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Disclaimer
Every effort has been made to ensure that the information contained in this Podiatry Manual is accurate at the time of publication. Before relying on the information in this Podiatry Manual, however,
users should check the currency of the information contained therein and completeness and obtain
any appropriate professional advice relevant to their particular circumstances. Please contact the
Australasian Podiatry Council to report any errors or to seek clarification of any ambiguities. The
Australasian Podiatry Council accepts no liability for any loss or damage suffered by any person or
corporate body in reliance upon any information provided within this Podiatry Manual or the accuracy, currency, completeness or interpretation of the information provided in this Podiatry Manual.
Copyright
Paper based publications
Australasian Podiatry Council 2013
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may
be reproduced by any process without prior written permission from the Australasian Podiatry
Council. Requests and inquiries concerning reproduction and rights should be addressed to the Australasian Podiatry Council, 89 Nicholson Street, Brunswick East, Victoria 3057.
Contents
Useful Information
Module 1 - Overview
1.1
1.2
1.3
1.4
1.5
Introduction
Registration and Accreditation
Role of the Podiatrist
Australasian Podiatry Council
Member Associations
2.1
2.2
2.3
2.4
2.5
2.6
3.1
3.2
3.3
Domiciliary Care
Nursing Homes, Hostels and Day Therapy Centres
Foot Health in Residential Aged Care
4.1
4.2
4.3
4.4
4.5
5.1
5.2
5.3
5.4
5.5
Medicare
Podiatry and X-Ray Referrals
Department of Veterans Affairs
Transport and Work Accident Authorities
Private Health Funds
6.1
6.2
5
7
7
7
8
9
10
11
73
77
85
11
15
22
59
63
67
73
74
75
77
77
81
82
83
85
92
98
99
101
103
103
107
6.3
6.4
7.1
7.2
7.3
7.4
7.5
Introduction
Sole Trader
Partnerships
Company
Trust
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
8.10
Financial Requirements
Banking and Bank Loans
The Business Plan An Overview
Other Financing Options
Financial Records
Australian Taxation Office
Budgeting and Financial Control
Operating as a Locum
Insurance Programs and Policies
Calculating your fees
9.1
9.2
9.3
Staff Recruitment
Important Issues when Employing Staff
Administrative Staff
108
109
111
125
149
Module 10 - Marketing
163
111
112
113
120
123
125
126
129
130
134
137
139
142
145
146
149
154
159
163
165
169
170
172
Useful Information
Australasian Podiatry Council Websites http://www.apodc.com.au and
http://findapodiatrist.org
Podiatry Registration Board of Australia - http://www.podiatryboard.gov.
au
APodC CPD Online - http://www.cpd.apodc.com.au/
Australasian College of Podiatric Surgeons - http://www.acps.edu.au/
Australian Academy of Podiatric Sports Medicine Inc - http://www.aapsm.
org.au/
Contact Lists
Member Associations:
Australian Podiatry Association NSW & ACT Suite 20/450 Elizabeth
Street, Surry Hills, NSW 2010. Phone (02) 9698 3751. http://www.podiatry.
asn.au
Australian Podiatry Association QLD Coronation Place, 4/10 Benson
Street, Toowong, QLD 4066. Phone (07)3371 5800. http://podiatryassociationqld.org.au
Australian Podiatry Association SA Lvl 2, 50 Hutt Street, Adelaide, SA
5000. Phone (08) 8210 9408. http://podiatrysa.net.au
Australian Podiatry Association TAS 22 Lantana Avenue, Newstead,
TAS 7250. Phone (03) 6344 2613. http://www.taspod.com
Module 1 - Overview
1.1 Introduction
This Manual has been produced by the Australasian Podiatry Council
(APodC) and it is provided as a resource for members of state podiatry
associations.
The Manual provides an overview of some of the practice issues which
the Australasian Podiatry Council believe are important to all practising
podiatrists. However, the manual does not replace the need for sound professional advice, for example from a lawyer and / or accountant when contemplating either the purchase of a practice, or when planning to establish
a new practice.
New members receive a complimentary electronic copy of the Manual at
the time of joining their association.
Registration
All new registrants are advised to review the requirements of the PBA
which can be located at http://www.podiatryboard.gov.au
1.2.2
10
Facilities
When establishing a clinical facility, consideration should be given to factors which will influence the comfort and safety of both the practising podiatrist (and any potential colleagues or other staff) and the clientele. Clinical facilities should be clean (and easy to keep clean) and fittings kept to a
minimum, thus minimising the risk of cross-infection.
In view of potential clientele, consider access to the facility, including proximity of public transport, parking availability and disabled access to the
premises. Toilet facilities should be available for both patients and personnel. If a podiatrist is likely to be working in isolation, extra security measures and medical emergency requirements may require special consideration. Compliance with Infection Control Standards (refer to Module 2.6:
Infection Control) and Workplace Health and Safety requirements (refer to
Module 2.3: Workplace Health and Safety) should be observed.
Note: All items are supplied by the employing body if the podiatrist is in a
salaried position.
Clean, well-lit and well ventilated clinical room.
Adequate floor space (minimum recommended 3.5 m x 3.5 m).
Washable floor surface, eg; vinyl or tiled - not carpet (refer to Module 2.6: Infection Control).
Hand basin with hot and cold running water, taps with hands off
controls and suitable drying facilities, such as single-use paper
towels (not mechanical or electrical dryers) - refer to Module 2.6:
Infection Control.
Separate stainless steel facilities for cleaning instruments -refer to
Module 2.6: Infection Control.
Adequate facilities for sterilisation as per Australian and New Zealand Standards (refer to Module 2.6: Infection Control).
Minimum of two double power points.
Rubbish disposal to include general waste, suitable containers for
infectious waste and sharps disposal receptacle - all appropriately
labelled and with suitable arrangements for collection. Suitable arrangements must be made for the clinical facility to be cleaned after
each session, including cleaning of all exposed surfaces and emptying of bins.
Separate waiting room and reception area.
Extra space may be required for office and desk (suitable writing
space is required within the clinic for report writing and correspondence).
Separate area for orthotic manufacture and construction, including
bench grinder with dust extraction, small bench oven, plaster and
materials storage and possibly a vacuum press. Adequate bench
space is required for assembly and adequate ventilation for gluing. Consideration should be given for the inclusion of a plaster
trap below the sink at which plaster-soiled water is rinsed. The area
should comply with Workplace Health and Safety regulations and
allow safe work practice (refer to Module 2.3: Workplace Health and
Safety).
Lockable storage is advisable for security purposes and necessary
if restricted substances and pharmaceutical prescription pads are
kept on the premises.
2.1.2
Equipment
This outlines the basic minimum equipment recommended by the Australasian Podiatry Council to establish a podiatry service.
Electrohydraulic patient chair, with reclining back and adjustable
leg rest. A chair that converts to a plinth is recommended as it enables biomechanical assessments to be performed. In multipurpose
clinics this also increases the chairs versatility.
Hydraulic height-control podiatrists chair with adjustable lumbar support, on five castors.
Cabinet / trolley with castors to accommodate equipment and materials during treatment.
12
Health Education
Foot health education may be required for other health professionals, for
members of the public or special interest groups such as diabetes or arthritis support groups.
In order to provide this service, the podiatrist will require access to audio
visual materials (e.g. DVDs, posters, pamphlets, models), library facilities
for researching lecture topics, and projection equipment.
Most Member Associations have available to their members a range of audio visual aids and equipment for loan.
The Australasian Podiatry Council produces other resource materials for
use in promotional activities which are available to members electronically.
2.2.1
As patient records contain information which is highly personal and sensitive in nature, it is important that the practitioner and clinical facility
respects the right of individual privacy and ensures steps are in place to
facilitate appropriate use, access and storage of records. There is further information found at http://www.privacy.gov.au/materials/types/infosheets/
view/6583 including 10 National Privacy Principals.
15
All handling of clinical records must comply with Federal and State / Territory Privacy Laws. Please go to the Office of the Australian Information
Commissioner web site http://www.oaic.gov.au (search for health) for
details on Federal laws and links to state laws.
The laws detail requirements related to the collection, storage, use, access
and disclosure of patient information in the context of health service providers. The National Privacy Principles provided aim to promote good
privacy practice in the health care setting.
The rights of the patient regarding access to their medical records are also
covered under this legislation. Generally patients have the right to access
any information about them which is held by the practice; however certain
limitations apply where it is in the patients best interest to limit access (eg.
A psychological condition may be affected). Please go to http://www.oaic.
gov.au (search for health) for more information.
While patients have access to their own health record, practitioners should
be cautious about releasing records to third parties. While there are provisions to pass on information to other health providers for the continued
treatment of the patient, and where the patient would have a reasonable
expectation that this would occur (e.g. a report back to a referring doctor),
practitioners should be cautious in releasing information. The law does
not require a release of information to any party other than the patient. If
practitioners are unsure of whether a reasonable expectation exists, they
should check with the patient. If the patient refuses to grant permission
then the information should not be released, as practitioners are required
to maintain confidentiality under the privacy legislation.
2.2.2
Report Writing
that patient records meet a minimu m standard, having regard for their
purpose.
Reports should be accurate, brief, complete and include reference
to any patient refusal of treatment or action contrary to advice.
Reports should be legibly written and include the signature of the
attending practitioner. In multiple practitioner clinics and surgeries
it is recommended that the practitioners name is also printed as
some signatures are difficult to identify.
Reports should be objectively written, based upon facts.
Entries should be made at the time of consultation and should be
recorded in blue or black ink.
All correspondence and any other reports concerning the patient
(e.g. pathology or radiology reports, detailed assessments, orthotic
prescriptions), should be filed in the clinical record.
Any telephone conversations with the patient and any consultation with
any third party should be recorded in the clinical record. Abbreviations
should not be used in clinical reports unless they are accepted by the clinical facility and included in that facilitys List of Common Abbreviations
which is documented to include the facilitys accepted interpretation of
each abbreviation.
Any errors made whilst writing an entry in a patients manual record should be dealt with by drawing a line through the incorrect
entry and initialling it before continuing. Correction fluid may not
be used.
No entry concerning a patients treatment should be made in a patients record on behalf of another practitioner.
In a multi-disciplinary facility, the reports of all health personnel
involved in caring for the patient should be part of an ongoing,
integrated, holistic record.
References
Australian Council on Healthcare Standards Ltd. (1996) The ACHS accreditation guide. Standards for Australian health care facilities. 13th Ed.
17
2.2.3
Documentation Format
18
19
20
Reference
Menz HB, Sherrington C, The Footwear Assessment Form: a reliable clinical tool to assess footwear characteristics of relevance to postural stability
in older adults - Clinical Rehabilitation 2000, 1999.
21
2.3.1
2.3.2
2.3.3
Regulations
The general duties in the Acts are supported by more detailed requirements set out in regulations for issues such as:
Manual handling
Hazardous substances
Noise
Plant
Confined spaces
Fact sheets and links to the regulations may be located on the website of
your state worksafe / workcover authority.
2.3.4
Guidance Material
2.3.5
2.3.6
A workplace health and safety (WH&S) program is a planned set of activities needed to make your work and workplace safe. It ensures that hazards
in your workplace are managed in a systematic way.
An WH&S program helps to protect your clinic, employees, patients, and
your personal liability as an employer, owner, manager or supervisor. It
will enable you to comply with workplace health and safety legislation and
reduce costs associated with work-related injury and disease.
