Starting a practice TABLE OF CONTENTS May 2003

Transcription

Starting a practice
May 2003
TABLE OF CONTENTS
Table of Contents
Acknowledgements
Page
Chapter 1:
Getting started
1
Chapter 2:
Business, legal and financial planning
18
Chapter 3:
Location, premises and practice fit-out
48
Chapter 4:
Policies and procedures
75
Chapter 5:
General management
82
Chapter 6:
Staff
115
Chapter 7:
Marketing
135
Chapter 8:
Resources, legislation and references
142
Chapter 9:
Checklist and index
153
Prepared by: Patricia Kiely and Olivia McHenry
W ith input fr
om: Ian Bluntish, Matt Ding, Paula Monaco, Andrew McKinnon and
from:
Optometrists Association Australia NSW Division, Nelson Oliver, Dan Ziffer, Joe
Chakman, Peregrine Horton, Maria deSouza
Design: Kate Rasmussen
Copyright  2003
Enquiries to Optometrists Association Australia National Office
204 Drummond Street CARLTON, VIC 3053
PO Box 185 CARLTON SOUTH, VIC 3053
Telephone: (03) 9663 6833 Facsimile: (03) 9663 7478
E-mail: [email protected] Website:www.optometrists.asn.au
May 2003
TABLE OF CONTENTS
1
Chapter 1
Getting started
This chapter pr
esents the basic elements that you need
presents
to consider as you contemplate establishing an
optometric practice.
• The factors influencing your decision
• How to use this kit to work thr
ough the many
through
elements involved in establishing a practice
• Information about pr
ofessional matters
professional
Disclaimer
ovided in this document is intended for use as a guide only and Optometrists Association Australia str
ongly
provided
strongly
The information pr
ofessional advice on legal, business or industrial
professional
r ecommends that optometrists wishing to establish their own practice seek pr
effort
provide
address
sufficiently
matters. While every ef
fort has been made to pr
ovide accurate information and to addr
ess a suf
ficiently wide range of topics,
preparation
neither Optometrists Association Australia, nor those people associated with the pr
eparation of this document, accepts rreefrom
esult of what is contained in, or what is omitted fr
om this
sponsibility for the rresults
esults of any action taken by any person as a rresult
ongly rrecommends
ecommends that members obtain their own advice prior to acting on any matter in
strongly
document. The Association str
connection with their employment or the employment of another person.
May 2003
GETTING STARTED—Chapter 1
2
Contents
INTRODUCTION .................................................................................. 3
USING THIS KIT ................................................................................... 5
PLAN OF ACTION ............................................................................... 6
PROFESSIONAL MATTERS ............................................................... 11
Optometric registration ................................................................... 11
Optical dispensing .......................................................................... 12
Medicare ......................................................................................... 12
Department of Veterans’ Affairs ...................................................... 14
Health funds ................................................................................... 15
Professional Indemnity Insurance .................................................... 15
Optometric organisations ................................................................ 15
Therapeutic medications licensing .................................................. 15
Low cost spectacles schemes ........................................................ 17
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3
Introduction
The establishment of a new practice is a demanding, but rewarding experience. It allows you to be in charge of the decisions about how you practice
and where you practice, about the people with whom you work, about the
fees you charge and the hours you keep.
The decision to establish a new practice can occur at a number of occasions
in an optometrist’s life. Some optometrists decide to open a new practice
when they first graduate. Others decide to do so when they have a number
of years experience and find that it is time to go out on their own or set up
a practice with another practitioner. Others develop a new practice because
an already established practice can no longer meet the needs of the local
community and needs to expand.
Whatever the reason for establishing a new practice, there is a huge range
of matters to address, varying from complicated financial and legal issues
to the selection of floor coverings and decor. The following document
aims to combine information from a number of sources to provide information, or to indicate where information can be obtained, regarding many
of these matters as an aid to assist optometrists to establish a new practice.
How you aim to develop your practice will be driven by the goals that you
have for yourself both in your professional and in your personal life. Optometrists who wish to establish their own practice need to weigh up all the
factors associated with their choice and compare them to the same factors
associated with being an employee optometrist, purchasing a practice, being a partner optometrist and numerous other employment options.
Some factors influencing the decision to establish a new practice include
the wish for autonomy of the optometrist and their preferred style of practice and practice location. Consideration must be given to financial matters, both initially and in the future, the long-term potential of the practice
and so on. Whilst the financial future of an optometrist in private practice
should be secure there is always a financial risk in such a venture particularly in the early stages. In a new practice the initial income is likely to be
low (if any at all) and the costs of establishing the practice high. If you are
the only optometrist at the practice the full burden of service provision
falls to you, making holidays and ill health serious issues to consider. Not
only do you have the responsibility of patient care, but you will also have
the responsibility of the management of the practice and the practice staff,
unless you are in the position to employ a practice manager from the start.
When entertaining the idea of establishment of a new practice either alone, or
in partnership, you should first consider the advantages and disadvantages of
the venture compared to being a salaried employee. The establishment of a
new practice requires enormous commitment and time, particularly in the
planning and establishment phases. Even when the practice is firmly established there may still be a considerable time commitment unless you are able
to delegate some responsibilities to other staff. Some people are not good at
‘letting go’ some of the control of their practice, so unless you are, it is likely
that the bigger your practice gets, the busier you will be and there will be less
free time and opportunity to pursue other interests outside optometry.
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4
Initially in a new practice you can expect a low starting income and high startup costs, but, if all works well, you should have a higher income potential over
time than if you continue as a salaried employee.
When you establish a practice, you will be responsible for the running of
the practice, so you are responsible for both the good things and the bad
things that occur. You are responsible for the way in which issues and
concerns are addressed – you no longer have a practice principal to whom
you can refer the ‘too hard’ matters. When you establish a new practice
these matters are now your problem. This has the major advantage that
you can handle matters your way (particularly if you were uncomfortable
with the way matters were handled when you were an employee).
You also have the responsibility for the selection of staff with whom you
work, for the charges you make and for the image you present to the
public. You have the responsibility for the choice of location, for the appearance of the practice and for the services you provide.
One of the most important considerations is choosing the most suitable time
in your career to undertake such a venture, making experience a major area
to consider. Much of the decision relating to the establishment of a new practice relates to the personal goals of the optometrist concerned. Factors such
as responsibility, security, challenge, satisfaction, autonomy all play a part in
such a decision. Attitudes can change over time, so that the person who is
happy to be an employee for a number of years at the beginning of their
career may, after several years, decide that this is not the way they want to
continue with their professional life indefinitely.
Generally, before a practitioner makes the decision to open a new practice, they will have had some experience as an employee optometrist, but
there have been situations in which newly graduated optometrists have
established new practices. This is a matter for personal choice but the
optometrist involved is wise to discuss their proposal to establish a new
practice with other optometrists who have done so, as well as with legal
and financial advisers before they commit themselves.
A new graduate is likely to require more time than an experienced practitioner to complete an examination. This may not be a problem in a new
practice if things are slow to take off, but it will restrict the income that
comes into the practice and hence is available to cover overheads and salary.
A further difficulty with going straight into a new practice after graduating
is that the optometrist has not yet had the opportunity to put into practice
the skills they have as an optometrist, before assuming the extra responsibilities associated with being a manager, a dispenser and an employer. Dealing with staff and patient complaints, determining policies on refunds/
replacements and other managerial issues are likely to be very challenging
unless the optometrist has some previous experience in these areas.
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5
It is thus essential that the optometrist determine what their goals are—is
establishing a practice now the best way to meet these goals? Make sure
that your goals are realistic, with the possibility of being achieved in a reasonable time-frame. Below are some goals that you may wish to consider:
Career satisfaction
How do you want to spend most of your professional hours: in examining,
testing, diagnosing and prescribing for patients or do you want involvement in management aspects?
Continuing education
and professional growth
Will you be able to participate in sufficient continuing education to keep
up with changes in the profession so that you can provide the best care to
patients?
Patient care
Will you have the opportunity to practice optometry the way you wish?
Will you be able to offer a satisfactory range of services?
Employee satisfaction
How can you utilise your employees so that they feel that they are valuable?
Office systems
Will you be able to organise your practice so that there are suitable office
systems that do not require your constant involvement once you have employed additional staff?
Office location
Where do you want to practise and what population do you wish to serve?
Financial management
Will you be able to manage financially? How long can you afford to continue if the practice is slow to start?
Family
Will you be able to balance your time between family and work?
If you wish to be in charge of your own destiny, starting a new practice
may provide the opportunity you want. With it comes the satisfaction of
having achieved your aim and of experiencing the benefits of a practice
run along the principles that you have defined.
Using this kit
The aim of this kit is to aid optometrists in establishing their own practice.
The chapters follow the order in which an optometrist is likely to approach the process of establishment, and follow the approximate sections
you would cover in your individual business plan.
Everyone enters a new business with hope and enthusiasm; unfortunately
many small businesses fail due to lack of planning, support, infrastructure and
experience. A business plan and kits such as this are an immense help to a new
venture, reducing the risk of costly mistakes and potential oversights.
Your accountant and solicitor will also be of considerable help to you in
developing a business plan. The importance of a business plan can’t be overemphasised—a business plan will help you secure business loans and assure
investors and/or potential partners that you are a good financial risk.
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This kit is not designed to take the place of a business plan or advice from
legal and financial experts. Instead, we have developed it to help you consider all of the aspects of establishing and successfully maintaining a practice in the first year of business. The information below includes some
suggested websites where you can obtain more information about business plans. The asterisk* indicates that the website is Australian in origin.
ACT Chamber of Commerce
Basic information about the structure and content of a business plan. Includes a sample business and financial plan. www.actchamber.com.au/info/
busplan.html*
Business Plans for Small
Business
An American site that markets business planning software, however the
free information may be useful. www.freebizplan.org
Business Tasmania
Select the small business guides. Download information about business
plans and other aspects of establishing a small business. www.development
.tas.gov.au*
Entrepreneur Business Centre
Select Information resource guides. This site provides some information
free of charge. Information includes business plans, financial management
etc. www.ebc.com.au*
MIT Enterprise Forum
Lists books available from libraries and bookshops that will help you to
write your business plan. web.mit.edu/entforum/www/Business_Plans/
bplans.html
Young Achievement
Australia
Select BizTips. Information about business plans written for young Australians and others with little previous business experience. www.yaa.org.au*
Plan of action
Professional issues and
requirements
Legal matters
Financial matters
Practice management issues
Premises
The following flow charts are designed to give an overview of the process
of establishing a practice and briefly indicate the important issues, licenses,
permits and requirements. These flow charts are not meant to replace reading the following chapters, where each area is explained thoroughly.
The areas of the flow charts do not completely correspond with chapter
titles of the same name. Rather, the flow charts are used to demonstrate the
five most important areas of practice establishment: professional issues and
requirements, legal matters, financial matters, practice management issues
and premises.
To gain the most from this kit, we suggest that you review the flow charts,
and then read the chapters in the order in which they are presented. You
may wish to develop your business plan as you read the kit, or you may
realise in the course of reading this information that there are areas you
haven’t addressed in your business plan.
The purpose of this kit is not to overwhelm you with the myriad details
and issues involved in the establishment of a practice; rather it should act
as a guide book to the challenging, exciting and sometimes confusing process
of establishing a new practice.
May 2003
May 2003
Establishment of a practice
Financial
Legal
• Australian Taxation
Office
• Business
registration
• Financial and
business plan
• Permits
• Loans
• Leasing/purchase
• GST/Tax
• Accounts
• Banking
• Professional
Indemnity Insurance
• Medicare fees
• Spectacle/contact
lens fees
• Leases
Premises
• Location
• Population
demographics
Professional
Management
• Professional
relations
• Staffing
• Privacy
• Policies and
procedures
• Specialities
• Insurance
• Zoning
classifications
• Partnerships
• Type of building
• Quality of care
• Optometric
registration
• Design and
modifications
• Medicare
registration
• Equipment
• Standards
• Salaries
• Patient records
systems
• Privacy
• HIC obligations
• DVA
• Health fund
requirements
7
May 2003
Financial
Financial and
business plan
• Goals for the
practice
• Sources of
income
• Analysis of
skills
• Marketing
• Projections
Accounts
• Format and
content
• Inclusion of
prescription
Australian
Taxation Office
• ABN
• Tax File
Number
• GST
registration
• PAYG
Medicare
fees
Leasing/
purchasing
• Schedule fee
• Non-Medicare
items
• Terms and
conditions
• Servicing/
maintenance
Fees for
spectacles/
contact lenses
• Mark-ups on
lenses and
frames
• Dispensing
costs
Loans
• Terms and
conditions
• Parties
Banking
•
•
•
•
Deposits
Credit cards
Security
Staff
responsibility
Legal
Business
registration
• Practice name
• Partnership
Optometric
registration
• Optometrists
Registration
Board
• Therapeutic
licensing
Permits
• Council
• Music
Medicare &
Health Insurance
Commission
• Terms:
duration, rent,
modifications,
ownership of
modifications
•
•
•
•
•
Forms
Spectacles
Consultation
Receipts
Accounts
Insurance
• Professional
indemnity
• Public
indemnity
• Practice
• Personal
Partnerships
• Agreements
and terms
8
• Provider
Number for
each location
• Participating
optometrists
agreement
• Forms
• Fees
• Referrals
• Prescriptions
• Recalls
DVA &
Health Fund
requirements
Leases
May 2003
Premises
Location
• Rural
• City
• Suburban
Population
demographics
Zoning
classifications
• Population
trends
• Ethnicity
• Age
• Income
• Mobility
• Council
regulations
• Planning
approvals
• Planning
projections
• Council
permits
Type of
building
Design and
modifications
Equipment
• House
• Office
• Shopping
centre
• Medical centre
• Shop front
• Layout
• Consultation
rooms
• Waiting room
• Dispensary
• Reception area
• Record storage
• Frame display
• Security
• Leasing/
purchasing
• Types
• Maintenance
Professional
Professional
relations
• Networking
with other
health
professionals
• Referrals
• Reports
Specialities
• Privacy policy
• Confidentiality
• Patient record
storage
• Contact lenses
• Low vision
care
• Children's
vision
• Domiciliary
visits
Standards
• Practice
standards
• Dispensing
requirements
Quality of care
• Competency
standards
• Clinical
practice
guidelines
• Continuing
education
9
Privacy
May 2003
Management
Staffing
•
•
•
•
•
•
•
•
•
Number
Type
Advertising
Interview
Appointment
Review
Job description
Staff training
Leave
entitlements
• Sick leave
• Uniforms
• Rostering
Salaries
• Awards
• Over-time
• Method of
payment
• Frequency of
payment
• Pay slips
Policies and
procedures
Patient records
systems
Privacy
• Contracts
• Written
procedures
eg. a manual
• Responsibility
for policy
development
• Refund policy,
dealing with
complaints etc.
