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LEDGER BEYOND WAYFAIR THE NEW LANDSCAPE OF ECONOMIC PRESENCE - Mazars Ledger
LEDGER
BEYOND WAYFAIR
THE NEW LANDSCAPE
OF ECONOMIC PRESENCE

  SEPTEMBER/OCTOBER 2018   Mazars USA LLP is an independent member firm of Mazars Group.
LEDGER BEYOND WAYFAIR THE NEW LANDSCAPE OF ECONOMIC PRESENCE - Mazars Ledger
CONTENTS

2 | Mazars USA Ledger
LEDGER BEYOND WAYFAIR THE NEW LANDSCAPE OF ECONOMIC PRESENCE - Mazars Ledger
CONTENTS

SEPTEMBER/OCTOBER 2018
4 | Space Oddity or Space Odyssey?                                                     21 | The Ongoing Feud Between Airbnb And New York City, Explained

6 | Putting Healthcare Consumers in the Driver's Seat                                  22 | Beyond Wayfair - The New Landscape of Economic Presence

8 | US and Germany Auto Markets Both Set For Major Sustainability                      24 | U.S. Treasury Report: A signal of an exciting future for Financial
Changes                                                                                Services

10 | 2018 Food & Beverage Industry Study Results Executive Roundtable                  27 | Is Your Organization Overdue for a Fraud Check-Up?

13 | How Developers Can Help New York City Reach Zero Waste By 2030                    30 | Are You Maximizing Your Data's Value?

15 | Charitable Planning Ideas for Individuals Under the New Tax Law                   33 | Employee Misclassification in the Trucking Industry

16 | On The Water                                                                      36 | Another Annual Interim Inspection Report

18 | NYC’s boutique hotels poised to draw more travelers—and investors                 40 | Healthcare Alerts

19 | A New Standard For Lease Accounting                                               42 | Tax Alerts

20 | Why Clinical Documentation Improvement (CDI)?

*The Mazars USA Ledger contains articles and alerts published from August 1, 2018 - September 30, 2018.

                                                                                                                                  September/October 2018 | 3
LEDGER BEYOND WAYFAIR THE NEW LANDSCAPE OF ECONOMIC PRESENCE - Mazars Ledger
AEROSPACE

                      SPACE ODDITY OR SPACE ODYSSEY?
                                                        BY PIERRE RAZZO
   “SPACE ODDITY,” THE 1969 SONG BY DAVID           philanthropic overtones are particularly attracting    Technological innovation, the reduction in the
   BOWIE PRECEDED APOLLO 11’S MOON                  the attention of the media, regulatory authorities,    cost of accessing space led by groups such as
   LANDING. IN THIS, THE FIRST HALF OF THE          investors, and markets.                                Space X, and the interest generated by data2
   TWENTY-FIRST CENTURY, WHICH NUMER-                                                                      has shown the possibility of a lucrative busi-
   OUS EXPERIENCED OBSERVERS PERCEIVE               These two competing projects, Oneweb and               ness. Thus, many diverse projects have been
   AS THE FIRST TRUE SPACE AGE, THIS                Starlink (working with Space X), have the com-         inaugurated, intensifying the race for internet via
   MELODY IS STILL RELEVANT FOR SEVERAL             mon goal of putting an end to the digital divide       satellite or related technologies (solar-powered
   REASONS, LIKE ELON MUSK’S PLAYFUL                affecting close to 4 billion individuals (53% of the   drones, helium-filled stratospheric balloons,
   NOD TO IT LAST FEBRUARY DURING THE               global population1), by guaranteeing high-speed        rocket-launching airplanes), with initial launches
   LAUNCH OF HIS NEW FALCON HEAVY                   internet access for all by 2027. The Solution That     expected for the end of the year.
   ROCKET AND PUTTING INTO ORBIT OF                 Came from Spaaace! … or Satellite Internet
   HIS STARMAN AT THE WHEEL OF A TESLA                                                                     STARLINK
   ROADSTER. DAVID BOWIE’S SONG ISN’T               A previous project named Teledesic was created
   THE ONLY ODDITY WE’RE SEEING IN SPACE            in 1994 with the goal of placing 840 satellites in     Although the trademark Starlink was not intro-
   RIGHT NOW – THE WORLD IS IN THE MIDDLE           low earth orbit (altitude of less than 2,000 km) in    duced until August 21, 2017, this project, which
   OF A WILD SPACE RACE BETWEEN NA-                 order to provide high-speed internet. Although it      would provide high-speed internet to all, had
   TIONS AND, RECENTLY, PRIVATE ACTORS,             was led by high-profile, internationally recognized    been suggested by Elon Musk in 2015.
   SOMETHING THAT IS TOTALLY NEW.                   personalities, such as Bill Gates, Craig McCaw,
                                                    and Saudi prince Alwaleed bin Talal, was a             Like its main competitor Oneweb, the idea con-
   Amid this nebula of futuristic projects (space   failure and was stopped in 2002, after incurring       sists of putting several small satellites (850 lbs.)
   hotels, the conquest of Mars, and the explora-   nearly $9 billion dollars in costs and only placing    into low earth orbit by launching them from Space
   tion of oceans in space), two major ones with    a single demonstration satellite.                      X’s Falcon 9 and Falcon Heavy rockets. The low