Every business should take these simple steps to improve the way they
manage health and safety in the workplace. In a small business, this is best
achieved if each step is incorporated into the day-to-day operations of the
business, to reduce duplication of effort.
http://www.business.gov.au recommends the Victorian Government Workplace Health and Safety Guide as a starting point. It can be located at http://
www.business.vic.gov.au (search WH&S). The steps to getting started
are:
Step 1 Know your responsibilities
Find out the legal workplace health and safety requirements that apply to
your business. Then write a health and safety policy to demonstrate your
commitment to a safe workplace.
Step 2 Involve your workers
Talk to your staff and set up ways for them to be involved and contribute to
decisions that may affect health and safety in the workplace.
25
26
2.3.7
Manual tasks involving repetitive procedures, forceful exertions and holding constrained or awkward postures for a long time can result in musculoskeletal injuries.
Common problems
Lower back pain caused by standing for long periods of time,
adopting awkward positions, sitting on chairs or stools without a
back rest or leg support.
Neck and shoulder pain (tendonitis) caused by prolonged static
postures, bending the head forward or to the side, holding arms
away from the body or above shoulder height.
Wrist and hand problems (carpal tunnel syndrome) caused by
gripping, repetitive movements, e.g. scalpelling, grinding and polishing.
The following factors should be considered to help you decide how
to reduce the risk of musculoskeletal injury:
Clinic layout and furniture
Provide enough space to allow free movement around work areas
and furniture.
Arrange equipment and materials on workbenches within easy
reach.
Store heavier and frequently used items at waist level to eliminate the need for lifting from below mid-thigh or above shoulder
height.
Adjust podiatry chairs to position the patient so that you do not
have to bend or twist your back.
Operator chairs should be height adjustable with good lumbar support, and have a five-point base on castors.
Design workstations so that staff can do most of their work in an
upright position with shoulders lowered and upper arms close to
the body. The working height and objects used in the task should be
roughly level with the elbows, whether the work is done sitting or
27
Podiatrists Chair
Correct posture must be maintained during treatment. This includes feet
flat on the floor, hips flexed at 90% (or slightly extended) to upper body
and a straight back with the lower lumbar curve maintained. A chair that is
too low increases flexion at the hip and promotes poor back posture.
The following features are considered essential on a podiatrist chair:
Hydraulic height control
Variable height control to accommodate different seating heights.
The height of the podiatrists chair should remain static throughout
treatment and the patient chair adjusted to enable access to different parts of the foot. A sufficient height range on the patient chair
is therefore vital. The podiatrists chair height should only be adjusted on those rare occasions when the patient chair height is not
adequate. Consider seating that is designed to be more ergonomic
for your professional needs: http://bambach.com.au/.
Swivel seat / castors
The podiatrist needs to be able to move from side to side around
the feet and turn to the trolley to collect materials, without twisting
the upper body. (A combination of twisting and reaching has been
implicated as the cause of many back problems.) A five castor base
increases manoeuvrability and non-carpeted floor surface ensures
this.
Adjustable lumbar bar / back rest
The lumbar bar / back rest supports the lumbar spine and helps
maintain correct back posture. It must be adjustable to cater for different staff. If the patient chair can be raised high enough, it is not
unreasonable for the podiatrist to work standing up. This tends to
limit the amount of lumbar spinal rotation which is a causative factor in many spinal injuries.
Patients Chair
A height adjustable hydraulic chair is vital in any clinic. It enables
easy patient access and treatment of all aspects of the foot whilst
maintaining correct posture of the podiatrist.
29
High chairs with steps are to be avoided as they immediately prohibit access to people with mobility problems such as the very frail
and patients with hip replacements. Such chairs should only be
employed on a temporary basis or in areas that receive a minimal
service and have fairly mobile patients.
A moveable arm rest improves access from the side of the chair
instead of climbing over the leg rests. Provide assistance where necessary to assist the safe transfer of patients into and out of the chair.
The material on the chair should be easily cleaned, vinyl is great.
Also refer to the infection control guidelines for cleaning material
as a cloth is not suitable.
An adjustable back rest enables the chair to be converted to a plinth
for biomechanical examinations and also multi-purpose use by other health professionals. An adjustable back rest is also essential to
accommodate patients who cannot flex their hips greatly after hip
surgery.
Electric hydraulic control
Foot control enables quick height adjustments whilst podiatrist remains seated. Manual height-adjusted chairs force the podiatrist to
change their chair height during treatment and so correct back posture is not always maintained. These chairs may be appropriate for
occasional use only, ie, no more frequent than once a week.
Height range
Podiatrists will differ in the chair height they comfortably work at,
but most will work in a range of 70-95 cm. Taller podiatrists will of
course require a higher range. Patient chairs should therefore rise
to a minimum heel height of 90 cm (i.e. the patients feet can be
raised to that level for comfortable working position).
Portability
It is often advantageous for the chair to be on castors for easy movement into a corner or another room, and for floor cleaning(though
most good patient chairs do not have castors.) During the use of the
chair the wheels can be locked into place.
30
Trolley/Cabinet
The trolley / cabinet should be on castors to keep materials and
instruments within easy reach of the podiatrist or moved out of
the way for better access to the feet. (This prevents excessive reaching and twisting of the upper body.) The trolley should be at desk
height (approximately 74 cm) for easy access. Ideally the trolley
should contain a lockable cupboard or drawer in which to permanently store materials. However, a trolley consisting of shelves is
considered adequate.
Reducing the Risk of Incidents
Educate your staff and colleagues about the risk of injury when using podiatry chairs. Maintaining a safe environment is everyones
responsibility.
Its not uncommon for clients to behave in a way you didnt expect.
Dont assume they will act safely.
Ensure the chair is positioned at the lowest setting before a client
enters the room.
If you leave the room while the client is undressing, instruct them
not to sit on the treatment chair or the podiatrists stool until you
return. Make a conventional chair available as needed.
Supervise the client getting on and off the chair. Instruct them not
to attempt to reach out or get off the chair without your help.
Adjust the base of the chair to ensure it sits level on the floor. Keep
any wheels locked at all times. Avoid moving the chair unnecessarily to prevent leaving the wheels unlocked.
Consider how a clients size and weight may impact the stability of
the chair, particularly when the chair is raised.
Do not allow children to play on or under the chair.
Reduce clutter in and around the treatment area. Keep equipment
or other objects away from the chairs foot switch to avoid accidently activating the pedal.
Perform regular housekeeping to remove hazards that may cause
injury.
Consider the benefits of using signage to further alert clients to the
dangers of not following safety instructions.
31
2.3.8
Safety equipment/PPE
protective equipment)
(personal
The following should be available for the podiatrists use to prevent injury
and infection in the clinic and workroom (see the Infection Prevention and
Control Guidelines for Podiatrists at http://www.apodc.com.au/):
Eye protection
High filtration mask
Sterile and non-sterile gloves
Gown / Apron
Podiatrists practising in institutional facilities including hospitals and
nursing homes should be aware of the dangers associated with lifting and
transferring of patients on-site. Training in local transfer techniques is advised as is the use of assistance of staff members. If treatment of patients at
the bedside is unavoidable, the number treated in any given session should
be limited and the podiatrist should avoid potentially injurious postures
and take frequent breaks.
2.3.9
Hazardous Substances
2.3.10
Most jurisdictions have introduced hazardous substances regulations under workplace health and safety laws. These regulations
apply to all workplaces where hazardous substances are used or
produced. To ensure that workers are not exposed to health and
safety risks, the regulations require employers to:
Obtain information about the chemicals used in the workplace.
Find out what the risks are (conduct a risk assessment).
Control the risks by eliminating or reducing exposure to the substance.
Provide training in the safe use of these substances.
Conduct air monitoring (if required).
Arrange health surveillance (if required).
Keep records, such as a register of hazardous substances, current
MSDS, risk assessment results.
The following table lists some of the hazardous substances used in podiatry clinics and their potential risks:
33
Product
Hazardous
Substance
Wart treatment/ Liquefied phenail surgery
nol
Trichloroacetic
(Monocholacetic) acid
Histofreezer Dimethyl
Cryosurgical
ether Propane
system
Isobutene
Plaster of paris Calcium sulphate
Risks
Methylated
Ethyl alcohol
spirits (cleaning
solvent)
Disinfectants
Adhesives
Medicament
Grinding
stones/wheels
Gases
34
Quarternary
Irritating to eyes and skin
ammonium
compounds
Gluteraldehyde Toxic, irritating to eyes, respiratory
system and skin headaches, nausea, asthma, allergic contact dermatitis
Solvents
Highly flammable, harmful to skin,
eyes and respiratory system
Potassium hy- Caustic
droxide
Aluminium
Inhalation of dust and fumes harmoxide Silicon
ful
carbide Zinc
oxide
Propane BuHighly flammable, asphyxiant
tane
2.3.11
Labels
Ensure that containers of chemicals and other substances in your
workplace have labels attached. A label must be in English and display the product name, risk and safety phrases, dangerous goods
symbols (identifying dangerous properties e.g. flammable, toxic,
corrosive) and directions for use.
Ensure that the contents of a container can be easily identified and
used correctly.
Always store chemicals in original containers.
If a chemical is transferred from one container to another, and the
substance is not entirely used immediately, you must ensure that
the second container is properly labelled and will not react with the
chemical. Do not pour chemicals into food or beverage containers.
If the contents of a container are unknown, it should be labelled:
CAUTION: DO NOT USE UNKNOWN SUBSTANCE.
Store all unknown substances in isolation until the contents can be
identified and properly labelled. If the contents cannot be identified, they should be disposed of in accordance with local Waste
Management requirements.
Material Safety Data Sheets (MSDS)
MSDS are a major source of information about a chemical product and is
additional to the information provided on a label. It contains information
about chemical ingredients, potential health effects, precautions for use,
safe handling and storage, first aid and emergency procedures.
The value in having an MSDS is that this information can be incorporated
into your work practices. You are required to keep a register containing a
list of all hazardous substances used in your workplace and a copy of the
current MSDS for each substance.
The supplier of the product must provide an MSDS for each hazardous
substance with the first order and also upon your request. Manufactur35
2.3.12
2.3.13
Controlling Exposure
2.3.14
Engineering Solutions
2.3.15
Dust,
Fumes, vapours and fine dust particles in the air can enter your lungs. If
too much dust reaches the lungs, it can overwhelm the lungs own defence
system, causing damage to the lung tissue. Some types of dusts, such as silica, cause permanent scarring in the lungs, known as fibrosis. Other types
of dusts can trigger asthma attacks.
Even the larger dust particles that do not reach the lungs can cause health
problems. Dust in the nose and in the tubes leading to the lungs can irritate
them, causing rhinitis or bronchitis.
Factors that generate dust in podiatry clinics are: grinding materials and
burring nails. Liquids such as solvents release harmful vapours. Aerosol
sprays release fine mist and heating materials such as thermoplastics/EVA
generates fumes that can also be inhaled.
Controlling Exposure
If there is airborne exposure to hazardous substances, you must control
exposure so that the relevant national exposure standard for that substance
is not exceeded. Work involving hazardous substances should occur in a
well-ventilated area.
Natural ventilation generally does not provide sufficient airflow to be suitable for use as a method for controlling exposure to airborne contaminants
in the podiatry clinic.
Air conditioning dilutes the contaminated air rather than removing it and
circulates airborne contaminant around the room. Unless there is uniform
airflow, it is likely that pockets of air will remain contaminated for long
periods.
39
Local exhaust ventilation is a more effective way of removing airborne contaminants at the source, before they can be breathed in. When installing
dust/fume extraction units, care must be taken in the design of the system
to ensure that it draws contaminated air away from, rather than past a persons nose and mouth (breathing zone).