• Waste disposal
• Type of form
• Content of
forms
• What is to be
attached to the
record
• Storage of
records
• Access to
records
• Confidentiality
of records
• Confidentiality
of all patient
communications
• Privacy policy
• Staff access to
records
• Telephone
conversations
• Privacy during
consultations
10
11
Professional matters
Before you commence the process of establishing a new practice there are
a number of areas you must address at a professional level. These relate to
registration as an optometrist and registration with health authorities so
that your patients will receive their full benefits when they consult you. In
addition you must have professional indemnity insurance and you may
wish to consider the benefits of membership of different optometric organisations.
Optometric registration
Prior to establishing a practice in a particular area, the optometrist must
ensure that they are registered with the appropriate registering authority.
The exact requirements and procedures for registration vary between jurisdictions, so you will need to contact the registration board in the State or
Territory to obtain the latest information (see the table below). You should
note that registration in one state or territory does not mean that you are
registered in adjoining or other states and territories. Optometric registration in any state means that you are entitled to be registered in any other
state or territory provided you make the appropriate application, pay the
appropriate fee and receive the necessary documentation from the state/
territory Optometrists Registration Board.
Optometric registration renewal fees must be paid yearly for an optometrist to remain on the register. Failure to renew your registration may
result in Medicare refusing payment and health funds refusing benefits.
The optometrist must advise the registration board of any change of address within a time frame specified by the board.
Optometrists should also note that requirements vary between the different registration acts in terms of use of titles, advertising, ownership etc, so
that they will need to check the Act or contact their registration board for
further information.
Registration boards
Australian Capital Territory
Optometrists Board of the Australian Capital Territory
PO Box 976
Civic Square ACT 2608
Phone: (02) 6205 1599 Fax: (02) 6205 1602
New South Wales
Board of Optometrical Registration
PO Box K599
Haymarket NSW 1238
Phone: (02) 9219 0233 Fax: (02) 9281 2030
www.optomreg.health.nsw.gov.au
Northern Territory
Optometrists Board of the Northern Territory
PO Box 4221
Darwin NT 0801
Phone: (08) 8946 9546 Fax: (08) 8946 9550
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12
Queensland
Optometrists Board of Queensland
GPO Box 2438
Brisbane QLD 4001
Phone: (07) 3225 2518 Fax: (07) 3225 2527
www.optomboard.qld.gov.au
South Australia
Optometrists Board
64 Greenhill Rd
Wayville SA 5034
Phone: (08) 8373 1266 Fax: (08) 8373 0228
Tasmania
Optometrists Registration Board of Tasmania
PO Box 6,
South Hobart TAS 7000
Phone: (03) 6224 9666 Fax: (03) 6224 9700
www.optomreg.com.au
Victoria
Optometrists Board of Victoria
Level 3, 293 Camberwell Rd
Camberwell VIC 3124
Phone: (03) 9882 8884 Fax: (03) 9882 1066
www.optomboard.vic.gov.au
Western Australia
Optometrists Registration Board
PO Box 263
West Perth WA 6005
Phone: (08) 9321 8499 Fax: (08) 9481 3686
Optical dispensing
There are regulations controlling optical dispensing in NSW, SA and WA
that have to be met before this activity can be incorporated into a practice in
these states. Contact the following for information:
New South Wales
Optical Dispensers Licensing Board (02) 9219 0211.
South Australia
Optical Dispensers Registration Committee (08) 8373 1266.
Western Australia
Department of Health (WA) (08) 9222 2295 www.public.health.wa.gov.au
Medicare
For your patients to be able to claim their consultations through Medicare
or for you to be able to bulk bill them, you will need to enter into the
Common Form of Undertaking or the Participating Agreement. To participate you must be registered as an optometrist in an Australian State or
Territory, obtain a provider number and if you practise at a number of
locations you must obtain a different number for each (having provided
documentation to indicate that you are registered in any state where you
seek to have a provider number).
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Services do not attract benefits if they occur prior to the date on which the
Health Insurance Commission (HIC) received the undertaking and benefits
cannot be paid until the optometrist has a provider number. (Employee
optometrists can be included in their employer’s agreement, although the
employer needs to advise of new employee arrangements. Ultimately, it is
valuable for each optometrist to have their own agreement that stays in
place until it is surrendered or revoked).
The only exception to the requirement to have a separate number for each
site is where a locum is employed for no more than two weeks at a particular practice location; in this case they may use their provider number for
their ‘base’ location. Details about the Undertaking can be obtained from
the Commonwealth Department of Human Services and Health. Enquiries about provider eligibility can be made on 132 150.
Further information is available on the HIC website: www.hic.gov.au/providers—select Publications and Guidelines, then Medicare notes, Optometrists Explanatory Notes, then April 2001.
The forms for optometrists: Application for Provider Number for an Optometrist, Schedule of Optometrists on whose behalf optometrical services are provided by a non participating optometrist and the Common
Form of Undertaking Participating Optometrists can be downloaded from
the HIC or the Optometrists Association website: www.hic.gov.au/providers/forms/medicare/optometrists.htm or www.optometrists.asn.au
When you register with the HIC you will need to supply it with an Australian Business Number (ABN) to enable it to generate a recipient tax
invoice (see www.hic.gov.au/providers: select Forms, GST forms and check
the details on this page regarding the information you need to supply).
Other information on payments is available by choosing Publications and
Guidelines, then GST/HIC payments and Guides.
You must notify the HIC within 28 days of any change or addition to
practice details and when you close a practice location.
Medicare agreement
The agreement has restrictions on a number of areas:
• Eligible patients may not be charged more than the scheduled fee.
• Advertising undertaken by you or on your behalf should not lead to
consultations that are unnecessary.
• Provision of spectacle prescriptions to patients:
- Prescriptions are the property of the patients and must be provided on
request.
- Patients should be advised of their right to obtain a copy of their
prescription before any dispensing. This requirement can be met through
a notice in the practice. If you consider that the prescription is no
longer valid or past its expiry date at the time when a patient requests
a copy of their prescription, you could provide a prescription noting
that the expiry date is past.
• You must refer any patient to a medical practitioner where they need
such services.
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Details regarding Pay group link can also be found at the HIC site
www.health.gov.au/pubs/mbs/mbs/css/mbs_book_november_2002.pdf.
The Medicare benefits schedule book can be found online at www.health.gov.au
/pubs/mbs/mbs/css/mbs_book_november_2002.pdf. The booklet covers:
• Participation by optometrists
• Provider numbers
• Patient eligibility
• Benefits/schedule fees
• Billing procedures
• Limitations of benefits
• Referrals
• Review/inquiry
• Penalties/liability
It provides details of billing procedures for optometrists under Medicare.
The information on a receipt so that a claim for a Medicare rebate can be
obtained (see Medicare benefits schedule book) must include:
• Name and practice address or name and provider number of optometrist
who rendered service
• Patient’s name
• Item number, description of service/consultation
• Date of service
• Amount charged
• If there were more than one attendance on a day, each item number
should be accompanied by the time of the service.
Further information regarding Medicare can be found in the document
Mediguide available on the HIC website: www.hic.gov.au.
Department of Veterans’ Affairs
The Veterans’ Affairs scheme is administered by the Department of Veterans’ Affairs (DVA) and all inquiries about your involvement as an optometrist in this scheme should be directed to the DVA office in your State.
Optometrists may choose to become a participating DVA optometrist by
signing an Agreement for the provision of optometrical services to entitled
persons eligible under the Veterans’ Entitlements Act and/or a participating
DVA optical dispenser by signing an Agreement for the provision of optical
supplies to entitled persons eligible under the Veterans’ Entitlement Act with
the DVA. Copies of these agreements may be obtained from the DVA in
your State. To contact the Department of Veterans’ Affairs directly, or to
obtain a complete copy of the Pricing Schedule for Visual Aids or to request
prior approval, phone 133254 for all States and Territories or toll free on
1800 555 254. Alternatively, these forms are now available on the web at
www.dva.gov.au (select DVA forms, form number, then D1206 Application
for allied Health Provider Registration). Other information for optometrists
and information concerning optical services and supplies can be accessed
from the DVA homepage by choosing Health, then Providers. Under Optical Services and Supplies, Fact Sheet HSV18: Veterans—Optical services
and supplies and Fact Sheet HIP08 Providers—Information for optometrists
and the Optical Services and Supplies Index Page can be accessed.
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All eligible veterans can have eye examinations with optometrists who have
signed an agreement with the DVA to be a provider of optometric services.
Optometrists may direct bill either the DVA or Medicare for the consultations. In addition, eligible veterans may receive certain optical appliances at
no cost from optometrists who have signed an agreement with the DVA to
become a DVA optical dispenser of those appliances. All accounts for appliances must be sent to the HIC.
Health funds
To assist patients to access rebates on spectacles and other optical devices,
optometrists may use the item numbers detailed in the Optometrists Association Australia Members’ Manual. It is now the requirement of a number
of health funds to have details of the patient’s prescription prior to the processing of a claim. Optometrists should remember that these details must not be
supplied to the Health Fund unless there is a request by the patient.
Note that there is often a section on claim forms to permit the health funds
to obtain information, but you need to be confident that the patient has
given permission and that the information provided is limited to details of
the prescription. You may be required to contact the patient. To overcome
this problem you can include the prescription on the receipt that is issued to
the patient. It is then up to the patient to decide whether they will provide
those details to the fund. More information concerning payments through
Health Industry Claims and Payments Service (HICAPS) and Electronic
Lodgement of Patient Claims (ELPC) via IBA HealthPoint can be found in
the section Electronic claims for services and products in Chapter 5: General Management Issues.
Professional Indemnity Insurance
If you do not have Professional Indemnity Insurance and there is a claim
against you, you could face enormous costs. Membership of Optometrists
Association Australia includes Professional Indemnity Insurance.
Optometric organisations
Over 95% of Australian optometrists are members of Optometrists Association Australia. Member services include Professional Indemnity Insurance, representation to government and other organisations, subscription
to the professional journal, the newspaper and various other publications
and numerous other services, details of which can be found on the website
www.optometrists.asn.au. Optometric and other professional resources that
may be relevant to you are listed in Chapter 8: Resources, Legislation and
References.
Therapeutic medications licensing
In certain states of Australia, specially licensed optometrists who have undertaken an advanced course of study and who have passed the appropriate examinations are permitted to prescribe a limited range of ocular
therapeutic medications. The optometrist must obtain the appropriate endorsement of their registration from their State Registration Board prior
to undertaking this role. This endorsement is not transferable between
states, so an optometrist endorsed in one state must apply if they wish to
prescribe therapeutics in another state.
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16
For those practitioners who are licensed to prescribe therapeutic medications, prescriptions should be written on practice letterhead with a clear
indication of full details of the prescribing optometrist, date of writing, the
name of the patient, drug (including name, dose strength and quantity),
precise directions (except where directions are too complex and are provided separately or where administration is to be carried out by a nurse or
optometrist) and be signed. In an emergency, verbal instructions for the
supply of S4 drugs may be given to a pharmacist but must be confirmed in
writing with a prescription as soon as practicable. It is also recommended
that the optometrist include their endorsement number and contact details
of their state registration board to assist a pharmacist who may wish to
check that they are endorsed to prescribe the drugs. A sample proforma for
prescriptions has been included in Chapter 5: General Management Issues.
Any S4 drugs must be stored in a lockable storage facility accessible only to
the optometrist. This must be kept locked except when necessary to carry
out an essential operation with the drugs stored therein. If you lose or have
stolen from you any poison or controlled substance, you must notify the
Department of Human Services or Health Department in your state:
New South Wales
Victoria
Tasmania
NSW Health—www.health.nsw.gov.au
Department of Health and Human Services—www.dhhs.tas.gov.au
Department of Human Services—www.dhs.vic.gov.au
Therapeutic licensing for optometrists
When dispensing medications in certain situations eg. remote areas or in an
emergency or where there are no pharmacists, endorsed optometrists have
legal requirements for record keeping, labelling and dispensing. There must
be adequate counselling about the use of drugs, their side effects and potential interactions. As the professional expertise of the pharmacist is not available to the patient in these situations the obligation on the endorsed
optometrist to meet these legal and professional duties is clearly increased.
NSW
See New South Wales Board of Optometrical Registration (www.optomreg.
health.nsw.gov.au). At June 2003 legislation has been passed but the list of
drugs is yet to be developed.
Victoria
See Optometrists Registration Board Victoria (www.optomboard.vic
.gov.au). S4 drugs approved for use by endorsed optometrists only in
Victoria are:
Aciclovir
Betaxolol
Cyclopentolate
Fluorometholone
Hydrocortisone
Levocabastine*
Oxybuprocaine
Proxymetacaine
Tropicamide
Amethocaine
Brimonidine
Dexamethasone
Flurbiprofen
Indomethacin
Lignocaine
Phenylephrine
Sodium Cromoglycate
Vidarabine†
* Now S2 and available over the counter
May 2003
Apraclonidine
Carbachol
Diclofenac
Framycetin
Ketorolac
Lodoxamide*
Pilocarpine
Tetracycline
Atropine
Chloramphenicol
Dipivefrin
Gentamicin sulfate
Latanoprost
Neomycin
Polymyxin
Timolol
Bacitracin
Ciprofloxacin
Dorzolamide
Homatropine
Levobunolol
Ofloxacin
Prednisolone
Tobramycin
† No longer available in Australia
17
See Optometrists Registration Board Tasmania: www.optomreg.com.au.
Substances that may be prescribed by specially licensed optometrists in
Tasmania are:
Tasmania
Bacitracin
Hydrocortisone
Neomycin
Tetracycline
Chloramphenicol
Ketorolac trometamol
Phenylephrine (S2)
Flurometholone
Levocabastine (S2)
Polymyxin
Framycetin
Lodoxamide (S2)
Sodium cromoglycate (S2)
Low cost spectacle schemes
If you wish to participate in the low cost spectacle scheme operating in
your state you will need to contact the relevant organisation, as some low
cost spectacle schemes require that the practitioner providing the finished
product is registered with the appropriate authority.