4 | Mazars USA Ledger
LEDGER BEYOND WAYFAIR THE NEW LANDSCAPE OF ECONOMIC PRESENCE - Mazars Ledger
altitude guarantees a fast internet connection and     On June 15, 2015, Oneweb announced the                  nal documents. For Space X, this “satellite inter-
very low latency – 25 to 30 milliseconds3 – owing      formation of a joint venture (JV) with Airbus           net” activity could result in revenues of $30 billion
to the short distance the signal must travel in        Defense and Space to manufacture 900 satellites         dollars and operating income between $15 and
comparison to geostationary4 satellites. However,      dedicated to the project. This JV will have to          $20 billion dollars in 2025. Although these dizzy-
the decreased altitude limits coverage, creating       take into account the two major challenges - the        ing amounts, which the company never intended
the need for a greater number of satellites.           expected satellite manufacturing cost ($500,000         to release, and that might have too optimistic in
                                                       dollars) and the constellation deployment               the past, must be regarded with prudence, this
In the next five years, Space X, located in Haw-       timetable, which will require the production of 15      activity would represent more revenue than the
thorne, California, plans to send 4,425 satellites     satellites per week, a true break away from the         current core business (launches) in 2020, and
into space to form its first constellation, which is   current model which could take months to build          nearly 86% of the company’s revenue in 2025.
nearly three times the number of currently active      a satellite or to paraphrase the official project
satellites! A second constellation of an additional    communication “mass production and satellites           Morgan Stanley predicted in October 2017 that
7,500 satellites in low earth orbit (at altitudes      have never been used in the same sentence.”             overall industry revenues would reach $1.1 trillion
ranging from 335.9 km to 345.6 km5) is also ex-        The first ten satellites will therefore be manufac-     dollars by 2040,10 with the provision of satellite
pected in the long term, according to information      tured in Toulouse. The rest of the production will      internet contributing nearly $412 billion dollars.
presented to the U.S. Federal Communication            take place at Exploration Park, near the Kennedy        This would be nearly three times the space
Commission (FCC) in May 2017.                          Space Center in Florida.                                industry’s current revenues and satellite internet
                                                                                                               contribution will be similarly tripled11.
To this end, two experimental satellites were put      On June 25, 2015, Oneweb also signed a
in orbit on February 21, 2018. Space X intends to      contract with the French company Arianespace            It is not surprising that corporate groups, such
begin the launches in 2019 with the objective of       to launch an initial subgroup of satellites into        as Facebook, start-ups and private equity firms12
completing the first constellation in 2024 and thus    orbit on 21 Soyuz rockets (with the option of five      have also embarked on the race to provide satel-
offer high-speed internet on a global scale.           additional Soyuz launches and three Ariane 6            lite internet. Welcome to Space Age 2.0!
                                                       launches). The first launch is expected August
Space X differentiates itself from its main com-       19, 2018 from the Guiana Space Center in                Pierre is a Manager in our New York Practice.
petitor Oneweb because of its integrated model         Kourou (ten satellites should be put in orbit during    He can be reached at 646.315.6155 or at Pierre.
– the company will manufacture the rockets and         this launch, then 32 to 36 satellites during each       Razzo@MazarsUSA.com.
satellites it will launch – and because the ITU        following launch).
                                                                                                               1
                                                                                                                 According to the latest figures from the International Telecommunication
has yet to assign the company frequencies for its                                                              Union (ITU) from June 2016. This entity is a sub-section of the United
signal distribution.                                   Two other launch contracts have been signed             Nations, in charge of information technology and communication.
                                                                                                               2
                                                                                                                 “Whoever gets the most data wins” declared in 2017 Masayoshi Son, the
                                                       with Virgin Group and Blue Origin LL (Jeff              President General Director of Softbank, who is one of Space X’s reference
ONEWEB                                                 Bezos).                                                 shareholders.
                                                                                                               3
                                                                                                                 Compared to 600 milliseconds to date based on existing technology
                                                                                                               (figures from Space X’s presentation on the project to the FCC)
The Oneweb Project, initiated under the name           Oneweb’s internet design, development, and              4
                                                                                                                 At an altitude of 36,000 km
                                                                                                               5
                                                                                                                 This is the same altitude as the International Space Station (350 km to
“WorldVu” in 2014, pursues the same objective          infrastructure manufacturing (software, physical)       400km)
of providing high-speed internet access to all at      were entrusted to Qualcomm Group, which is one          6
                                                                                                                 Thus, we speak of a fleet of potentially 2,620 satellites in total
                                                                                                               7
                                                                                                                 $500 million dollars in January 2015 from, In particular, Qualcomm, Virgin
an affordable price as early as 2027. To this end,     of the project’s shareholders.                          Group, Coca Cola, Boeing, Airbus and nearly €1.7 million euros raised from
the Arlington, Virginia based company plans,                                                                   Softbank in December 2016 and 2017
                                                                                                               8
                                                                                                                 “The web enables us all to participate. This is not just our mission, it’s
according to founder and President Greg Wyler,         PHILANTHROPY OR BUSINESS?                               everyone’s.” (Oneweb official website)
to place three satellite constellations in low earth                                                           9
                                                                                                                 “Exclusive peek at Space X Data shows loss in 2015, heavy expectations
                                                                                                               for Nascent Internet service” (Wall Street Journal January 13, 2017)
orbit between 2018 and 20276.                          The space race which the key players are en-            10
                                                                                                                  Michael Sheetz “ Morgan Stanley predicts space industry will triple in
                                                       gaged is not simply one of philanthropic activities.    size: Here’s how to invest”
                                                                                                               https://www.cnbc.com/2017/10/12/morgan-stanley-how-to-invest-in-1-
648 small satellites (275 lbs. to 330 lbs.) should     Underneath the marketing,8 the financial stakes         trillion-space-industry.html
be sent into space as the first constellation          couldn’t be higher.                                     11
                                                                                                                  Michael Sheetz “ These 90 Private Companies are Reshaping the Space
                                                                                                               Industry, says Morgan Stanley”
between 2018 and 2020. In order to achieve                                                                     https://www.cnbc.com/2017/12/13/morgan-stanley-spacex-blue-
this, the company was structured around the key        The Starlink project’s launch cost is estimated to      origin-and-other-private-companies-reshaping-space.html?__
                                                                                                               source=sharebar|twitter&par=sharebar
players so as to guarantee the project’s financial     be $10 billion dollars, but the potential profits are
stability ($2.2 Billion dollars raised at the end of   staggering as shown by the Wall Street Journal
December 20177) and technical feasibility.             on January 13, 2017,9 based on Space X’s inter-

                                                                                                                                         September/October 2018 | 5
LEDGER BEYOND WAYFAIR THE NEW LANDSCAPE OF ECONOMIC PRESENCE - Mazars Ledger
HEALTHCARE

   PUTTING HEALTHCARE
   CONSUMERS IN THE
   DRIVER’S SEAT OF THEIR DATA
  BY GILLIE MCCREATH

6 | Mazars USA Ledger
T
          he use of electronic health records         of unprecedented change and innovation, many         put pricing information on their websites. But it’s
          (EHR) came out of the American Re-          segments of the healthcare industry are still        important to note that there are two types of trans-
          covery and Reinvestment Act of 2009         leveraging outdated record review and storage        parency: cost transparency and price transparen-
          with $19 billon of the stimulus package     processes, ultimately putting their patients as      cy. While “price” refers to what the hospitals are
dedicated to healthcare IT improvements. How-         well as their bottom lines at risk.                  charging consumers, is it going to actually cost
ever, the disconnect between medical devices                                                               me as a consumer out of pocket? The healthcare
and EHR, or even between different systems,           While the patients themselves might be willing to    system has a relatively long way to go in terms of
persists. A movement to connect clinical and          share their records and additional data between      becoming truly transparent. By and large we still
financial data would ultimately allow the industry    doctors, specialists, or health systems, they        don’t estimate or pre-adjudicate a claim around the
as a whole to get new insight into consumer           often find that the hospital, perhaps their past     whole consumption of care. Patients today want to
behavior, and for consumers to make more              insurance company, and even the technologies         know not only what their hip surgery will cost, but
informed decisions about their healthcare.            themselves are acting as barriers. The issue of      also the complete cost of recovery and rehabilita-
                                                      data silos not only affects the clinical aspects     tion. Many medical practices in other countries are
TECHNOLOGICAL CAPABILITIES TO IM-                     along the provider chain, it affects the revenue     able to pre-adjudicate claims, with the full cost of
PROVE INTERACTION                                     cycle.                                               service ultimately being paid for upfront.