The breathing zone is a hemisphere of 300mm radius extending in front of
a persons face:
40
2.3.17
Your staff must know how to use hazardous substances safely. Training
should cover:
Reading and understanding labels and MSDS
Where the MSDS are kept
The health effects associated with the use of hazardous substances
Safe handling and storage procedures
Use of personal protective equipment
Clean up of spills, first aid and emergency procedures
Ensure that you update training when there is a change in: materials used,
in work practices or control measures.
41
2.3.18
Please refer to the Infection Prevention and Control Guidelines for Podiatrists 2012.
2.3.19
Mechanical Safety
HAZARD
Noise, dust, entanglement, vibration, electrical
hazard
Burns, electrical hazard
Falls coming onto, or off the chair
and cutting tools and use only on materials for which they were
designed.
Provide suitable gloves and/or tongs to remove hot items from ovens.
Eye protection and dust masks should be worn during grinding
and polishing.
2.3.20
Electrical Safety
Electricity is an invisible hazard and therefore it is easy to become complacent about electrical risks. The two major causes of electrical accidents are:
Lack of maintenance of electrical equipment
Unsafe work practices
The following control measures are necessary to ensure that risk of injury
or death from electric shock for all people at the workplace is reduced as
far as is reasonably practicable.
Electrical equipment must be either:
Inspected, tested and tagged (some states require annual inspections), or
Connected to a residual current device (RCD) or safety switch
Visual inspection
Conduct regular (monthly intervals at least) visual inspections of electrical
equipment to check that:
Equipment (including accessories, connecting lead and plug) has
no obvious external damage or inadequate temporary repairs.
Inner cores of electrical leads are not exposed and outer coverings
are not cut, frayed, worn or otherwise damaged.
Sockets are not cracked or broken.
The connection of the lead to the appliance is secure.
Control switches/knobs are undamaged and secure.
43
ately after connection and at least every three months (push-button test). A
competent person must also test the device for operation every two years.
The use of an RCD can enhance safety but does not remove the need to
observe safe work practices and conduct regular maintenance.
Australian Standard 3760: 2001 provides frequency of inspection and testing recommendations.
2.3.21
Gas Cylinders
Many podiatry clinics use gases from portable cylinders in which the gas is
contained at high pressure, eg. cryotherapy systems, liquid nitrogen. The
hazards associated with the use of gas cylinders relate to the accidental
escape of the gas, whether in liquid or vapour form, increasing the risk of
fire, explosion, asphyxiation, corrosion, cold burns or frostbite. There are
many smaller systems in use also.
Dangerous Goods classification for gases is:
Class 2.1
Class 2.2
Class 2.3
Class 5.1
Flammable
Non Flammable
Toxic
Oxidising
Obtain Material Safety Data Sheets for the gases that you are using. Check
the requirements of Dangerous Goods legislation in your State/Territory.
Avoid the indoor use and storage of gas cylinders wherever possible. Where
it is impracticable to provide an outdoor storage and reticulation system,
the keeping of cylinders is subject to the following precautions:
Use cylinders only if they are properly labelled.
Check the test date for older cylinders cylinders should be tested
every 10 years.
Protect the cylinder against falling, damage and excessive temperature rise.
45
2.3.22
Fire Safety
be mounted at the appropriate height and the extinguisher, or extinguisher location sign, shall be clearly visible from a distance up
to 15m in all directions of approach.
Choice of an appropriate extinguisher for the type of fire most likely to occur.
b.
Size and mass of the fire extinguisher and the ability of the user to
carry and operate it.
c.
d.
e.
48
2.3.23
Noise
Various processes and equipment in podiatry clinics emit noise. Besides
the risk of hearing loss, exposure to high or continuous levels of noise can
also result in fatigue and distraction. Noise is a problem if it is difficult to
hear a normal voice within a distance of one metre.
The current noise exposure standard sets a limit of 85 dB(A) for exposure
to an 8 hour equivalent continuous sound pressure level. For impulsive
noise, the existing peak noise standard is 140 dB. Three elements which
need to be considered in controlling noise are:
Noise source Noise path Noise receiver
1.
49
2.
3.
Vibration
Podiatrists are exposed to hand vibration when holding a work piece
against a moving tool, such as a grinding wheel or when using a hand drill
to burr nails.
The most common condition caused by prolonged exposure to high levels
of local vibration is vibration white finger or Raynauds disease. Initial
symptoms are slight tingling and numbness. Later the tips of fingers have
attacks of whiteness and are painful; with continued exposure to vibration the fingers turn permanently blue-black, sometimes with the advent
of skin necrosis.
Precautions
The most dangerous frequencies appear to be between 40 Hz and 120 Hz.
Disabilities from hand vibration are significantly increased when the operators hands are cold.
Reduce vibration by:
Using insulating covers on hand tools.
Replacing old equipment with new equipment that has less vibration.
Regularly servicing machinery.
50
2.3.24
Work Environment
Construction of Premises
It is recognised that not all existing clinic premises are designed to meet
current standards, however if businesses renovate, relocate or if you are
opening a new businesses - these standards should be met.
Planning for new construction or major renovation requires early and continuous consultation between architects, engineers, government authorities and trade persons all of whom are familiar with the requirements of
the podiatry industry, to ensure compliance with workplace health and
safety legislation. Consult other clinics to ascertain what problems, if any,
they encountered.
Workplace health and safety and infection control issues must be considered at all stages of the design and construction of new premises. Access
and egress, the texture of flooring, height and positioning of sinks/basins,
benches and switches must all be taken into account during the design
phase as they may be difficult and or expensive to rectify after completion
of the works. Work practices during and after construction of the premise
or facility must incorporate workplace health and safety principles.
Additional Resources
Building Code of Australia
The Australian Commission on Quality and Safety in Health Care
Standards (2011), and
Relevant Australian Standards such as AS 4187 - 2003 Cleaning,
disinfecting and sterilising reusable medical and surgical appliances and equipment, and maintenance of associated environments in
health care facilities
51
Floor Surfaces
Uneven or slippery floors hinder smooth movement, make floor surfaces
unpredictable and increase the likelihood of slips, trips and falls. The presence of steps, changes of floor coverings, etc can also increase the risk of
injury.
Measures to reduce the risk of injury from inadequate floor surfaces include:
Using non-slip surfaces. This does not have to be expensive. However, the use of carpet in the clinic area is not recommended as it
contravenes infection control standards.
Wearing shoes with low heels, non-slip soles and which enclose
and support the whole foot.
Spillage of water, oil, chemicals and other substances is common on
floors and should be removed as soon as possible.
Lighting
Poor lighting can adversely affect safety and can contribute to:
Accidents and injuries
tired, sore eyes
headaches
blurred vision
Common lighting problems include too much or too little light. Glare and
shadows can force the worker to use awkward body positions to see work.
Poor lighting conditions can increase the risk of injury. For example, going
from areas of bright light to shadow can temporarily impair vision and
increase the risk of tripping. A good lighting system eliminates shadows,
and highlights potential hazards.
Natural or artificial light needs to be at appropriate levels for the task.
Some activities will require lamps to provide adequate light on the work
52
53
Maintenance
Building material
New
Damaged
Work activities
Grinding, polishing
Using chemicals
Using ovens
Heat producing
People
Smoking
Dust
Body odour
Perfumes
Outdoor air
Entering through air- Exhaust fumes, dust, pollens
conditioning systems
and through open
windows/doors
Air-conditioning systems can provide a comfortable indoor environment
in terms of air temperature, humidity and air-movement. If an air-conditioning system is installed, it should operate whenever people are in the
workplace. Air -conditioning systems need to have air filters cleaned and
monitored at least every 3 months. Systems which operate by automatic
timer should have an override facility if people are required to use the
building out of normal work hours. The following factors need to be considered in assessing the thermal environment:
Effect of solar heat (sun shining through window) and heat sources
inside the laboratory (furnaces)
Clothing worn by workers, including protective clothing
Nature of the work being performed
54
2.3.25
First Aid
Number of kits at least one first aid kit should be provided for each
workplace. If necessary, consider locating a central first aid kit in the
laboratory and a smaller kit in the clinic.
Location of kits close to areas where there is a likely risk of injury/
illness occurring. They should be clearly visible and easily accessible.
First aid kits should be provided for persons working in remote areas
or in vehicles where access to medical and emergency services may be
limited.
Signs the following symbol should be displayed on the outside of the
first aid kit:
2.3.26
2.3.27
Recording of Injuries
First aid record systems should be integrated with other incident and accident reporting systems, in particular with the Register of Injuries required
by workers compensation laws. The first aid report form should be completed by the trained first aider and include information on:
Name of injured person
Date and time
Description of symptoms
Treatment provided
Any referral arrangements (e.g. ambulance, hospital, medical service)
Remember to keep personal information about the health of an employee
or patient confidential.
Any patient injury should be reported to your professional indemnity insurer to ensure future claims arising from the injury are covered.
57
2.3.28
Domiciliary
The podiatrist should ensure at all times when carrying equipment into the
patients home that:
Correct back posture is maintained whilst lifting.
Not too many items are attempted to be carried inside at once (multiple trips are better than overloading one trip).
Only equipment that is necessary should be taken into the home.
It is advisable that the podiatrist does not treat in any one position for
a prolonged period, particularly if unnatural such as sitting on the floor.
Regular breaks to stretch the back are recommended and treatment positions should be altered often.
Allow enough time to pack/unpack the car, arrange furniture at the home
of the patient to provide the best possible treatment setting, conduct the
treatment, pack equipment, write up the patient history and make a follow
up appointment. Be realistic about the number of patients it is possible to
treat in a day (on average, one per hour- depending on travel time).
1.
2.
3.
ACT Dept. of Health, Housing and Community Care Infection Control Guidelines for Office Practices and other Community Based Facilities, September 2001
4.
5.
6.
Chubb Fire
7.
8.
58
9.
10.
Australian Standards :
AS/NZS 3760: 2003 - In-service safety inspection and testing of electrical equipment
AS 4332: 1995 The storage and handling of gases in cylinders
AS/NZS 1596: 2002 The storage and handling of LP Gas
AS/NZS 1716:2003/Amdt 1:2005 - Respiratory protective devices
Background
Currently two formats for the description of clinical interventions and professional activity have accepted national usage. The Minimum Data Set is
commonly used in the public sector and includes methods for describing
clinical activity for which the patient may not actually be present and important professional duties which are not specifically attributable to individual patients. It is the only acceptable format for data processing used
by the national Centre for Classification in Health, supported by the Case
Payment section of the Casemix branch of the Commonwealth Department
of Health. This Centre is responsible for developing national consistency in
classification for morbidity and mortality for Australian healthcare services.
The codes are listed for inclusion in the MBS - Extended Procedure Classification in the ICD - 10CM (International Coding of Disease - 10th Clinical
Modification). Although these codes were developed for use in the acute
hospital sector, a standardised form of data collection nationally enhances
comparability and improves information and decision making processes
in health planning and service evaluation. As the National Casemix project
moves from acute care into the rehabilitative and ambulatory settings these
codes will become more important to podiatrists practising in the public
health sector, where recognition of service provision which is not directly
therapeutic and costs of expensive items such as orthoses and wound care
must be taken into account when determining funding formulae.
The Podiatrists Procedural Terminology describes direct interventions
and is generally used in the private sector. It provides an accepted format
for health funds and government departments including Department
59
2.4.2
60
2.4.3
Introduction
The Podiatrists Procedural Terminology is a recommended schedule of
services that has been adopted by the Australasian Podiatry Council in July
1997 for use by individual practices when rendering podiatric services in
private practice.
Definitions
New Patient:
A patient new to the podiatrist.
Established Patient:
A patient known to the podiatrist with records on file.
