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July Outlook by the Numbers

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Do you have questions on the housing market, labor market and interest rates? Check out UMB Investment Management team’s July 2017 Outlook by the Numbers for a quick snapshot on these and other economic drivers.

Also, be sure to review the following articles for more market and wealth management information…

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Follow UMB‡ on LinkedIn to stay informed of the latest economic trends.

 Interested in learning more about our Private Wealth Management division? See what we mean when we say, “Your story is our focus.

UMB Financial Corporation (Nasdaq: UMBF) is a diversified financial holding company headquartered in Kansas City, Mo., offering complete banking services, payment solutions, asset servicing and institutional investment management to customers. UMB operates banking and wealth management centers throughout Missouri, Illinois, Colorado, Kansas, Oklahoma, Nebraska, Arizona and Texas, as well as two national specialty-lending businesses. Subsidiaries of the holding company include companies that offer services to mutual funds and alternative-investment entities and registered investment advisors that offer equity and fixed income strategies to institutions and individual investors.

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EHRs: The Facts, Future and Financials

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To comply with Meaningful Use initiatives, more than 95 percent of hospitals have implemented some form of electronic health record (EHR) system since 2011. Some have spent hundreds of thousands of dollars to simply comply and put a system in place, while others have spent millions – even billions – to tailor a program unique to their needs.

The truth is EHRs are expensive to plan for, implement, train and maintain. And today, only a few years after installing new systems, nearly 38 percent of CIOs are already investing in optimization projects to improve or upgrade their current EHR programs, making this the biggest area of spending in healthcare IT.

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While EHR provides many answers and solutions, it presents many questions, as well.

  • What is the ROI for this massive technology upgrade?
  • How will EHRs really improve healthcare for doctors and patients?
  • What does the future of EHRs look like?

These questions and others are being considered and tested at hospitals around the country. Here are some of the more innovative practices and uses for EHRs that may help hospitals and executives plan for the road ahead and get the most out of their EHR investment.

Big Data

Gathering big data from a patient population is one thing. Deciphering and applying that data to solve real-world health issues is another. Hospitals that are successfully doing this are finding it is a game-changer for helping patients, the community and their care outcomes.


  • Identifying at-risk or high-risk patients to help reduce readmission rates: This data analysis looks at EHR information, zip codes and socioeconomic data to assign patients a risk score. This can also include monitoring patients with numerous chronic diseases (diabetes, heart failure, cholesterol, cancer, etc.) in real-time to help reduce hospitalizations and drive down the cost of care.
  • Clinical trial enrollment: Using big data could help patients enroll in clinical trials that will help improve quality of care and enhance outcomes. For patients, this helps match them to clinical trials and have access to safety monitoring during the treatment. For healthcare providers/researchers, this means having the data they need to find patients for trials and evaluate therapies.


A technology that has been talked about and hypothesized for decades is now at its tipping point and gaining the attention of healthcare executives across the industry. More than 83 percent of telemedicine executives who were surveyed in 2017 by the American Telemedicine Association said they are likely to invest in telehealth this year. And more importantly, they see patient-centered healthcare and EHR interoperability as top advancements they are most excited about.

Using EHR systems to treat patients with telehealth can reduce the cost of the care for both patients and providers. This technology allows doctors to stay more organized, save time, log into the patient’s record from anywhere, and prescribe medication in real time.


  • Remote patient monitoring for issues such as weight gain in at-risk heart patients. One of the biggest readmission rates for heart attack patients occurs when they start to gain weight. By using monitoring devices, doctors can receive weight readings every day allowing them to track patients’ health and have an idea of risk for readmission.
  • Doctors, hospitals and nurses are using telemedicine to treat children at school. This type of visit includes a nurse at school using a telehealth cart with video capabilities and high-tech ear, nose and throat scopes to communicate with a pediatric doctor or hospital staff for a remote patient visit. Parents can video in on the visit from work, allowing children to stay in school, parents to stay at work and nurses/doctors to best assess the child. It also allows children who do not have access to health care to see a doctor without going to the ER, further reducing overall healthcare costs for hospitals and patients.
  • Treating at-risk patients with numerous chronic conditions remotely with telehealth. Hospitals can track at-risk patients through their physiological data remotely with biometric sensors. This data can track everything from weight and heart rate to blood pressure and oxygen saturation. This information allows the team to provide remote support and communicate with patients at important times. The pilot program at Banner Health reduced hospitalizations by 45 percent ‡ and drove down the overall cost of care by 27 percent.