Contacts and information on low cost spectacle schemes:
ACT Seniors Spectacles Program: (02) 6207 7753, www.decs.act.gov.au/
services/cons_lv3.htm
New South Wales
VisionCare NSW can be contacted on (02) 9344 4122 or toll free 1800 806
851, www.community.nsw.gov.au/help-08.htm
Northern Territory
(08) 8999 2833, www.nt.gov.au/health/comm_svs/aged_dis_ccs/pensioner/
pcs.shtml
Queensland
www.families.qld.gov.au/seniorscard/concessions.html
South Australia
South Australian Spectacle Scheme (08) 8226 6485 or 1800 188 115, www.
.onkaparingacity.com/services/doc-south_australian_spectacle_scheme.html
Tasmania
Tasmania Spectacles Assistance: www.dhhs.tas.gov.au/spectacles
Victoria
Victorian eyecare service: (03) 9349 7434. Access information via:
www.optometry.unimelb.edu.au/VCO/ves/VES.html
Western Australia
WA Spectacles Subsidy Scheme: (08) 9222 2384 www.fcs.wa.gov.au/_
content/concessions_guide/health.html#specs
May 2003
18
Chapter 2
Business, legal and
financial planning
This chapter presents the information you need to
consider regarding the legal and financial aspects of
establishing a practice.
• The type of practice you may establish
• Financial matters
• Legal matters
• Business licence information services
Disclaimer
The information provided in this document is intended for use as a guide only and Optometrists Association Australia strongly
recommends that optometrists wishing to establish their own practice seek professional advice on legal, business or industrial
matters. While every effort has been made to provide accurate information and to address a sufficiently wide range of topics,
neither Optometrists Association Australia, nor those people associated with the preparation of this document, accepts responsibility for the results of any action taken by any person as a result of what is contained in, or what is omitted from this document. The
Association strongly recommends that members obtain their own advice prior to acting on any matter in connection with their
employment or the employment of another person.
May 2003
BUSINESS, LEGAL AND FINANCIAL PLANNING—Chapter 2
19
Contents
TYPE OF PRACTICE ............................................................................. 21
Solo Practice ..................................................................................... 21
Partnership ........................................................................................ 21
Proprietary companies ....................................................................... 24
Employer optometrist ......................................................................... 24
Franchise .......................................................................................... 24
Services............................................................................................. 24
Hours of opening ............................................................................... 25
FINANCIAL MATTERS ........................................................................... 25
Accountant/tax adviser services ......................................................... 26
Your accountant ................................................................................ 26
Meetings with your accountant .......................................................... 26
Employer obligations .......................................................................... 27
Business plan .................................................................................... 27
Taxation Office ................................................................................... 27
Superannuation ................................................................................. 28
Payroll Tax ......................................................................................... 28
Insurance .......................................................................................... 28
Banking ............................................................................................. 28
Financial Plan .................................................................................... 29
Leasing/purchasing ............................................................................ 30
Leasing/purchasing property .............................................................. 30
Sub-Leasing ...................................................................................... 31
Leasing/purchasing equipment ........................................................... 31
Practice modifications ........................................................................ 32
Overheads ........................................................................................ 32
Contingencies .................................................................................... 33
May 2003
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Expenditure ....................................................................................... 33
Income .............................................................................................. 34
Financial policy ................................................................................... 36
Consultation and other fees ............................................................... 37
LEGAL MATTERS ................................................................................. 37
Legal adviser ..................................................................................... 37
Meetings with Legal Adviser ............................................................... 37
Lease/purchase agreements ............................................................. 37
Refunds, replacements and alterations ............................................... 39
Workcover ........................................................................................ 39
Optometric Registration ..................................................................... 41
Optical Dispensing ............................................................................. 41
Waste disposal .................................................................................. 41
Medicare Provider Number for the location and approval of
participating optometrist ..................................................................... 41
Music licences ................................................................................... 41
Building permits ................................................................................. 41
Registration of a business name or a limited partnership ..................... 41
Drawing up of agreements if there is to be a partnership .................... 41
Taxation Office ................................................................................... 42
Superannuation ................................................................................. 42
Payroll Tax ......................................................................................... 42
Insurance .......................................................................................... 42
Optometrists Association Australia Insurance ...................................... 42
Privacy Policy .................................................................................... 42
Business Licence Information Service (BLIS) Reports .......................... 42
May 2003
21
Type of practice
When establishing a new practice you need to have determined the best way
that a practice can be developed to meet your goals. You need to determine
whether you wish to have a solo practice, or whether you wish to be part of
a group practice either as a partnership or as an employer. A number of
questions need to be addressed:
• Do you want the full responsibility for the day to day running of the
practice?
• Do you want to see all of the patients coming to the practice?
• Do you want to be the only person to whom staff can come to discuss
matters relating to the practice?
• Do you want to be responsible for the financial management of the
practice?
• Do you want to share any or all of these roles with another optometrist?
• What hours do you want to work?
• Are there specialised services you would like to offer?
Solo Practice
Solo practice means that the optometrist is responsible for how the practice
is run, for the staff, finances and planning, the optometrist sees all patients
coming to the practice, and has the opportunity to provide continuity of
care. How the practice develops is thus dependent on the individual
optometrist’s goals and philosophies and abilities as a practitioner, manager,
and entrepreneur. Since your strongest assets are likely to be expertise in
optometric care and a desire to serve people, to practise successfully you
(and your staff) also need to develop your managerial and entrepreneurial
abilities.
However there can be a number of problems associated with solo practice,
particularly relating to management of patients and utilisation of locums
when the optometrist takes sick leave or recreational leave. Similarly it can
mean that the optometrist may need to spend significant amounts of time
dealing with practice matters rather than generating income through seeing
patients. There is little opportunity to discuss patient management issues
with another optometrist, particularly at the time the issue arises.
Whether you trade as a sole trader under your own name or with a business
name you must register your business name as soon as possible. It may be
difficult to secure assistance from banks and government authorities without it.
Partnership
A partnership is the relationship between people carrying on a joint business
for profit. In a partnership or group practice, you share responsibility with
your partner.
There are various types of partnership arrangements that are suited to different
situations:
• An associate practice is where one optometrist works for another for a
salary but has no other interest in the practice.
• A group practice is where three or more optometrists work together under
a pre-arranged agreement.
May 2003
22
• A shared-expense practice is where two optometrists share practice expenses
but maintain their professional autonomy.
• A merged practice is where two or more practices join together.
• Two or more optometrists may wish to pool resources and form a
partnership opening a new practice.
Why establish a partnership?
There are many reasons that a practice might require an additional partner.
An expanding practice may need another optometrist to help handle the
growing patient load, or the original partner may be advancing towards
retirement and planning for the future. Whatever the reason for extending
the practice, there are advantages and disadvantages that need to be
considered both by the practice and the intended partner. The practice will
gain a partner with new experience and expertise. With an additional partner
better service may be provided to patients, who will have access to a wider
scope of services. For an optometrist planning for retirement the attractions
of a partner include fewer working hours and a lighter workload. If you are
unsure whether your practice requires a new partner, market and financial
research should enable you to make an informed decision.
Every partnership agreement, whether written or oral, implies the utmost
good faith and honesty between the people involved. This requires that the
optometrists are able to agree about matters relating to patient and practice
management to ensure the smooth day-to-day operation of the practice.
Initially when there may only be a small volume of patients, this arrangement
allows the optometrists to practise part-time elsewhere to ensure ongoing
revenue. Advantages also include that there can be an optometrist in
attendance when the other takes sick leave or recreation leave. A further
advantage is that the optometrists are able to discuss the management
strategies for patients with more complex needs and practice management
issues. Partnerships may have more buying power although this would be
dependent on how quickly the practice grows and where there end up being
a number of practice locations, there is possibility of an expensive item of
equipment being purchased for one location with referral of patients requiring
that testing occurring from other branches. More information about
partnerships is available to members on the association website,
www.optometrists.asn.au. It is essential that the parties involved have a
contract drawn up by an appropriate legal adviser to specify the way in
which matters relating to salaries, staff and the general management of the
practice are to be handled.
The intention to enter a partnership should be recorded in a written document
(letter of intent) during the trial period before the partnership is finalised
and contain details of the probationary arrangement. This document should
address:
• The starting salary and the method of determining the salary including
raises.
• Fringe benefits (medical benefits, retirement, life insurance and professional
memberships).
• Vacation and sick leave (time with pay, policy regarding additional time).
• Areas of authority and responsibility (to be clearly understood and accepted
by both parties).
May 2003
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• Buying in (associate’s obligation for interest in partnership, time for paying
off interest).
• Termination of employment (severance pay, holiday pay accrued).
• Restrictive covenants to protect the senior partner from competition should
the associate arrangement dissolve—the covenant may stipulate that either
optometrist not practice within a certain distance of the practice within a
certain period after termination, although such covenants are probably
unenforceable under the Trade Practices Act. The period and distance
may vary from location to location, as 10 kilometres can be relatively
close in rural areas, yet distant in the city.
• Requirement for all partners to have indemnity insurance as other
optometrists may be equally liable in a claim against an action by one
member of a partnership.
The partnership contract is ideally drawn up in consultation with a lawyer
as Partnership Acts differ between states. The contract needs to include:
• Identification of individual partners.
• The name, purpose and location of the practice.
• Specification of personal liability of the partners as limited or unlimited:
partners’ first monetary responsibility is towards the practice and any
creditors acquired by the practice.
• Non-transferability of partners’ interest, a partner cannot transfer their
share in the partnership away from the existing partnership group unless
the other partners agree.
• Provision for taking in additional partners/withdrawal of a partner/
expulsion of a partner.
• Voluntary dissolution of a partnership.
• Partners’ powers and limitations, for example, policy and procedures
decisions, the right of each partner to take part in management; the basic
nature of the practice management may not be changed without the
agreement of all partners.
• In the partnership agreement there should be a clause that everyone in the
partnership is to have indemnity insurance as each may be liable in a
claim against one member.
• Value of the practice, assets, each partner’s financial interest (goodwill,
capital, assets, division of profits and expenses, provision for retirement
or death, provision for deceased partner’s share).
• Statement of capital/financial records and accounting procedures/new
equipment fund/spending.
• Additional income.
• Vacations, continuing education, postgraduate courses.
• Disability/life insurance/superannuation/remuneration after retirement.
• Optometric fees.
• Nepotism.
• Prohibited acts.
• Outside employment or business interests.
• Arbitration clause.
• Protective covenants.
• Standards/liability/malpractice.
• Amendment and review.
• Meetings of partners.
• Location of books.
• Signatures.
May 2003
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Copies of the Partnership Act can be obtained from the government
information service or bookshop in your state. A small fee plus postage and
handling may be charged. (There is no umbrella federal version of the
Partnership Act.)
Proprietary companies
In some states it is possible for a company to be the Participating Optometrist
under the Medicare agreement but with each optometrist employed by the
company having their own provider number. In other states, only individual
optometrists can be Participating Optometrists. This must be checked with
the registration board in the state in which you wish to establish your practice.
Employer optometrist
A further option in the establishment of a new practice is that the optometrist
acts as an employer, employing another optometrist to see patients, whilst
also seeing patients themselves but retaining responsibility for the
management of the practice. This could be the case when an optometrist
already has a practice and wishes to open a branch. It could also occur in a
new practice if there were sufficient patient numbers such that both the
employer and employee optometrists needed to work within the practice.
Often this need cannot be established prior to the opening of the practice
because of the difficulty to make projections of patient numbers.
In addition the optometrist will need to have decided whether the practice is
to be consulting only or whether dispensing services are to be provided. If
dispensing is undertaken the optometrist needs to determine who will look
after dispensing: whether jobs will be sent out or a dispenser employed or
the optometrist assumes responsibility for dispensing as well.
Franchise
There are limited franchising opportunities in the optical industry in
Australia. Those opportunities that are available can be purchased by an
optometrist or a dispenser. The name of the franchise is licensed and the
group has an existing corporate structure and business model, and provides
support such as artwork, advertising etc. The optometrist must be sure to
gain legal and accounting advice from professionals experienced in franchise
operations.
Services
In addition to general consultations, the optometrist needs to determine
whether they wish to be involved in other areas of practice such as:
• Contact lenses
• Low vision service provision
• Children’s vision
• Sports vision assessment or sports vision programs for local sports clubs
• Domiciliary care (this can be to private homes, to nursing homes, to
retirement villages or to patients in hospital)
• Industrial screening
• School and kindergarten screenings etc
• Dispensing (initially it may be less expensive to send work to laboratories)
May 2003
25
It is important for the optometrist to determine whether these services are
already being offered in the local community and how well the services are
utilised, and thus establish whether there is further need. Consider the needs
of your patients, beyond the provision of traditional services. For example,
one service that may benefit patients, and be particularly useful for nursing
home residents and school children, is engraving the name of the patient on
their spectacles or other devices.
Hours of opening
Patients expect to be able to access optometric services during normal business
hours but there is a growing expectation, particularly where practices are
located in shopping centres, that services will be available whilst the centre
is open so that late evening opening on Thursday and Friday, opening all
day Saturday and even on Sundays may need to be considered. Indeed,
some shopping centres require that all businesses within the centre adhere to
the advertised opening hours. This may lead to the need for the optometrist
to consider employing another optometrist on a casual basis unless they are
prepared to be at the practice most of its opening hours. (Some optometrists
may be prepared to work 50 hours per week, but an additional part-time
receptionist will be necessary).
See Chapter 9: Index and checklist, for information about further reading
and contacts on practice matters.
Financial matters
Before you advance too far in the establishment of your practice it is important
to register your business name and obtain your ABN to assist in the opening
of bank accounts and applications for loans. An ABN and other information
for businesses can be obtained from the Australian Taxation Office at
www.ato.gov.au.
Financial advice is necessary before you embark on the establishment of the
practice. Not only is there the cost of the lease or the purchase price of the
building, but the cost of modifications and renovations, the costs of leasing or
purchasing equipment and allowances for salaries for staff and for you. For
most optometrists it will be necessary to obtain a loan to finance the establishment
of the new practice. This may be through a bank, building society, or other
financial organisation. Initially, day-to-day costs of running the practice might
not be met by patient consultations and sale of spectacles, so you will need to
have a reserve to cover this possibility. (See later section: Business Plan).
Avoid proceeding too far too quickly. Unfortunately, you are likely to
experience delays at almost any stage during the establishment of your
practice. It will waste money if you have leased equipment or a car or
purchased frames while the fit-out of your practice is still months from
completion because of delays in obtaining permits or in obtaining the services
of tradespeople. Be sure that you are clear on when you have to start repaying
loans. Ensure that this date is delayed as long as possible by waiting to
obtain the items for which you have to borrow as long as possible.