61
Fees billed for some codes involving supply of a full foot orthoses or shoe
insoles are likely to vary depending on the nature of materials utilised and
complexity of additions such as soft-tissue supplementary padding (F201,
F221, F263, F265, F271, F341, F331).
Physical Therapy:
Practitioners are advised to select the code that is most closely associated
with the therapy provided. The codes may be used as an alternative to the
General services codes, where an established client/patient presents for an
isolated physical therapy, or where a physical therapy intervention is provided in addition to a General service.
Podiatric Surgery:
The listed surgical procedures include the operation per se, all sterile packs
and other requisite materials and equipment, local anaesthesia and normal, uncomplicated, post-operative follow-up.
General Podiatric Services and Consultations:
CLINIC
The billing guide is a comprehensive list of F codes and descriptions of all
the services provided by podiatrists. It is used for private health insurance
billing and rebates. The billing guide can be obtained through both your
member association and the Australasian Podiatry Council.
Quality Assurance (Q.A.) is a planned and systematic approach to monitoring and assessing a service, which identifies opportunities for improvement and ensures that action is taken to make and maintain these improvements. Total Quality Management (T.Q.M.) refers to the philosophy which
complements quality assurance. Prevention of problems, risk management, continuous improvement, team work and satisfying customers are
the major themes.
63
2.5.2
Essentially Q.A. serves to demonstrate the quality of services and care provided in a health care facility, providing factual information on which to
base decisions to plan and improve on service delivery. With increasing
demand to provide high quality healthcare at a cost the community can afford, public institutions in particular need a formal process whereby they
can objectively evaluate clinical programs and examine the effects of cost
containment to assist with future planning. As Q.A. also offers information
such as levels of patient satisfaction and offers public assurance through
process and documentation, its inclusion in private clinics is just as valid
and important.
2.5.3
Where do I start?
2.5.4
Implementation,
The
Improvement Cycle
Quality
Monitoring Activities
This is a systematic, ongoing process to collect information on the objectives and core tasks of the service. Periodic monitoring may be commenced
to identify particular activities (e.g. following a change in work practice).
Information sources include questionnaires, check sheets, audits, utilisa64
This is the planning and problem solving aspect of the activity and includes:
1.
2.
3.
4.
Set study parameters (including time frame, sample size and characteristics).
5.
6.
7.
Collate and analyse the data - the analysis may identify a strength
or weakness.
8.
Action
The required action will result from the planning and problem solving process generated by the analysis of collated data. Action may not always be
necessary, particularly if no problem or weakness is identified.
Follow Up
If action has been taken it is necessary to ensure that the desired changes
have resulted or the identified problem has been resolved. Thus monitoring activities remains important and further assessment may be required
at a later date.
2.5.5
Clinical Indicators
2.
3.
All podiatrists are advised to obtain copies for reference. The National Infection Control Guidelines for Podiatrists can be downloaded by members
from the APodC CPD Online site http://www.cpd.apodc.com.au/.
Summary of Infection Control as per NHMRC guidelines:
Healthcare-associated infections (HAIs) can occur in any healthcare setting. While the specific risks may differ, the basic principles of infection
prevention and control apply regardless of the setting.
In order to prevent HAIs, it is important to understand how infections occur in healthcare settings and then institute ways to prevent them. Risk
management is integral to this approach.
If effectively implemented, the two-tiered approach of standard and transmission-based precautions recommended in these guidelines provides
high-level protection to patients, healthcare workers and other people in
healthcare settings.
Infection prevention and control is integral to clinical care and the way in
which it is provided. It is not an additional set of practices.
Involving patients and their carers is essential to successful clinical care.
This includes ensuring that patients rights are respected at all times, that
patients and carers are involved in decision-making about care, and that
they are sufficiently informed to be able to participate in reducing the risk
of transmission of infectious agents.
The information presented in this part is relevant to everybody employed
by a healthcare facility, including management, healthcare workers and
support service staff.
Identifying and analysing risks associated with health care is an integral
part of successful infection prevention and control.
Adopting a risk-management approach at all levels of the facility is necessary. This task requires the full support of the facilitys management as
well as cooperation between management, healthcare workers and support staff.
68
The full document Australian Guidelines for the Prevention and Control
of Infection in Healthcare NHMRC can be downloaded at http://www.
nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_infection_control_healthcare.pdf. The above is a summary only from the publication.
Australian Standards AS 4815 (2006) Office-based health care facilities
Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment
Diabetes Assessment Guidelines
These guidelines have been prepared by the Australasian Podiatry Council
in conjunction with Diabetes Australia. They provide a guide to baseline
foot assessment for all people with diabetes and include a recommendation that all people with diabetes have an annual assessment by a podiatrist. This has been updated in 2011 - http://www.diabetesaustralia.com.
au/For-Health-Professionals/Diabetes-National-Guidelines/#DiabetesManagement-in-General-Practice.
71
72
74
75
It is important that foot care services offered to residents of Aged Care facilities meet both legislative and standards requirements to ensure safety
and quality of care provided.
76
4.2.1
In brief, the principles currently guiding the minimum standards for ensuring patient privacy is protected are as follows:
NPP1 - Collection of information
You should only collect information necessary for assessing and
treating the patient. The collection of personal information must be
fair, lawful and not intrusive. It should be collected with your patients consent and preferably directly from the patient. You should
make clear the reason for collecting the information if this is not
obvious, and inform the patient that are allowed to request access
to the information. Consent should also be obtained if you intend to
disclose the information to other health providers.
NPP2 - Use and disclosure
Where information has been collected with your patients consent,
you may use or disclose it to assist in assessing, diagnosing or treating a particular or suspected health condition. If you intend to use
the information for other purposes - for example, statistical or research use - you must obtain the patients consent.
There are some instances in which you may disclose information
about your patient without their consent, but these situations are
limited, and doing so will require extreme caution. It would be advisable to seek legal advice in these circumstances.
NPP3 - Data Quality
You must take reasonable steps to ensure the information you hold
about your patients is accurate, complete and up-to-date.
NPP4 - Data Security
You must take reasonable steps to protect patient information from
misuse, loss or unauthorised access. This includes ensuring that
staff members have varying and appropriate levels of access to patient information, depending upon their role within your practice.
You must also destroy or permanently remove identification from
data no longer required.
79
NPP5 - Openness
You must develop a policy document outlining your informationhandling practices and provide this to anyone who requests it.
NPP6 - Access and Correction
The Act gives people a general right of access to personal information held about them by private organisations, which in a podiatry
practice includes clinical records. There are some exceptions to this
general right of access, such as if release would have an unreasonable impact on other individuals, however before refusing access it
is advisable that the practitioner seek legal advice.
The patient will not have to provide a reason for obtaining their
records and will not be required to put the request in writing. You
should confirm the identity of the person seeking access to a particular clinical record. It is expected that access to the record must
be provided within 30 days of the request. You may not charge patients for lodging requests for access, but they may be charged for
administrative costs associated with providing access, so long as
this does not prevent an individual from accessing their records.
NPP7 - Identifiers
You must not adopt, use or disclose an identifier issued by a Federal government agency eg. Medicare numbers.
NPP8 - Anonymity
Patients have the right to be treated anonymously where this is
practical and lawful; eg. in using telephone counselling services.
NPP9 - Transborder data flows
This relates to the transfer of patient information overseas, without first obtaining consent. Generally in these circumstances you
would be required to ensure that the country to which the information is transferred can afford at least the same level of protection of
privacy as can Australia.
NPP10 - Sensitive Information
80
You must not collect sensitive information unless the patient has
consented to this collection or it is required by law or in other
specific circumstances, such as where it concerns public health
and safety or to lessen or prevent a serious and imminent threat
to life or health. Sensitive information is defined as information or
an opinion about an individuals racial or ethnic origin; political,
philosophical or religious beliefs and associations; membership of
a professional or trade association, sexual preferences; or criminal
record.
Full details and a range of information sheets can be downloaded at www.
oaic.gov.au
4.3 Negligence
The cardinal principle of liability is that the party complained of should
owe to the party complaining a duty to take care and that the party complaining should be able to prove that he has suffered damage as a consequence of a breach of that duty - Donoghue v. Stevenson (1932) AC 562
In order to be found negligent, a number of principles are required to be
established. First it must be shown that the defendant owed the plaintiff a
duty of care. Podiatrists, as health practitioners, owe a duty to their patients
to act with reasonable care. This duty extends not only to podiatric treatment, but also to the counselling of patients and keeping them informed of
their clinical options and their consequences.
After establishing that a duty of care is owed by the defendant to the plaintiff, it needs to be shown that the defendant breached their duty of care.
A defendant practitioner breaches their duty of care in providing professional services if their act or omission is not in accordance with professional practice as widely accepted by other practitioners as competent professional practice.
Thirdly, the harm suffered by the plaintiff needs to have resulted from the
defendants breach of their duty of care to the plaintiff. The harm could be a
direct occurrence, such as when a procedure is negligently performed and
injures the patient, or more indirect, such as where a practitioner neglects
to warn of a material risk of a procedure, that ultimately materialises.
81
2.
3.
The potential risks of the various treatment options have been discussed with the patient, including those risks that are unlikely but
may be of concern to the particular patient.
4.
The expected outcomes of the treatment options have been discussed with the patient.
In the case that a patient decides not to proceed with treatment, the patient
should be informed of the consequences and risks of not proceeding with
the treatment.
83
Y You are responsible You are accountable for your actions and
the services you provide.
5.1.1
5.1.2
The Medicare scheme commenced on 1st July 2004 and allows patients under a GP Management Plan (GPMP) for which Team Care Arrangements
(TCA) have been established to gain access to Medicare rebates for up to 5
visits per calendar year to an Allied health provider.
Thats a total of 5 allied health visits per patient, not 5 visits per provider.
Medicare only provides a rebate back on the cost of the consultation. See
http://www9.health.gov.au/mbs/search.cfm?q=10962&sopt=S for more information.
5.1.3
Who qualifies?
Patients with chronic conditions or complex care needs, who are managed
under a GPMP and TCA by their GP, qualify for rebates. The Chronic Disease Management (CDM) items apply to treatment of people with asthma,
cancer, arthritis, diabetes, heart disease, mental illness and other chronic
medical conditions that would benefit from a team care arrangement.
(Also refer to http://www.medicareaustralia.gov.au/provider/incentives/
allied-health.jsp for further information on chronic disease management
under Medicare).
Please note that patients admitted to a hospital or day hospital facility do
not qualify for Medicare.
5.1.4
If you are registered with Medicare (i.e. if Medicare has issued you a provider number), you are already registered for this scheme. If not, contact
the Medicare Provider Enquiry line on 132 150 or the Medicare Australia
web site www.medicareaustralia.gov.au for details on how to register and
gain access to forms.
If you want to claim directly from Medicare Australia then the two forms
you will need along with a Medicare card Imprinter
Assignment of benefit form (DB1N-AHa)
Bulk bill voucher (Allied health provider) (DB2-AHa)
The imprinter, envelopes and forms, including a guide on how to complete
them, are available from Medicare Australia website. Pre - addressed envelopes to Medicare (ENVa) are also available. Some EFTPOS machines or
practice management software have integrated systems to claim medicare
bulk billing/easyclaim services.
86
5.1.5
The GP needs to complete, and most importantly lodge for payment with
Medicare Australia a GPMP and TCA item. Part of this plan will involve a
referral to you and the other team members to participate. The invitation
and acceptance can be returned signed by any podiatrist in the practice.
Although its not compulsory GPs are encouraged to send you a copy of
the plan , if they dont you can always ask the patient to bring their copy in
for you to take a copy.