Patient Engagement

Enabling patients to access their own EHRs has shown great promise in helping them take control and engage in their overall wellbeing as well as helping providers prioritize patients’ concerns. The practice of allowing patients to collaborate on EHR notes and help set the agenda for their appointment has shown to improve communication between the patient and the provider, increase patient satisfaction, decrease visit times for doctors and optimize the appointment.


  • A University of Washington pilot study of patients setting agendas for their appointments found that most patients and clinicians felt it enhanced their relationships, and most said they would like to continue the practice. Also, patients who created their own agenda for the visit gave the doctor a more collaborative feeling and increased patient engagement – a key component of accountable care organizations and patient-centered medical homes under the Affordable Care Act.
  • An OpenNotes study found that by reviewing their medical records and clinician notes, patients could spot safety concerns (usually pertaining to medication errors or misreported pre-existing health conditions), and many of the flagged reports were turned into medical record revisions. The findings suggest that patients can help identify mistakes and are eager to have accurate medical records on file.

These are only a few examples of how EHRs are being implemented and used by providers and patients. The truth is that this technology is constantly morphing and evolving to help improve healthcare treatments and outcomes across the board. Clearly, there is an inherent need for healthcare executives, doctors and patients to find more valuable uses for EHRs to enhance patient care, improve outcomes and save costs.

Furthermore, what’s most critical to the evolving world of EHRs is that you have the right partners at the table to help educate, train and effectively adapt this technology to your unique needs. This includes your vendors, IT department, doctors, nurses and users.

Finally, the financial burden of improving and updating your EHR system will be a consistent line item for the foreseeable future. Knowing how to budget and prepare for those costs is vital to the financial success of your organization. And working with a banking partner who understands the complex world of healthcare finance is just as important.

Richard Ziegner is director of healthcare banking at UMB Bank where he is responsible for leading the bank’s efforts in the healthcare sector and providing capital and financial solutions to healthcare providers. He can be reached at


Richard Ziegner is executive vice president and director of healthcare banking at UMB Bank where he is responsible for leading the bank’s efforts in the healthcare sector and providing capital and financial solutions to healthcare providers. He graduated from the University of Arizona in Tucson, Ariz. with a Bachelor of Science degree in finance and earned his Master of Business Administration degree from Northern Arizona University in Flagstaff, Ariz.

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Business Owners: Planning a Roadmap for Success in 2017

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We are almost halfway through 2017, which means it is an opportune time to revisit business goals set at the beginning of the year. Conducting a mid-year check-in allows business owners to evaluate if goals for the year are being met as projected and whether plans need to be adapted to help optimize future success.

Several questions business owners should ask include:

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Is the business prepared for rising interest rates?  

Rising interest rates and Federal Reserve sentiment are in the news regularly, with the public continuing to watch rates gradually rise after years of stagnation.

With the country steadily rebounding from the recession, the Federal Reserve increased the interest rate for the second time in three months in March 2017 to a range between 0.75 percent and 1.00 percent (most recently they elected to maintain this rate in early May).

Interest rates are important to business owners to consider as they look at items such as loan terms and evaluating leasing versus purchasing for commercial real estate.

Is refinancing a business option?

As rates fluctuate, it is critical to evaluate refinancing options. This could be the time to consolidate debt or secure a better rate for a loan. Refinancing could open the door for a larger purchase later in the year or allow for a different goal to be reached more quickly.

Additionally, refinancing into a fixed rate loan may provide some peace of mind for business owners who are nervous about the impact of rising rates on an existing variable rate loan. A fixed rate offers something that business owners crave – predictability.

Do you have the right product for your needs?

It is also important for business owners to ensure they understand all the aspects of the loan. Take time to research the different terms, and make sure they are still in line with business goals. There are several different financing options available to small businesses, and it might be time to explore a different type of product that better suits the needs of that particular business or the current business environment.

Make a list of business goals, and discuss these options with an experienced banker, as they should be able to help clients prepare and best navigate any economic environment with sound lending advice.

Is it time to make a large purchase?   

Mid-year is the perfect time to evaluate what is needed to help business owners navigate the rest of 2017. Since interest rates are unpredictable and have been on the rise, it is important to understand how a purchase now will impact the business down the road. For example, it might be worth considering owning instead of renting equipment or property.

Real estate is also a key consideration for business owners, as it is often one of the largest expenses they face. Purchasing a space instead of renting could be a better long-term solution, given rents in many cities continue to rise at a pace that makes long-term agreements a less attractive option.

Ultimately, the window for low rates seems to be closing, so moving to a more entrepreneurial mindset and investing through capital expenditures may be beneficial. Bankers can help owners evaluate these options for the short- and long-term.

Be in regular communication with your banker.

