MEDICAL KNOWLEDGE FIESTA A COMPETENT PHYSICIAN KEY TO

MEDICAL KNOWLEDGE FIESTA A COMPETENT PHYSICIAN: KEY TO A HEALTHY NATION SETTING UP A PRIVATE PRACTICE KWASI ODOI-AGYARKO (MB Ch. B, MPhil, Ph. D, FGCP, FGMA, Cert. Ger. )

01 November 2020 2 LET US FLY TOGETHER

01 November 2020 3 IN THE BEGINNING • The two most significant problems physicians face when making the decision to start their own practice are: 1. Lack of planning. 2. Trying to do it all your self.

01 November 2020 4 PREPARATION LEAR N

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01 November 2020 8 You need a business plan

01 November 2020 9 WHAT IS A BUSINESS PLAN? • What is a business plan? A business plan is a professional document that sets out what your business is, your short & long term goals for your business and the mechanisms used to achieve them. • Why do I need a business plan? • Who is a business plan for? . • What to include in your business plan: • Executive summary • Vision for business • Sales and Marketing • Running the business • Finances

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01 November 2020 11 VISION FOR YOUR BUSINESS The vision you have for your business explains more about your business and how you believe it will develop. Within this section: • sum up your business idea • explain how and when you are going to start the business • explain your services and benefits to clients • explain why clients will choose you and why your service is different • provide business aims and show what you want to achieve - where do you want to be in 1 year? - where do you want to be in 3 -5 years? - create aims that are measurable to allow later comparison • explain how you will meet any legal and insurance requirements

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01 November 2020 13 SALES & MARKETING Being a good clinician or professional is not enough for a successful private practice – you must also develop a fundamental understanding of how to market and sell your services to help you find and keep your clients.

01 November 2020 14 LEARN FROM EXPERIENCE OF OTHERS Learn from both the mistakes and the successes Speaking to those already in private practice, or to someone who has had experience of setting up a small business, will give you an insight into the realities of starting up a practice. Suggested sources of local contacts: • Professional Bodies • Private Practitioner Groups (if available) Ask the Advisor

01 November 2020 15 MENTOR • What is a mentor? • it is good to have someone experienced to help guide you. A person who is willing to take on this role is called a ‘business mentor’ and they can have a positive impact on both you and your business. • Who can be a mentor? • How and when do you meet your mentor?

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01 November 2020 17 PROS AND CONS Is private practice right for you? Elements you may wish to consider Pros • Personal challenge & opportunity • Independence & autonomy • Flexible working hours & flexible work location • Direct ‘effort & financial reward’ relationship Cons • Business & financial insecurity • Self finance of pension & work benefits • On going business administration • Impact on work/life balance )

01 November 2020 18 NOT ONE GLOVE FITS ALL • There are no off the shelf solutions when it comes to starting a medical practice. • One key to a thriving practice is getting off to a healthy start, • with the right structure, • people, and processes. • • • ? ? ? ? From securing a loan to hiring staff to choosing software and equipment, a myriad of tasks and important decisions awaits you that may affect your practice operations for years to come.

01 November 2020 19 LEGAL ORGANIZATION • In Ghana, the legal organization of the practice will have specific • financial, • legal, and • tax ramifications. • Following is a brief description of the options for the legal organization of a medical practice.

01 November 2020 20 PROPRIETORSHIP • A one-owner, unincorporated business (includes husband wife). • Easy to form and dissolve • Owner pays all state income tax; • Owner fully liable for all business debts and liabilities; • Limited medical deductions allowed to owner; and • Limited deductions available for retirement plans.

01 November 2020 21 PARTNERSHIP 2 • A multiple-owner, unincorporated business. • Can be easy to form; however, the more time and expense spent during formation, the less time, expense, and potential litigation involved in dissolution; • Partnership files “information State income tax return, ” but pays no tax; • Partners pay tax on their shares of partnership income and loss (whether received or not);

01 November 2020 22 PARTENERSHIP 3 • Limited Liability Partnership (LLP) • A general partnership, but with the following differences: • Partner not subject to personal liability for the malpractice of another partner unless he or she participates or is responsible for supervising the partner committing the malpractice. • The partners are liable for the contractual debts and other liabilities and obligations of the partnership. • The owners of a limited liability company are called members.

