MEDICAL KNOWLEDGE FIESTA

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

2. LET US FLY TOGETHER

3. In the Beginning • The two most significant problems physicians face when making the decision to start their own practice are: • Lack of planning. • Trying to do it all your self.

4. PREPARATION

8. You need a business plan

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

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

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.

14. LEARN FROM EXPERIENCE OF OTHERS • Learn from both the mistakes andthe 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

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?

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 • )

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.

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.

20. Proprietorship • A one-owner, unincorporated business (includes husband and 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.

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);

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.

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 annual fees);

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

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

26. Basic practice categoriesSOLO PRACTICE

27. Basic practice categories 2Multi-specialty group practice

28. Practice Location • When choosing a practice location, consider the following criteria: • Competition • Economic factors • Demographics of the area • Availability of space

29. Professional Affiliations • Banker - You may need to acquire a loan for start-up operations and working capital needs. • Health care attorney - to helping you establish the legal organization of the practice • Health care accountant. • Health care consultant.

30. Licenses • Before you see your first patient there are 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. • HeFRA

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. etc.

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.

33. Laboratory License • If you plan on having an in-office laboratory, you must comply with HeFRA • This State regulation stipulates that all physicians’ practice laboratories be licensed according to the complexity of the tests they perform.

34. X-Ray Equipment Registration • If you plan to operate X-ray equipment in your office, registration information can be obtained from HeFRA

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

36. FIRE CERTIFICATE

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.

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.

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.

40. Top 10 Tools for Hiring Success • Create an accurate job description • Advertise wisely • Develop a consistent interview process • Conduct reference/background checks • Hire the right person • Orient the new hire • Train, train, train • Provide feedback • Conduct exit interviews • Develop retention strategies

42. Top 10 Mistakes to Avoid • Believing job descriptions aren’t necessary • Hiring too quickly • Not equally emphasizing skills, behaviours, and cultural “fit” • Doing most of the talking in an interview • Waiting until review time to assess performance • Basing performance appraisal on opinion, not documented fact • Performing one-way appraisals • Believing turnover is a fact of life and out of your control • Not involving physicians and staff in the retention program • Failing to recognize the power of praise and recognition

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

44. Key elements of a policy and procedure manual: • Employee issues - Hours of operation, dress code, vacation, holidays • Employer issues - Hiring, interviews, performance evaluations • Administration - Scheduling, telephone protocols • Billing compliance - Coding and documentation, billing and collections • Insurance - Managed care requirements, claim forms • Medical records- Retention, release, maintenance • Office safety- Fire safety, evacuation plan • Patient issues - Rights and responsibilities, dismissal • Health Insurance Portability and Accountability Act compliance

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.

46. Financial Management • Be prepared to play an active role in the financial management of your practice • Stand behind the practice’s established policies. • Financial policies should address monthly and yearly reports, billing and collections, and embezzlement controls.

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)

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.

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.

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 • ) • :