For a patient to be considered to be currently managed under an EPC plan
then the GP has to have claimed both MBS item numbers 721 and 723 together within the last two years.
5.1.6
Once the GP has finished and lodged the care plan they will refer the patient using the Medicare referral form, an example can be viewed at: http://
www.medicareaustralia.gov.au/provider/incentives/allied-health.jsp . This
MUST be complete or Medicare may seek to recover fees paid under the
referral.
A normal GP referral letter is not sufficient and will be rejected by Medicare Australia.
The referral remains valid for the stated number of services NOT a 12 month
period. If the services are not used during the calendar year in which the
patient was referred, the unused services may be used in the next calendar
year. However, they will be counted as part of the five services for allied
health services available to the patient during that calendar year (that is,
the maximum number of rebates a patient can access in a calendar year is
five regardless of how many were accessed the previous year).
NOTE: It is not necessary to have a new CDM plan prepared every 12 months
just to access a new set of allied health referrals. Patients continue to be eligible for
rebates for eligible allied health services while they are being managed under an
EPC plan, as long as the need for the eligible services continues to be recommended
in their plan.
87
5.1.7
5.1.8
5.1.9
The Medicare Benefits Schedule (MBS) item number is 10962. The scheduled fee can be located by searching the MBS Online at http://www9.health.
gov.au/mbs/search.cfm . The rebate amount is the highest amount you can
bill Medicare Australia directly.
The Medicare Easyclaim allows practitioners to charge full fee, the patient
pays full fee to the podiatrist practice, then , if the patients bank account
details are lodged with Medicare, the rebate is paid directly to the patients
account.
The rebate is only payable for patient consultations; not for care planning,
paperwork, splints, or appliances. It is important to note that once a claim
is made to Medicare there is no private health insurance rebate available to
88
the patient for that particular consultation. Therefore it is necessary for the
patient to decide if they are better off continuing to claim on any private
health insurance they may have instead of Medicare. This is likely to be
influenced by any anticipated out of pocket charges.
It is also important to note that any Medicare gap amount payable qualifies
towards the patients Medicare Safety Net.
5.1.10
There are two methods of receiving payment for your services. You can
either invoice the patient and let them make the claim themselves or bill
Medicare directly.
If the patient pays in full on the day, the patient takes the receipt to Medicare and receives a refund for the rebate amount, or they can utilise the
Easyclaim system.
If the patient doesnt pay on the day, you issue an invoice to the patient and
they lodge the account with Medicare, and then await a cheque made out
to the provider. This along with any gap amount payable by the patient can
then be forwarded to you to settle the account.
5.1.12.1 Billing
billing)
Medicare
directly
(bulk
91
The purpose of this module is to provide the podiatrist with clinical and
procedural details pertaining to the referral of patients for diagnostic radiology.
Podiatrists in all states of Australia are permitted to refer directly to radiologists for the purpose of diagnostic radiography of the foot, ankle and
leg, and for other imaging techniques such as ultrasound, CT scanning and
MRI.
Patients (in Australia) who are referred to a radiologist by a podiatrist for
approved radiological services, that is, specified plain diagnostic x-ray examinations, will receive a full Medicare rebate for these services. CT scans,
ultrasound, and MRIs where referred by a podiatrist will not be rebated.
5.2.2
93
5.2.3
The Australian Medicare Program provides access to medical and hospital services for all Australian residents and certain categories of visitors to
Australia. Legislation covering the major elements of the Program is contained in the Health Insurance Act 1973 (Cth).
5.2.4
Under the Health Insurance Regulations 1975 (Cth), a podiatrist may request the following plain x-ray items:
From Group 13 -Diagnostic Radiology
Subgroup 1 - Radiographic Examination of Extremities and Report
Item 57521 Foot or ankle or leg or knee or femur
Item 57527 Foot and ankle or ankle and leg or leg and knee or knee
and femur
Item 55832 55842 Ultrasound of lower leg, foot and ankle
5.2.5
Provider Numbers
A Medicare provider number must be obtained in order for a practitioner to refer a patient to specialist services, diagnostic imaging services or
pathology. It is also required to allow patients to seek Medicare benefits
for the service requested and provided. Without a provider number any
94
patient for whom you have requested radiological examination will not be
able to seek a Medicare rebate.
The podiatrist must apply in writing to Medicare for an initial Medicare
provider/registration number for Allied Health Professionals. A separate
provider/registration number must be obtained for each site/clinic at which
the podiatrist practices.
Details of your name, registration and addresses of practice sites will be required. Health Insurance Regulations provide that, for Medicare purposes,
a valid account/receipt must contain the practitioners name and either:
The address of the place from which the service was provided.
Or the provider number for the place from which the service was
provided.
Medicare provider number information is released in accordance with
the secrecy provision of the Health Insurance Act 1973 (Cth) (Section 130),
to authorised external organisations including private health insurance
funds, the Department of Veterans Affairs, and the Department of Health
and Family Services.
5.2.6
5.2.7
95
5.2.8
5.2.9
Medicare benefits are payable for medical expenses for professional services that are wholly covered by workers compensation or damages under
a Commonwealth or State or Territory law. The exception is where a person has entered into a reimbursement arrangements with a compensation
insurer.
Some radiologists have a policy of bulk billing, while others will charge the
patient who then claims the benefits portion through Medicare.
References
Medicare Benefits Schedule Book, May 2013.
5.3.1
5.3.2
5.4 Transport
Authorities
5.4.1
and
Work
Accident
reimbursed for podiatry services will vary. Podiatrists need to become familiar with the requirements in their state / territory by contacting their
local authority, prior to treating patients under these schemes.
5.4.2
Australian
Websites
Workcover
Authority
5.4.3
Australian
Transport
Authority Websites
Accident
101
In the case of a locum who has no fixed place of work, they must work under a provider number issued to their primary location (eg. home office).
A locum must establish a new provider number when they work for more
than 4 weeks in the one establishment.
Practitioners must only claim for treatment provided under their own provider number. They should not allow any other practitioner to use their
provider number. Some insurance companies insist on a patient signature
on an invoice (re: fraud allegations) to confirm that the service was provided.
5.5.1
HICAPS
HICAPS is an electronic, real time, claims and payments system, which can
be used in private podiatry practice to automatically process patients podiatry health insurance claims (for participating health insurance funds).
To utilise this system you need to contact HICAPS initially and lodge an
application form. Once the application has been processed and accepted
HICAPS provide installation and training in around four weeks of the application being accepted.
The HICAPS terminal installed in the practice works through a swipe card
system whereby after providing treatment, patients can access their health
fund entitlement on the spot. The terminal will calculate and deduct the
insurance rebate amount and patients then are able to pay the gap to you
directly. HICAPS settles the amount owing to you from the health insurance rebate the following day thereby reducing delays in you accessing
payment. The HICAPS terminal can also operate as an EFTPOS or credit
card facility. Currently mobile EFTPOS machines are not able to process
HICAPS transactions as they are not address linked required by provider
number identification.
Charges apply for the HICAPS services. You can contact HICAPS for further information and application details on free call number 1800 80 57 80
or go to their website at http://www.hicaps.com.au/
102
Disadvantages
* Financial insecurity
* Long/irregular hours
* You are on your own
* Risk of failure
* Pressure on family life
* Isolation/frustration
6.1.1
6.1.2
When going into business it is essential that your finances are in order. Begin by being thoroughly aware of your personal assets and liabilities.
To some extent, your personal worth will determine whether you can afford to finance a lease or a loan on the purchases you make, i.e. a practice,
new car, equipment, etc. A statement of personal worth is required by a
potential financier and also helps you define your financial position. You
m ay need to consider BAS payments which will be made quarterly. Doing a cash-flow budget is just as important as a balance sheet when starting out. Also consider how to save for BAS which will be payable at least
quarterly.
105
$
$
$
$
$
Assets
Cash/bank deposits
Shares/investments
House
Car (s)
Insurance/superannuation
Other
Total
(Less) Liabilities
Your Net Worth
$
$
$
$
$
$
$
$
$
You need sufficient assets to provide equity and/or to support your loan
application. The lender will expect you to bear the risk.
Your Personal Needs
This is the sum of all the expenses you have and includes all bills (monthly,
quarterly and yearly), plus your regular living expenses. These expenses
should be calculated on a monthly basis and will include: house, car and
loan repayments, insurance premiums, phone and power, rates, and taxes.
Your living expenses include food, clothes, entertainment, education, sport,
transport, etc. By totalling all of your living expenses you have an amount
that represents the net (after tax) monthly income you require.
Regular Monthly
House Payments
Car Payments
Credit Cards
Insurance Premiums
106
$
$
$
$
Other Monthly
Food
Health
Clothes
Entertainment
$
$
$
$
Regular Monthly
Phone, electricity
Rates, taxes
Other
$
$
$
Other Monthly
Transport
Education
Other
Total Monthly Bills
$
$
$
$
The new practice, especially during the start-up period, will make a heavy
demand on your funds. As it would be unwise to expect that you could
withdraw your regular income from the business for some time, you should
plan for funds to provide for your personal needs.
Summary
If you are satisfied that you are ready and able to start, you will need to
consider:
Whether to buy an existing practice or set up a new practice.
What business structure you want to adopt.
What finance you will need.
107
Choice
Some Advantages
Starting a Choose your
practice
pace
Possible Disadvantages
own High risk and uncertainty
No immediate income
108
Therefore goodwill, that intangible asset being the difference between the
net asset value and the asking price, could be said to represent the capacity
of the practice to earn future profits.
Some people feel that goodwill is worth around 25% of the annual turnover of the practice, averaged over the last three years. However, the figure can be higher or lower for a variety of reasons, e.g. the supply of new
patients versus repeat consultations for existing patients, or whether the
practice is in a significant growth curve in a growing community; alternatively, whether the current principal has a network of personal contacts,
e.g. via church or clubs.
There are several approaches to valuing goodwill however a practice is
ultimately only worth what a willing buyer is prepared to pay. A valuing
your practice fact sheet is included with this manual. There are several
methods of valuing a practice, some based on potential future earnings
rather than good will.
Goodwill and Capital Gains Tax
Goodwill is a premium the purchaser is prepared to pay in excess of the
net asset of the practice in order to acquire the practice as a going concern.
As a result, goodwill is classed as a capital asset for the purpose of capital
gains tax, and this means that the disposal of goodwill after 19 September
1985, may give rise to a capital gains tax liability. Generally, no such liability will be payable where the practice was established before this date.
However, you must check this with your accountant.
Should you be in a position to require a planning permit in order to conduct a home occupation, that permit must be obtained prior to the commencement of business from your residential premises.
Where premises are used to conduct business in breach of an existing planning permit or used without planning approval, the user of the premises
may be served with an infringement notice under the relevant State or Territory planning legislation. Should the user of the premises fail to comply
with such a notice, he/she is liable to prosecution by the planning authority.
Should your application for a planning permit be refused by the local
council, you will be served with a notice of refusal to grant a permit. The
grounds of refusal will be listed on the notice. You may be advised by your
local council before this notice is given if the local council anticipates that
the permit will be refused, allowing you time to amend your application
or address councils concerns. If your application is refused, the notice will
provide information on how apply for a review of your application in your
State or Territory should you wish to lodge an appeal.
If, at the application stage, you have reason to believe that granting of your
permit may not be a simple routine matter, you may be wise to retain the
services of a professional town planner to submit your application on your
behalf. Should your permit application reach appeals stage, you will probably need to consult your solicitor as well.
110
Module 7 - B u s i n e s s
Structures
The below is for information only and should not be taken
instead of appropriate advice. Please consult your
accountant and / or legal advisor for independent advice.