Today, 50% of consumers are okay with sending         When hospitals or physicians are considering         Even with new technologies, hospital consol-
their health information digitally. Take the ex-      improvements to their technical capabilities, they   idations, and staffing strategies, maturing the
ample of a patient who has recently received an       should explore how they will affect consumers        Quadruple Aim (reducing costs, reducing physician
EKG, but now another health system is asking          and staff around the multiple lines of business      burn out, improving patient experience, and
for a new one. Would the second procedure be          they serve, along with the operational, clinical,    improving health populations) is still a formidable
deemed necessary if the provider had access           and financial impact. The ability to relieve         challenge. We can’t lose sight of the key elements
to more complete data about the patient? This         operational pain points often features promi-        that healthcare consumers need - accountability,

                          ”While the patients themselves might be willing to share
                             their records and additional data between doctors,
                            specialists, or health systems, they often find that the
                         hospital, perhaps their past insurance company, and even
                           the technologies themselves are acting as barriers. The
                        issue of data silos not only affects the clinical aspects along
                               the provider chain, it affects the revenue cycle.”

duplication of procedures has cost and clinical       nently into the decision-making process when         accessibility, and affordability. We certainly have
implications. And ultimately, it’s just a big waste   selecting technology solutions. Often, though,       tools that are maturing and going to help us along
of healthcare, especially for a system that’s         it’s worthwhile to flip the discussion, examining    that spectrum, but until we put the consumer in
experiencing extremely high rates of physician        the operational ineffectiveness of the organiza-     the driver’s seat of their own data, it’s going to be
burnout and data fatigue.                             tion that needs technology, and what solutions       a real problem to get behavioral health and other
                                                      will result in the highest return.                   information across the system.
Add to that the fact that 9% of patients’ misiden-
tifications ultimately lead to death or permanent     COST AND PRICE TRANSPARENCY                          Gillie is a Principal in our New York Practice. He
injury, and that 35% of denied claims are due to                                                           can be reached at 212.375.6568 or at
patient misidentifications, and the seriousness       To better meet their patients’ needs for             Gillie.McCreath@MazarsUSA.com.
of this data problem comes into focus. In this era    affordability, some hospitals are beginning to

                                                                                                                              September/October 2018 | 7
AUTOMOTIVE

              US AND GERMANY AUTO MARKET
                   BOTH SET FOR MAJOR
                 SUSTAINABILITY CHANGES
                         BY JEREMY RICE AND KRISTIN JOHANNIMLOH

  B
             oth the US and German auto markets have been slower than                commitment. General Motors has already seen growing, albeit small, inter-
             other countries to adapt to electric vehicle (EV) technology,           est in its electric vehicle (EV) offering, the Chevy Bolt, and has announced
             partially because of their larger size as countries, both in terms of   similar intentions to increase its electric and hybrid fleet. But while sustain-
             population and geographic area. At the same time, these deeply          able mobility momentum is picking up at company level, taking into account
  inter-linked markets are going through substantial innovation both individually    the geographical make-up and demographics of the US is key to catering
  and in tandem.                                                                     for consumer needs and preference.

  With large combustion engine SUVs still the best-selling vehicles in the US,       Similarly, in Germany, car manufacturing giants such as BMW and Volk-
  OEMs are struggling to find an approach that takes advantage of cutting            swagen have built their reputations on their expertise in combustion engine
  edge thinking on sustainable mobility development, while at the same time          technology and manufacturing excellence built up over the past 80 to 100
  keeping Wall Street happy. Conscious that the sustainable winds of change          years. Accounting for 20% of total German industry revenue and employing
  are blowing stronger, Ford has recently announced an $11bn investment              approximately 800,000 people, there is little political will to meddle with an
  program in electric vehicles by 2022, which more than doubles its previous         industry that is an integral part of the country’s social fabric.

8 | Mazars USA Ledger
However, with the political and regulatory landscape moving firmly in the              the public that EVs are both a viable and reliable alternative.
direction of car electrification, the industry is having to seriously examine its
future. For example, a Federal Administrative Court ruling in February 2018            In both the US and Germany, charging station infrastructure is key to
giving cities the right to ban diesel cars, together with a fall in diesel car sales   gaining consumer traction. The complexity of changing established infra-
and the lingering emissions scandal, are creating the perfect storm forcing the        structure to propel EV popularity has been slower than hoped, resulting
automotive industry to explore alternatives.                                           in bottle necks as governments struggle to accommodate consumer
                                                                                       charging needs.
LEVERAGING R&D INVESTMENT IN GERMANY
                                                                                       Germany’s recent move to convert 12,000 distribution boxes into
The automotive industry is by far the biggest investor and employer in the             charging stations is a great example of how to leverage existing
R&D arena in Germany, employing over 110,000 people., and has been one                 infrastructure to create more EV charging points without infrastructure
of the main reasons for the country’s reputation for reliability, safety and           displacement.
manufacturing excellence. According to German’s automotive industry associ-
ation, VDA, the industry accounts for more than one third of total global R&D          THE CHALLENGE OF SECOND GUESSING INNOVATION
spending in the automotive sector, putting it ahead of Japanese and American
companies. Moving forward, it will be critical to leverage this investment for         While advances in technology, particularly in the area of automated
development of sustainable automotive technologies.                                    driving, are disrupting OEMs, it’s equally as hard to envisage what the
                                                                                       end game is for those in the US supply chain. As a result, some players
Elon Musk’s Tesla has spent millions of dollars developing and testing EV              are hedging their bets and investing heavily in technology to cope with
batteries. But investing money into new technology doesn’t always equate to a          life without combustion engines or traditional car materials. While it’s
mass-market ready product as quickly and effectively as anticipated. German            a gamble to invest in expertise and capabilities 5-10 years before the
auto-makers are still on a learning curve. Learning from pioneers such as              landscape becomes readable, companies that delay plans to acquire the
Tesla and honing production capability, while learning from pioneers can help          right skills and expertise could potentially fall too far behind the curve.
achieve a better and more revenue-certain product as is one late-mover ad-
vantage that Volkswagen and Daimler are currently exploiting in the EV sector.         In Germany, despite the fact that Volkswagen has recently pledged
                                                                                       34 billion euros towards the development of battery-powered and
AN URBAN VERSUS RURAL STRATEGY IN THE US                                               autonomous vehicle technology, and has partnered with Silicon Valley
                                                                                       start-up, Aurora, to bring self-driving taxis, cars and trucks to the road, it
Despite a decrease in engine cylinder size over the past 10 years, the market          and other German OEMs are still working to improve traditional engine
for larger vehicles such as SUV/Crossovers has never been stronger. This is            powertrain development.
not surprising based on the sheer size of the US, where 97% of land is rural.
                                                                                       The ultimate winners and losers in the global automotive industry will
While Ford‘s F150 pick-up truck is America‘s best-selling vehicle, smaller             not only be decided by national considerations, but also what happens
cars are gaining popularity in more densely populated cities, particularly on          worldwide. As players in the industry jockey for position, an increase in
the coasts. This gives a potential market for EVs from younger city-based              investment and research into sustainable mobility solutions, collabora-
consumers who use cars to commute to work and prefer to fly for longer                 tion and acquisitions will
trans-America journeys. With fully 80% of America’s 327 million population liv-        become the strategic norm.
ing in urban areas it makes sense for OEMs to have a specific urban-focused
sustainable mobility strategy. This also opens the door for building partner-          Jeremy is a Partner in our Chicago Practice. He can be reached at
ships that give access to shared mobility options such as ride-hailing and car         312.863.2406 or at Jeremy.Rice@MazarsUSA.com.
sharing which have more traction in densely populated areas. Meanwhile,
in rural areas hybrid vehicles offer an interim solution to current consumer           Kristin is a Manager in our New York Practice. She can be reached at
reluctance for EVs.                                                                    646.435.1623 or at Kristin.Johannimloh@MazarsUSA.com.