May 2003
26
Accountant/tax adviser services
The services that you need most from your accountant and tax adviser are
quarterly income and expense reports, tax estimates and tax return
preparation, advice about tax laws and the tax consequences of any personal
or professional moves, and advice or warnings about the financial direction
of your practice. A bank manager may serve as an adviser for your
investments, for any trusts that you have for your spouse and your children,
or as a loan consultant. Using an insurance broker does not restrict you to
one company’s insurance products as their role is to advise you on the relative
merits of different policies. You may also seek advice from stockbrokers,
investment counsellors or management consultants.
Your accountant
Choosing an accountant can be a difficult task when you first start in practice.
If you have already practised elsewhere and have seen how that practice
worked with its accountant, the task may be easier. You can check in the
telephone directory to determine the accountants in the local area or check
with other health professionals and optometrists to see whom they have
consulted. Someone with experience in optometry/optical retail should be
an advantage, as they would already be aware of the purpose and activities
within the practice.
It is possible to access the CPA (Certified Practising Accountants) website
www.cpaaustralia.com.au for assistance in locating an accountant in your
general area—there is a facility to choose someone with experience in Health
and Community Services or Wholesale/Retail Trade. Alternatively you can
visit the ICAA (Institute of Chartered Accountants in Australia) website at
www.icaa.org.au.
You will need the person you choose to be able to assist you with the details
relating to the setting up and financing of the practice, ongoing financial
advice and recommendations on how you can improve your financial position
within the practice.
Meetings with your accountant
When you first meet with your accountant, you may wish to establish their
qualifications and experience. Determine how often it will be necessary for
you to meet with them and the degree of service you wish them to provide.
Establish their fee structure.
Consult your accountant about the method by which they would like to deal
with your finances (time-frame for consultations with them, the documentation
they require, best methods for your staff to record financial information,
filing of financial information etc).
There is computer based practice software for optometric practice—some
covering accounting procedures and others also covering clinical records
(some links to companies providing this software are included in the members
section of the Optometrists Association website: www.optometrists.asn.au).
Ask your accountant for advice on computer accounting packages.
May 2003
27
Employer obligations
Employer financial obligations regarding staff (eg. fringe benefits,
superannuation, income tax, payroll tax) are detailed (state by state) in the
document Unravelling the threads: Who is and Who is not an employee?
developed by the Department of Employment, Workplace Relations & Small
Business. It can be accessed at www.industry.gov.au.
Business plan
The optometrist needs to consider the investment they need to make versus
expected returns, and attempt to construct a time-frame within which the
practice would be expected to generate sufficient revenue to pay for itself. In
some cases it may be necessary for the optometrist to work at the new
practice only in a part-time capacity, maintaining an income from other
employment elsewhere. This has disadvantages when patients come to the
practice and find that they cannot be seen immediately, although many
people are aware that there is usually a waiting period before an appointment
with a health-care professional becomes available. This is a situation where
it may be advantageous to have two optometrists involved as there could
always be one of them at the practice.
Before approaching a bank or other financial institution seeking a loan you
will need to develop a business plan. A business plan will also help you put
in perspective the business activities necessary for the establishment of your
practice. (References to websites with information about Business Plans can
be found in the section Using this kit in Chapter 1: Getting Started).
In your Business Plan, consider the following sections:
• Introduction/summary—this will need to contain an analysis of the current
situation: brief information about you (experience and objectives),
information about optometric practice (aims, services provided, potential
patients, trends in optometry and the optical industry etc), the market
(consultations/spectacles/contact lenses/etc).
• Background to proposition: location, population demographics,
competition, property being considered, modifications required, financial
plan, your marketing strategy.
• Specific practice goals: aims for expansion of the practice, employment
of staff, time-frame.
• Two-year cash-flow forecast (consider salaries, insurance, purchasing, stock
control).
Taxation Office
Contact the Australian Taxation Office (web address is www.ato.gov.au)
regarding:
• Australian Business Number (ABN)
• Tax File Number (TFN)
• Goods and Services Tax registration (GST)
• PAYG withholder registration
• Fringe Benefits Tax requirements (FBT)
May 2003
28
Superannuation
See section in legal matters on page 37.
Payroll Tax
Payroll tax is a state government matter and you will need to obtain
information through your State Revenue Office or equivalent.
Insurance
More information about insurance is provided under legal matters. Insurance
cover is necessary for:
• Professional indemnity
• Product liability
• Public liability
• WorkCover
• Building and contents
• Income protection (as part of Optometrists Association Australia, from
2003, the members benefit program will offer Income Protection Insurance
with Guild Insurance)
• Motor vehicle insurance
• Legal expense insurance
• Tax audit insurance
Banking
Prior to approaching a bank to open an account you will need to have
obtained an Australian Business Number (ABN) from the Australian Taxation
Office.
The choice of bank is a personal decision - shop around to see which bank
offers the best service to cover your needs. You may wish to have a credit
card associated with the practice for payment of accounts or alternatively
you may prefer to pay by cheque. Determine the costs and details of both
options to determine which is more suitable and more convenient.
Cheques
When writing cheques be sure to:
• Write clearly
• Match written and numerical amounts
• Sign appropriately, cross cheques (unless they are to be cashed)
• Do not sign blank cheques
• Write with a pen that is not erasable
• Arrange for a trusted staff member or associate to write and countersign
cheques
Credit cards
With credit cards:
• Allow only trusted staff to know the number and details of the card
• Specify when the card is to be used
• Review all accounts to ensure that only goods received have been billed
• Ensure that payments are in good time to avoid interest charges
May 2003
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Develop suitable policies for management of counting, banking, payments
etc. It is useful to determine whether your bank has an automatic fund transfer
system so that you can keep your deposits in a maximum interest account
until the time you draw a cheque. It is also worth asking whether the bank
could handle your pension and retirement funds to your satisfaction.
Financial Plan
Develop a financial plan that can cover your goals for the practice, your
sources of income, professional development, analysis of your skills,
information technology, marketing, succession planning and implementation,
expenditure necessary for the leasing or purchase of premises, optometric
equipment, modifications to premises and salaries, overheads etc. Consider
from where the money to pay for these items is to come. This is likely to
form a significant proportion of your business plan. In the beginning, try to
keep costs to a minimum without jeopardising quality.
Fee schedule
Set professional fees keeping in mind the Medicare agreement. Determine a
fee schedule for materials you supply that is in line with what you feel is
necessary. Is your emphasis to be on services or materials? Determine what
you consider to be a reasonable mark-up on frames, lenses, contact lenses,
contact lens solutions, optical devices, sunglasses etc. Advice on reasonable
mark-ups is available from professional groups such as ProVision
(www.provision.net.au)—further information about the services provided
by ProVision is included in Chapter 8: Resources, legislation and references.
(Statistics from Medicare can assist you in the evaluation of your financial
plan after a number of months as they will provide an indication of the
number of first, subsequent and contact lens consultations that you are
providing if you bulk-bill all of your patients).
It is essential that an appropriate accounting system is introduced from the
commencement of the practice. Assistance may be obtained from your
accountant, but be sure to determine how much this will cost. The accounting
system needs to address:
• Bookkeeping
• Daily record keeping
• Filing taxes
• Balancing books
• Paying bills
• Insurance
• Deposits
• Weekly reports
Repayments
May 2003
In the early days of the practice check whether some costs can be paid
monthly or weekly to guard against large bills coming in together. Systems
that do not deal directly with patients include ordering and stock control,
bill paying, salaries, office cleaning and maintenance, equipment cleaning
and maintenance, laboratory cleaning and maintenance, utilities management
(phones and electricity), insurance form handling, and equipment purchasing.
These are all essential services. Determine the frequency with which these
payments need to be made and set aside funds appropriately.
30
Establish credit accounts with suppliers—ProVision does this for members
and all preferred suppliers. After a period of months evaluate the performance
of the practice against your financial plan.
Leasing/Purchasing
Overall it is usually cheaper to buy equipment than to lease but lease rentals
are tax deductible business expenses. The cost of capital equipment is totally
tax deductible. Check whether lease amounts alter as interest rates change.
Leasing/purchasing property
The decision whether to lease or purchase property and equipment depends
on your finances. Weigh up the advantages and disadvantages of leasing or
purchasing both premises and equipment. Determine which items of
equipment you must have to be able to provide an appropriate service to
patients, then obtain information about different ways you can purchase or
lease equipment without a large outlay at a time when the practice will not
be generating much income.
Contracts
Few would be able to buy a property, modify and refurbish it and fit it out
with all the necessary equipment as well as generate income to pay salaries
of staff and the optometrist. So in most cases, leasing, or purchase through
a loan would be the preferred option. Financial and legal advice is
recommended concerning the terms of contracts, eg. duration of the lease
period or the loan agreement, what the optometrist is permitted to do to the
property, repayments (amount and frequency), service arrangements for
leased equipment, liabilities (legal obligations and responsibilities) of the
optometrist/property owner/equipment owner etc.
Whether you purchase or lease property you should have the quality of the
premises checked. Visiting at odd times can provide you with information
that the landlord may not, eg. are the toilet facilities at the shopping centre
well maintained, is the temperature regulation appropriate, how much car
parking space is not used, how much pedestrian traffic is there, how much
road traffic noise is there, etc.
Retailers associations
Consider joining small retailers associations to check whether all businesses
in your area (eg. a shopping centre) are paying similar rent for similar
valued space.
It is essential for you to include costings of the different options in your business
plan, including how long it is expected to take for loans to be repaid etc.
Consider whether the income you expect to generate will be sufficient to cover
the rent for a particular sized property, the cost of salaries and overheads.
Instead of leasing property or office space, you may be able to organise the
purchase of property. In most cases it would be necessary for you to borrow
money to purchase the property and this requires consideration of the terms
of loans and whether you consider that you will be able to repay the loan on
the terms required by the financial institution.
May 2003
31
Further considerations are:
• Whether any lease covers council and other rates.
• Whether car spaces are available under the lease eg. dedicated car spaces
in a shopping centre.
• Whether sub-leasing is permitted.
Sub-Leasing
Depending on the terms of the leasing agreement and the size of the premises, it
may be possible to sub-lease a room(s) to another professional(s), thus generating
extra income and allowing the possibility of shared reception staff, depending
on the nature of the work of the other professional. Ensure that sub-leasing is
permitted under the terms of your lease before you act in this area.
Increased revenue
The increase in revenue from sub-leasing of rooms within the premises you
are leasing can be particularly valuable in the early days when income from
patients may still be low. The rental for the property sub-leased can be based
on daily rental for a room, or daily rental for the room plus services (eg.
secretarial, clerical and telephone services by your staff), or sessional rental,
or in the case of another professional rental based on number of patients seen.
Sessions may be irregular ie. as the need arises, or a regular allocated time
every week, or subject to availability or variants on these. You need to
determine in all instances whether the person subleasing is going to use
your staff for preparation of accounts and reports, for billing, appointment
making, filing, message taking, banking etc. You will also need to determine
whether they will need to use other services such as your telephone,
photocopier, etc. Additional costs associated with these activities will need
to be factored into their rental.
Leasing/purchasing equipment
Once you have decided which brand of each item of equipment you prefer
to work with, determine how much each item will cost and the options in
terms of buying and leasing. Determine whether there are options to purchase
secondhand equipment or equipment that has been used on display. Remember
that, in general, patients are more impressed by new equipment and new
fittings and are not necessarily aware that an older less attractive item may
perform its function just as well as the new item.
It is important to seek financial and legal advice when entering into lease
agreements. Determine:
• How much personal tax you are likely to pay (this may assist in determining
depreciation etc).
• Interest rates available (you may wish to take a loan from a bank or other
financial institution).
• Which items of equipment you require.
• What you already have and what you need to purchase or lease.
• For those items you already own, what sort of condition they are in and
what length of time they should be able to be used.
• Which brands of different instruments you prefer and whether you can
obtain an adequate supply of spare parts (eg. globes).
• The cost for all those items that you consider necessary and that you do
not already possess.
May 2003
32
Compare prices for leasing and purchase, then prepare two tables, one with
leased items and the other with items to be bought; include the relevant prices.
For those items you intend to purchase outright determine whether you will
pay the amount in full or whether you will make a down payment with
regular instalments. Ensure that the table has a section to indicate that
ongoing instalments are to be made and the duration and frequency of these
payments. Include lease repayments and their frequency.
Determine the amount you require to pay initially for purchase and lease of
equipment, and the monthly amount required. Indicate the period of time
over which any instalment payments need to be made.
Leasing vs purchasing
The following provides a guide to assist in determining the value of leasing
against purchasing equipment (figures included are fictitious and are not
meant to indicate a real-life situation):
Item of equipment
Price paid up front
Initial payment
Monthly instalment
Office chair
$200
Cor
neal topographer
Corneal
($12,000)
$2000
$500 for 24 months
Automated perimeter
($?)
($?)
Monthly lease
Practice modifications
Firstly, ensure that you will be able to gain a council permit for any modifications you plan to make and that there are no other regulations (eg.
shopping centre requirements) that need to be considered. If you want to
deal with the council, there is a lot to learn, so employing an architect may
be a better option. If you do decide to have an architect deal with organising council permits and so on, ensure that they report regularly to be sure of
the stage you have reached. Determine the cost of the modifications that
you wish to make to the practice, will you need to take out a loan to cover
these costs? What will the weekly/monthly repayments be? What are the
costs associated with any permits required? (See Chapter 3: Location, premises
and practice fit-out for further information).
Overheads
When determining the costs of overheads, include costs such as electricity,
telephone calls, stationery and other consumables, including cartridges, promotional material etc. It is essential that you do not run short of office
supplies, so it is advisable that a staff member is assigned to be responsible
for the maintenance of adequate levels of stock. They will need to be responsible for an inventory of office stock and for purchasing and storing.
You may wish to establish a card file with details of office stock (item name,
where purchased, how long from ordering to supply etc). Consider buying
some of these items in bulk. The responsible person should check items
supplied against the order and against invoices.
May 2003
33
Contingencies
Once you have established your projections for expenditure and income,
you should be able to determine whether you are likely to need to borrow
money or to seek a secondary source of income elsewhere until the practice
becomes established. Develop a secondary financial plan addressing the
situation where the practice starts off more slowly than expected. This would
necessitate dropping your income so that the business is still cash flow positive by the end of the first year, but may have a negative net cash at bank
necessitating a request for a working overdraft. It is important initially to
keep costs to a minimum as it is very difficult to determine how a practice
will grow.
Expenditure
The following plans are based on information supplied by Nelson Oliver.
Expenditure
Factors to consider
Property lease
Ongoing regular payment; note when increments are likely and if
charges are dependent on practice income. For monthly rent, set
aside an amount per week.
