessarily expenses but all of the cash out because our owner's draws are in there at 26 000. so we're gonna have a total disbursements or cash out of 240 2 000 so we actually on a profit and loss perspective show that we're thirty four thousand dollars ahead but we're our line of credit is that we're in the whole thirty thousand dollars so really we're only cash positive by 4 000. and that's the tricky part when you're trying to make predictions for you know particularly how much money will be available for the owner to take as a draw because that first year of operations how quickly you're collecting the money is going to really indicate how much money is available so comparatively speaking if we look at a simplified p l that just looks at okay you know let's go back to here so in this case at the top we were guesstimating 276 thousand dollars in income so maybe somewhere between these two numbers and then when you're doing your profit and loss for the bank you're you got to still get that number from somewhere like where are you going to get that number of how much money are you going to make you're going to get that from your cash flow analysis but then you're only going to be booking here expenses that are true write-offs so these are going to be all of the expenses that are associated with running a clinic and you'll notice that when we get down to banking as an example the only thing that you can write off are the interest of your line of credit or your Capital loan interest even though there was a much bigger cash flow requirement to service those loans you're it all the interest is the only thing that reduces your actual profit you also have to make estimations in this case we haven't admin making the big twelve dollars an hour but we've assumed that we've hired a stock physio so in our budgeting we'll assume that our staff physios if they're an experienced physio we expect are all in employee expense to be 50 that's not to say the physio is getting 50 because if they're on payroll we still have other expenses that we have to remit so we're saying our whole expenses related to that Vizio being on payroll are going to be 50 percent so you'll see that with these income numbers I've assumed what if it was all done by staff what's the expense going to be for their wages because the owner's wages aren't reflected there at all and we can see in the different scenarios what our actual profit would be so profit on a one physio Clinic was fifty thousand dollars or a 32 profit margin that doesn't mean that 51 000 was available to take because the loan payment still had to come out of that fifty thousand dollars the actual loan payment isn't really reflected on the profit and loss but the bank will want to see that you are going to eventually generate profit and you will want to see as an owner that there will be profit that you could draw from for your own wages because in my experience as an owner most physios are not only treating but they're managing the business and you're working considerably more than your stock physio that is coming to work to see clients so again this is just a simple Excel sheet I there is no way that you would not be able to find a nice clean version of an accounting template that you could use in your business plan but you will need to show the bank those two statements one being your profit and loss the second being your cash flow analysis so hi Jackie in your experience have you seen opportunities to purchase Clinic space rather than lease well absolutely we own two of our buildings that so we have 10 clinics and we own two of the buildings we did not purchase off the get-go obviously that would be another layer of risk that you would have so there are things that I can tell you if you were looking at purchasing um because that would become another financing need it would be interesting to see how the bank would respond to you buying a building and starting a brand new practice in it I know when we bought our buildings we were an established clinic so there are things called owner occupied financing where if your business occupies more than 50 percent of the building that you're buying you can get preferred financing which usually means that they will lend somewhere between 65 and 70 percent of the purchase price so if the building cost a million dollars the bank's going to lend you at the most 750 000 which means you're going to have to come up with that differences but uh as a down payment because from a cash flow standpoint often um servicing the mortgage isn't a lot different than paying rent it's it's just the level of comfort the bank will have if your business is actually viable enough to be their guarantee that you'll be able to pay your mortgage so you can absolutely look to buying the buildings and I think my experiences has been very favorable to own the buildings you get to control your second biggest expense being rent so that's great it uh I feel like even if the business was to go south which we all hope it doesn't at least you have an asset being the building that you could sell so it's really just whether the bank thinks your business is strong enough um okay I'm going to show you one other thing to close this off to hopefully wrap it up for you and I very purposely picked very dated things because I wanted to protect lots of people's privacy oh I will I'll add this to the chat but I forgot where I found this but here is a um basic physiotherapy checklist which I thought was pretty darn exhaustive that you could go through and check out equipment lists um summary that I wanted to show you so this is this again was done in 2006 so very old we opened a clinic in Milton I gave those kind of unique things about our Clinic location where we were there wasn't another physiotherapy Clinic we had good anchors talked about the population was projected to double we were going into the area where the population was doubling um based on the proposed market analysis we we we're predicting that this Clinic would be a two to three physio Clinic a little bit about my business partner at the time what his experience was where we would draw our referral sources from so thinking about that basic level of marketing that you could you could go into more detail at the time I didn't now I knew this was not our first Clinic that we opened so it was easier um for us to go to our bank who our competitors were what our time frame was our financial needs I would attach it as an Excel sheet so I would outline what our Capital needs would be which would be all of our equipment and as I mentioned