The Situation

A Kansas City based medical group had experienced a decline in revenue and cash flow due to lower insurance reimbursements and rising and unbudgeted operational costs. The decline had resulted in months where the physician owners often had to go without paychecks so there would be cash flow for paying overhead costs.

The Solution

Fulling Management & Accounting, Inc. worked with the medical office as a team to identify areas of cash flow drain and looked for areas to generate additional revenue. We developed an incentive-based pay system for the physicians that resulted in positive cash flow as well as payroll bonuses rather than check-less paydays. We identified areas to leverage the physicians time appropriately to allow them to generate more revenue while working more efficiently.

The Result

The medical group recently moved into a brand new leased facility and purchased a state of the art medical billing system without incurring additional debt. Payroll bonuses are a common occurrence and income and expenses are budgeted and properly managed.


“In 1996, Rusty Fulling was called in to do an in-depth study of our practice. Using his financial background and objectivity, he analyzed everything from cotton balls to malpractice insurance and developed a plan to control costs. Our increased profitability was a direct result of his knowledge and efficiency. Now, our practice has a long-term relationship with Fulling Management & Accounting, and Rusty is instrumental to our success. He has restructured our physician compensation plan, helped get financing for malpractice insurance, and recommended medical management software. Rusty doesn’t shy away from difficult situations; he is willing to make the right decision even when it is not popular. Rusty is just flat out honest. I never wonder what he is really thinking. You just trust somebody like that. At the same time, he has developed a great rapport with our physicians, who rely on him for business advice. He’s allowed them to practice medicine. Rusty proved to them that we can give good patient care and still be financially successful.”  –  Lisa McCoskey, Office Manager, Heartland Womens Health Care, P.C.     

“Rusty Fulling is not a typical accountant. He goes above and beyond what you would expect. In addition to managing our general accounting, he has helped us develop our Web site, evaluate our computer system hardware and medical management software, choose vendors, and recruit new physicians. Rusty crunches numbers for the bottom line and bases his recommendations on facts. He helps us understand the impact of our choices and make better-informed decisions. By helping us get quality products at reasonable prices, he has saved us a lot of money. Rusty is extremely conscientious and caring — I can’t say enough nice things about him. Rusty wants to see his clients succeed. He takes a personal interest in our practice and will do anything he can to help us succeed.” — James Morgan, D.O., Heartland Womens Health Care, P.C.

“Fulling Management have been working with us for nearly ten years, and they have made an amazing difference in our medical practice. As physicians, we weren’t necessarily business-minded, but Rusty has coached us to think more like a business and shown us how to run our practice like a business. For example, he set up a computer system to streamline our billing procedures. Now, all of us are more cognizant of the importance of charge slips. He also improved our long-range planning, which helped us curb costs and reduce debt. As a result, as of December 2008, our practice is debt free!”

“By far, the biggest crisis that Rusty and Fulling Management has helped us manage was when we lost our malpractice insurance. We had paid $500,000 to an insurance carrier that went out of business. We had to eat these costs, and we didn’t even know if we would be able to stay in business. We had many late night hours and phone calls with Rusty. He had ideas about how to work this out. He helped us negotiate with insurance carriers and hospitals.”

“Fulling Management has even helped us market our practice. They are amenable to anything that will improve our practice and productivity. Rusty is also the easiest accountant that I have ever worked with. I am not particularly business-oriented, but he always has time to answer my questions and can explain complex financial concepts without being patronizing. Rusty’s integrity is impeccable. This may sound a bit old-fashioned, but it’s true: Rusty is a good, solid, honest Christian man. He has above-board ethics and a strong business sense. I’m really impressed by that. We all feel that Rusty is a valuable part of our practice and that he is both a friend and a colleague.” — Patricia Mooney-Smith, M.D., Heartland Women’s Healthcare