01 November 2020 23 PARTERNERSHIP 4 • Corporation/Professional Association (PA) • A corporation formed by physicians for the purpose of conducting the practice of medicine. The business organization is a legal entity separate and distinct from its owners. • Fairly complex to form and dissolve (plus filing with the secretary of state and applicable filing and

01 November 2020 24 TAX IDENTIFICATION • Once you have decided on the legal organization of your practice, you must obtain a state tax identification number (TIN) or an employer identification number (EIN

01 November 2020 25 PRACTICE OPTIONS • Structure • Your choice of structure and environment for your medical practice involves several factors, • including autonomy of decision making, • financial implications (including risk taking and income sharing), and • professional considerations (including provision of after-hours coverage for patients

01 November 2020 26 BASIC PRACTICE CATEGORIES SOLO PRACTICE Advantages Autonomy Personal Satisfaction Disadvantag es Lack of readily available after-hours coverage Financial Risk Time demands Inability to solve all problems

01 November 2020 27 BASIC PRACTICE CATEGORIES 2 MULTI-SPECIALTY GROUP PRACTICE Advantages Readily available consultation Provision of a full range medical services Sharing of afterhours coverage Sharing Financial Risk Disadvantag es Loss of autonomy Questions of income distribution

01 November 2020 28 PRACTICE LOCATION • When choosing a practice location, consider the following criteria: • Competition • Economic factors • Demographics of the area • Availability of space

01 November 2020 29 PROFESSIONAL AFFILIATIONS • Banker - You may need to acquire a loan for startup operations and working capital needs. • Health care attorney - to helping you establish the legal organization of the practice • Health care accountant. • Health care consultant.

01 November 2020 30 LICENSES • Before you see your first patient there a number of licensing and registration requirements involved in starting a new practice. • Medical License (Professional Degrees) • Physicians must be licensed by the Ghana Medical and Dental Council. • You must re-register your medical license each year. • He. FRA

01 November 2020 31 DEA REGISTRATION • Drug Enforcement Administration (DEA) registration, The specific application form to request depends upon the type of activity you intend to conduct. Eg: • Pain Management • Surgery • Chemotherapy – etc.

01 November 2020 32 ? ? DISPENSING PHYSICIAN REGISTRATION • A physician who dispenses prescription drugs, for a fee or other charge, must register with the Board of Pharmacy each year. • All dispensing physicians must comply in all aspects with the laws and regulations that apply to pharmacists governing the distribution of drugs. • These responsibilities include drug utilization review, patient counseling, appropriate packaging, labeling, and record keeping.

01 November 2020 33 LABORATORY LICENSE • If you plan on having an in-office laboratory, you must comply with He. FRA • This State regulation stipulates that all physicians’ practice laboratories be licensed according to the complexity of the tests they perform.

01 November 2020 34 X-RAY EQUIPMENT REGISTRATION • If you plan to operate X-ray equipment in your office, registration information can be obtained from He. FRA

01 November 2020 35 INSURANCE • Although professional liability insurance is not required for licensure in Ghana, it is required in varying limits for hospital staff privileges and for insurance credentialing. The limits of liability (per occurrence and aggregate) usually vary by specialty

01 November 2020 36 FIRE CERTIFICATE

01 November 2020 37 PRACTICE MANAGEMENT SYSTEMS • Selecting the right practice management software system for a physician practice is ensuring that the software meets the specific needs of the practice • You must research and plan your system carefully to avoid the pitfalls of system software incompatibility – consult experts.

01 November 2020 38 MEDICAL EQUIPMENT AND SUPPLIES • Medical equipment and supplies are available through a number of sources. • You can purchase them directly from sales representatives, or through mail order catalogues or Internet sites. • The prices usually are competitive, so you should monitor them frequently.

01 November 2020 39 PERSONNEL MANAGEMENT • Personnel management is critical to the success of a medical practice. • However, finding qualified staff for your office in the first place can be difficult at times due to market saturation, low unemployment rates, and other factors.