Cost of modifications
This may be through a loan or an up front payment; what are your
repayments? When do repayments start?
Loan repayment
Ongoing regular payment.
Equipment lease
Ongoing regular payment.
Equipment purchase
Loan, up front payment, or pay it off over time; what are the
repayments?
Security costs
Initial outlay, with ongoing costs for monitoring property.
Car/petrol
Estimate likely use, costs.
Stationery/ consumables
Estimate likely weekly usage.
Promotional material
and marketing
Your costs may be higher when you open and during your initial
period of operation. Incorporate these costs with your likely weekly
amount spent on marketing.
Spectacle frames
You may wish to start with 200 frames @ $xxx each and 20 sunglasses @ $xx each. There may be ways in which you can negotiate
payment later for spectacle frames.
Lenses
If you send work out, this may not be necessary and with the high
turnaround in supplying lenses for edging, you may not need to keep
significant amounts of stock.
Contact lenses
Small disposable contact lens stock, stock inventory.
Contact lens accessories
Do not purchase too much stock initially, monitor use-by dates.
May 2003
Weekly estimate
34
Expenditure
Factors to consider
Weekly estimate
Staff and wages
Initially need optometrist, receptionist, possibly a part-time receptionist to cover extended practice hours. If the practice picks up quickly
consider employing more staff. Consider awards, superannuation, tax
payments, leave entitlements, cost of employing a temporary replacement for leave/sick leave etc.
Telephones
Number of lines needed, installation, rental, call costs, telephone system,
fax, modem.
Office equipment
Computer, printer, chairs, desks, filing cabinets (see Chapter 3).
Electricity/gas/water
Determine any initial deposits, and regular costs.
Insurance
Insurance needs to cover professional indemnity (if not an association
member), office and practice contents, income protection, public
liability etc.
Professional fees
Optometrist registration fee, association membership fee etc.
Legal and professional
fees
Obtain as much information as possible about fees from your lawyer,
architect, interior designer etc prior to using their services.
Licences/Permits
Council permits, music licences etc.
Locums
For when sick, holidaying, during emergencies and peak periods.
Income
Income
Calculation
Calculate weekly
for specific length
of time
Factors to consider
Patients:
Professional
fees for initial
consultations
Estimate the number
of new patients (requiring an initial consultation) each day over a
period of say three
months—how many
weeks might it take until
you have reached a
ceiling of eg. 10
patients per day?
Multiply the number
of new patients by
the Medicare rebate
for an initial
consultation.
How much time will you be able to
devote specifically to seeing patients at the practice? Are these
numbers likely to vary throughout
the year eg. will you be dependent
on a university population, or
holidaymakers? If you are performthese calculations over an extended
time frame, factor in the return of
previous patients (retention rate).
Patients:
Professional
fees for
subsequent
consultations
Estimate the percentage of new
patients who could
be expected to
need a subsequent
visit within this time
frame.
Multiply this number
by the Medicare rebate for a subsequent
consultation.
The need for subsequent consultations will be influenced by the age
group and needs of the population
in your area. This calculation assists
in determining how many appointments should be left available for
subsequent consultations per week.
May 2003
Weekly
estimate
35
Income
Calculation
Calculate weekly
for specific length
of time
Factors to consider
Spectacles
What percentage of
your patients do you
think will require a new
spectacle prescription?
Multiply the number
of patients expected
to have new spectacles
by the average cost
of your frames and
standard lenses. Multiply the number of
patients expected to
require lenses only by
the cost of new lenses.
What are the socio-economics of
the area in which your practice is
located? Are your patients more
likely to ask that new lenses be
fitted to their current frames or
are they more likely to request
that new lenses be fitted to their
new frames? These numbers will
vary with the ages of the patients
you see.
Contact lens
patients
How many new contact
lens patients do you expect to see each week?
Multiply the number of
new patients by the
fee payable by them.
The number of contact lens patients
will be related to the population
in the area.
Contact lenses
What income can be
expected to be generated by new patients
for new contact lenses?
new patients by the
cost of the lenses.
Is the cost of contact lenses
likely to be a prohibitive factor in
the area in which you practise?
Contact lens
solutions
Calculate numbers likely
to purchase solutions.
Multiply the number of All contact lens patients, other
patients by the cost of than those with daily disposables,
solutions.
will require cleaning solutions. Estimate how frequently your patients
will need to replenish their supplies.
Sunglasses
Calculate the number
of patients likely to
require non-prescription
sunglasses.
people by the average
cost of non-prescription
sunglasses.
Vision Training
Calculate the number
of children likely to need sessions by the fee.
vision training and the
frequency of the training.
Outside work
Determine the number
Multiply by the locum
of hours you are likely to rate per hour.
work elsewhere whilst the
practice is growing.
Sub-lease
May 2003
Weekly
estimate
There is likely to be considerable
seasonal variation with the need
for sunglasses and also a variation
depending on practice location.
Calculate income.
36
A rough method to determine ‘chair cost’ is to add annual costs and divide
by the number of consultations in a year – when starting a practice this can
be difficult to estimate so some information from other practitioners could
be useful. Such a method is more applicable to a consulting-only practice as
it places all the burden for the generation of income on the consultations.
Suggested types of expenses to be considered in these calculations are:
• Salaries
• Employees benefits
• Pension/profit sharing plans
• Rent
• Insurance, worker’s compensation
• Telephone, postage, gas, electricity, office supplies
• Legal and other professional fees
• Depreciation
• Interest
• Business/business property taxes
• Subscriptions
• Lease payments
• Printing
• Motor vehicles
• Maintenance
• Lease payments
• Cleaning
• Continuing education
• Bad debts
• Promotional activities
• Miscellaneous
Alternatively, calculate the total number of hours spent in your office per
year and calculate the overhead cost per hour. Calculate the overheads per
type of service eg. if an initial consultation occupies 45 minutes of your
time, then it attracts proportional overheads.
Financial policy
It is recommended for the benefit of staff and patients that there is a written
financial policy in place. Such a plan can be included in a Policy and Procedures Manual where it is easily accessible to all staff. This policy should
contain information relating to:
• Consultation and other fees
• Accounts and time-frame for their payment
• Banking
• Types of payment accepted
• A policy on accepting assignment of payment from third parties
• Discounts
• Refund policy (also cover exchanges and replacements, warranties etc)
• Debt collection
• Accounting procedures/payments
May 2003
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Consultation and other fees
Details regarding optometric consultations and fees can be found at:
www.health.gov.au. All practices require some form of price list with clear
details of the fees for different optometric services and as far as is possible
prices of appliances. There should also be a policy relating to charges for
missed or broken appointments. All staff should be aware of the person to
contact with questions about accounts within the practice.
Setting costs
If the optometrist is not the person who determines the cost of frames and lenses
there should be a clear guide for the staff member who does, so they are able to
calculate the costs. The price list should be regularly updated to ensure that
it is current. (See Chapter 5: General management).
Legal matters
Employer’s legal obligations regarding staff (eg. annual holidays, antidiscrimination, common law, long service leave, occupational health and
safety) are detailed (state by state) in the document Unravelling the threads:
Who is and Who is not an employee? developed by the Department of
Employment, Workplace Relations & Small Business. It can be accessed
at: www.industry.gov.au. Information about partnerships can be found in the
section Type of Practice above.
Legal adviser
A lawyer may be needed to provide legal advice on documents or contracts,
and can advise you when you need a specialist in taxes, insurance, or estate
planning.
File all legal documents of the practice together so that they are easily available
if you need to consult your solicitor or lawyer. Have a system for producing
back-up copies of documents and filing them separately from the originals.
Meetings with legal adviser
Many lawyers will charge by the hour, so this is not a service to be utilised
unnecessarily. Plan the areas you need to discuss when you need to seek
legal advice and take all necessary documentation to any meetings.
Lease/purchase agreements
As tenancy laws vary between states, it is essential that legal advice in the
negotiating, drawing up and signing of leases is sought. Prior to entering
into a lease ensure that any buildings erected on the property to be leased
comply with local zoning and building regulations. Determine whether there
are any outstanding charges (eg. rates, mortgages) associated with the
property. Legal assistance may be necessary to determine these matters and
to determine whether council regulations and shopping centre management
restrictions will allow the premises to be used for an optometric practice
and to have modifications made. In addition ensure that in the lease agreement
it is clear which party is responsible for which aspects of the maintenance of
the property eg. plumbing, electrical, roofing, windows, doors etc.
May 2003
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Other areas concerning leases in which a lawyer can assist (modified from
information from Hall & Wilcox, Lawyers: Avoiding Common Lease
Problems, p2, in Legal News for Business, December 2001 and Optometrists
Association Australia, NSW Division, Starting (Or Re-Launching) Your Own
Optometric Practice, 1999):
• Ensuring correct naming of the parties in the lease agreement.
• Determination of the ownership of the premises (this may necessitate a
title search) and whether there are any mortgages on the property.
• Correct identification of the premises in the lease.
• Mortgagee’s consent to lease of the premises by the landlord.
• Dates and term of the lease (note that in some shopping centres the terms
of the lease may be five years with no guarantee of renewal, also note
that in some shopping centres there may be clauses regarding compulsory
relocation within the centre at your own cost).
• Rent to be paid and review of this amount (note whether the amount of
rent to be paid will vary with the turnover of the practice and determine
whether GST is considered in this arrangement, ensure that you are aware
of how the rent is to be paid eg. fortnightly in advance etc.).
• Bonds and guarantees.
• Details of ownership of any alterations or improvements to the property;
• Expenses to be incurred by either party (eg. payments for lifts, airconditioning, electricity, repairs).
• Permitted use of the premises.
• The condition in which the premises must be left.
• Costs for the preparation of the lease and other documents.
• GST, assignment and transfer.
• Whether there is exclusivity (ie. if you are guaranteed that you will be the
only optometrist in the centre).
• Protective covenants.
• Lease exit penalties.
• What you are permitted regarding signage.
In Victoria the Retail Tenancies Reform Act 1998 and the Retail Tenancies
Reform (Amendment) Act 2001 were introduced so that dealings between
landlords and tenants would be fair and so that tenants were provided with
adequate disclosure. Commonwealth and state legislation pertaining to
tenancy can be searched at www.austlii.edu.au/databases.html.
Lease periods
May 2003
Consider the advantages and disadvantages associated with different lease
periods. Be aware that when you take out a long-term lease eg. in a medical
centre or in a shopping centre, you will not have the ability to change if the
other tenants around you change and make it difficult for you to carry on
the practice of optometry as you would like or if they do not fit with the
image you would like to project. Similarly if the needs of the local area
change you will have to continue with your lease. It is essential that you are
aware of the rights, legal obligations and responsibilities of yourself and the
parties (landlords) from whom you are leasing the property (further details
can be found in the article by O’Donnell and Coppin, 2002, see reference
list in Chapter 8: Resources, legislation and references). Non-compliance
with the terms of a lease can result in eviction and you could have to pay
rent until the completion of your lease agreement if a new tenant is not
found.
39
Landlords
It is usual to expect the landlord to seek your permission before they enter
your premises (this is your right to privacy as a tenant). Similarly other
parties not visiting your premises for the purposes of utilising your services
should also seek your permission before entering. However, if a police officer
produces a warrant you must grant entry (AGPS 1992, see reference list in
Chapter 8: Resources, legislation and references).
As for leasing agreements, it is essential that if you wish to purchase property,
you seek legal advice in the title search, determination of ownership, zoning
and building permit requirements, determination of any outstanding charges
against the property, any easements associated with the property etc. It is also
important to seek legal advice in any contracts entered into with banks.
Apart from seeking legal advice regarding lease and purchase agreements etc.,
it is essential that the practitioner establishing a new practice obtain all of the
necessary permits, approvals and other documentation required by law in the
relevant state. In many cases these will need to be scrutinised by a lawyer, and
optometrists generally should not sign anything without legal advice, or if they
do should consider inclusion of the phrase ‘subject to approval by our solicitor’.
In leasing/purchasing equipment or motor vehicles etc, proceed with caution
and seek legal advice as for property lease agreements. Ensure that you are
aware of all of the conditions relating to the lease of equipment eg. who is
responsible for repairs, are there any guarantees about how long repairs
will take, will you be provided with a replacement piece of equipment whilst
the equipment is being repaired etc. When you purchase equipment, either
new or secondhand, be sure that you are aware of any guarantee periods
and service arrangements.
Refunds, replacements and alterations
As a provider of services and a supplier of goods it is necessary to determine
the rights of your patients in terms of refunds, replacements and alterations.
You must not make false or misleading statements or representations about
any goods you supply. Similarly as a purchaser of goods you have rights in
terms of replacement of defective goods etc.
Workcover
www.workcover.vic.gov.au
www.workcover.nsw.gov.au
www.workcover.qld.gov.au
www.workcover.sa.gov.au
www.workcover.wa.gov.au
www.workcover.tas.gov.au
www.workcover.act.gov.au
www.deet.nt.gov.au
There are a number of obligations for you as an employer that are described on
workcover websites. Check for information relating to being an employer in
the state in which you wish to practise. These include the need for the workplace
to be safe and healthy for both employees and patients (Occupational Health
and Safety). In addition you must take out a WorkCover policy with a WorkCover
insurer of your choice (Workers Compensation). Other areas such as premiums,
claims and return to work are addressed at these websites.
Note also, that as an employer, you may have some liability for the actions,
conduct and statements of your employees. Similarly as a partner in a
practice you may have some liability for the actions, conduct and statements
of other partners although generally this would be restricted to activities to
which you were a party (AGPS 1992, see reference list in Chapter 8: Resources,
Legislation and References).
May 2003
40
Common law duties of the employer are:
• To pay agreed (or award) wages.
• To provide medical aid for sick or injured employees.
• To reimburse employees for expenses reasonably incurred in the course of
their employment.
• To provide work for the employee (to some degree). This is most important
for skilled and professional workers, and those paid on a fee per patient
basis.
• Not to subject the employee to an unreasonable risk of injury because of
unsafe working systems, premises or equipment (ie. you must take reasonable care to provide a safe work environment for your staff).
• To comply with and exhibit relevant awards.
• To maintain time and wage sheets.
• The employer has no right to order a worker to do anything that could
result in injury to the worker.
However the employee also has Common law duties:
• To carry out their work with due skill and care. In some cases eg. negligence,
the employer may rightfully recoup damages from an employee.
• To practise according to the Optometrists’ Registration Act and the Codes
of Ethics of relevant professional bodies.
• To obey lawful commands.
• If in a supervisory capacity, to convey information about other workers in
some circumstances.
