Investing in the latest technology can bring important benefits to your practice and allow you to compete effectively. But funding that investment can be difficult with pressure on cash flow and competing demands for budgets. Medical practices often find themselves trying to keep pace with advancements in technology, but keeping up is easier said than done. Investment in technology places heavy demands on capital resources. As a result, administrators are exploring alternative sources of capital beyond customary bank loans.

Many administrators are taking a fresh look at lease financing and that’s raising some significant questions. Financing offers an alternative—a flexible method of acquiring technology, spreading the cost over a period of time with predictable monthly payments that ease cash flow, protect capital, and preserve other lines of credit. The strategy of leasing can be attractive because it can offer more flexibility in structuring cash flows and provides the agility to change technology as conditions dictate. Administrators should know what leasing options are available when leasing is an appropriate solution, and what business issues must be addressed in a leasing program.

When seeking a means to fund expensive but essential technologies, operating and capital leases are two options that administrators should consider. The differences between the two options have to do mainly with the accounting method, the tax treatment, and the ownership of the equipment.


Operating leases

An operating lease is more like the monthly rent that you pay on your medical building. It is a lease with no transfer of ownership interest or title between lessor and lessee.

Unlike with a capital lease, equipment tied to an operating lease is not considered an asset. The operating lease payments are treated as operational expenses on your profit and loss statement.

An operating lease may be appropriate if the asset being financed is not a mature technology and it poses a high risk of technological obsolescence, which would cause major problems for you. It also may be appropriate in any instance where the asset is likely to be used for five years or fewer. Since there is no ownership involved, operating leases offer a great deal of flexibility.


Capital leases

A capital lease is similar to a loan in that you are seeking a long-term commitment to use a piece of equipment with or without the eventual opportunity to purchase that asset. The equipment you are leasing is treated as an asset on your balance sheet and the loan payments are treated as liabilities.

The most common type of capital lease is the full-payout lease, often referred to as a “dollar-out” lease. It functions like a lease-purchase contract in that at the end of the lease term and upon payment of the final lease installment, you will automatically acquire title to the asset. Your accountant treats the related depreciation and the interest portion of each lease payment as expenses to the income statement.

A capital lease may be appropriate when the asset being financed is a mature technology with little or no risk that technological obsolescence would be problematic for you and/or the asset is likely to be used for more than five years. Practices can fully deduct depreciation and lease payments against their income taxes, while only lease payments are deductible with operating leases.

Technology is evolving rapidly as suppliers introduce upgrades and enhancements, as well as innovative new products. This can be a concern if you buy your technology outright. The equipment you buy now may be obsolete in just a few years. The issue of being the owner of obsolete equipment is one to consider when you are comparing capital versus operating leases. Since you will retain ownership of the equipment at the end of the term of the capital-type lease, you could be the owner of obsolete equipment that is difficult to get rid of but can no longer be used in your field. Technology that is right for your practice today may need to change as your practice develops and grows.

Leasing can make sense when cash is tight because you don’t have the big upfront costs you would face if you purchased the equipment outright or put money down on a financing loan. After all, why tie up a large amount of cash, especially when you could use that money to establish or grow your practice? You generally just have a flat monthly payment over the lease term, with perhaps a small deposit. A good rule of thumb is to deal only with financing sources that have operated at least as long as the term of the proposed lease. Before you decide to lease, read over any lease agreement carefully as there can be some hidden penalties or stipulations.

Nick Hernandez, MBA, FACHE

Nick Hernandez, MBA, FACHE,, is the CEO and founder of ABISA, a consultancy specializing in strategic healthcare initiatives.

Since founding ABISA in 2007, his emphasis has been on developing and maintaining a strong relationship with physicians and identifying areas for business opportunity and support. The company’s client list includes physician groups, hospital systems, healthcare IT organizations, venture capitalists, private equity firms, and hedge fund managers.

Nick is a graduate of the United States Naval Academy and a former Captain in the U.S. Marine Corps. He holds MBA degrees in both Operations Management and Information Technology & E-Business Management from Wake Forest University. He is Board Certified in Healthcare Management and has been named a Fellow of the American College of Healthcare Executives.

He is a frequent guest lecturer and is often quoted in the national media. He has consulted with clients in multiple countries and has over 20 years of leadership and operations experience. Nick is a Subject Matter Expert in business strategy, practice management, telemedicine, health IT, and oncology.


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