Office Hour April 16, 2026: From Activity to Revenue: Fixing Your Service Line Blind Spots

Clinical Business Framework Office Hour April 16, 2026

Service line tracking and reporting gaps @ 1:42
Florence discussed challenges with tracking service line numbers and revenue generation through the EMR system. Her manager explained that the number of studies performed doesn't always correlate directly with revenue generated due to timing lags (e.g., busy December leads to revenue in January/February). To address this, Florence has her staff manually track each study monthly, which is more reliable than EMR reporting. She also identified ongoing difficulties with running denial reports and has scheduled a Zoom meeting with a customer success manager on Monday to learn how to properly generate these reports, as her previous support person was ineffective.

Tax complications and accountant transition @ 4:32
Florence faced significant tax payment challenges, including an unexpectedly high tax bill that required last-minute corrections from her accountant. Key issues included: (1) late receipt of financial documents from a third party ("Black Swan stuff"), (2) uncertainty about whether equipment purchases were properly deducted or placed on a depreciation schedule, and (3) incomplete documentation sent to the accountant (only monthly loan payments rather than total loan amounts). Florence recently switched accountants and is optimistic about the new firm's organization and communication. She plans to follow up with them in 1-2 months once they return from vacation and finalized numbers are available, with the goal of establishing a pre-tax planning questionnaire to streamline future years.

Hiring challenges in competitive market @ 11:14
Florence is struggling to find qualified neurologists despite multiple recruitment efforts. She signed with a recruiting firm and is considering working with multiple firms simultaneously (no exclusivity clause required). She tried Indeed advertising but found minimal candidates—one interested person ultimately declined due to the commute and preference for remote EEG reading work. She hasn't posted on LinkedIn due to her limited activity on the platform. The broader market is tight: everyone is hiring, new graduates are already placed, and she's not finding candidates even when reaching out personally. A recruiter mentioned that many people want to stay in New York, but availability is limited. She's open to candidates who aren't new graduates and is considering reaching out to her residency program.

Staten Island clinic launch @ 16:19
Florence is opening her Staten Island clinic in two weeks (April 28th) with a grand opening planned for May 17th. She's starting with a half-day schedule to test the market, and the half-day is already fully booked with new patients. She recently held a small networking event with local independent providers (internists, pediatrician, physical therapist, ophthalmologist) to build referral relationships. She's in "crunch time" preparing the space, including ordering office supplies and setting up four of the eight available rooms.

Supply management for multi-location practice @ 17:05
Jennie shared lessons learned from opening multiple clinic locations: ordering too much inventory led to significant wastage, particularly with items that expire (lidocaine, injectables, medications, EEG supplies, EMG needles). She recommended Florence take a "tackle box" approach—bringing a box of supplies (e.g., 40 EMG studies worth) from her Brooklyn clinic to Staten Island, restocking it weekly at the main office. For non-expiring items (gauze, cotton swabs, tuning forks, hammers), bulk ordering is acceptable. Florence currently orders supplies herself through Henry Schein and is considering whether to ship directly to Staten Island or consolidate at Brooklyn. She also uses BJ's/Costco for basics like toilet paper and batteries but is the sole person managing these orders, which is inefficient.

Real estate strategy and Stark law compliance @ 25:41
Florence is considering subletting unused rooms in her Staten Island clinic (she has 8 rooms but plans to use only 4 initially). Jennie explained critical Stark law considerations: (1) any medical tenant must be charged the same rent rate as Florence charges herself, (2) rent should be calculated as a "triple net lease" including all expenses (property taxes, insurance, maintenance, utilities, snow removal, cleaning), and (3) the per-square-foot rate should be consistent across all tenants. Florence's Brooklyn location is a mixed-use building where she owns 25% (shared with her sister), making aggressive rent allocation less beneficial since she only receives 50% of proceeds. However, her Staten Island property is solely owned, making it advantageous to maximize rent expenses to reduce tax liability on the practice entity. Jennie advised Florence to calculate all expenses and create a per-square-foot rate, potentially including aesthetic services providers (e.g., aestheticians) who would rent space but not be her employees (avoiding liability issues).

Networking event and market intelligence @ 39:44
Florence held a small networking event with local independent providers last Thursday, which generated valuable market insights. She met a physical therapist who revealed her company has 40 locations across NYC (started in 2021, likely through acquisitions). This sparked Florence's interest in understanding how to scale quickly. The PT company handles in-house billing, credentialing, and uses rotating residents/students for staffing. This conversation prompted Florence to reconnect with her residency program as a potential recruitment pipeline. The event also reinforced the value of peer networks—all attendees were solo practitioners who recognized the loneliness of independent practice and expressed interest in ongoing collaboration and referral relationships.

Recruitment strategy and compensation benchmarking @ 42:47
Florence is offering market-rate compensation ($280-300K) for neurologists, which is significantly higher than academic positions (starting at $240K at Cornell). She learned from a movement disorder specialist friend that it takes years in academia to reach Florence's starting salary. Florence's key advantage is lifestyle: she offers 4-day work weeks (32 patient-facing hours), whereas academic institutions typically require 5 days. She's planning a one-year income guarantee for the first hire since the schedule may not be fully booked initially. She's also considering recruiting new graduates who may value work-life balance and are willing to accept lower initial compensation. For locum coverage, she previously paid $1,500/day plus malpractice insurance (~$100/month), but the locum only saw 12 patients (below the 15-patient break-even point at $190 average claim per visit), resulting in losses.