• To ensure confidentiality of practice details and practice records during
the term of employment and subsequently.
• To give appropriate notice if leaving employment. The employer may
rightfully sue for damages if they suffer financial loss as a result of the
employee’s premature departure.
As an employer, seek information on Federal and State awards that apply to
your practice employees. You must abide by anti-discrimination legislation
(in hiring, dismissing and advertising for staff). Be aware of contracts for
employment. Be careful to follow appropriate procedures in the hiring and
dismissal of staff. Be clear when employing staff that both you and they
know the conditions of their employment (eg. roles and responsibilities,
activities which are beyond the scope of their role in the practice,
confidentiality of patient records, dress code, code of conduct, no work
under the influence of alcohol or drugs etc). Staff training assists with ensuring
that your staff are aware of what is expected of them. Be clear about what
constitutes grounds for instant dismissal and what constitutes grounds for the
provision of a warning. If there are grounds for instant dismissal the employer
must act as soon as the actions come to his attention as a delay could be
considered as partly condoning the action. Are staff aware of how many
warnings they could receive before they are dismissed? Be aware of amount
of notice necessary with a termination notice other than one for immediate
dismissal. As an employer be aware of the need for a probation period
during which time the employer can determine the suitability of the person
for the position. The employer can dismiss this person at any stage during
the trial period with no notice but once the trial period is passed this factor
no longer applies. (AGPS 1992, see the reference list in Chapter 8:
Resources, Legislation and References.
May 2003
41
Both employers and employees should have the same obligations regarding
provision of notice. The length of notice should be as long as possible, but
should be at least two weeks where the employee has worked up to three years
and four weeks if they have worked more than four years. In some organisations,
the notice period is equivalent to the time between salary payments. It could be
reasonably expected that between one and three months would be an adequate
time for employer and employee optometrist to make alternative arrangements,
unless the relationship is terminated because of crucial difficulties. If the employer
wishes to dismiss the employee immediately, payment should be made in lieu,
unless there are special circumstances such as damages caused by the employee.
Optometric registration
See Professional Matters in Chapter 1: Getting Started.
Optical Dispensing
See Professional Matters in Chapter 1: Getting Started, as there are
regulations controlling optical dispensing in NSW, SA and WA. See also
Chapter 4: Policies and Procedures for policy on dispensing.
Waste disposal
There are Occupational Health and Safety requirements including waste
disposal ordinances.
Medicare Provider Number for the location and
approval of participating optometrist
You must contact the Health Insurance Commission to organise this (see
Professional Matters in Chapter 1: Getting Started).
Music licences
If you wish to play background music in your practice and/or use music when
your telephone is on hold, it is likely that you will require two licences for
public performance of protected sound recordings and copyright music. These
are obtained from Phonographic Performance Company of Australia Limited
(www.ppca.com.au) and from Australasian Performing Right Association
Limited (www.apra.com.au) (see end of this chapter for further details).
Building permits
These are generally obtained from your local council. However there may
be shopping centre management requirements that also have to be met.
Registration of a business name or a limited partnership
You will need to register this name in the state(s) in which you intend to establish
your practice (and any branches). (See the end of this chapter). Check whether
there are any registration board requirements regarding the name of a practice.
Drawing up of agreements if there is to be a partnership
Information on partnerships is available on the Optometrists Association
Australia website: www.optometrists.asn.au. See earlier in this chapter.
May 2003
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Taxation Office
See section on Financial matters earlier in this chapter for information on
Australian Business Number (ABN), Tax File Numbers (TFN), Goods and
Services Tax registration (GST), PAYG withholder registration, Fringe Benefits
Tax (FBT) requirements.
Superannuation
Employer obligations regarding superannuation can be obtained by visiting
the Superannuation homepage at the Australian Taxation Office
www.ato.gov.au and selecting Superannuation Guarantee. Employers will
need to register with the funds to be used by their staff.
Payroll Tax
See section on Financial Matters in this chapter for information on Payroll tax.
Insurance
As an occupier it is essential that you have appropriate insurance. Obtain quotes
on insurance for public liability and contents (stock, fittings, equipment, glass).
Other necessary insurance is Principal’s insurance and workers' compensation.
Professional indemnity insurance is covered by OAA membership fees. Determine
what insurance is held by the owners of the shopping centre or the medical centre
where you are establishing your practice and what aspects of insurance cover are
your responsibility. Ensure that you have their responsibilities in writing. Also
ensure that you have cover against fire, theft of your own property and equipment,
theft of property and equipment that you are leasing or paying off, public liability
insurance, accident and sickness insurance, life assurance (eg. of partner optometrist).
Optometrists Association Australia Insurance
As part of the Member Benefits Program, Optometrists Association Australia
through Guild Insurance has made the following products available to
members for a competitive fee:
• Public and Products Liability ($10 million cover, can arrange more).
• All practice insurances for stock, building etc.
• Full range of private insurances from Income Protection to Life Insurance
to all Household Insurances.
Privacy policy
Information on privacy policies can be found in Chapter 4: Policies and
Procedures and Chapter 5: General Management.
Business License Information Service (BLIS) Reports
Information about the establishment of a small business is available through
the Business Licence Information Service (BLIS) via the internet. This provides
information about the licences and permits needed for the establishment of
a small business in a particular area. Some relevant contacts are included
below. To access a BLIS report, enter the website, www.bli.net.au, choose
the appropriate state and enter information about the type of business you
wish to establish, the area in which you wish to establish the practice and
other details relating to the business through prompts on screen.
May 2003
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Within a few minutes you are provided with details of the required licences
and approvals together with information about the agencies to which you
need to apply to obtain these. The following are summaries of a BLIS report
for Victoria and Western Australia.
Victorian BLIS report
In Victoria information about licences required to open a small business
and tailored to meet your requirements (Tailored Detailed Licences Report)
can be accessed through the Business Licence Information Service (BLIS)
(Victorian Business Line telephone number is 13 22 15 or the BLIS website
address is: www.business.channel.vic.gov.au/BLIS). The report provided
includes a summary of the Victorian, Commonwealth and Local government
licences required and information, legislation and contact details to facilitate
the process of obtaining the necessary licences.
As regulations and requirements vary between states and between local
councils, you will need to determine the requirements for the location where
you wish to establish your practice. We suggest that you run your own BLIS
report so that it is tailor-made for your circumstances. Consult your legal
adviser to determine if there are any other requirements that must be met
eg. legislative, legal, codes of practice.
Item
Obtained
Optometrist registration in the relevant state: Contact State Optometric Registration Board
Medicare Provider number for the particular location:
Contact Health Insurance Commission—email:: [email protected] Telephone: 132 150
Provider Liaison Section, GPO Box 9822, Melbourne VIC 3001)
Approval of participating optometrist
optometrist: Contact Health Insurance Commission as above
IF YOU WISH TO PLA
Y PROTECTED SOUND RECORDINGS IN PUBLIC
PLAY
Licence for Public Performance of Protected Sound Recordings
Phonographic Performance Company of Australia Limited—email: [email protected]
Licensing Manager
9th Floor, 263 Clarence Street, Sydney NSW 2000
PO Box Q20, QVB PO, Sydney, NSW 1230
Telephone: (02) 92677877, Fax: (02) 9264 5589
Music Licences for Public Performance and Communication of Copyright Music
Australasian Performing Right Association Limited—email: [email protected]
Licensing Manager,
3 and 5 Sanders Place, Richmond VIC 3121
Telephone: (03) 9426 5200, Fax: (03) 9426 5211
IF YOU WISH TO DEVELOP OR MODIFY BUILDINGS, CHECK WITH THE LOCAL
COUNCIL ABOUT THE REQUIREMENTS REGARDING:
Planning Certificate, Planning Permit, Building Permit, Certificate of Final Inspection
Certificate of Compliance, Works Approval, Occupancy Permit
May 2003
44
Item
Obtained
IF YOU WISH TO OPERATE AS A SOLE TRADER
TFN Application/Enquiry—Individual
Contact: Australian Taxation Office, ATOaccess—Telephone: 132 866
Registration of a Business Name
(Note: if you want to register a business name that differs from your own name, it is necessary to
register that name with the Office of Fair Trading and Business Affairs at the address below).
Consumer Affairs Victoria, Customer Service Officer
Level 2, 452 Flinders Street, Melbourne, Victoria 3000
GPO Box 4567, Melbourne, Victoria 3001
Telephone: (03) 9627 6200, Toll Free: 1800 240 251, Fax: (03) 9627 6210,
Website: www.consumer.vic.gov.au
Search the Victorian Names Register Online online.justice.vic.gov.au and choose ‘Business Registration’.
Australian Business Number
Australian Taxation Office
Tax Reform Infoline—Telephone 132 478, Website: www.business.gov.au
Goods and Services T
ax (GST) Registration
Tax
Australian Taxation Office, Tax Reform Infoline—Telephone: 132 478, Website: www.business.gov.au
IF YOU WISH TO OPERA
TE AS A P
AR
TNERSHIP OR JOINT VENTURE
OPERATE
PAR
ARTNERSHIP
Contact: see Registration of a Business Name above as for a sole trader
TFN Application/Enquiry—Partnership or Joint Venture
— Telephone: 132 861
Australian Taxation Office: Taxation Enquiry Officer—
Registration as a Limited Partnership
Contact: see Registration of a Business Name above as for a sole trader
Number: see above for contact
Tax
Registration: see above for contact
IF YOU WISH TO OPERA
TE AS A COMP
ANY
OPERATE
COMPANY
Registration as an Australian Company
Australian Securities & Investments Commission Service Centre
Level 17, CU Tower, 485 La Trobe Street, Melbourne VIC 3000
GPO Box 9854, Melbourne VIC 3001
Telephone: (03) 9280 3500, Toll Free: 1300 300630, Fax: (03) 9280 3550
TFN Application/Enquiry—Company
Contact: Australian Taxation Office, ATOaccess: Telephone: 132 866, Website: www.ato.gov.au
See contact above as for sole trader
Tax
May 2003
45
Item
Obtained
IF YOU ARE GOING TO EMPLOY STAFF
Employer Requirements—Superannuation Guarantee
You must obtain Registration as a Group Employer.
Contact: Australian Taxation Office Superannuation Business Line re Superannuation Guarantee—
Telephone: 131 020
Registration as a P
AYG witholder
PA
Australian Taxation Office, Tax Reform Infoline: 132 478
Victorian Workcover Licensing
Victorian Workcover Authority Field Officer at the appropriate Zone Office:
Level 24, 222 Exhibition Street, Melbourne, Victoria 3000
GPO Box 4306, Melbourne, Victoria 3001
Melbourne (03) 9628 8111; Geelong (03) 5223 2300; Mulgrave (03) 9564 9444;
Preston (03) 9485 4555; Ballarat (03) 5331 8388; Bendigo (03) 5443 8866; Mildura (03) 5021 4001;
Shepparton (03) 5821 6724, Traralgon (03) 5174 8900; Wangaratta (03) 5721 8588;
Warrnambool (03) 5562 5600.
Website: www.workcover.vic.gov.au, Email: [email protected]
IF YOU EMPLOY STAFF AND PROVIDE NON-SALARY EMPLOYMENT RELATED BENEFITS
(FRINGE BENEFITS TAX)
Requir
ements for Fringe Benefits T
ax
Requirements
Tax
Australian Taxation Office Fringe Benefits Section: 133 328
IF YOU EMPLOY ST
AFF WITH TOT
AL W
AGES OVER P
AYROLL T
AX THRESHOLD
STAFF
TOTAL
WAGES
PA
TAX
OF $515,000 PER FINANCIAL YEAR
Registration for Payr
oll T
ax
Payroll
Tax
State Revenue Office: Team Leader, Pay-roll Tax and Returns Assessing
505 Little Collins Street, Melbourne, Victoria 3000
GPO Box 1641N, Melbourne, Victoria 3001
Telephone: (03) 9628 0000, Fax: (03) 9628 6222, Email: [email protected], Website: www.sro.vic.gov.au
IF YOU OPERATE A BUSINESS THAT REQUIRES A REGISTERED
AUSTRALIAN BUSINESS NUMBER (ABN) FOR GST AND TAX PURPOSES
IF YOU OPERATE A BUSINESS (OVER $50,000 ANNUAL TURNOVER) OR A NON-PROFIT
ORGANISATION (OVER $100,000 ANNUAL TURNOVER) OR PROVIDE TAXI TRAVEL—MUST
REGISTER TO CLAIM INPUT T
AX CREDITS FOR GST (OTHERS MA
Y ELECT TO REGISTER)
TAX
MAY
Tax
May 2003
46
WA BLIS report
The Business Licence Information Service (BLIS) is a free service provided
by the Small Business Development Corporation (SBDC). It contains a summary of local, state and federal government licences applying to the type of
small business in the application. There are details for administering agencies for each licence, information on fees, periods of cover and where these
are available, there are application forms and other relevant documents.
Requirements for optometric practice include but are not limited to:
Item
Obtained
Australian Taxation Office, Tax Reform Infoline: 132 478, Website: www.business.gov.au
Optometric Registration (see registration boards in Chapter 1: Getting Started).
Licence to carry out optical dispensing (Any business in WA undertaking optical dispensing
requires licensed staff (with appropriate qualifications and experience) to prepare optical aids).
Department Of Health: Website: www.public.health.wa.gov.au
Executive Director, Public Health
Population Health
2nd Floor, B Block 189 Royal Street EAST PERTH WA 6004
Telephone: (08) 9222 2295, Fax: (08) 9222 2322
Medicare Provider Number for the particular location (contact: Health Insurance Commission)
Approval of participating optometrist (contact: Health Insurance Commission)
Business name registration (in WA this legislation applies if a person wishes to operate a business
with a name other than their own or which involves an addition to their name: note that this name has
to be registered in a number of states if the business is to carry out activities in other states)
Contact: Department of Consumer and Employment Protection: www.docep.wa.gov.au
Manager/Assistant Manager
Business Names Registration Branch
219 St Georges Terrace PERTH WA 6000
Tel: 1300 304 014, Fax: (08) 9282 0851
Registration as an Australian Company
Company: Australian public or proprietary companies must be
registered as companies with the Australian Securities and Investments Commission (ASIC).
Retail T
rading Hours-Exempt General Retail Shop Certificate
Trading
Certificate: required for small retail
businesses wishing authorisation to trade beyond normal shopping hours.
Contact: Department of Consumer and Employment Protection (www.docep.wa.gov.au)
Retail Branch, Consumer Protection
219 St Georges Terrace PERTH WA 6000
Tel: (08) 9282 0841, Fax: (08) 9282 0862
EMPLOYER REQUIREMENTS
Superannuation Guarantee Scheme
Scheme: prescribed minimum level of superannuation support to be
paid by the employer for each eligible employee by 28 July each year.