ARE WE THERE YET?

For EVs to match their combustion engine counterparts, significant investment
in infrastructure and continued development in longer life battery technology
is required. OEMs that can achieve this will be in a better position to convince

                                                                                                                                  September/October 2018 | 9
FOOD & BEVERAGE

  MAZARS USA 2018 FOOD & BEVERAGE INDUSTRY
  STUDY RESULTS EXECUTIVE ROUNDTABLE
  BY HOWARD DORMAN

   SO FAR IN 2018, THE FOOD & BEVERAGE                      For close to 90 years, the Food Institute      Bob: Uncertainty due to government actions is
   INDUSTRY CONTINUES TO SHOW SIGNS OF                      has been the best source for food industry     causing a lot of concern because companies
   GROWTH, PAIRED WITH A STRONG SENSE                       executives delivering actionable informa-      don’t know what their true cost of doing business
   OF TRANSFORMATION THROUGHOUT ALL                         tion regarding current, timely and relevant    is or may be. Tariffs and removal of countries
   INDUSTRY SUBSECTORS.                                     information about the food industry            from long-standing trade programs are two
                                                       •    Richard McArdle, Executive Director at the     issues that come to mind. Some announcements
   HOWARD DORMAN, PRACTICE LEADER                           Rutgers Food Innovation Center. Richard is     come with little advance warning and most don’t
   FOR THE FOOD & BEVERAGE SECTOR                           a thought leader in the food and agriculture   allow time to develop suitable replacement pro-
   SPOKE WITH LEADING EXPERTS TO GAIN                       industry and an authority on product devel-    ducers (if they exist) of the products in question.
   AN UNDERSTANDING OF WHAT’S GOING ON                      opment and commercialization.
   AND WHAT IS AHEAD.                                                                                      Brian: The low inflation in commodity prices, in-
                                                       The three of you represent very important,          cluding deflation in some categories, should aid
   The group included:                                 but different, sectors of the F & B commu-          food and beverage manufacturers in their efforts
                                                       nity. Our study showed optimism and an              to increase profitability in the short term, as the
   •    Bob Bauer, President of the American           expected increase in sales and profitability        positive economy hopefully helps lift sales. Fur-
        Food Industries (AFI). The AFI is a trade      over the short term. At the same time, our          ther down the pike, however, commodity prices
        association of more than 1,000 companies       respondents felt the top concerns are rising        will likely rise and managing those increases will
        worldwide involved in importing a wide         commodity and other costs, food safety and          be vital to maintaining profitability.
        variety of food products into the U.S. and     quality assurance, and the ability to develop
        Canada. Their specialties range from Food      new products. What do each of you view              Being aware of the new omnichannel market-
        Import Issues to Food Safety.                  as challenges in F & B over the next 12-18          place will also be an important factor so com-
   •    Brian Todd, President of The Food Institute.   months?                                             panies and products are relevant to a variety of

10 | Mazars USA Ledger
consumers who use multiple channels to buy their food products. Food and            leaving their home.
beverage processors will have to be fluent in this new language, actually
multiple languages, dealing with new means of distribution and sales.               And I think down the road we have to deal with a bifurcated consumer pop-
                                                                                    ulation who will demand convenience, but also wants products and meals
It will also be vital to be aware of any regulatory changes, such as those          that meet their own specifications. This will go beyond the refrigerated
being implemented through the Food Safety Modernization Act.                        prepared food cases supermarkets offer now and simply ordering meal kits
                                                                                    online. At some point, the process will become more personalized for each
Richard: With strong overall economic growth, low unemployment and                  consumer so they can have exactly what they want in the format they want:
rising wages, both retail and foodservice operations should do well for both        to prepare themselves, partially prepared, fully prepared, frozen, etc.
topline (food businesses have the ability to pass on inflation in higher prices
in good economic times) and bottom line, and I see commodity prices being           That’s a deep dive into the crystal ball, however that will take a melding of
tempered by surpluses and the current trade/tariff issues. I think most             technology, food safety, and logistics.
large food companies will finally see respectable increases in topline in the
next year, and cost-cutting programs will have similar impact on profitability.     Bob: A combination of the ongoing trends of better-for-you, sustainability
                                                                                    and convenience will drive disruption/innovation. Having said that, the latter
For retail products, the competition at the retailer level (store and on-line)      two often are at odds with one another and the first is often asked for by
will continue to accelerate. I see increased consolidation of retailers and         consumers for some products, though they’re willing to make exceptions for
retailer space, and expansion of online selling (whether shipped, or store          long-standing favorites.
to door). This competition may force some price/margin concessions from
large manufacturers.                                                                With all of this optimism in our study, what can companies improve
                                                                                    on to continue the success they are having?
I see the biggest issue in the short term as the talent war. After a long
period of recovery, demand for skilled employees is outstripping supply and         Bob: Since much of AFI’s work focuses on compliance, I’ll go there. Com-
there is a significant issue for many businesses around getting skilled work-       panies need to spend the resources to ensure they are in compliance with
ers for manufacturing jobs, and top talent for management, especially since         regulations. One food safety issue, for example, can set a company back
management, finance, marketing, and sales tend to move and compete                  several years, or perhaps even cause its demise, and one regulatory issue
across industries.                                                                  can wipe out the profit made on many other successful entries or production
                                                                                    cycles.
Everyone talks about disruption. I would rather refer to it as inno-
vation. What is causing it and with the crystal ball you have on your               Richard: “Digitize” and automate all possible processes. Growth (compet-
desk, what is something you see coming down the pike?                               itive advantage) and profit will come from the value adds of efficiency and
                                                                                    convenience, to creating, manufacturing, marketing and delivering the food
Richard: F&B in the US is a saturated market, although beginning to frag-           and beverage products. While there will be some disruption in the types of
ment – especially because of the connectivity and direct sourcing models            foods people consume, the highest value will be in taking advantage of the
provided by mobile/internet. So the F&B industry will continue to segment,          efficiencies and speed available in robotics, IOT, AI, and automation.
by age and income (as in the past), but now also by geography. More local,
regional and small/direct ship companies will gain a foothold in the market.        Brian: Don’t be complacent and to be ready to change as needed to meet
                                                                                    the demands of the consumer and the marketplace. Also embrace innova-
My prediction for innovation (in 5-10 years) is that the selling and distribution   tion, but make sure the numbers work to keep a positive bottom line.
models will change, not so much the food. This will include much more
direct selling from small/regional players, an increase in out-of-home food         Information is key in that effort, from your own people to being informed
purchases, an increase in premium segment offerings and especially, direct          about the industry…your customers, your competitors and your partners.
delivery of prepared meals. This won’t be the result of one technical innova-
tion or company’s actions, but a slow change in how consumers obtain their          Howard is a Partner in our New Jersey Practice. He can be reached at
meals and meal components.                                                          732.205.2040 or at Howard.Dorman@MazarsUSA.com.