7.1 Introduction
There are four commonly used business structures you can choose from:
Sole trader
Partnership
Company
Trust
You should decide carefully on the structure best suited to your circumstances, and the way you want to operate your business, weighing up the
advantages against the disadvantages in each case.
The business structure of your practice has, amongst other things, implications for your tax position and your personal liability for debts. The form of
business structure you choose deserves close consideration and you should
seek advice from your accountant, financial advisor and solicitor.
In this section of the Manual, considerable attention is given to issues relating to the operation of partnerships as this form of business structure is
often inadequately understood by private practitioners.
7.3 Partnerships
When does a partnership exist?
Characteristics of a partnership
Liability of partners
The Partnership Contract
Dissolving a Partnership
Financial Aspects of Partnerships
A partnership is the relationship or association between two or more people carrying on a business with a common view to a profit. The partners of
a partnership may be individuals or companies. Every partnership agreement, whether it is in writing or verbal, implies a term of the utmost good
faith, that is, each partner must act with absolute good faith in all dealings
relating to the partnership.
A partnership, like a sole trader situation, is reasonably simple to establish
and inexpensive. Where a business of the partnership is to trade under a
business name rather than the names of the partners involved the partnership must register a business name with ASIC.
Legislation of each state and territory sets out well established legal principles governing partnerships in Australia (Partnership Acts).
Tax considerations
Although a partnership is not a separate legal entity, for taxation purposes
an annual partnership income tax return must be lodged on behalf of the
business to show the total income earned and deductions claimed by the
business. The taxable income of a partnership flows out to the partners according to each partners share in the partnership. Each partner must pay
tax, at that partners marginal tax rate, on their share of the partnership
income earned. Therefore, it is important that the partnership accounts
properly record income and losses so that each partner can calculate their
individual tax liability.
The liability of the partners in a partnership is known as joint and several.
113
This means that each partner is jointly and severally liable for all of the
debts and liabilities of the partnership; that is, each partner is fully responsible (100%) for all of the partnerships debts regardless of the proportionate share of the partnership.
Furthermore, a partners personal assets are potentially available to creditors of the partnership to satisfy the partnership debts.
Each partner can be held liable for the debts of the partnership with no
limit even though they did not directly incur or were not a party to the
incident causing the debt.
In this respect, the partnership structure can expose a partner to a greater
risk of personal liability than a sole trader because as a partner you are not
only liable for your own acts, but also the acts of your partners in the conduct of the partnership business.
Many partners will decide to incorporate their partnership into a company
structure for this reason alone.
When does a partnership exist?
The Partnership Acts set out important rules in relation to the creation,
operation and termination of partnerships.
It doesnt really matter whether the partners call themselves partners or
not. In some cases, a partnership can exist even where the parties say that
they are not in partnership.
In determining whether a partnership does or does not exist, regard will be
had to the following:
The joint intention of the parties in connection with a business.
How the parties jointly participate in the sharing of the income of
a business.
Whether the parties are each others agents.
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Characteristics of a Partnership
The four main characteristics of a partnership are:
a.
b.
c.
d.
Liability of Partners
Much more thought should be devoted by people contemplating entering
a partnership as to the liability imposed on them by a partnership situation. This issue is discussed in detail below.
115
a.
b.
c.
d.
e.
116
ner permits the sale of partnership property, the other partners may
choose to dissolve the partnership.
f.
Liability to Account
Partners must render true accounts of the partnership and full information of all things affecting the partnership to any partner or
their legal representative.
Every partner must account to the partnership for any benefit derived by the partner without the consent of the other partners from
any transaction concerning the partnership or from any use by the
partner of the partnership property, name or business connection.
If a partner, without the consent of the other partners, carries on
any business of the same nature as, and competing with, the partnership business, they must account for and pay over to the partnership all profits made by them in that other business. This does
not apply where the partner uses information acquired in the business to venture into non-competing areas of business.
b.
c.
If there is no period specified in the agreement, on any partners giving notice of their intention to dissolve the partnership.
d.
e.
f.
g.
119
7.4 Company
The third option, a company, is characterised by the fact that a company
is, as a general proposition, an independent legal entity, separate from its
shareholders in both liability and taxation concerns.
A proprietary or private company, must have at least one director, but does
not need to have a secretary. The director and secretary (if any), must ordinarily reside in Australia.
A proprietary or private company does not permit the trading of its shares
in public.
All company officeholders, being a director or secretary, must follow the
requirements set out in the Corporations Act 2001 (Cth) (Corporations
Act). It is important that company officeholders know what their legal
obligations (http://www.asic.gov.au/asic/asic.nsf/byheadline/Company+of
ficeholders?openDocument) are, for example:
Ensuring company details are kept up to date.
Maintaining various registers and records.
120
tax at the company rate. The owner must still be paid a salary commensurate with the income they have generated within the company although
residual profits can be retained in the company and taxed at the company
rate. The retained profits, generally, will build up in the company or eventually be paid out to the shareholders as franked dividends.
The Australian Taxation Office does not prohibit the incorporation of professional practices. The main effect of incorporation seems to be to reduce
the professionals income by the amount of an appropriate superannuation
cover. There may also be other taxation advantages for the podiatrist.
It is recommended to seek the professional advice of your accountant or
financial adviser on this taxation issue.
7.5 Trust
A trust is a relationship where a trustee (an individual person or persons
or a company) carries on business for the benefit of other people (the beneficiaries). For example, a trustee may carry on a business for the benefit of
a particular family and distribute the yearly profit to them.
A trust provides asset protection and, especially where there is a corporate
trustee, limits liability in relation to the business. Trusts are also very flexible for taxation purposes. A discretionary trust provides flexibility in the
distribution of income and capital gains among beneficiaries.
A trust is a complex legal structure, which should be set up by a solicitor
or an accountant.
There are two commonly used types of trusts:
1.
2.
A unit trust where the interests in the trust are divided into units,
similar to shares, and distribution from the trust is determined according to the number of units held by the unit holder.
A third type of trust is a hybrid trust, which is a combination of a discretionary trust and a unit trust.
123
124
Module 8 - F i n a n c i a l
Management and Fees
Startup Costs
Growth Costs
Operating Costs
8.1.1
Business Equity
Personal loans
If you are a recent graduate the most accessible finance for you will probably be a personal loan from a Bank. These loans can be used for any worthwhile purpose, such as purchasing a car, or travelling overseas. Personal
loans are usually less than $20,000, and are often unsecured.
126
Personal loans always have a fixed interest rate and the interest amount is
added to the principal at the outset and repaid over the term of the loan
(generally up to 7 years).
When you buy goods with a personal loan ownership of the goods rests
with you.
8.2.2
Overdrafts
8.2.3
A fully drawn advance is a loan account with a set original amount (like a
personal loan), a fixed term and prearranged repayments. A fully drawn
advance is most often utilised for significant purchases and is often secured
by: a mortgage over property, and/or a guarantee from another party.
The amount which can be borrowed through a fully drawn advance is limited only by the available security and the demonstrated ability to repay
the money.
Fully drawn advances are often used by medical professionals to purchase
existing practices.
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8.2.4
When lending money, bankers look for three things in the borrower: Character (willingness to repay money)
Capacity (ability to repay money)
Collateral (what to do if the borrower cant repay - security1)
Character is a constant, whilst (to a degree) capacity and collateral can be
balanced against each other. That is to say, a lender must be satisfied that a
borrower intends to repay the money but will allow some leeway for partly
secured or unsecured loans where there is strong evidence of an ability to
repay the loan.
The sort of things bankers will look for to satisfy themselves that you can
repay the money is stability of past employment (if applicable), past history with borrowed money and credit cards, and most importantly, the
income you are likely to make from your practice.
For these reasons it is important to look beyond interest rates when choosing a bank, carefully evaluate all bank fees as well as their service for private practice / small business. For the same reason that you dont buy a car
based on its price alone, you need to look beyond interest rates and special
packages when choosing your bank.
8.2.5
Bank Accounts
Records.
and
appropriate
When you graduate and begin work, either for yourself or for another podiatrist, you will be confronted with the Australian taxation system.
1
Security is a generic term which describes assets over which a lender takes a legal charge.
This charge gives the lender the right, in specific circumstances, to exercise its control over the asset
and sell it to recover its money. Only if there is money left over at the end of this process does the
borrower get a share of the sale proceeds. Banks take security to limit the downside risk to their
investors.
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To ease stress at the end of the financial year it is always best to prepare in
advance. The most important thing to do is to ensure that your records are
complete and easy to interpret. The way you structure your bank accounts
at the outset is fundamental to this requirement.
Make sure your personal expenses and banking are kept separate from
business banking
Studies show that businesses which develop and use business plans have a
higher rate of success than those which do not. Banks often require a business plan when considering a loan application.
Checklist of items you should include in a Business Plan
1.
The Practice
A description of the practice, reasons for being in the practice.
2.
An Opportunities Statement
Identify trends and outlooks for the practice and its overall performance.
3.
A Strategic Audit
Statement of practice mission, directions for growth, identifiable
advantages over competitors.
4.
Objectives
Identify and establish performance measures and targets.
5.
Business Strategies
Identify marketing, personnel and financial matters.
6.
Action Plans
Identify plans for making it happen - the who, when and how of
being in business.
129
7.
8.3.2
Most banks and some building societies offer special packages to professionals. These usually involve discounted home loans, small unsecured
facilities, and a Gold Card - Credit Card facility. Be very wary of these, usually any package is just a way for banks (and building societies) to buy a
low risk business.
At the end of the day it is pretty hard to make a dollar from one bank look
any different from a dollar from another bank, therefore the products offered by all banks and building societies are sometimes fairly similar. The
impressive sounding names such as Mortgage Power, The Negotiator,
and Advantage Saver, are put there to make the products seem different.
Either you are borrowing money or you are investing it. Also, you can rest
assured that all banks, like any other business, are out to make a profit,
and any discounts and special rates will probably be picked up somewhere
else.
Financing can be particularly suitable for a fast-growing, profitable practice which needs to conserve funds for expansion. In such circumstances, a
practice might find that leasing is a more tax effective form of finance than
the traditional bank options. Whether this would actually be the case could
involve some quite complex calculations. You should therefore ask your
accountant, a lease broker or some other professional adviser for specific
advice on this. You may want to consider the cost of the item and utilise a
depreciation schedule for larger items over $1000.
Note:
130
Virtually any equipment that produces income for you can be financed. The parameters are broad, but the test is that the goods
must be used in the course of your business and financiers generally prefer to finance new equipment.
As a lease is a debt requiring periodic repayments, a lending institution will look at your overall ability to service future borrowings.
A regular and consistent track record of repayment with a lease or
hire purchase contract will provide you with an excellent credit rating, which will be very beneficial with future borrowings.
It is sometimes possible to change over to new goods if equipment
becomes unworkable or obsolete during the term of a lease. A new
lease agreement will be arranged in keeping with the altered values
resulting from such a change-over and the possible scrapping of the
obsolete goods.
A finance lease
The financier retains ownership of the goods financed.
The client is renting the goods over a long term.
The client obtains a tax deduction for the payments (according to
business use).
The term and residual are defined according to Tax Offices rulings
and the wishes of the client.
The goods must be wholly or mainly for business use.
Government stamp duty may be applicable.
Penalties are applied for early termination of the loan.
Rates are fixed for the term of the loan.
Commercial hire purchase
The client retains ownership of the goods (the financier retains a
mortgage).
The essence is that you are paying off the loan to obtain full ownership if required.
The interest payable on the loan is tax deductable (according to
business use).