Contact: Australian Taxation Office www.ato.gov.au Tel: 13 1020
Business Leader, Superannuation Business Line
2 Meredith Street BANKSTOWN, NSW 2200
May 2003
47
Item
Obtained
Occupational Safety and Health Requirements
Requirements: (To cover situations where work activities may be
associated with the risk of injury or disease).
Contact: Department of Consumer and Employment Protection: www.docep.wa.gov.au
Freedom of Information Co-ordinator, Worksafe
Westcentre 1260 Hay Street WEST PERTH WA 6005
Telephone: (08) 9327 8771
Requir
ements for Fringe Benefits T
ax: Fringe Benefits Tax is payable on a range of non-salary
Requirements
Tax:
employment related benefits (eg. company car that is available for personal use).
Contact: Australian Taxation Office www.ato.gov.au Tel: 13 3328
Fringe Benefits Section
45 Francis Street Northbridge WA 6001 NORTHBRIDGE, WA 6003
Workers’ Compensation Insurance
Insurance:
Contact: Workcover Western Australia: www.workcover.wa.gov.au
Manager Scheme Operations
2 Bedbrook Place SHENTON PARK WA 6008
Telephone: (08) 9388 5555
Licence for Public Performance of Protected Sound Recordings
Recordings: required for Public
Performance of Protected Sound Recordings (eg. hold music).
Contact: Phonographic Performance Company Of Australia Ltd
Licensing Manager, Licensing Department
9th Floor 263 Clarence Street Sydney NSW 2000
PO Box Q20 QVB PO Sydney, NSW 1230
Telephone: (02) 9267 7877
Music Licence for Public Performance, Broadcast or Diffusion
Diffusion:
Contact: Australasian Performing Right Association Limited
Licensing Representative, General Performance Licensing Department
177a York Street Subiaco WA 6008 SUBIACO, WA 6008
Telephone: (08) 9382 8299
Tax
Registration: Register for Goods and Services Tax (GST) where
there is annual turnover of $50 000 or more. Contact: Australian Taxation Office: www.ato.gov.au
Tax Reform Infoline—Telephone: 13 2478
Registration as a P
AYG W
ithholder
PA
Withholder
Contact: Australian Taxation Office: www.ato.gov.au Tax Reform Infoline Tel: 13 2478
Tax File Number Application/Enquiry
Contact: Australian Taxation Office: www.ato.gov.au Tel: 13 2866
ATOaccess
45 Francis Street Northbridge WA 6001 NORTHBRIDGE, WA 6003
May 2003
48
Chapter 3
Location, premises and
practice fit-out
This chapter addresses the issues relating to selecting
the location and premises of your practice, and fittingout the practice.
• Local population demographics
• Location of other health
professionals
• Factors regarding the premises
• Practice fit out
Disclaimer
The information provided in this document is intended for use as a guide only and Optometrists Association Australia
strongly recommends that optometrists wishing to establish their own practice seek professional advice on legal, business
or industrial matters. While every effort has been made to provide accurate information and to address a sufficiently wide
range of topics, neither Optometrists Association Australia, nor those people associated with the preparation of this
document, accepts responsibility for the results of any action taken by any person as a result of what is contained in, or what
is omitted from this document. The Association strongly recommends that members obtain their own advice prior to acting
on any matter in connection with their employment or the employment of another person.
May 2003
LOCATION, PREMISES AND PRACTICE FIT-OUT—Chapter 3
49
Contents
LOCATION ............................................................................................ 50
Where do you want to practise? ........................................................ 50
What are the patient demographics? ................................................. 54
What type of building are you looking for? .......................................... 54
SELECTING PREMISES ....................................................................... 55
Modifications ...................................................................................... 58
Security ............................................................................................. 58
PRACTICE SET-UP ............................................................................... 58
Exterior .............................................................................................. 59
Interior—Entrance.............................................................................. 60
Practice environment ......................................................................... 60
Waiting area and patient reception ..................................................... 62
Office set-up ...................................................................................... 62
Consulting rooms, contact lens delivery room,
visual field assessment room .............................................................. 64
Equipment ......................................................................................... 64
Dispensary ........................................................................................ 65
Frame selection area ......................................................................... 65
Staff Room ........................................................................................ 66
Security ............................................................................................. 66
Finishing touches ............................................................................... 68
OPTOMETRIC EQUIPMENT LIST ......................................................... 69
May 2003
50
Location
One of the most significant decisions you need to make in the establishment
of your practice is the choice of location. When choosing a location for your
practice there are a number of issues to consider:
• Where do you want to practise?
• What are the patient demographics?
• What type of building are you looking for?
• What is the exposure, image and convenience of the location?
• Design of the practice.
Where do you want to practise?
The first decision to make is the state in which you wish to practise. The
distribution of the optometry and optical dispensing industry in Australia is
shown in the table. Source of industry profile is www.ibisworld.com.au (select Health and Community Services, then Health Services Industry Reports),
accessed December 2002. Source of population data is ABS website†
www.abs.gov.au, (see page 52).
State
NSW
VIC
QLD
WA
SA
TAS
ACT
NT
Per cent of industry
45.1
23.2
17.9
7
4.5
1.5
1.5
0.8
Population ’000s
6,629
4,839
3,652
1,912
1,516
472
200
322
Once you have established the state, the main options for the location of a
practice fall into the categories of city, suburban or rural.
It is important to establish:
• Whether there is already an optometrist(s) practising in the area
• The age of any optometrists practising in the area
• Whether they are in solo practice
• Whether they practise full time
• What style of practice they run
• What services they provide, and what services they do not provide
• How long they have been there
• How busy they are
• How far away the nearest practices are
• Whether the area requires the services of an additional optometrist
Location guide
May 2003
The Optometrists Association Australia website—www.optometrists.asn.au,
has a location guide for optometrists at different postcodes. Similarly use of
the Yellow Pages will indicate the distribution of optometrists within different
areas. It is also important to determine other competition in the area with
respect to the provision of services relating to eye and vision care. Determine
the number of ophthalmologists and the number of optical dispensers in the
neighbourhood as well. Consider whether any other optometrists practising
in the area have the same skills as yourself and determine what the optometrist patient ratio is and what it would be if you established a practice. If
practices that are already established are not busy, you may need to reconsider whether this is an appropriate location.
51
Assessing the area
Determine whether the neighbourhood around the practice is the type of
area in which you would like to work. Visit the area at different times of
day and different times during the week to assist you in making this decision. (This visit will also help you to determine how the population visiting
the area varies through the day and on different days of the week). If you
are considering a total change in lifestyle, for example, moving from the
city to the country or vice versa, you need to spend some time in the area to
see what it would be like for you to live there. Effects on both you and your
family need to be considered.
Consider questions such as:
• What are the educational opportunities in the area?
• What are the other health facilities in the area?
• How much interaction would you be able to have with optometric
colleagues?
• What continuing optometric education could you access?
• Will your spouse be able to find employment?
Commuting
If you want to continue living at your current location you need to determine whether commuting to and from the practice will be satisfactory and
the amount of time it takes to travel to the practice during peak hour and at
other times.
In addition, you need to determine whether there are any unusual taxes
imposed on services and businesses in the area where you propose to establish the practice. It is a good idea to obtain a map of the area in which you
wish to establish your practice. On it, indicate the location of your practice, other optometrists in the area, the location of other significant practices (eg. medical, physiotherapist etc), schools, university/TAFE colleges,
nursing homes, shopping centres, hospitals etc. Consider the public transport associated with the location, parking availability and areas from which
you might expect your patients to come.
Population growth
You need to determine whether the location is in an area of population
growth or decline or whether it has a stable populace. Population information for different areas can be obtained from the Australian Bureau of Statistics (ABS). Prompts from this location allow you to access information
about populations within suburbs (there is a charge for specific suburbs) or
local government area populations can be accessed for no fee through
www.abs.gov.au (select Statistics).
Using data from this website and numbers from the OAA database, the
number of optometrists per 100,000 of the population can be calculated
(see following table). On the basis of US literature (American Optometric
Association), which suggests that the optimal ratio is 16 and above optometrists per 100,000 population, these results indicate that the large eastern
states are very well served, but there is a great need for optometrists in the
Australian Capital Territory and the Northern Territory, and a significant
need in South Australia, Tasmania and Western Australia. Further consideration of populations in different areas within the states is necessary in the
determination of an appropriate location.
May 2003
52
State
Population †
Optometrists
Optometrist per 100,000
Population/Optometrist ratio
ACT
322,061
23
7.1
14,003
NT
200,236
17
8.4
11,779
SA
1,516,596
170
11.2
8,921
472,740
57
12.0
8,294
WA
1,912,832
245
12.8
7,807
VIC
4,839,392
763
15.7
6,343
QLD
3,652,431
588
16.0
6,212
NSW
6,628,640
1109
16.7
5,977
TAS
City practices (eg. Melbourne CBD or Sydney CBD) will tend mainly to
have patients who work or visit the area, although increasingly there are
sections in these districts where people are able to live. Your patients are
most likely to comprise local office or retail workers or people who make
regular visits to the city to utilise other services provided in the city. These
areas are usually fairly easy to access by public transport. Consider also
how the people visiting such an area are likely to change during the week:
are they there mainly during the day or are there local restaurants and
cinemas that would be utilised more at night?
Suburban practices that are often located in shopping centres or in shopping
strips are more likely to have as their patients local residents (during the
week this tends to be limited to an extent to parents with young children and
retired people) who do their shopping, banking etc. or who work at the
centre or in the local area. On weekends suburban practices are more likely
to draw from local families. Whether these local families comprise a high
proportion of families with children or a predominantly elderly population
can in part be determined by ABS figures. Again note the number of local
restaurants, cinemas etc that will attract people at times other than usual
business hours. Information from a local Chamber of Commerce, the local
City Council or a public library may also be useful to indicate:
• Growth or decline of industry within an area
• New building developments
• Parking regulations
• Planned openings or closing of nearby factories or office complexes
• The type of medical care facilities available and their recent growth or
decline
• Populations trends
• Planning information
Local real estate agents may also be able to provide information about the
current market and trends in growth or decline in growth. It is also useful to
check zoning classifications (from commercial to residential or vice versa)
in say an 8 km radius around the practice eg. is it mainly residential, commercial, industrial or mixed? Costs of housing (rental or purchase) in an
area and the percentage of people who own their own homes will to some
extent determine the amount of disposable income in the area and thus the
amount of money patients are prepared to spend on spectacles.
May 2003
53
You may also wish to consider vacancy rates in rented housing in the area,
how many houses are for sale, numbers of children attending local primary
and secondary schools, and nursing home facilities in the area.
Rural practices
Rural practices may draw patients from a wide area depending on the availability of optometric services in the surrounding region. Often practitioners
in rural areas will need to consider the option of visiting other practice
locations in a region. Again, information from the ABS or a local Chamber
of Commerce or the local City Council or Shire may be useful.
To determine potential numbers of patients, determine the population in
your town, or in the 8 km radius around your proposed practice. Divide by
the number of optometrists in the same area (hopefully you will come up
with a number no lower than 10,000). Consider that about 9% of the population could be expected to utilise optometric services per annum. Also look
at the current ratio of general medical practitioners in the region and determine the optometrist to general practitioner ratio—an approximate guide is
a ratio of one optometrist to five to 10 general medical practitioners, or to
three dentists or to 10,000 to 12,000 people. Consider whether the costs of
altering premises in a rural location are likely to be higher than in a city or
metropolitan location. There are likely to be lower overheads for rent and
staffing, but there may be fewer opportunities to relocate or access continuing education programs and there may be slower delivery from suppliers. It
may also be difficult to obtain locums. Consider also the general economic
climate of the area and the likelihood that the need for an optometric practice will be sustained.
City and suburban practices
City and suburban practices offer the advantages of easy access to other services such as ophthalmological care and hospital emergency departments.
Access in rural areas can be much more restricted with ophthalmologists
visiting at specified times. How comfortable you would be with the support
structure in a particular area will be important in determining your selection
of an area in which to practise. Similarly if you want to live in the country, a
country practice may be more appropriate unless you are prepared to travel.
Some practitioners have a city practice as their main practice and visit country locations at specified times; financially this is unlikely to warrant the
fitting out of the location visited, and portable equipment becomes necessary.
It is important in a situation where the establishment of the practice requires the purchase of associated real estate, to determine trends in the
costs of real estate in the local area. What is the potential for selling the
real estate if you decide to change the location of the practice in the same
area, or start a new practice in a different region? This determination
requires consideration of the easements associated with the land purchased,
zoning classifications etc.
What are the patient demographics?
Population demographics information—available from the ABS—is useful
to look at elements such as: the total population in the area, the breakdown
into different age groups, family size and composition, income level, occupations, unemployment, education levels and housing types. Data on the
percentage of students, pensioners, disabled may also be obtained.
May 2003
54
Patient profile
However, knowing which people live in the local area or region may not
provide an indication of the people who are likely to utilise your practice,
particularly if the majority of these people commute to work elsewhere. So, in
order to determine the profile of the patient group you could expect to encounter you need to consider which people are usually found in the area around
your practice during practice opening hours, and whether this population is
dependent on people visiting the area or residing there. If you practise in the
city or a suburban area with many offices you would expect to predominantly
draw office workers. In a shopping centre servicing a large suburban area,
patients may include local retailers but would predominantly consist of their
customers. A useful source of information is a visit to the shopping centre at
different times of the week to see how busy it is and the age groups represented.
Also consider whether there is any major industry in the local area eg. factories
where there may be a need for safety eyewear etc. You may be able to provide
vision screenings and assist in the provision of safety eye wear. Other large
companies in the local area may provide vision care benefits, and you may be
able to become involved in the provision of services.
If you speak a second language you may wish to establish a practice in an area
where you would see patients who speak this language. Similarly if the people
in the area you are considering tend to be from a particular background, it may
be difficult to manage a practice there unless you are able to speak the appropriate language or employ a staff member who is able to do so. The possible
clientele, eg. racial mix, age distribution, the need for optometric services,
optometrist/patient ratios are all factors in choosing the location.
Changing demographics
Optometrists should consider whether there have been any changes in the
demographics in the area in the past couple of years or whether there are
likely to be changes eg. has there been an opening of a new housing development in the local area that is expected to bring families with children to
the area, or has there been the establishment of a retirement village in the
nearby area that is likely to attract older people to the area?