Brian: I believe we are in the midst of the most innovative and disruptive
period the food industry has ever experienced. Consumers have the ability
to access any type of product from virtually anywhere on the globe without

                                                                                                                                September/October 2018 | 11
UPCOMING EVENTS

   Mazars USA 2018 New York Food & Beverage Executive Forum | October 10, 2018 | New York City, NY
   The Mazars Food and Beverage Executive Forum is the premiere Food & Beverage Industry event in the New York, New
   Jersey and Pennsylvania metropolitan markets. Each year over events bring together over 300 food and beverage senior
   executives collectively for an evening to network and to hear from leading industry panelists.

   Mazars USA 2018 Consumer Products Forum | October 24, 2018 | New York City, NY
   Please join Mazars USA and MMG Advisors for an exclusive, invitation-only retail and consumer products forum. This
   year's topic will address Growing in the Age of eCommerce - It’s All About Strategy!

   Real Estate and Construction Roundtable Breakfast | November 15, 2018 | Philadelphia, PA
   Please join us for a lively gathering of area Real Estate and Construction professionals to discuss current issues affecting
   our industry. Our guest speaker will be B. Scott Zuckerman, Principal of Domus Inc. Scott will discuss Domus’ current
   projects as well as share his views on the state of real estate development in our area. Leaders of the Mazars USA Real
   Estate and Construction practices will moderate the discussion.

   Mazars USA 2018 Pennsylvania Food & Beverage Executive Forum | November 28, 2018 | Bensalem, PA
   The Mazars Food and Beverage Executive Forum is the premiere Food & Beverage Industry event in the New York, New
   Jersey and Pennsylvania metropolitan markets. Each year over events bring together over 300 food and beverage senior
   executives collectively for an evening to network and to hear from leading industry panelists.

   FEATURED SURVEY

   2018 U.S. Water Industry Outlook
   We are seeking the views of leaders and decision makers in the water industry. With your help, we will continue to
   define industry trends and build a knowledge base of challenges and opportunities that are shaping the future of the
   water industry. Scan the barcode to participate in our survey.

   WELCOME OUR NEW PARTNERS

   What Mazars Means to Me
   Stacey Barbaro, Michael LaMantia, Christopher Lieto, Chris Moore, Laura Peth, Jeremy Rice and Jennifer Safran
   have been elected for admission to the Partnership effective September 1, 2018. Stacey is in the ESG group located
   in Long Island, NY, Michael is in the Real Estate group located in New York City, Christopher Lieto is in the PCS
   group located in New Jersey, Chris Moore is in the Management Consulting group located in Maryland, Laura is in the
   Healthcare Consulting group located in Sacramento, Jeremy is in the Manufacturing & Distribution group located in
   Chicago and Jennifer is in the Real Estate group located in Long Island, NY. Our new Partners recently made a video
   on what Mazars means to them. Scan the barcode to watch our video and learn more about our new partners.

   Welcome to the Partnership!

12 | Mazars USA Ledger
REAL ESTATE

        HOW DEVELOPERS CAN HELP
  NEW YORK CITY REACH ZERO WASTE BY 2030
               BY BISNOW, SPONSORED BY MAZARS

 Take a walk on one of New York City’s busy sidewalks, and chances are you will see
piles of trash blocking the street. A new report recently named New York the dirtiest
city in America, but the city’s waste management problem is not new. The Big Apple
 has a legacy of struggling to manage its approximately 50,000 tons of daily waste.

   In 2015, Mayor Bill de Blasio announced plans to mitigate some of these issues
through OneNYC, a program to establish a "fair and just city" for the people of New
York. In addition to lifting hundreds of thousands of New Yorkers out of poverty by
 2025, the comprehensive plan outlines a strategy to send zero waste to landfills by
2030. The city is relying on commercial real estate developers, who control much of
             the city’s land and property, to help make this goal a reality.

