September 2016 - Anders CPA

September 27, 2016

Constructing a Growing St. Louis

There are currently several large construction projects going on all over St. Louis, bringing positive media attention and tourism to the gateway city. With the Anders office located downtown, we are fully invested in the city of St. Louis, keeping an interest in the community, and more specifically the construction and growth in our city.

One of the largest construction projects to come to St. Louis is the new National Geospatial-Intelligence Agency (“NGA”) West Campus in North St. Louis. NGA provides geospatial intelligence to the officials who make our country a safer place. The project has an estimated cost of $1.75 Billion, while generating thousands of new jobs and millions of dollars in St. Louis Earnings Tax. The project will be complete in 2022.

Another billion dollar project in St. Louis is BJC’s campus renewal project of Barnes-Jewish Hospital, St. Louis Children’s Hospital, and Washington School of Medicine. Not only has this project pushed money into the St. Louis economy, it is helping St. Louis become a destination for new medicine.

St. Louis’ Union Station Phase II (amusement park phase) is underway. This $70 million project will create hundreds of new jobs and include a 200-foot Ferris Wheel, roller coaster, other rides, and new tourist entertainment venues in downtown St. Louis.  The new Ferris Wheel is planning to open in 2018.

Another major renovation to attract tourists to St. Louis is the City Arch River project. The $380 Million update to the Arch grounds includes an expanded Museum, bicycle trails, children play areas, performance venues, and more.  Completion is on target for fall of 2017.

The historic 20 story Robert A. Young Federal Building in downtown St. Louis, built in 1933, is going through a $62 million dollar seismic retrofit/renovation in order to make the St. Louis City skyline building earth quake proof. After the increase in seismic activity in St. Louis over the last few years, the government began looking into this renovation for the safety of the tenants.

Other Projects that are currently under construction include: Carondelet Coke, St. Louis University Housing, St. Louis College of Pharmacy, Delmar Apartments, Lindell Apartments, and several other sites, including numerous housing and apartment complexes all over the City of St. Louis. In addition to projects that are currently under construction, there are several other projects in their beginning phases, including: St. Louis University SSM Hospital, Ballpark Village Phase II, Cortex Phase III, Railway Exchange, Jefferson Arms, and many more. With all of these large construction projects, it is obvious that St. Louis is growing, and in the process we will attract more business, citizens, and tourists to our great city.

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September 20, 2016

How to Build and Manage a Startup Board of Directors

Every public company and most large private companies have a board of directors. These directors help with governance and give recommendations to keep the company growing. It may seem like a board of directors would only benefit large companies, but to ensure continued success, small companies and even startups should have a board of directors or an advisory board.

What does a board of directors do?

The board of directors is elected by shareholders to oversee the management of the company. The day to day management is usually handled by someone the board puts in place. Typically in a new startup company, it will be the original founder. As the company grows, the board may choose to hire an experienced CEO and/or CFO, while the founder focuses on growth of the core business.

Does my startup really need a board?

Yes, your startup should have some type of board in place to help your company grow. They will take a different look at the company and provide recommendations you may not receive without a board. If the startup founder does not know much about interpreting financial data, it would be in their best interest to find someone with a CFO background. The right board in place can help grow your company, and give you credibility when looking for new investors.  If you are not ready for a paid board of directors, you can look into an advisory board to benefit from outside advice.

How do I select board members?

To start, usually investors will want a seat at the board for investing in the startup. The owner of the startup will then want to pick members to fill seats that have experience or skills in areas the owner may be weak in. It’s also important to ensure members have a good reputation in the business community; look for people who have ran multiple companies successfully and have diverse skill sets. A good number for a startup board is around five members. The more diverse the board, the more advice and recommendations you will receive.

Using the board’s advice

Be willing to make changes if the board advises something. They are there to help you succeed and give you counsel you would not have on your own. The board may not always back the CEO on every decision, so be prepared to handle those situations.  Creating a structure for the board, and documenting what the board’s role is and governance policies will help in understanding each member’s role.

Though a startup may not always need a board in the non-revenue phase of the company, it is a good idea to start vetting potential directors right away so you have a good network to create a board quickly as the company grows. For more information or assistance with understanding the benefits of having a board of directors for your startup, please contact an Anders Advisor today.

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September 14, 2016

Closing the Documentation Gaps in Your EHR

Documenting accurate health care data is important to both practitioners and patients, because as we’ve all heard, “if it isn’t documented it isn’t done”. Reimbursement regulations require correlating notes to billed services, and patients expect accurate, compiled health records. Certified Electronic Health Record (EHR) systems are designed to record and track accurate documentation for exchange with other health care facilities or to be accessible in the patient’s portal.

Checking for Documentation Gaps in your EHR
To maximize the potential of an EHR and patient safety, it’s important to ensure there are no documentation gaps, and that what is captured in the EHR is consistent with the document produced. To avoid being caught with vital, trapped data in the chart, we recommend performing a documentation gap analysis.