01 November 2020 40 TOP 10 TOOLS FOR HIRING SUCCESS 1. Create an accurate job description 2. Advertise wisely 3. Develop a consistent interview process 4. Conduct reference/background checks 5. Hire the right person 6. Orient the new hire 7. Train, train 8. Provide feedback 9. Conduct exit interviews 10. Develop retention strategies

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01 November 2020 42 TOP 10 MISTAKES TO AVOID 1. Believing job descriptions aren’t necessary 2. Hiring too quickly 3. Not equally emphasizing skills, behaviours, and cultural “fit” 4. Doing most of the talking in an interview 5. Waiting until review time to assess performance 6. Basing performance appraisal on opinion, not documented fact 7. Performing one-way appraisals 8. Believing turnover is a fact of life and out of your control 9. Not involving physicians and staff in the retention program 10. Failing to recognize the power of praise and recognition

01 November 2020 43 POLICIES AND PROCEDURES 1. You can use the policy and procedure manual as a training and orientation guide 2. Be sure to keep it current. 3. All employees should sign a statement indicating that they have read and understand the practice’s policies and procedures. 4. Finally, it is imperative that your practice actually implement and enforce all policies and procedures. 5. Developing personnel policies and office procedures for your practice will help streamline its operations and improve efficiency.

01 November 2020 44 KEY ELEMENTS OF A POLICY AND PROCEDURE MANUAL: 1. Employee issues - Hours of operation, dress code, vacation, holidays 2. Employer issues - Hiring, interviews, performance evaluations 3. Administration - Scheduling, telephone protocols 4. Billing compliance - Coding and documentation, billing and collections 5. Insurance - Managed care requirements, claim forms 6. Medical records- Retention, release, maintenance 7. Office safety- Fire safety, evacuation plan 8. Patient issues - Rights and responsibilities, dismissal 9. Health Insurance Portability and Accountability Act compliance

01 November 2020 45 MANAGED CARE AND CREDENTIALING • Participation in managed care contracts requires credentialing, • a process that includes verifying the physician’s education, • licensure status, • medical liability insurance status (including a claims history), and • hospital privileges. • As you open your medical practice, various managed care organizations will approach you to contract for a defined patient population under an arranged fee schedule.

01 November 2020 46 FINANCIAL MANAGEMENT 1. Be prepared to play an active role in the financial management of your practice 2. Stand behind the practice’s established policies. 3. Financial policies should address monthly and yearly reports, billing and collections, and embezzlement controls.

01 November 2020 47 RAISING FINANCE How will you fund the early stages of your business? Every new business needs money to cover the initial start up costs and fund the early stages of running the business. You will need to: • identify your start up costs – what are they? how much? how will you fund them? • create a Personal Financial Forecast – expected costs to cover living expenses • create a Business Financial Forecast – expected income/expenditure & cash-flow Once you know how much you need, your options for raising funding are: • use your own money • borrow from a bank • non-bank borrowing (eg friends and family, outside investor)

01 November 2020 48 MARKETING • Successful marketing plans are long-term investments. • To market effectively to your target population, you must understand it. • In addition, you should identify your practice’s • main competition, • who your referral base is, and • which insurance companies have the largest market share in the area.

01 November 2020 49 NAMING YOUR PRACTICE What’s in a name? • Naming your practice needs careful consideration. • The name will define your business, so ensure it is relevant to clients and it conveys the service you wish to provide. • The practice name is significant for future branding & marketing.

01 November 2020 50 WORKING FROM HOME If your home could accommodate your business requirements, then working from home may be an option. Advantages: • lower costs (no rental fees or commuting costs) • flexible working hours Disadvantages: • difficulty in keeping a good work-life balance • isolation ) :

01 November 2020 51 DISABILITY ACCESS & CONSIDERATIONS Under the Equality, any business that provides a service to the public is legally required to make ‘reasonable adjustments’ to the ‘physical features of your premises to better enable disabled people access to your services’. This can include ‘reasonable adjustments’ to: • entrances and exits • parking areas • toilets.

01 November 2020 52 CLINICAL STANDARDS Each profession has their own set of clinical standards and guidelines. They are set out by each Professional/Association Body. Clinical standards and guidelines form the basis of practice accreditation schemes. It is important to familiarise yourself with them as they will influence: • • the type of premises you choose the equipment you will need the health and safety guidelines you need to follow the environmental guidelines you need to follow.

01 November 2020 53 CONSIDER YOUR FEES When you decide on the prices to charge for your services, remember what is required to provide that service and the costs you need to cover: • • • your clinical knowledge and skills your time variable costs (eg strappings, dressings etc) fixed costs (eg rent & rates, CPD, marketing, administration etc) Pension/Tax/NI payments Your professional body may also be able to advise on current fee scales. In addition to setting fees, consider what forms of payment you will accept and discuss the options with your bank.