                                                                     September/October 2018 | 13
REAL ESTATE

  “Environmental and economic sustainability must go hand in hand – and            Other developers have employed sustainable strategies by recycling
  OneNYC is the blueprint to ensure they do,” de Blasio said in prepared           the ruins of already demolished buildings. This approach requires an
  remarks at the time.                                                             understanding of what kinds of materials are recyclable, including wood,
                                                                                   glass, plastic and brick.
  As the people who build the city’s buildings and facilities, developers are
  responsible for ensuring the built environment meets the needs of its users.     Reducing the disposal of construction and demolition materials not only
                                                                                   benefits the environment, it also has positive implications for the developer.
  One way developers can help manage the city’s waste is by implementing a         This strategy eliminates unnecessary building expenses, and developers
  more sustainable approach to construction and development. As developers         who donate recovered materials to qualified nonprofit organizations and
  mark their territory in neighborhoods across the city, they are demolishing      charities are eligible for tax benefits. Reusing C&D materials can also create
  several existing structures to build new ones. These activities have played a    economic growth through increased employment opportunities for workers in
  role in increasing the city’s waste. According to the Environmental Protection   the recycling industry.
  Agency, an average 13,300 SF commercial demolition project generates over
  2 million pounds of waste.                                                       The city continues to work with developers and construction managers to
                                                                                   push its Zero Waste effort. In 2016, de Blasio challenged local businesses to
  "Developers need to look at waste as a design flaw," Mazars partner Arthur       reduce waste. Participating businesses collectively diverted 36,910 tons of
  Adams said. "While most have taken steps on energy conservation, they            waste that would have otherwise ended up in a landfill.
  need to take the same approach to waste management. They must make
  upfront plans for waste segregation for recycling, look to use recycled          “This challenge proves that our commitment can be achieved so long as
  materials in their materials and finishes, plan for off-site or modular          every New Yorker does their part to create a more sustainable city,” de Blasio
  construction, which has been shown to reduce errors and waste, and design        said in a release.
  with the idea of standardized dimensions to reduce cuts that lead to waste.
  These steps will help the construction industry contribute to a zero-waste       As developers rebuild and reshape New York City, they have a crucial role
  initiative and greater sustainability."                                          to play in the fight for a cleaner and more sustainable city. Implementing
                                                                                   a recycling strategy as part of development plans can ensure the city’s
  Many of these costs can be mitigated through adaptive reuse projects.            buildings serve the environment, and the people who live there.
  Instead of demolishing buildings, developers can repurpose existing
  structures. This approach has both economic and environmental benefits.          This feature was produced in collaboration between Bisnow Branded Content
  Using existing resources cuts construction costs, which would otherwise be       and Mazars. Bisnow news staff was not involved in the production of this
  allocated to purchasing materials for new construction. This has become          content.
  more of a concern for the industry over the past few months, as tariffs have
  made materials like steel and lumber more expensive. These adaptive reuse        Arthur is a Partner in our New York Practice. He can be reached at
  projects offer a more sustainable alternative.                                   212.375.6524 or at Arthur.Adams@MazarsUSA.com.

   FEATURED VIDEO

   Women@Mazars - Good Day To Be Visible featuring Stacey Barbaro and Tifphani White-King

   Welcome to our latest installment of Be Visible! We are taking the conversation outside with intimate one-on-
   one conversations with our women leaders over coffee and tea at some of NYC's trendiest spots.

   Our "Good Day To Be Visible" video features new Partner Stacey Barbaro interviewing Partner Tifphani White-
   King as they discuss what's at stake when we are not visible and the impact that it has on our clients and staff.
   Scan the barcode to watch our video.

14 | Mazars USA Ledger
PRIVATE CLIENT SERVICES

CHARITABLE PLANNING IDEAS FOR INDIVIDUALS
UNDER THE NEW TAX LAW
BY LAUREN REO

The Tax Cuts and Jobs Act of 2017 brought with it many changes,                    fund. This way, they can benefit from the tax deduction in one year as well
including several to itemized deductions, such as a limitation                     as continue to support the charity each year. On the flip side, by making a
on the total deduction for state and local taxes, changes to the                   small direct donation to the charity annually, the taxpayer may not be able to
mortgage interest deduction, an increase in the AGI limitation on                  itemize their deductions and as such claim the standard deduction, resulting
cash contributions and the elimination of the deduction for 2%                     in zero tax benefit for these small annual contributions.
miscellaneous itemized deductions.
                                                                                   Another option is to bundle your charitable donations into one year, to cover
These changes will certainly impact many taxpayers and new planning ideas          multiple years of support. This way, you would notify the charity that the
are a necessity. Many taxpayers’ largest itemized deduction was the state          larger gift covers a multiple-year period and likely increase the opportunity
and local tax deduction. With the new law allowing only $10,000, we may            for you to itemize deductions in the year you make the donation while still
see many taxpayers claiming the standard deduction. For a couple filing            giving the same level of support to the charity.
married filing joint, the standard deduction is now $24,000.
                                                                                   These planning opportunities should be considered as part of your entire
These changes will put taxpayers at risk of losing the benefits of most of their   tax plan for any given year. If there is a year where you know income will
charitable contributions. One strategy to mitigate the potential loss is the use   be significantly higher due to a specific tax event, you may want to plan
of a Donor Advised Fund (DAF). A DAF gives the owner the flexibility to keep       to increase your charitable deductions so that you are able to itemize and
their annual charitable giving the same, while maintaining most of the tax         maximize your deduction amount to minimize tax.
benefits for charitable contributions.
                                                                                   The TCJA will impact many planning practices and open the door to many
A taxpayer can open a DAF, which is relatively economical to establish and         new planning ideas. Be sure to consult your tax-advisor.
maintain, and make a large contribution to it one year to ensure the benefit
of itemizing their deductions. In subsequent years, where there may not be         Lauren is a Senior Manager in our New Jersey Practice. She can be reached
a large addition to the fund, they will likely claim the standard deduction, but   at 732.475.2145 or at Lauren.Reo@MazarsUSA.com.
still be able to support their favorite charity by making donations from the

