Client: A premier multi-specialty ambulatory surgery center in Orlando. For privacy purposes, the center will be referred to as “Orlando Ambulatory Specialists” (OAS). Service Area: Full-Service Accounting & Controllership Challenge: A lean administrative team and lack of sophisticated financial oversight led to delayed reporting, poor visibility into procedure costs, and mounting administrative burdens on the physician-owners. Solution: Orivon Advisory Group was engaged to provide a complete, outsourced accounting and controllership function, streamlining all financial operations and delivering the strategic insights needed to boost profitability and physician focus.

Introduction

Orlando Ambulatory Specialists (OAS) was founded by a group of leading surgeons dedicated to providing high-quality, cost-effective outpatient surgical care. Their state-of-the-art facility and reputation for clinical excellence led to rapid growth in patient volume. However, the back office was struggling to keep pace. The financial operations were managed by a small administrative team juggling everything from medical billing reconciliation to payroll and vendor payments. The physician-partners, while brilliant in the operating room, found themselves increasingly consumed by financial questions they were not equipped to answer, diverting their focus from patient care and strategic clinical growth.

The Problem: Clinical Excellence Undermined by Financial Drag

OAS’s core challenge was an accounting function that was purely transactional, not strategic. It was reacting to day-to-day needs rather than providing the forward-looking guidance the business required. This created several critical issues:

• Delayed Financial Visibility: The month-end close process consistently took over three weeks, meaning the partners were making decisions based on financial data that was nearly a month old. They had no real-time pulse on the financial health of the center.
• Lack of Procedural Profitability Insight: The center’s leadership knew their overall revenue, but they couldn’t accurately determine the true profitability of each type of surgical procedure. A high-volume procedure might have razor-thin margins due to supply costs, while a less common one might be far more profitable. This made it impossible to strategically manage operating room schedules or negotiate effectively with insurance providers.
• Inefficient Revenue Cycle Management: Reconciling complex insurance payments and patient co-pays with the billing system was a manual and painstaking process. This led to delays in identifying underpayments and a growing accounts receivable balance, negatively impacting cash flow.
• Physician Administrative Burnout: The lead surgeon was spending nearly 10 hours a week reviewing invoices, approving payroll, and wrestling with financial reports instead of focusing on clinical leadership and patient outcomes.

The Catalyst for Change: A Costly Surprise

The breaking point came at the end of the fiscal year when OAS was hit with an unexpectedly large tax bill. Their existing CPA, who only received their books annually, had not been able to provide proactive tax planning. The physician-partners realized their lack of ongoing, expert financial oversight was now directly impacting their personal earnings and the center’s ability to invest in new technology. One of the partners, having heard about Orivon’s work with another medical group, made the call.

OAG’s Diagnosis and Strategic Solution

The Orivon team began with a full diagnostic of OAS’s financial operations. We identified workflow bottlenecks, system inefficiencies, and a critical gap in strategic financial leadership. Orivon’s solution was to implement its Full-Service Accounting & Controllership model. This wasn’t just about providing advice; it was about taking complete ownership of the finance function.

1. Dedicated Controllership Team: Orivon assigned a dedicated controller to serve as the single point of contact for the OAS partners, supported by a team of accounting specialists. Our team took over all day-to-day financial tasks: accounts payable, payroll processing, bank reconciliations, and managing the general ledger.
2. System Optimization and Automation: We streamlined the existing accounting software, creating automated workflows for invoice approvals and vendor payments. We also built a robust process to reconcile billing system reports with bank deposits daily, allowing for the immediate flagging of payment discrepancies.
3. Cost Accounting and Profitability Analysis: Orivon implemented a cost accounting system to precisely track the direct costs (supplies, disposables, specific staffing) associated with each surgical procedure.
4. Delivering the “CFO-in-a-Box”: The controller prepared and presented a comprehensive monthly financial package. This included standard financial statements, a detailed analysis of revenue and expenses against budget, and—most critically—a dashboard showing profitability by surgeon and by procedure.

The Transformation: Savings, Benefits, and a Clear Path Forward

By outsourcing their entire accounting function to Orivon, OAS underwent a complete operational transformation.

• Massive Efficiency Gains: The month-end closing process was reduced from 22 days to just 5 business days, providing the partners with timely, relevant data to manage the business effectively.
• Improved Cash Flow: The rigorous daily reconciliation process identified and helped recover over $275,000 in insurance underpayments within the first six months.
• Data-Driven Profitability Growth: The new procedure-costing reports provided a revelation. The partners discovered that by slightly modifying their surgical supply kits for two high-volume procedures, they could cut costs without impacting clinical outcomes. This, combined with optimizing OR schedules to prioritize higher-margin procedures, led to a 20% increase in overall profitability in the first year.
• Renewed Focus on Medicine: The lead surgeon regained nearly 40 hours per month, which he reinvested into mentoring junior surgeons and developing a new outpatient orthopedic program, creating a significant new revenue stream for the center.

With Orivon as their integrated financial department, the partners at Orlando Ambulatory Specialists were finally freed to focus on what they do best: providing exceptional surgical care. They now have a clear, accurate, and strategic view of their finances, giving them the confidence to grow the practice and enhance patient services for years to come.