earlier I would always try and put as much equipment into that package as possible and then what are operational line of credit would be and that would be the introduction letter to our package that we would send that would include that more detailed analysis of um our sorry I'm having trouble speaking and clicking at the same time um it would be that would be our short introduction letter that we would include our profit and loss and our cash flow analysis and our list of our Capital Equipment means so I think that is it I um I'm happy to answer any questions about business plan or actually about our clinics didn't really give a good introduction about our business so we're 25 years old last year so we're in our 26th year and we're in eight different cities we have 10 different clinics now I have bought and sold several clinics along the way um and a have all been very good learning experiences and uh yeah we're still in a very exciting time and hoping to grow I see someone typing so I'm just going to wait to see what the question is I'm assuming that you're you guys do have access to microphones please feel free to speak versus type 2. no we don't have access to microphones oh that's okay that's good to know I assume that every laptop would have that um there's a couple other typing questions so I'm just waiting on the bubbles the microphone's been disabled very strange what would you consider to be the most important referral source yeah so I mean I think that so the question is what would you consider to be the most important referral source meeting with family physicians online marketing or Word of Mouth so I will talk a little bit about this in the marketing talk and it's definitely changed over the last 25 years um I I think that the medical referral source is still very important and has shown to be ongoingly important in our business so that is something that we've been very consistent over 25 years we regularly meet with Physicians we have a very educational marketing platform um over time you know we used to have I mean there's still like over 350 positions that might refer but they they used to be you know Dr jockey would refer five patients a week but because we I think we did really well with those clients then of course our Word of Mouth um numbers started to refer so at this point in time our Word of Mouth um referral rate is broaching on 70 so that means 70 of every initial assessment that we do the client is identifying that they heard about the clinic through one of our word of Med categories which you know if I was to give some advice and this is a much more around the marketing talk is to really recognize that early and that's when I said at the beginning don't minimize um the similarities that we have with the hairdressers with your dentist all of these service related businesses you do want to have a very solid engagement uh platform in your marketing with your current and your previous clients because in my experience the word of mouth has grown exponentially um and that is overall why I think our clinics grow because while that referral source is growing then um we're also continuing our medical marketing so we're still getting those direct referrals from the different levels of medical community and the last piece with online marketing for sure that is um very important and I personally find got a lot of physios that are running their own business are very willing to be on social media and to really self-promote and it can be quite an effective tool um in our business you know our physios don't need to do that because they're getting clients filling their schedule anyway so I I almost feel like we attract physios that don't want to do that either they want you know some of our physios don't even have social media personally so the last thing that they want to do is be on their marketing um their services for physio but it it is absolutely effective I can tell you that our strategic goal is to have 10 percent of our initial assessments come from Google so we do pay uh for Google AdWords and then of course try and you know meet all of the algorithm requirements of Google to you know have people identify that they're finding us because of because of Google so you know as an example one of the one of the um platforms that we use I can track if someone looks us up on their phone the number that they click on to call the clinic is actually a tracking number it's not our actual clinics number so then I can look on that platform for how many people called the clinic and then I can cross-reference their telephone number with our initial assessment telephone numbers in the same time period so I can tell you objectively that on a monthly basis uh our Google adword investment pays for the amount of new clients that we see so um that answers that question Brandon your question what has been your strategy for advertising and how it translated into new clients coming through the doors do you find Word of Mouth the most effective or what to prefer so our our overall platform across all referral touch points is educational we're not a clinic that's known to put a good golf tournament on and that's why we get clients um whether we're out doing um free talks in the community or whether we're doing lunch and learns with medical touch points um we have a very educational platform so that is often how we get people in the door and then from there our word of mouth or our client engagement um strategies continue to grow year after year so those those two things are really important um how do or would you approach an approach medical marketing as a new Clinic I think that you know you want to go you want to always think about it if we're thinking about family docs what are you going to do to make their life easier um I don't think going in and saying hey I'm Jackie I opened up down the street please send me patience is necessarily going to call um engage them to refer people but again we go in with an educational platform that you know for example our number one joint is the shoulder joint so we'll go in and review with them when they should send clients for an ultrasound an x-ray an MRI and when physiotherapy can be useful so we're trying to help expedite their filtering system and you know we can say we're you know the shoulder is our joint of Interest that's what we like to treat and you know we're in a geographic area where there are no other physiotherapy clinics um a lot of doctors for lots of different reasons can be quite sensitive to um feeling like they're choosing a physiotherapy Clinic over