                                                                                                                              September/October 2018 | 15
WATER

   ON THE WATER BY JEROME DEVILLERS
   THERE IS NO QUESTION THAT THE U.S. WATER INFRASTRUCTURE                           and distribution/collection networks is focused on reducing capital
   NEEDS REPAIR. THE UNPRECEDENTED FLOODING AND DROUGHTS                             and operating costs, particularly those associated with maintaining or
   ACROSS THE COUNTRY OVER THE PAST 15 YEARS AND THE LEAD                            enhancing distribution networks. The traditional economic model for
   CONTAMINATION OF PUBLIC WATER IN FLINT, MICH., ARE JUST A                         funding these distribution network improvements is collecting tariffs
   FEW EXAMPLES THAT HIGHLIGHT WIDESPREAD NEED FOR MORE                              from users, and banking on these long-term future cash-flows to finance
   RESILIENT WATER INFRASTRUCTURE. WHILE THERE HAS BEEN                              construction. As a result, having a financing mechanism in place is
   MOVEMENT TO IMPROVE U.S. INFRASTRUCTURE – INCLUDING                               essential for the civil engineering construction vertical to play in that field.
   A $1 TRILLION PLAN RECENTLY ANNOUNCED BY THE CURRENT                              On the other end, improved technology offers promising solutions at
   ADMINISTRATION TO BOOST INFRASTRUCTURE INVESTMENT – THE                           the point of use and creates opportunities in residential and industrial
   NEED FOR CONSTRUCTION IN THIS AREA MAY GO WELL BEYOND                             construction. For example, not all water must be of drinking quality, and
   CURRENT PLANS. ACCORDING TO THE AMERICAN WATER WORKS                              self-sustainable building, encompassing re-use of grey water and/or rain
   ASSOCIATION, THE TOTAL COSTS TO REPLACE ALL PIPES IN THE                          water for lawn irrigation, production processes, toilets or showers, is a
   UNITED STATES COULD VERY WELL PASS $1 TRILLION – THAT’S                           less expensive and easier to implement solution that has been gaining
   BEFORE ANY WORK ON ROADS, BRIDGES OR OTHER PROJECTS                               momentum.
   CONTEMPLATED IN THE PLAN BY THE CURRENT ADMINISTRATION.
                                                                                     Finally, real-time monitoring/smart management is becoming a critical
   More than one-third (41 percent) of survey respondents in the Mazars USA          element of innovation. Smart metering and data analytics foster more
   2017 US Water Industry Outlook said they expect capital expenditures to           detailed and accurate metrics to identify weaknesses and highlight
   increase in excess of 5 percent compared to the prior year. While water           opportunities for improving water and wastewater operational cycles.
   is currently a very small contributor to the overall construction industry,       Construction companies targeting water-related projects must incorporate
   there are still very large water-related projects with important construction     these technologies into their plans for greenfield and brownfield
   components. For example, the water management project being developed             developments.
   in Fargo-Moorehead Metropolitan Area Flood Diversion Channel P3
   Project, which will markedly reduce flood risk. Add to that the fact that there   RISK-SHARING MECHANISMS
   are many pipes that will need replacing soon – 39 percent of respondents
   estimated less than 10 years of useful life remaining in their water mains        Water projects, like all major construction undertakings, are dependent
   – and there are plenty of potential opportunities for constructions projects      on the developer’s ability to predict future cash flows and profitability. The
   today.                                                                            accuracy of these projections is a challenging exercise, and the reality
                                                                                     sometimes differs significantly, due to delays, poor estimation processes
   While it can still be a challenging process to get water-related construction     and failed risk management.
   projects off the ground, there are a few key factors that are critical:
   innovation, risk-sharing mechanisms and financing.                                As the industry seeks to address challenges, limit costs and attract capital,
                                                                                     it will benefit from alternative procurement methods, also known as public-
   INNOVATION                                                                        private-partnerships (P3). This alternative procurement process, which
                                                                                     allocates risks to different stakeholders based on their ability to manage
   At the forefront of innovation in water-related construction are                  them, results in on-time and on-budget project delivery, and thus reduces
   environmental regulations compliance, reduced capital and operating               construction companies’ risks.
   costs, and real-time monitoring/smart management. The technologies
   developed address challenges at different levels of the treatment,                This model has proven important to successful infrastructure plans in a
   distribution, use and collection cycle of water management, and they will         number of developed countries. Companies looking to seize opportunities
   affect the opportunities for the construction industry.                           in water-related projects should build teams of experts who understand
                                                                                     the water sector, can educate the construction company team, and can
   On one end, innovation targeted at large-scale treatment facilities               facilitate connections with P3 players.

16 | Mazars USA Ledger
FINANCING                                                                          aging infrastructure where rates have increased to a point of becoming an
                                                                                   excessive burden to water users.
As underscored in the above-referenced Outlook, financing is readily
available for infrastructure projects. The administration’s proposed tax           Construction companies can take advantage of alliances and programs
incentives and infrastructure bills suggest that even more capital can be          such as the Water Resources Development Act, which seeks to better
expected for the sector in the coming years. However, the water segment            manage the country’s water resources, to ultimately bring down financing
is hampered by its small size relative to projects in transportation, roads        costs.
and bridges, ports and airports. Thus, the water industry must ensure
its voice is heard and is part of the suite of ideas for the administration        With the right mix of factors, it is likely that water-related construction and
and Congress, in order to attract its share of the infrastructure capital          development in the United States will continue to grow. Those companies
poolAs education around the importance of water continues, infrastructure          that can work with municipalities, utilities and other stakeholders to address
financing will inevitably come through municipal bonds for state programs,         local water infrastructure challenges and secure available financing will be
public utilities or listed investor-owned utilities. One barrier to greater        positioning themselves well for that growth.
infrastructure investments, resulting in additional construction spending,
might be wider customer acceptance. In today’s model, rate payers end up           Jerome is a Partner in our New York Practice. He can be reached at
funding these investments, which is particularly troubling in jurisdictions with   212.375.6866 or at Jerome.Devillers@MazarsUSA.com.

                                                                                                                              September/October 2018 | 17
REAL ESTATE

   NYC'S BOUTIQUE HOTELS POISED TO DRAW
   MORE TRAVELERS—AND INVESTORS
   BY MICHAEL MOCTON
   A BIG FIRST QUARTER AND OTHER TRENDS BODE WELL DESPITE
   AIRBNB AND FOREIGN POLICY HEADWINDS.

   GOOGLING “BOUTIQUE HOTEL MIDTOWN MANHATTAN NY” YIELDS
   A WHOPPING 713 LODGING OPTIONS. THIS IS A RECENT DEVEL-
   OPMENT AS THE CITY IS SEEING A BOOM IN BOUTIQUE HOTELS,
   WHICH ARE DEFINED AS SMALL HOTELS WITH BETWEEN 10 AND
   100 ROOMS, UPSCALE ACCOMMODATIONS, AND UNIQUE SELLING
   POINTS OR A THEME. MANY ALSO HAVE RESTAURANTS THAT
   REFLECT THE AMBIANCE AND CULTURE OF THE HOTEL.

   Much of this can be attributed to a change in the average New York City
   visitor. Historically, hotels have had a harder time filling rooms on weekends   Despite the disruption from Airbnb, occupancy rates for New York City
   than on weekdays. However, data from STR show weekends are now gen-              hotels are growing and anticipated to continue in that direction, at least for
   erally seeing higher prices (as measured by average daily rate) and higher       the near term. The expectation is for the current supply of hotels as well
   occupancy rates, which suggests that city visitors are now more leisure          as those scheduled to open in the next few years (22 hotel openings are
   travelers; indeed, a 2017 US Travel Association report noted that leisure        anticipated in 2018, adding 5,000 rooms) to be fully absorbed by visitors.
   visitors comprise a healthy 79% of Big Apple travelers.
                                                                                    Boutique hotels should enjoy the same occupancy trends. The flip side
                                                                                    to this is the average daily rate, which has declined or remained steady
                                                                                    throughout 2016 and 2017. However, the first quarter of 2018 was a break-
                                                                                    through, with hotels experiencing a 3.5% increase in that rate.

                                                                                    The increase in average price per room was led by the luxury hotel class.
   This is good news for the boutique hotel industry, which caters to the leisure   The pricing for the 713 search results ranged from $53 to nearly $1,000 per
   market. Boutique hotels usually charge a premium for rooms, and business         night. The recent indicators of the return of “pricing power” to city hoteliers
   travelers' companies are usually not inclined to cover these costs. The          may be a great sign for boutiques.
   standard hotel occupancy rate in the city is 86.7%, and overall in the U.S.,
   boutique hotels enjoy a higher occupancy rate than other hotel categories.       With the hotel market’s overall positive performance, hotels continue to
                                                                                    be an acquisition target for both institutional investors and private equity
   If developers and operators are to maintain these high rates in 2018, the        nationally. As one of the most significant hotel markets globally, New York
   4,000 boutique hotel rooms in New York City would need to attract 1.3            City remains a key investment target. Hoteliers should focus on differenti-
   million visitors. According to NYC & Company, 65.1 million visitors are          ating their offerings to attract this investment capital, and a well-designed
   expected this year, which means boutique hotels would need to capture 2%         boutique hotel is the way to do it.
   of the market. They comprise 3.5% of the city’s hotel supply, so this seems      .
   achievable.                                                                      Michael is a Senior in our New York Practice. He can be reached at
                                                                                    646.225.5960 or at Michael.Mocton@MazarsUSA.com.
   Nothing is guaranteed, of course. Risk factors for boutique hotels and the
   whole hospitality industry include perception of the U.S. as unfriendly to
   foreign travelers, stemming from the nation's current foreign policy and
   media narrative, exchange rate issues, and the ever-present risk of natural
   disasters and terrorist threats.