Finally, it is critical to maintain regular communication with your banker. Business owners should consistently share what is happening and ask the tough questions to see what changes can be made for the time ahead.

Bankers are here to support owners and to help businesses succeed—having the full picture will result in sound advice and recommendations.

Interested in learning more about UMB Business Banking Solutions? See what we mean when we say, “Grow with Confidence.

Dominic is a executive vice president for the Business Banking division at UMB. He joined UMB in 2013 and has more than 20 years of experience in the financial services industry.

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How to finance your dental practice: the most important questions to ask

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As a dental professional, you’ve probably spent at least eight years in school preparing for your career (12 to 14 if you are a dental surgeon). After that, your focus will be on growing your new practice by building your patient panels and providing quality dental care to the community you serve.

dental practice financing

But what’s next? There are questions you need to ask yourself as soon as you open a practice:

  • Does your practice need remodeling or construction?
  • Do you see yourself bringing on a new partner at some point?
  • And most importantly, are you adequately planning for your retirement?
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As we work with dental practitioners, we’ve noticed a trend within this profession. A lack of strategic borrowing to pay for their practice’s expenses is a leading cause that prevents dental practitioners from retiring when and how they want. Only around 8 percent of dentists are able to retire and maintain the lifestyle they had during their working days.

Dental practitioners face many challenges in today’s market. Those challenges are further motivation to properly manage your funds. An important aspect of your finances is considering the best borrowing practices for your office. Some questions to consider when thinking about a loan for your dental practice:

What are your goals for your practice?
Determine where you see your practice over time. Figure out how quickly you want to grow your practice or if you have aspirations to open multiple locations. Identify a plan and partner with industry professionals who will help you achieve your ultimate objectives. Then discuss with your banking partner what financing structure will help – not hinder – this plan.

Are you borrowing with the best interest of your practice in mind?
Ask your banking partner to explain all loan options so you can align the loan structure to the best interest of the practice.  For example, some loans have a balloon payment at the end, which could require you to pay additional interest. The money you might have to pay in additional interest could be used instead to help expand the practice or could be committed to your retirement.

What are your ramp-up and wind-down strategies?
In addition to determining the long-term growth of your practice (ramp-up), you will also need to eventually consider succession and retirement strategies (wind-down). Have you considered hiring an associate to purchase your practice as a component of your exit strategy? Have you engaged a CPA firm to complete an evaluation of your practice? These are potential issues to consider as part of a succession plan.

Every practice is unique and you might even find that long-term goals change over time. Start planning early and understand what financing options are paramount for your practice. Find a banking partner who will help you determine the best loan options for your practice and your eventual retirement and succession plans.

For more financial advice, take a look at my video on Business Banking for Dentists.


When you click links marked with the “‡” symbol, you will leave UMB’s website and go to websites that are not controlled by or affiliated with UMB. We have provided these links for your convenience. However, we do not endorse or guarantee any products or services you may view on other sites. Other websites may not follow the same privacy policies and security procedures that UMB does, so please review their policies and procedures carefully.


Dave Bauer is a Vice President / Region Manager for UMB Business Banking. He is responsible for leading the Business Banking teams in the St. Louis and Oklahoma City regions. He joined UMB in 2011 and has eight years of experience in the financial services industry.

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Business Banking for Dentists

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Should new dentists purchase their first home or buy their practice? Watch to find out our recommendation and some pitfalls to avoid when financing a dental practice.

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Dave Bauer is a Vice President / Region Manager for UMB Business Banking. He is responsible for leading the Business Banking teams in the St. Louis and Oklahoma City regions. He joined UMB in 2011 and has eight years of experience in the financial services industry.

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How to secure a commercial loan: a lender’s inside scoop

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From bakers and brew masters to dentists and doctors, all business owners have one thing in common – they all need money. That fact is true regardless of the stage: starting, expanding or continuing their operations. Securing financing for a business can be one of the most overwhelming tasks an entrepreneur will ever face.

Lenders ask the same questions and look at certain criteria when evaluating loan requests no matter the amount of money a business owner needs.

small business owner


What’s the Plan?

Lenders want to know how much money will be personally invested in the business, how much money the creditor is being asked to fund and how the money will be used. For a startup company, you will need to present more than the basics. You’ll need to show a business plan, giving the opportunity to answer the aforementioned questions as well as the following:

  • Who will own and operate the business?
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  • What experience and/or qualifications do you have to operate the business?
  • What will the business sell/provide?
  • Who is your target market?
  • What is your marketing plan?

For a company that has already been in business two or more years, lenders will require current balance sheets, profit and loss statements, and interim balance sheets. It’s a good idea to bring personal tax returns and financial statements, as well.