01 November 2020 54 NETWORKING Contacts and Support Networking can help you to: • Build your business When you start your private practice you should aim to create a network of professional contacts who have the potential to provide you with referrals. • Provide a network of support Working as a sole practitioner can be isolating, so it is important to create a network of support

01 November 2020 55 GROW YOUR BUSINESS Should you expand? Once your practice is established you may want to consider growing your business. It must be done at the right time for you, and based on the strengths of your business. Possible options for future growth include: • employing staff • engaging a self-employed associate • expanding your premises or purchasing new premises • selling part of the goodwill. If you regularly monitor your business performance, you will recognise the point when expansion may be a consideration.

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01 November 2020 57 HFRA Health Facilities Regulatory Act 829

01 November 2020 58 KEY FEATURES OF HFRA • Restricted to allopathic medicine facilities • Provides decentralized governance structure with a multi-stakeholder focus • Provides for licensing, inspection, standards for personnel & equipment, monitoring, quality assurance, certification & accreditation& maintenance of professional standards • Applies to all levels of facilities providing hospital & clinical care, pharmacies, diagnostic and imaging facilities and facilities providing other allied health services

01 November 2020 59 HFRA FACILITY LICENSING REQUIREMENTS • • Planning approval • Clearance from environmental protection agency • Plans for disposal of medical waste • Copies of professional certificates of facility owners and key staff and evidence of 5 or more years of experience • Good conduct of owners and key staff • Description of services to be provided • List of equipment to be used • Evidence of financial capacity • Ghanaian professional partner in the case of non-citizens • Applicable fees • Other requirements

01 November 2020 60 HFRA 2 • Key features of HFRA (2) • Makes it mandatory for facilities to furnish the agency with health services data • Provides sanctions for non-compliance • Transitional provision for existing facilities to renew their current licences upon expiry • 5 -year transition period for Pharmacy Council to transfer facility licensing operations

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Kwasi Odoi-Agyarko, MB Ch. B, Ph. D 62 JOHN 21; 18 • Truly, truly, I say to you, when you were younger, you used to gird yourself and walk wherever you wished; but when you grow old, you will stretch out your hands and someone else will gird you, and bring you where you do not wish to go. ” November 1, 2020

01 November 2020 63 SUCCESSION PLANNING

November 1, 2020 64 HE IS ALWAYS WITH US Kwasi Odoi-Agyarko, MB Ch. B, Ph. D • Isaiah 46: 4 Even to your old age I will be the same, And even to your graying years I will bear you! I have done it, and I will carry you; And I will bear you and I will deliver you.

01 November 2020 65 RECOMMENDATIONS • The LI to the HFRA 829 – written presentations • Pharmacy Act • DHIMS II • Certificate course for all wishing to venture to Private practice. • Entry requirement should be at least a membership

REFERENCES CIM. 2009. Marketing and the 7 Ps - A brief summary of marketing and how it works. Available at: http: //www. cim. co. uk/resources/understandingmarket/definitionmkting. aspx CIM. 2012. Definition of Marketing. Available at: http: //www. cim. co. uk/resources/understandingmarket/definitionmkting. aspx Business Gateway. 2012. Available at: http: //www. bgateway. com General Regulatory Council for Complimentary Therapies (GRCCT). 2012. Regulator or Association: What is the difference. Available at: http: //www. grcct. org/difference. htm Government Equalities Office. 2010. Equality act 2010: What do I need to know? Quick start guide for businesses who sell goods and services. Available at: http: //www. homeoffice. gov. uk/publications/equalities/equality-act-publications/equality-actguidance/business-quickstart? view=Binary Hills, K. , Swaffin-Smith, C. , Thomas, A. 2008. Private Practice Handbook. London: The Society of Chiropodists and Podiatrists. HMRC. 2012. Record keeping (self employed). Available at: http: //www. hmrc. gov. uk/sa/rec-keep-self-emp. htm HMRC. 2012. Starting a business. Available at: http: //www. hmrc. gov. uk/startingup/index. htm HPC. 2012. Continuing Professional Development. Available at: http: //www. hpc-uk. org/registrants/cpd/ Physio 123. 2012. Benefits of private practice. Available at: http: //www. physio 123. co. uk/private-practice-resources/benefits-ofprivate-practice. html Santander. 2012. Santander business guides, Industry Sector: Chiropodists. Available at: https: //www. allianceleicestercommercialbank. co. uk/bizguides/full/chiropodist/index. asp [All online sources accessed 18 May 2012]

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