Real estate investing, financial mentorship & career coaching for physicians

Enhancing the Patient Experience using Mobile Technology

Mon, 05 Mar 2018 14:17:06 -0800

By: Michael Warner, MD, FRCPC, MBA

The long-term success of businesses in most industries is influenced by the balance between supply and demand. Medicine is different. Physicians and hospitals are in limited supply, and there is an unrelenting demand for services. As a result, there is little economic motivation to improve the patient experience.

Widespread use of mobile technology has shaped consumer expectations in nearly every retail industry. To remain competitive, transactional businesses must offer convenience and low cost. Service-based companies strive to provide customers with a personalized, hassle-free experience.

Unfortunately, when it comes to interactions with the healthcare system, consumers have been conditioned to dial back their expectations. The process of accessing a physician can be inefficient and inconvenient. Once patients have entered the healthcare system, communication can be incomplete and provider-centric.

Consumers' improving experience in other industries has raised expectations for their experience as patients. Fortunately, there are several companies and organizations profiled below who are using mobile technology and principles from other industries to improve both access to, and communication within, healthcare.

Improving Access

It has been widely reported that Canadians wait longer to see a physician than patients in other highly developed countries. The reasons for this are complex and not solely due to the way physicians operate. Factors such as human resource planning, fee schedule rules and lack of integrated healthcare IT are all contributory.

Although...Read More

Federal Budget 2018: Taxation of Passive Investment Income

Tue, 27 Feb 2018 19:39:00 -0800

By: Michael Warner, MD, FRCPC, MBA.

President, AdvisoryMD

Minister Morneau presented the 2018 Federal Budget on February 27.

Read the full document here.

A 5-page backgrounder on the treatment of passive investment income is here.

Highlights for Incorporated Physicians

1. Punitive taxation of passive investment income above $50,000/year has been abandoned.

The taxation of passive investment income will not be changing
There will be no need to to track new and legacy pools of passive investments
Compliance and accounting costs should not materially increase

2. Access to the small business deduction limit of $500,000 will be reduced if passive investment income is > $50,000 in a given year

Currently, the small business deduction limit allows up to $500,000 of active business income to be subject to a lower small business tax rate (13.5% vs normal active business income rate of 26.5% in Ontario)
The small business deduction limit...Read More

Taxation of Passive Investment Income

Thu, 15 Feb 2018 08:33:46 -0800

By: Michael Warner, MD, FRCPC, MBA

President, AdvisoryMD

Finance Minister Bill Morneau will be releasing the 2018 budget on February 27. Small business owners, including physicians and other incorporated professionals should circle this date on their calendars as the expected "reveal day" for how the government plans to implement changes to taxation of passive investment income earned by small businesses.

On July 18, 2017, Minister Morneau released a discussion document outlining proposed changes to the taxation of Canadian controlled private corporations. One of the most controversial proposals will dramatically increase the tax on passive investment income earned by these businesses. The graph below from the AdvisoryMD accounting team at Saeed & Company demonstrates the punitive nature of the planned tax rates.

On October 18, 2017, Minister Moreau announced that the passive income taxation proposal will be adjusted . Once implemented, $50,000 of investment income (on a go-forward basis) will be sheltered from the new tax rates. The technical description of how this change will be implemented is expected in the Spring Budget announcement.

Small business owners have been left with many questions which makes planning difficult.

1. What does the $50,000 threshold actually mean?

The government backgrounder explains that the $50,000 threshold was set to...Read More

Equitable Access to Healthcare for Obese Patients

Tue, 28 Nov 2017 14:30:07 -0800

By: Michael Warner, MD, FRCPC, MBA

President, AdvisoryMD

According to Statistics Canada 61.8% of men and 46.2% of women were classified as overweight or obese in 2014. Obesity is a risk factor for many serious health problems including heart attack, stroke, sleep apnea and hip & knee arthritis. Given its prevalence, harmful effects and cost, obesity prevention should be a priority for individuals and all levels of government.

While the link between obesity and the diseases described above is clear, the health of obese patients is also at risk because physicians treating them may lack the necessary data to make an accurate diagnosis or prescribe appropriate treatment. For example, CT and MRI scanners have weight and size limits which exclude some obese patients from having these tests. Similarly, dosing guidelines for many medications, including antibiotics, do not exist for patients greater than 220 lbs (100 kg).

As described in the following radio interview on AM 640, and article & video from CBC's The National, the healthcare system needs to adapt to ensure that patients living with obesity have equitable access to the benefits of modern medicine.

Michael Warner is the President of AdvisoryMD. He provides healthcare entrepreneurs with medical advisory/director services and also performs clinical due diligence for investors evaluating healthcare companies.

A physician-entrepreneur's response to Morneau's tax changes

Tue, 26 Sep 2017 17:49:30 -0700

By: Michael Warner, MD, FRCPC, MBA

President, AdvisoryMD

As the 75-day consultation period on Tax Planning Using Private Corporations comes to a close on October 2, small business owners continue to share their feedback about the proposed changes. As an incorporated physician and entrepreneur, I am discouraged by the divisive strategy used by the government to communicate the proposals, concerned about the implications for existing labour agreements and disappointed by the lack of analysis of the economic impact of the changes.

From the outset, the government has relied on inflammatory rhetoric to fan the flames of outrage in the general public about the way small businesses are taxed. Physicians, in particular, have been targeted for exploiting tax “loopholes” implying that those who use legal tax planning strategies are being dishonest. Missing from the government’s message is that in Ontario, physicians negotiated for the right to incorporate in 2000 in lieu of fee increases or being granted employee benefits. Physicians were subsequently encouraged by the government to incorporate as part of their tax planning and retirement savings strategies.

The concept of “good faith” is fundamental to all labour negotiations in Canada. Unfortunately, the actions by the federal government call into question their belief in this principle. The proposed tax changes will eliminate nearly all the financial benefits of incorporation for physicians. The rules by which incorporated physicians have planned their business and financial future will be changed unilaterally and outside the process of re-negotiation. This will functionally sever the covenant made between Ontario's physicians and the provincial government. If these proposals become legislation, the sanctity and durability of all labour agreements made with...Read More