Give January a Head Start

Last week was about finishing this year stronger: the schedule you already have, patients who meant to come back, and money you've already earned.

This week is about January, and the decisions December makes harder: the renewal you missed, the hire you haven't planned for, and the equipment deal that expires Friday.

Most of them share a feature. They come with a clock. A notice window, a credentialing timeline, a vendor deadline, your accountant's December calendar. The work isn't a five-year strategy. It's one page with every date that has a cost attached, and a decision about each one before the holiday rush.

A contract renewal isn't much of a decision if you discover it after the cancellation window closes.

Ask your administrator to list the next few renewals: software, the laser service contract, the pathology courier, equipment leases, the EHR add-on nobody has opened since the trial. Start with the tools people complain about and the ones nobody seems to use. Those are where renewals get expensive quietly. Note the notice deadline, who uses it, and whether it still earns its place.

Maybe you're paying for seats assigned to people who left. Maybe two systems send appointment reminders. Or maybe the team has built a manual workaround around a feature you're already buying.

Before renewing, ask the people doing the work what they would keep, fix, or stop paying for. As we discussed in What the Vendor Hall Is Really Selling You, a product should prove itself in your workflow.

Choose one renewal to review first. You don't need to reopen every contract in the building.

"We'll hire someone" is the beginning of a staffing plan. It doesn't tell you when that person will be able to help.

If you want a PA seeing patients in March, work backward. Recruiting takes time. Training takes time. Payer credentialing and enrollment can take months, so confirm billing requirements and effective dates early. A signed offer and a full schedule are different milestones. Budget for the gap between them.

We explored that connection between growth and available capacity in The Practice Math Behind Your 2027 Budget.

Look at the team you already have, too. Who needs a backup? If only one person can order Mohs supplies or handle a particular scheduling workflow, their vacation becomes everyone's problem.

One useful October move: pick a task that depends on one person and train a backup. It is a small investment that makes taking time off easier for everyone.

That laser rep who shows up unannounced with lunch may have more room to negotiate in Q4, with annual sales targets looming. Use that leverage: ask for a better price, included training, or service coverage.

If you were already planning to buy a laser in the next six months, year-end can be a good time to move. Just make sure the practice is ready: patient demand, trained staff, room in the schedule, and a budget that includes supplies, maintenance, and financing. A discount doesn't make an idle laser productive.

There may be a tax opportunity, too. If you're expecting a strong profit year, a Section 179 deduction may let you deduct some or all of the cost of qualifying equipment in the year it's placed in service, subject to income and other limits. Signing the order or paying a deposit isn't enough; the equipment must be ready and available for use before your tax year ends.

We're not tax advisors. Ask yours whether moving an already-planned purchase forward makes sense for your practice, and confirm delivery and setup timing before committing. The goal is to buy something you need on better terms, not find something to buy because the calendar says December.

Put a year-end planning meeting on the calendar while your accountant has time to help you think.

Bring your existing financial statements and a short list of decisions: planned purchases, possible hires, owner compensation, and how much cash you want available going into January. Ask what needs a decision this fall and what can wait.

Don't assume the bank balance tells you what is available to spend. Payroll, taxes, debt payments, and other commitments may already have a claim on it.

You don't need a new reporting project. You need a useful conversation about decisions you actually expect to make.

For many patients, deductibles reset on January 1. Patients arrive with new cards, changed plans, and a different answer to "what do I owe?" for the same visit they had in November. In dermatology, the patient this hits hardest has an excision or Mohs case booked the first week of the year.

Walk through that one example with the team now: who verifies benefits, who has the cost conversation, and where an unanswered question goes so it doesn't land on the physician at 8:05.

Then rehearse on something real. In the last week of December, pre-verify the first two clinic days of January and flag anything that needs rechecking when coverage takes effect. Whatever surprises you there will surprise you less on the 5th.

1. Put every date with a cost attached on one page. Renewal notice windows, the accountant meeting, the hire's first productive month, the January rehearsal.

2. Plan the people before the promise. Equipment and growth need trained staff, usable capacity, and someone whose job it is.

3. One decision a month, with a date on it. You don't have to settle everything before the holidays. You have to stop discovering deadlines after they pass.

Clarity RCM manages revenue cycle for 200+ dermatology practices across 44 states. It's all we do. See how we work.