Start by selecting a variety of visit types including a sampling of procedures.  Follow all EHR screens, taking a screen shot if possible.  Generate the final document and compare it to the data entered.  Are there gaps?

Documentation gaps may be intentional or unintentional. Some intentional examples include:

  • Practitioner’s personal use: This could serve as a personal reminder for subsequent visits, not intended for inclusion to a chart note.
  • Alert: This may be used for a variety of reasons including non-compliance such as drug-seeking behavior. It could be a safety alert such as recognizing the patient is a fall risk.
  • Not pertinent to current service: Some structured data may be eligible for compilation to a visit or procedure note, but the clinician deems it is not relevant to the current note, awaiting the appropriate reason for visit to incorporate that table or information to the note.

Unintentional examples can come from multiple areas within the EHR, which is why we suggest sampling a variety of visit types.  With the adoption of EHRs, the resulting document can compile so much data that a one page SOAP note is now six pages, including a variety of demographic and historical information not necessarily reviewed by the provider generating the final document.  The practitioner may not recognize items missing.  Data unintentionally left out of the EHR-generated document may include the following:

    • Marked boxes for findings
    • Free-text boxes
    • Pop-up template items
    • User Error – For example, the EHR may have a check box to include a section to the final note. Missing the checkbox means it is not pulled to the document.

Closing the Gaps
Create a listing of the EHR documentation gaps, mapping to specific sections in the EHR and where the documentation should be placed within the visit note.  Check with the EHR vendor or company if gaps found are “known issues,” and what update or fixes are available.  Representatives from the clinical team, such as the Medical Assistant, Nurse, and Practitioner should review the findings as a group, possibly with an EHR super-user From the analysis, the clinical team can recognize and prioritize the gaps that need addressed, and conduct further testing if needed. Alert the entire clinical team to gaps discovered and the work around.

Contact an Anders advisor to learn more about closing the gaps in your EHR.

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September 6, 2016

St. Louis: The City of Startups

Startup companies are being created everywhere in the St. Louis region these days, and many people are asking the question, “What changed in St. Louis to make it into a startup hub?” This blog will be the first in a series that will help answer this question, and serve as a resource for startups to succeed in the local ecosystem.

In this series, we will take deeper look into the St. Louis startup ecosystem and how it has progressed over the past five to ten years. The four main areas we will focus on to pinpoint this growth includes the rise of accelerator organizations, the expansion of the sources of funding, the development of different mentorship organizations, and finally the development of startup office spaces.

Accelerators
Over the past five years, the number of startup accelerators has grown tremendously in the St. Louis area. These accelerators are being created to help startup companies attain success, and accelerate the growth of their company into something great.  While the accelerator programs vary in terms of size, industry focus, number of “classes” per year, and several other factors, they are designed to help educate startups in various business disciplines.  Additionally, the accelerator programs foster collaboration between the startups in their “classes,” which helps each company realize how they are an integral part of the St. Louis startup ecosystem.

Funding
As most business owners know, startup companies generally need some level of funding in order to build and expand their businesses.  While startups have an ever increasing thirst for investment dollars, St. Louis has seen an increase in funding sources available to them over the past five to ten years. Not only are there local individual investors willing to invest in startups, there are also many other “institutional” sources for funding.  While there is always more demand for funding than there is supply, St. Louis is in a much better place from a funding perspective now versus five or ten years ago.

Mentorship Organizations
St. Louis has also become home to a wide variety of mentorship organizations that have helped build the startups they mentor. These organizations offer technical training courses, connect startup companies with other startups and professionals, including legal and accounting, and overall help guide them to accomplish their goals. Many of the mentorship organizations pull their mentors from various business backgrounds, and can tailor the mentors for a particular startup based on any areas of expertise they may be lacking.  For example, if a startup does not have a strong marketing professional on their team, the mentorship organization may be able to pair them with a current or retired marketing executive from an established St. Louis business.

Startup Office Spaces
Over the past five years, the affordable office space available to startup companies in St. Louis has increased tremendously. This office space is essential for the startup companies to expand and grow their businesses. Since most of the office spaces are collaborative work spaces, the companies get an opportunity to build their company while communicating and getting to know different startup companies working in the same building. These facilities help connect and build the startup community also, as many offer regular happy hours, events, speakers, and other social and educational events.

While the growth of accelerators, the sources of funding, the development of mentorship organizations, and the development of office spaces are not the only factors that have helped St. Louis become a startup hub, these are four of the notable drivers of startup growth in the St. Louis region. Look forward to the next blogs that dive deeper into these four areas of the St. Louis startup ecosystem and how each of them plays an integral role in making St. Louis the startup hub that can propel your business forward.  For more information on any of these areas, or to discuss ways to plug your startup into the St. Louis ecosystem, please contact the Anders Startup Group.

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