131
8.4.2
8.4.3
Leasing
Advantages
Disadvantages
and
Advantages
The use of 100 percent financing allows you to conserve capital for more
profitable use elsewhere, such as stock, debtors and other investments.
Generally security is not required, however it may be required when you
are establishing yourself.
The total lease rental is tax deductible, provided the arrangements meet
Taxation Office requirements and the leased goods are used solely for business use.
Leasing charges are fixed for the term of the loan and are therefore not affected by subsequent changes in interest rates.
133
You are not committed to go on using the leased goods at the end of the
lease period; you can buy or lease more modern equipment or undertake a
further lease on the goods you have been using.
The amount of finance provided is fixed, unlike an overdraft, and your
rental payments may be structured to suit your seasonal cash flow variations.
Disadvantages
Because leasing is 100 percent financing, lessees can become over-committed on high monthly or quarterly charges.
At the end of the lease period technically you have no more equity than at
the start of the leasing agreement. But the residual that remains is generally the market value of the items leased, and this figure becomes the agreed
figure between you and the financier to purchase the items if required.
A penalty may be applied if you wish to pay the loan off early.
8.5.1
8.5.2
Bank Accounts
8.5.3
Cheque Butts
Fill them out clearly including the name of the payee, the date, the
nature of the expenditure.
File completed cheque books carefully.
135
8.5.4
Deposit Books
8.5.5
Maintain remittance advices and other documents relating to nontrading income in a special file/folder.
Keep copies of invoices aside in readiness to give to your accountant.
Keep hire purchase agreements and lease agreements in readiness
to give to your accountant.
Where funds are obtained for the business from a bank or finance
company, keep the bank letter or loan agreement in readiness to
give to your accountant on request.
Value stock at cost unless the market value of the item has fallen
below cost. If this is the case, value the item at market value and
mark market value on the stock sheet.
8.5.6
Accounting Systems
While it is possible to start a business using manual bookkeeping, we recommend a computerised accounting system such as MYOB or Quickbooks.
Check with your accountant before purchasing a system to ensure they can
accept a file from the system. A system that can expand to include employee information in the future is a good idea. This reduces your ongoing
accounting costs. You should also check with the supplier of your practice
management system to ensure you can transfer billing information into the
system regularly and easily.
8.5.7
It is important that small businesses seek the services of an accountant before starting a business and thereafter on a regular basis during the operation of that business. In this way the risk of making costly errors is avoided
as the accountant is in the best position to provide a wide range of necessary advice. At the same time the accountant can provide guidance on a
simple and effective record keeping procedure, enabling the progress of
the business to be periodically measured.
136
Apart from medical services, other health services are GST-free if they
are:
Listed in the table in section 38-10 of A New Tax System: Goods and
Services Tax Act 1999; recognised professional and
Generally accepted in the relevant health profession as being necessary for the appropriate treatment of the recipient of the supply.
Most (but not all) podiatry professional services and goods supplied are
GST-free. Products not supplied at the time of appointment and orthotic
devices being re-made incur GST.
Further information regarding GST may be obtained by:
Phoning the ATO on 13 24 78.
Downloading information from the website at www.ato.gov.au.
Obtaining A Fax From Tax on 13 28 60.
Phone the Telephone Typewriter Service (TTY) if you have a hearing or speech impairment; or Write to the A.T.O. at PO Box 9935 in
your capital city.
8.6.2
In 2002/2003 the Australian Taxation Office conducted an effective life review of podiatrists assets.
137
Table A of Taxation Ruling TR 2006/5. The following assets are listed under
that sub-heading:
TABLE A
ASSET
LIFE
(YEARS)
LIFE
(YEARS)
PODIATRY SERVICES
(85399)
Podiatrists assets:
Computerised orthoses manufacturing assets:
Contact pin digitiser
Carving mill
Doppler vascularscopes
Electric nail drills:
Dust extraction drills
Portable dust extraction
drills
138
7
7
5
*
*
*
1 July 2003
1 July 2003
1 July 2003
7
5
*
*
1 July 2003
1 July 2003
1 July 2003
10
1 July 2003
10
1 July 2003
1 July 2003
10
5
7
*
*
*
1 July 2003
1 July 2003
1 July 2003
1 July 2003
12
3
*
*
1 July 2003
1 July 2003 1
July 2003
Vacuum Presses
3
Vascular neurological assessment assets:
Monofilaments
2
Tuning forks
10
*
*
1 July 2003
1 July 2003
Budget estimates are the best forecasts available before the financial year
starts. Certainly, be flexible in your thinking at the time of preparation, but
once fixed it should be the control point against which actual figures are
compared. Be realistic in setting the estimates, so that you can see the factors which are the underlying basis for the figures established, and then direct your attention to the actual problem areas. Thus control of the practice
is obtained from setting the budgets.
A budget is your best estimate before the financial year starts of what the
business will achieve during that year, and should highlight the opportunities and difficulties which may occur. In this context, it is for a period
of twelve months, but it can be extended to three or four years, thereby
encompassing a business plan.
The budget is segmented into various categories such as fee income, overheads, and final net profit. In turn, one must look at the cash budget to
ascertain the change in cash requirements including capital expenditure,
and working capital, such as stock requirements.
The budget is a prediction of the time periods ahead, and also includes
financial benchmarks, to which the business should aim to adhere to.
8.7.2
8.7.3
Operating budget
This covers the forecast income and expenditure accounts, and is used on a
regular basis, say monthly, for comparison with actual results.
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8.7.4
Budgets
You should be aware of the actual and forecasted fee income for the current
year, perhaps divided into groups or categories, say on a monthly basis. If
a 3% growth plus inflation of 5% is predicted, there is the starting point for
the following year. At that point, you should look at the outside factors,
e.g. other practices and their profitability, profit margins and so on. The
answers to these questions will assist in predicting the fees forecast.
New business will have to rely entirely on information from outside, such
as experience and market research.
8.7.5
8.7.6
There are three areas which can be looked at in conjunction with your financial advisor:
Cash flow statement
Working capital
Projected balance sheet
The cash flow highlights the surplus or deficiency of funds over a twelve
month period, broken down into months. It can be done by a forecast of
future cash receipts and cash payments and must include additional items
such as:
Leasing charges
Capital expenditure
Mortgage payments
Bank and other interest
Taxation including fringe benefits taxation
It will tell us if the business requires more cash, either permanently or short
term. This is one of the crucial elements of the budget, perhaps even more
so than the operating budget.
The effect of working capital on the business highlights those items which
may tend to be overlooked, such as stocks, debtors and creditors. Again it
should be available on a quarterly or monthly basis.
A projected balance sheet assists with any lending programmes.
2.
142
3.
4.
Ensure you have Professional Indemnity insurance, podiatry registration and the practice is covered for Public Liability. It is wise to
have good income protection insurance.
5.
6.
Ensure that the clinic has stock in place for your arrival that includes your preferred glove size and type, preferred dressings and
any other specific requirements that you consider important to your
proficient consultation ability.
7.
8.
9.
10.
11.
12.
13.
Keep a record of all leases, any mortgages for your home and costs
of equipment which you may have bought (for a depreciation
schedule).
143
14.
Ensure you have enough training to cope with new record keeping
methods, especially if on an unfamiliar computer software system.
15.
16.
17.
In recent years the taxation office has amended their rules in relation to substantiation of business expenses. They have introduced
stringent rules and guidelines that need to be adhered to in relation
to the maintaining of records to verify business expenditure. Consider whether to use an ABN as a contractor and requirements of a
contractor.
18.
19.
Locums must also have a provider number (do not use another providers number). Have an ABN number if your income requires it
and be knowledgeable of GST in your invoicing and completing
BAS statements.
20.
21.
One grey area is Workcover premiums. We advise anyone employing you as a contractor to include fees in their Workcover premium
calculations to be on the safe side.
22.
Ensure you have someone to contact in case of emergency, especially if consulting without reception assistance.
144
Range of Programs
The Australasian Podiatry Council has negotiated competitive rates on insurance through Guild Insurance. The package has been tailored to suit the
needs of podiatrists and is available to members of the Australian Podiatry
Association.
The insurance and financial services offered to podiatrists by Guild include:
Business Insurance
Provides cover for contents, loss or damage, fire, theft, etc.
NB: the above comments are subject to the terms and conditions of the current Policy.
145
Government regulations
Desired lifestyle
Profit required
Fees that you charge must be sufficient to cover the forecast costs, including your remuneration, as well as a return on investment of your funds,
and a reward for the business risk which you undertake. Also an understanding of what clients will pay and what the competition may be charging is important.
Calculations to Consider
Note: Use annual figures in the following.
Dividing the total income required by the total number of patient hours
will give a base hourly rate.
148
Module 9 - Personnel
Employment Issues
and
Please note this is for information only and should not be taken
instead of appropriate advice. Please consult your
accountant and / or legal advisor for independent advice.
Overview
The need to employ and select staff is common to all businesses. This section is therefore general by nature and you should consider the points
raised in the light of your own practice requirements.
The decision to recruit someone into the practice should not be taken lightly.
Employees often are a practices greatest asset and the investment required
is considerable. Not only are funds required to meet salary and related expenses (for example, workers compensation, superannuation, holiday and
sick pay) but also adequate training and settling in periods need to be budgeted for, as often new staff may take time to be economically productive.
Initially the need for the practice to employ someone should be justified.
This justification can be carried out by considering a number of questions,
for example:
How many people does the business need in order to operate effectively?
What is the reason for the vacancy?
Taking into consideration the return on investment, how many
people can the business afford to employ?
9.1.2
The Vacancy
9.1.3
Screening
Some applicants will not be suitable from the outset and should be screened
out.
If initial telephone applications are being received, basic details pertaining to the applicant can be summarised by the receptionist. When this is
analysed, it will quickly reveal which candidates are suitable for interview.
When written applications are invited, all applications should be acknowledged promptly.
It is important that the screening process be quickly and efficiently completed as a delay may result in the withdrawal of a suitable applicant.
Once this initial screening has taken place, there will be a group of candidates who show potential. To explore the suitability of each in more depth
an interview is required.
9.1.4
Interview
The interview can sometimes be just as nerve racking for the interviewer as
it is for the applicant. Create a relaxed easy going atmosphere that enables
you to learn the true character of the applicant.
151
It is a good idea to have at least one other person to assist in the interviewing process. The supervisor or manager of the prospective employee
would be a logical choice.
Suitable questions may include:
Why do you want this position? (This is a most important question
which is used in most interviews. It requires the interviewee to give
an indication of their understanding of the position. It also requires
them to talk about themselves - their likes, dislikes, strengths etc.).
Qualifications/ past employment experience?
Have you been to a podiatrist before (non clinical staff)?
Health attitudes?
Willingness to attend weekend seminars?
Involvement in community groups (source of referrals)?
Do you live in the area?
Other commitments?
Is there anything in your personal circumstances which may affect
your ability to carry out the requirements of the position?
It is also useful to provide the interviewee with some hypothetical workplace scenarios (eg. an abusive patient) and ask how they would respond in
that situation. This will give an insight into their personality and temperament and whether they think on their feet.You should only ask questions
that are relevant to the skills, abilities, experience and knowledge required
for the position. For example, you should not ask questions which require
a person to comment on his or her marital status, sexuality, religious beliefs
or prior workplace injuries or sick leave history. Federal and State and Territory anti-discrimination prohibit discrimination on the grounds of who
may be offered employment therefore inappropriate interview questions
could form the basis of a discrimination claim.
Reference Checks
If the potential employee nominates a past employer as a referee, you should
contact the employer and check for details of absenteeism record, position
held, work performance, reason for leaving and attitudes to safety.