Money Makes the Business World Go Round

Once the lender has reviewed your business plan and expertise, they will move on to the money. For a startup, the first question a lender will ask is how much money is needed to start the business and make it profitable. Think about working capital such as inventory, real estate, equipment and furniture.

The next question is how much money will you personally contribute to the business? Actual cash investment by the business owner is necessary. An existing business will need to present its current balance sheet to demonstrate how much has already been invested and how the money was spent. All of this information will be reviewed to determine how much actual cash investment remains after paying out expenses and providing a living for the business owner.

These questions will be evaluated by the lender to determine if the business will operate soundly, that the debt burden does not place unreasonable demands on the profits of the business to repay the debt, and that you have enough capital at risk to keep you committed to the success of the business.

The Payment Terms

The biggest challenge business owners face when seeking a loan is showing the lender how and when they will pay the money back.  This is the chance to prove to the lender that your earnings will be enough to repay the loan.

To accomplish this goal, existing business owners should bring historical operating statements to showcase prior sales, expenses and profits. If you’re new to this, provide projections of sales, expenses and profits for the next two to three years, and an annual budget of cash expected from sales. Industry and market research data can serve to back up your projections.

Borrowing money is all about convincing the lender that you have the capital needed to succeed, the ability to repay the loan, the character and skill to implement the plan and the collateral to serve as backup. When entrepreneurs clearly understand the process and questions a lender will ask, they are adequately prepared to go out and secure a loan that will help their business succeed.

For more tips to prep you before your meeting with a lender, check out this earlier blog post: The 5 C’s of Credit.

Michael Rosales is senior vice president and small business banking manager at UMB Financial Corporation. Mr. Rosales joined UMB in 2005 as part of the founding crew of the Small Business Banking Department. He manages a group of associates who process requests for small business loans. Mr. Rosales can be reached at

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The 100-Year Old Entrepreneur

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A century is a significant amount of time for anything. However, it’s an especially meaningful milestone for UMB. When you think about some of the challenges over the past 100 years: the Great Depression, world wars and most recently the Great Recession, it’s a unique feat to not only survive 100 years, but to thrive. We aren’t the only century old company, there are many more like us. So, what’s the secret to success?

It’s the story of the 100-year-old entrepreneur.

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What do I mean by that? It’s the idea that regardless of how long a business operates, the leaders must make a conscious effort to always incorporate the entrepreneur mindset in their day-to-day work. It’s the visions, strategies and practices that continue to reinvent, reset and remind an organization of who they are, what they offer, and how/why they do what they do.

There are several common values entrepreneurs bring to the table – below are a few I believe are most important.

Evolution is not optional

It sounds simple, but this can be hard for companies. As time, customers, technology and pretty much everything else change, so must elements of a business. Having the foresight and commitment to take calculated risks based on these evolving needs is critical. Entrepreneurs start a business venture because they see an opportunity for a new way to do something – a mindset existing businesses should also adopt. Whether it’s adapting delivery models, expanding or eliminating offerings, or entering new markets, continuing to evolve as a business will help you stay relevant. Fear of failure cannot be an inhibitor. We all know, the only constant is change…and that’s actually a good thing for business.

Surround yourself with the best team

We all say it, but not everyone does it. Successful entrepreneurs understand that associates are as important as their business model. They are the heartbeat of the organization. A business can have the best offering in the marketplace, but it won’t mean anything if the right people aren’t part of the team. Having people that continually evaluate, question, advise and champion the way products and services are formed and executed will determine your success. Associates are also the face of your company, so having people who are passionate about your organization and what you do is a must. We all know in a competitive market, customer service and relationships can be the differentiator. Anyone can win on price. The real question is whether you can win, and more importantly keep the business, based on service.

Ethics and Integrity

It’s the Golden Rule. It’s your moral compass. It’s your reputation and the value behind your brand. How you conduct business defines your worth as a trusted advisor, a community member and an employer.  I’ve often said, “We do what’s right, not what’s popular.” And it’s been one of the biggest contributors to our success. Having these types of guiding philosophies that are passed down generation after generation and consciously employed in the daily culture and actions of your organization will result in outstanding client relationships, quality community involvement, and loyal, engaged associates—all of which will support the longevity of your business and overall success.

Mariner is the chairman and chief executive officer of UMB Financial Corporation and UMB Bank, n.a. He joined UMB in 1997. Mr. Kemper is active in both civic and philanthropic endeavors. One of the causes he is most passionate about is the arts. He currently serves as a trustee and executive committee member for the Denver Art Museum and is a past board member for The Arts Council of Metropolitan Kansas City.

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