18 | Mazars USA Ledger
HEALTHCARE

      A NEW STANDARD FOR LEASE ACCOUNTING
                                     BY JASON GUTMAN AND JESSICA HESS

O
         n February 25, 2016, the FASB issued        Lessees will classify their leases as either             WHEN TO START?
         ASC 842 Leases - a new standard             operating or finance; each classification has its        We expect implementing ASC 842 will be a
         seeking to address concerns of financial    own unique accounting treatment. All leases are          significant challenge for most organizations. Now
statement users and provide a clearer picture        initially recorded as liabilities equal to the present   is the time to gather data and identify solutions in
of companies’ leasing activities. For public         value of the lease payments, along with a corre-         order to achieve compliance by the effective date
companies, ASC 842 will be effective for fiscal      sponding ROU asset equal to the lease liability.         of the standard. Visit mazarsusa.com/hc to see
years beginning after December 15, 2018; for all     The level of financial statement disclosure around       the effective solutions our experts can offer you.
other entities, including most non-profits, ASC      leasing activities also increases under the new
842 is effective for fiscal years beginning after    standard.                                                Tifphani is a Manager in our New York Practice.
December 15, 2019.                                                                                            He can be reached at 646.225.5992 or at Jason.
                                                     WHAT ARE THE STEPS TO IMPLEMEN-                          Gutman@MazarsUSA.com.
WHAT ARE THE MAJOR IMPACTS?                          TATION?
ASC 842 establishes a new concept in lease           •    Gather and catalog your current inventory           Jessica is a Senior in our New York Practice.She
accounting known as the “right of use” (“ROU”)            of leases, store lease data in a centralized        can be reached at 646.315.6125 or at Jessica.
asset. An ROU asset results from a contract               repository                                          Hess@MazarsUSA.com.
which conveys the right to control an “identified    •    Design and implement a new lease
asset” for a period of time, in exchange for              accounting process to manage your organi-
consideration. In the healthcare industry this new        zation’s lease data
standard will affect leases for the use of:          •    Select a software solution that will support
•    Inpatient and outpatient treatment facilities        your organization’s adoption of the new
•    Medical and diagnostic equipment                     lease accounting standards, and ongoing
•    Offsite document storage                             lease monitoring and maintenance
•    Software solutions for case management,         •    Transition to Business as Usual (BAU), fully
     billing, and compliance                              train staff on new software solution, design
                                                          and implement internal controls

                                                                                                                              September/October 2018 | 19
HEALTHCARE

  WHY CLINICAL DOCUMENTATION IMPROVEMENT (CDI)?
  BY DOUG BARRY AND ALICIA GORDON
  RESEARCH REVEALS THAT A LACK OF
  ADEQUATE CLINICAL DOCUMENTATION IS A
  PROBLEM THROUGHOUT THE HEALTHCARE
  INDUSTRY. WHILE HIGH-QUALITY
  DOCUMENTATION IS ALWAYS SOUGHT,
  IT REMAINS UNCOMMON WITHIN MOST
  HEALTHCARE SETTINGS.

  Provider documentation is the sole data source
  for coding professionals, reimbursement and
  public reporting. Coding professionals use
  documentation in the patient record and translate
  it into ICD-10 codes using very specific Centers
  for Medicare and Medicaid Services (CMS) and
  National Center for Health Statistics (NCHS)
  within the US Federal Government’s Department
  of Health and Human Services (DHHS)
  guidelines. Once these codes are submitted via
  claims, the data is used to develop perceptions of      26, 2017, a study by Change Healthcare Healthy     accurately reflect medical management/decision-
  performance in quality of care, mortality/severity      Hospital Revenue Cycle Index found there           making and illustrate the importance of specific
  of illness scoring, length of stay and readmission      are many reasons for denials, and the second       documentation. Appropriate selection of CDI
  rates.                                                  leading cause is missing/invalid claim data        staff, effective communication of the CDI program
                                                          (14.6%).                                           mission, appropriate metrics and C-suite support
  Consumers are more aware of, and are                                                                       are essential for sustained success. As providers
  choosing facilities/providers based upon scores         An effective CDI program can help solve            learn the goals of the program and query
  provided by governmental agencies, accrediting          this problem. CDI programs are considered          process, provider engagement increases.
  organizations, or non-profit organizations such         a bridge between a host of professionals,
  as health grades and US News and World                  including physicians, mid-level providers, case    In summary, Clinical Documentation programs
  Report. Some of the challenges with these               management, coding, quality management and         can lead to improved quality scores, faster
  scoring systems are the potential inaccuracy of         financial services.                                coding, higher case-mix indices, increased
  data and the possibility that it may be incomplete                                                         revenue capture and help with facility
  or old. Scoring systems are proprietary. One            The goal of an effective CDI program is to         compliance. As one of the key areas of focus in
  organization’s rating attribute(s) may be different     support medical staff efforts to most accurately   the Mazars Revenue Cycle consulting services,
  from another organization’s depending on the            depict:                                            CDI is driving higher reimbursement and
  focus of the score/rating. It is up to the patient to   •    The patient’s comorbidities on presentation   improved CMI for clients across the US.
  interpret these scores and determine where to           •    What caused the patient to seek treatment
  seek care.                                              •    What happened during treatment                Doug is a Principal in our New York Practice.
                                                          •    Reasons for resource utilization              He can be reached at 212.375.6558 or at Doug.
  Payers are also moving from fee-for-service             •    Reflection of personalized, quality medical   Barry@MazarsUSA.com.
  to fee-for-value reimbursement models in an                  care
  effort to strategically manage costs while also         •    Continuum of care on discharge                Alicia is a Manager in our Sacramento Practice.
  requiring improvements in care quality. Providers                                                          She can be reached at 802.999.4688 or at Alicia.
  and payers alike struggle with incomplete or            Clinical documentation education is often not      Gordon@MazarsUSA.com.
  inaccurate claims based upon incomplete                 provided during medical training. CDI programs
  documentation. Per Becker’s CFO Report, June            help providers understand what is necessary to

20 | Mazars USA Ledger
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