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Do this by way of a telephone call and remember to have listed the questions you want to ask. Always ask whether that company would re-employ
the person. Any reservations indicated by the employer should be investigated.
Most but not all employers will provide such information and it is usually
reliable. All information must remain confidential.
Where a potential applicant produces written references, these should be
substantiated. Generally, written references only really confirm dates of
employment.
Never telephone an applicants present employer without the applicants
permission. You should not contact a former employer without the potential employees consent in writing.
9.1.5
Offer
Once the final choice has been made, a Letter of Offer should be sent to the
successful applicant detailing the job title, benefits and conditions, date
and time of commencement and hours of work. An acknowledgment of
this letter of offer should be sent back by the successful applicant, signed
and dated.
It is important to note that it is a requirement under the Fair Work Act 2009
(FW Act) that all new employees must be provided with a Fair Work
Information Statement. The statement is published by the Fair Work Ombudsman and is available on line. The statement must be provided as soon
as practicable after the employee starts his or her employment. The failure
to provide the statement is an offence for which fines can be imposed. As
a matter of good practice a copy of the statement should be attached to any
employment agreement or letter of offer.
A copy of the statement is available at:
http://www.fairwork.gov.au/FWISdocs/Fair-Work-Information-Statement.
pdf
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9.1.6
Induction
9.2.1
rated entities are covered by Federal employment laws under the FW Act
which contains the National Employment Standards often referred to as
the NES. The FW Act does not apply to sole traders, partnerships or unincorporated entities in Western Australia and the applicable industrial laws
continue to apply in that State.
9.2.2
The National Employment Standards are 10 minimum conditions for National System Employees. Together with the national minimum wage, they
are a minimum safety net for employees. They include minimum entitlements for leave, public holidays, notice of termination and redundancy
pay. An employees minimum entitlements can also come from a modern
award or agreement.
9.2.3
Awards
As an employer you are legally obliged to follow the terms and conditions of the Modern Award which applies to your employees. The Modern
Award which covers Podiatrists is the Health Professionals and Support
Services Award 2010,
http://www.fwc.gov.au/documents/modern_awards/pdf/MA000027.pdf
Modern Awards commenced operation on 1 January 2010.
They set out minimum entitlements in respect of rates of pay, penalty and
overtime payments, allowances, annual leave, sick leave, maternity leave,
long service leave, hours of work, meal and tea breaks, termination and
superannuation and the like.
As a matter of good practice, you should obtain a copy of the Health Professionals and Support Services Award 2010 and ensure that you are familiar with the minimum entitlements contained therein especially in relation
to base rates of pay, overtime, loadings and penalty rates and the like.
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9.2.4
You are required by law to deduct income tax from employees wages. For
new employers the Australian Taxation Office publishes a kit called Tax
Basics for Small Business and a booklet entitled A Guide to Pay as You
Go. PAYG summaries, declaration of TFN when starting employment,
general exemption declaration forms to be completed by employees and
taxation schedules can also be obtained online or by contacting the Australian Taxation Office.
9.2.5
You must register for PAYG Withholding if you have withholding obligations.
9.2.6
Group Tax
You must pay the amount of the tax instalment deductions you have made
from your employees earnings to the Tax Office following the deductions.
9.2.7
Payroll Tax
This is a state tax which may apply in your state. Search for payroll tax
at www.business.gov.au for details.
9.2.8
Employee or Contractor
Employers should note that workers may be deemed employees for a variety of purposes including superannuation, workers compensation, legal
liability and taxation. Its important to understand whether your workers
are genuine contractors or are deemed employees.
9.2.9
Workers Compensation
Workers compensation schemes operate on a state basis throughout Australia. You must be registered under the state workers compensation scheme
if you have employees. There may be a minimum wage level where you do
not need to register but your employees are still covered.
Details of workplace health and safety and workers compensation are
found at: www.safeworkaustralia.gov.au.
The definition of a worker often includes a person who has entered into or
works under a contract of service at common law, or is deemed to be working under a contract of service. Thus, in certain circumstances, a locum or
self employed associate may be considered to be an employee. If a locum
or associate is deemed a worker then appropriate workers compensation
premiums should be made by the principal.
9.2.10 Superannuation
Employees are able to choose the super fund that works best for them.
A business with employees (and some contractors) must make superannuation payments for eligible employees. A failure to pay superannuation
will result in penalties being applied by the ATO and a loss of tax deductibility of contributions. Modern Awards also contain default superannuation funds into which the superannuation contributions must be paid if the
employee does not have a nominated fund. Podiatrists need to become
familiar with key information that involves them as an employee and / or
an employer. Note that from July 1, 2013 the rate of superannuation contribution will be 9.25%.
The Australian Government Superannuation Website contains information
and links on key superannuation issues. Please go to: www.ato.gov.au/super
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b.
c.
d.
e.
f.
g.
h.
i.
j.
Adherence to policies such as confidentiality and privacy requirements, the code of conduct
k.
Details regarding allocation of travel expenses and supply and usage of equipment
l.
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clinic. The atmosphere that you desire for your clinic will give you a lead
to the type of person you require. The need to employ a receptionist and/
or podiatry assistant should become apparent at the appropriate time. The
ideal time will be different for individual businesses.
9.3.1
Practice Manager
9.3.2
Receptionist
Computer literacy
Experience in handling money
Ability to organise and plan ahead
Basic Maths and English skills
Experience of working in busy situations
9.3.3
Confidentiality
Probably the most important aspect of the receptionists role concerns confidentiality. Podiatrists are legally responsible for the actions of their staff
members in the course of their employment and must ensure that staff
members comply with relevant laws and regulations. A signed confidentiality agreement at the start of employment is advisable. Patient confidentiality must be maintained; staff members must not discuss patient issues
with any party where the provision of information is not reasonably required in the provision of the service.
Any facts that the receptionist learns about a patient, either from the patient, the patients records or from the podiatrist or any other health professional must never be disclosed to others.
A receptionist should not give information to a patient unless specifically
told to do so by the podiatrist. A receptionist should never discuss patients
or their problems in the hearing of other patients. Confidentiality must
also apply to any information the receptionist gains about the financial and
personal affairs of the podiatrist and the practice.
9.3.4
Record Keeping
An efficient filing system and a methodical appointment system is necessary for good office operations. Simple bookkeeping may also be a part of
the receptionists duties, together with familiarity with the current health
insurance schemes and common types of insurance claims, such as Workers Compensation, as well as the documentation processing required by
the Department of Veterans Affairs.
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9.3.5
People Skills
Look for people with experience in people related jobs and who are active
in community or volunteer groups.
Qualities to look for include:
Empathy
Active listening
Confidence (without being over bearing)
Ability to communicate with people of different socio-economic
groups (depending on clientele)
Ability to remember details about patients family, etc. (Helps if reminder notes are used)
Empower the receptionist
Give the receptionist as much responsibility as they can competently handle. Involve them in decision making and staff meetings. Seek their advice on how the practice could improve - their perspective is usually more
closely aligned to that of the patients. The more a receptionist feels a sense
of ownership, the more committed they will be to the well-being of patients and with the growth of your practice.
Clearly defined job description
A detailed Office Policy which is updated regularly gives the receptionist a clear direction of their responsibilities.
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Module 10 - Marketing
10.1 Marketing
Practice
and
Promoting
Your
Promoting your practice is an important aspect of being a successful practitioner. Theres not much use in establishing a practice with the latest equipment and great staff if you dont let people know about it. The majority
of business for most podiatrists seems to be generated through word-ofmouth and referrals from other health professionals, but when youve just
started out its especially important that you know how your professional
association can help you to promote yourself and your practice. Its also
important for both yourself and the profession that you are aware of any
limitations which may exist in relation to advertising your own practice.
To allow us to work best for you please also ensure that your Member Association has your current practice details on record.
from handling media interviews These are more difficult to do now adays
with insurances, please consult your local member association.
The Australasian Podiatry Council also oversees sponsorships on a national level, arranges publicity and support for its biennial national conference, and regularly provides the media with information about podiatry
through media releases and articles.
maintaining and developing their knowledge and skills in podiatry practice, ultimately rewarding individuals with accreditation status.
Why do we need an accreditation system?
Increasingly, the general public is seeking reassurance as to the qualifications and competence of health practitioners. Health care, like many industries, is rapidly changing and consumers demand expertise in current
methods and standards of practice.
Government funding bodies and third party organisations have proposed
a variety of systems for accrediting practitioners - one system, driven by
the profession is simpler for individuals and third party organisations. It
ensures a relevant and appropriate approach is taken.
Who can participate?
Any podiatrist who holds current membership with their local podiatry
association or society may participate in the program.
Please direct any queries to your Member Association.
More details can also be found on the Australasian Podiatry Council website: www.apodc.com.au.
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Module 11 - Policies
of
the Australasian Podiatry
Council
Accredited Podiatrist Program (APP) Logo
Trade Mark and Logo Authorised Use
11.2.1 Roles/Responsibilities
It is the responsibility of the affiliated bodies to oversee the practice of podiatry in their areas of interest, and to recommend minimum standards of
education required of their members.
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11.2.2 Accountability
The affiliated bodies are accountable to their membership.
The affiliated bodies are also accountable to the profession for policies
which they develop in relation to their areas of interest.
Affiliated bodies must maintain communication with the Australian Podiatry Council. They must also provide a current copy of their constitution,
code of ethics and report to the Australasian Podiatry Council as determined from time to time by the Council.
11.2.3 Authority
The affiliated bodies do not have authority through the voting process, as
they are not members of the APodC, but affiliated due to their similar aims
and objectives.
The only authority which is vested in the affiliated bodies is the authority
to set the standards of education required for membership of those bodies.
Affiliated groups must be incorporated under the Companies Code
or Associations Act.
The objectives of an affiliated organisation must be complementary
to the objectives of the APodC.
11.2.4 Australian
(APodC).
Podiatry
Council
(ii)
(iii)
(ii)
A trade mark owners rights are infringed if a person uses as a trade mark,
a sign that is substantially identical with, or deceptively similar to, the
trade mark in relation to the classes of goods or services in which the trade
mark is registered.
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Deceptively similar is defined by the Act as the use of a trade mark that
so nearly resembles that other trade mark that it is likely to deceive or
cause confusion.
A Court may grant the following remedies to the Council for an infringement of its trade mark:
(i)
An injunction and/or
(ii)
The Council authorises the use of the Logo in its discretion in accordance
with the Australasian Podiatry Council Trade Mark Use Policy below, and
may withdraw its consent for the use of the Logo by a user at any time.
Authorised users
Subject to the terms of the Trade Mark Use Policy and any other
conditions determined by the Council from to time the use of the
Logo is granted by the Council to the following:
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(a)
Member associations who are registered financial associations of the Council (Member Associations) and
(b)
3.
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(b)
The colour of the Logo is with colour coding PMS 285; black
or alternate colours may be used.
(c)
The word podiatry may be left off the when using the
Logo if it appears in prominence adjacent to the Logo for
example, on a sign board for a podiatrists room, the Logo
may appear without the wording if podiatrist or podiatry appears beside the Logo and the connection is obvious.
(d)
(e)
(f)
Restrictions on use
(a)
The Council may grant the use of the Logo by the authorised user subject to conditions at the time it grants the use
of the Logo. The Council may vary these conditions or issue
the authorised user with further conditions in respect of the
use of the Logo from time to time.
(b)
(c)
4.
5.
(a)
(b)
6.
(a)
(b)
(c)
On clothing worn by Individual Members or their employees, primarily at the Individual Members place of business.
Notice to Users
The Council requires that all authorised users agree and acknowledge that the Logo will be used in conformity with the Trade Mark
Use Policy.
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