another but will often make that choice if they feel that that particular Clinic actually has a unique program that's their client is going to do better with so that gets back to how I would Market to the medical communities I would know what I'm good at and when you say what you're good at make sure that you're willing to invest the time you know we say we're good at the shoulder but we spend a lot of time reviewing studies we spend a lot of time mentoring our junior staff on shoulder treatment so that when people do come in with shoulder pain that it doesn't matter who you see they feel like they know a lot about the shoulder when you are looking for potential Partners around a new location so our most successful Partnerships are definitely coming out of um knowing that we share the same philosophy of practice so we often will um not talk about Partnerships with people until we've worked with them for some time all of our partners do you have um their Advanced credentialing done in the manual therapy or sport or pelvic so we do look for our partners to be clinical leaders so often we take on and that's how we've grown all of our locations are now owned or managed by physios that initially started off working for us but expressed interest in ownership and we're willing to become a clinical leader so for us those discussions around partnership are not just about business but knowing that we share the same philosophy of practice um a whole bunch of people typing so I I would have loved to figure out how to get the microphone off but I'm gonna have to ask my marketing and Communications person um so I'm coming back to you um okay do you try to maintain consistent margins or do they vary month to month yeah absolutely the margins will vary um so we like to not only from a profit margin standpoint but also to try and create a culture that all of our professional staff like to work in we try and keep our private insurance um funding at least 70 percent of our patient population because those clients do tend to be I'm making very broad Strokes here but they do tend to be highly motivated um clients that don't come with a lot of extended paperwork so are are not the same type of administrative burden on either the professional staff or the administrative staff so we like to try and keep that funding source at least 70 percent or higher and have our combined MBA wsib funding um no more than 30 percent so we are careful on how much we Market to those third-party payers um which will also affect your overall profit margins just another question coming up here foreign the other thing that I'll say while I'm waiting for this question to come in um that covid really did uh highlight to us was those third-party funding groups that were coming from wsib and MBA I know a lot of clinics have opted out of that which I think is a bit tricky from a marketing standpoint um you know to go to the medical doctors and say you know what I'm only going to treat your private people like only send me the good clients I don't want to deal with you know the clients that come with extended baggage we never really wanted to say that to the Physicians we felt like we should be an inclusive Clinic that gave everyone the opportunity for good care having said that I mentioned that we do control how many wsib will come into the clinic but we still are um accepting wsib people and the other thing that it did teach me during covid was that those funding sources actually were a stable foundation for the clinic we bounced back really quickly because we had those funding sources whereas you know we would it would look like from the outside looking in at some of our competitors that were exclusively private insurance they seem to be slower to get their staff back so I mean I obviously don't know that firsthand but that is just sort of an observation yeah so with regards to competitors there are so many more clinics everywhere now how do you navigate this and I think the market has changed and um I had someone ask me about like what's the point of saturation like obviously no one understands what the point of saturation is the great thing for the physiotherapy profession is if you're positioning yourself in a city that like most of our cities in southern Ontario are growing then you know having more and more physios on every corner doesn't necessarily hurt you it actually increases awareness um I think it's harder and harder to build a larger physiotherapy practice I think you're seeing um you know people that are you know maybe not that entrepreneurial that really just want to um create a job and you know really be you know in control of you know their own hours or whatever the case may be so you're seeing a lot of one to two physiotherapy clinics so how do we navigate this we do look at that in some of those ratios still like I still will look and see overall how many physios are listed in Guelph compared to dentists and then you know how many um Family docs are there um so I do look at those um demographics and I still will when we open the Women's Health clinic that clinic only opened five years ago so certainly there were a lot of physios in Guelph by the time we opened that clinic but again we went to an area that you know there wasn't another clinic in walking distance to where the clinic was and we were very niched at that point like that clinic was specifically a women's health clinic that primarily did pelvic physiotherapy so it didn't even matter that you know um an orthopedic clinic was six blocks away because they didn't even offer pelvic physiotherapy anyway in fact they refer to us because you know we're doing pelvic physio there's one other question coming in oh maybe we're good um if anyone does have any follow-up questions uh why email is pretty simple jacket aromasophysio.com you can I'm definitely happy I've been doing quite a bit of mentoring in the physiotherapy Community for um mostly women because I think it was a lot harder for um people having kids and raising families but that's a slight bias but I'm happy to Mentor anybody that has questions and I think that we've learned a lot along the way so I'm happy to share that I see someone typing certainly feel free to go at any time I'm glad getting lots of comments that the information I tried I really hope that I made things practical and at least introduced you to some new language that you might not have heard in the physiotherapy program great you guys have my email happy to answer any questions and I hope you have a great night and maybe I'll see some of you next week bye guys