Other relevant information may come from shopper survey results in a shopping centre or shopping strip, information about construction planned in the
local area and in the surrounding area—if there is a new shopping centre to
be established in a particular radius would it be a better location than the
one you are considering?
Consider traffic patterns—are there any modifications planned that will
alter the flow of traffic past the location you are considering or that would
make it more difficult to access your planned location? How does the traffic
flow vary at different times of the day and at different times during the
week? What is the pedestrian traffic like? Consider how much it costs for
your patients to come to you—eg. public transport costs, parking fees etc.
What type of building are you looking for?
The establishment of a practice is a costly and time-consuming activity,
unlikely to be repeated in a short time-frame so the choice of premises
requires careful consideration.
May 2003
55
Optometrists practise in a variety of buildings, each offering a particular
image to the patient population and each offering the potential for a different style of practice. When you choose the location for your practice, consider whether you feel comfortable with the image that the location projects
to potential patients eg. trendy, traditional, specialist services? Determine
whether the image you want to project fits in with the image of the area in
which you intend to establish your practice. Is there a certain prestige or
exclusivity associated with the area?—these factors will have an impact on
the type of people who visit and shop in the area.
Determine how the size and type of neighbouring businesses impact on the
range of people who visit the area and thus would see your practice. Are the
surrounding neighbourhood and the support businesses (eg. banks, post office, restaurants, other retail outlets) likely to draw sufficient numbers of
people requiring the services of an optometrist? Determine what competition eg. other optometric practices or optical dispensers, is in the vicinity of
your proposed practice. In addition consider accessibility to ophthalmological and general medical services.
Feasibility studies are necessary in choosing your location. The cost of opening
a practice may vary between different areas, depending on such factors as
distance that materials have to be transported, cost of labour in different
regions etc. Also consider the mix of population, and the unemployment
rate. Other factors that you can consider are (from Pieper B. Feasibility
studies for ODs, Optometry 2002; 73: 511-515):
• Identify the target patient market and determine the best ways to reach it
• Identify current and potential competition
• Identify risks involved in pursuing practice objectives
• Forecast current needs and growth potential for the products/services the
practice would offer
• Establish the resources required to achieve practice goals
• Determine whether a practitioner will be able to create a competitive
advantage given their resources and capabilities.
Selecting premises
In establishing your practice you need to be sure that it is relatively easy for
patients to access the practice either by car or by public transport. How far do
your patients need to walk after they have parked their car or alighted from
public transport? This is important for any location, whether in a shopping
centre or on a street, as you need to consider whether the distance is prohibitive for elderly or disabled patients. How complicated is it to get to the practice or to find the practice once a patient arrives in the general area? If the
practice is located in a building or a shopping centre is it close to the elevator/
ramp/escalator and rest rooms and where is the nearest entry point? How
easy would it be to explain the location of the practice to patients?
You need to consider the practice visibility. Is the location you are considering close to a main thoroughfare? Is it likely to attract the attention of
passing traffic?
May 2003
56
If the practice location is off a main thoroughfare, determine the means available to draw attention to the fact that there is an optometric practice in the
vicinity: Could you arrange for street signage? Could you place a sandwich
board near an intersection or outside your practice? You need to ensure that
potential patients are aware that there is an optometry practice close by.
Determine whether there is disabled access. This is of particular significance if the practice is located upstairs or downstairs relative to the street.
In shopping centres you will not be concerned with car parking as this
would have been dealt with by the centre's management. In street practices
more consideration of access to public transport and car parking is necessary. Is there adequate car parking for the number of businesses in the area?
Determine whether ‘walk-in’ patients (those patients who do not make an
appointment but come in as they pass) will be attracted by the premises
because of its convenient location or whether the main source of patients is
likely to be people who organise an appointment.
Shop location within a shopping centre
Shopping centres draw many people so there is good exposure to the public; it
is likely that this style of practice will attract a number of ‘walk-in’ patients
because of the surrounding shops. There can be significant variation in busy
times and you may need to consider Saturday and Sunday opening and late
hours on Thursday and Friday. It is generally easy for people to access these
locations by public transport and car as there are generally good car parking
facilities. If there are unexpected delays that require the patient to wait, there
are more places where the patient can pass the time if the optometrist has
been unable to advise them of the delay before their arrival at the practice.
Premises on the street front
This may be in a shopping strip or in a more residential area (depending on
council regulations). These practices are often dependent on off-street parking and local flow of traffic etc. Walk-in patients are also likely to be attracted to these locations. There is more control of the hours of opening as
you are not regulated by shopping centre requirements. Such locations are
possibly more susceptible to burglary as they are more isolated and may
not have the security arrangements that are available in shopping centres.
They may allow for more independence and individuality if there are controls on displays in shopping centres etc.
Converted house
This has usually been a more traditional type of practice and does not lend
itself to signage and window displays etc. It is less likely that this style of
practice would attract ‘walk-in’ compared to shopping centres and shopping
strips. For those patients who prefer a more traditional approach to the provision of optometric care, this may be a more inviting type of practice set-up.
Medical centre
Location of your practice in a medical centre or centre with other health care
professionals allows patients to attend all of their health care professionals in
the one premises. Advantages are that some of the costs can be shared between the different practitioners, for example, the cost of receptionists etc.
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Negotiation
How you manage matters such as the retail side of optometry and frames
displays etc would need to be negotiated. Because patients attend for other
health care needs, they may also note the presence of an optometrist and
retain that information for the time when they do require optometric services. Sharing of common areas such as reception and staff rooms allows you
to have more interaction with other health professionals and to learn more
about what they do for patients. It also enables you to explain to these
professionals what the optometrist can do for their patients. Association
with other health care practitioners may indicate to some patients a degree
of professionalism that they may not associate with a service that they can
access in a shopping centre.
In addition expenses are likely to be lower than in a shopping centre. One
consideration in selecting a medical centre is to determine who owns the
centre (eg. a large company, a practitioner with a practice in the centre etc)
and how long different staff have been at the centre. There may be less dispensing generated by patients in a medical centre particularly if many patients are referred by other practitioners at the centre for non-refractive matters
(eg. assessment of diabetic retinopathy). Also consider whether you will be
able to train the staff who are shared by different health care practitioners in
frame adjustment etc, or whether patients with these needs will have to wait
until you are available. Consider also that professionals outside the medical
centre may not be keen to refer a patient to a service within such a centre in
case their patients decide to obtain other health care services at the centre.
Buildings with professional rooms
(Not classified as medical centres). Such practices will often have little more
than a listing on a directory of tenants or a plaque on the exterior of a
building so you need to consider whether a new practice at that location
would attract patients, particularly ‘walk-in’ patients.
Selecting premises
You need to consider both the short-term and the long-term. The building
must be able to be modified so that it is suitable for an optometric practice
immediately. However, it is also necessary to consider the potential of the
location for expansion in the long-term and whether the location will continue to be suitable over an extended period.
Floor space
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The amount of floor space will influence the number and size of rooms and the
range of activities undertaken at a practice. This means that you should determine how many consulting rooms are likely to be needed in the long term,
whether a dispensing section is required, how much space is needed for frame
display and selection, reception and waiting areas, whether there are to be
toilet facilities in the practice, and whether a special purpose room for visual
field assessment or contact lens deliveries is required. This does not mean that
all rooms set aside as consulting rooms must be fitted out immediately, but
consideration should be given to the cost of space leased or rented but not put to
good use. As a guide, a practice with two consulting rooms and display and
office areas will require 80 to 100 square metres.
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Modifications
Any plans for modifications must comply with council regulations and be
possible within the terms of the lease agreement. Plans must address functional requirements such as the relationship between the different areas in
the practice eg. location and size of consulting rooms, waiting rooms, dispensary, display area, the reception area and records storage.
In selecting a building you may also wish to determine whether there is natural
light at the location and the orientation of the building. External views can be
relaxing, but blinds, shades and shutters may be necessary depending on the
sound level from traffic or glare from the sun. In addition, you need to determine whether the cost of the proposed modifications falls within your budget.
Modifications can vary from relocation of internal walls and installation of
handwashing facilities to laying of computer cables or phone lines, or additional electrical wiring. In some circumstances sound proofing may be recommended.
Security
In the choice of premises for an optometric practice particularly those with shop
fronts or on the street, the current security of the building and the possible
measures that could be undertaken to increase security need to be considered.
Some possible measures are the use of removable steel bollards (check council/
shopping centre management/local traders for suitability), the use of reinforced
glass with a glass-shatter alarm or shutters, installation of closed circuit television system in, eg. the frame area, reinforcement of doors/hinges, the type of
locks to be used, inclusion of signage outside the practice indicating that there
is video surveillance etc, use of a monitored internal alarm system. Note the
roofing and the security of neighbouring shops to ensure that these do not provide a potential point of entry for burglars.
It is essential that you are aware of all parties who have access to the practice.
Determine which staff members can be given responsibility for opening and
closing the practice and thus know of any security codes for alarm systems etc.
Practice set-up
Once the location of the practice has been decided and the lease or purchase
agreements put in place, you need to develop the premises for optometric
practice. Prior to the purchase or lease you must have determined what changes
are permitted to be made to the property and whether you will be able to
obtain permission from local councils, shopping centre management etc, to
make these changes. Following lease or purchase, appropriate council and
other permits must be organised prior to the commencement of any work.
When you lease a property you must be clear about who owns the improvements. Under some leases they would become the property of the landlord,
and others require that the premises be restored to their original condition
when the lease expires. A written inventory of items that are to be included
in the purchase price such as office furnishings, partitions, and air conditioning units is vital for both parties.
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You should find out if you are permitted to sublease the property. Permission
from the landlord as well as a sublease from the seller are necessary here.
Designers
If an interior designer or an architect is employed to design and manage the
modifications to the premises, there must be a clear brief describing their
role and responsibilities in the process. They should be aware of whether it
is their role to seek tenders from builders and determine who is to be chosen
to undertake the work. You will need to have a clear indication of the cost
of shopfitting per square metre. Costs are significantly greater than those
for building a house—a complete shopfitting without equipment and stock
can easily exceed $100,000.
There must be a clear indication of the number of rooms that are required,
the function of the different rooms (eg. consulting, dispensing), the location
of doors in consulting rooms (eg. to allow easy movement between consulting room and frame area or between consulting room and specialist testing
room or between waiting room and consulting rooms) and how the rooms
need to be organised with respect to each other. This organisation is necessary to minimise traffic flow of staff and patients in the practice and can be
achieved by a circular arrangement in the practice in which corridors are
minimised and a combined reception/business area forms the centre of the
circle.
Components of practice design could be written in a form that could be
handed to your architect or interior designer as a brief. Before being able to
draw up the plans for your practice, the architect will need to be made
aware of the requirements with respect to distances for visual acuity charts,
and how equipment needs to be organised within the consulting room so
that it is easily used by both the optometrist and the patient. In addition,
consideration must be given to the installation of equipment—door widths
must be sufficient for equipment to be moved through, and movement of
heavy equipment eg. up steps should also be considered.
In the members’ section of the Optometrists Association website
www.optometrists.asn.au are links to optical industry sites concerning:
• Frames and sunglasses
• Spectacle lenses
• Contact lenses
• Contact lens solutions and pharmaceuticals
• Instruments
• Software
• Miscellaneous
Exterior
It is essential that people seeking your services can find you. Clear signs are
the major method for identifying your practice. When signage is directly on
the exterior of the practice, such as when a practice is located on a street, it
is essential to have the name of the practice, the hours of opening, the
telephone number of the practice and after hours contact details so that it is
visible to a person walking past. Additional signage may be necessary that
is visible to a person driving by looking for the practice.
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Logos
Consider also the inclusion of logos indicating your affiliations in the signage
associated with your practice. One such logo is that of Optometrists Association Australia. Window stickers are available to place in your practice
window to identify you to your community as being an Optometrists Association member (contact the National Office of the OAA for details). The
association suggests you employ the standard colours whenever possible in
your practice’s public aspect. In time people will come to recognise optometric practices because of it.
Other logos must conform with any local registration board requirements.
When the practice is located within a shopping centre there may be signage
to indicate that there is an optometrist at the centre included with the general signage of the centre (with no details of the name of your practice,
hours of opening or contact details). Limited details would be expected to
be included in a store directory. Thus detailed signage needs to be placed at
the actual entrance to the optometric practice and would include details
similar to those described above for a practice with street frontage.
Signage must be in accordance with state Optometrists Registration Board
requirements, Council regulations and shopping centre requirements.
Another feature of the practice that can be viewed from outside the practice
is your window display eg. contact lenses, name brands, frame displays,
posters etc. Aspects of the practice that may be visible through a window
but would not be described as a window display include frame displays
within the practice, the layout of the waiting room etc. It is essential that
whatever can be seen from outside the practice gives the impression of
attention to details of cleanliness, tidiness and organisation.
Interior—
Entrance
A factor to consider in the design of the entrance to the practice is that the
doors should not be too heavy for the frailer patient and that they are sufficiently wide to allow entry of a wheelchair or for a person pushing a stroller
or a pram. Whilst sliding doors are often easier to open, they are also less
likely to be closed by the patient using them. Automatic sliding doors may
provide a solution to this problem depending on their cost. In shopping
centres the entrance may be left open all the time depending on noise levels.
Be sure to pay attention to the reduction of drafts when patients enter and
leave the practice in the winter months. You may wish to consider using
some form of sensor to indicate when people enter and leave the practice if
you do not have sufficient staff for someone to be at reception all the time.
Also consider that even a small step up or down into the practice (and into
any rooms within the practice) can create difficulties for patients in wheelchairs or people with low vision.
Practice environment
The décor of your practice is important in how the practice is perceived by
the patient. Factors to be considered are the colour scheme, lighting, materials and furnishings.
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Designers
You may wish to consult an architect or interior designer to determine which
colours would work well, whether you are able to use natural or artificial
light, lighting requirements in different areas of the practice eg. display,
reading, examination room, suitable light fittings, decorations such as pot
plants, paintings etc, types of curtains or blinds that will suit the practice,
the style of furniture (including materials and patterns) that will be appropriate in the waiting room, the design of material used for curtains and
patterns on carpets. Determine whether you wish to have a children’s area
and furniture, toys and other items needed in such an area.
As well as décor you need to consider ventilation, temperature regulation,
placement of lighting controls, sound proofing, hand washing facilities, staff
areas (eg. a lunch area/room), storage areas, record card filing areas,
accessibility, location of electrical outlets etc.
Windows
If there are windows allowing views outside the practice, there may be a
need for blinds, shutters or shades depending on noise levels from traffic or
glare from the sun. Noise control measures may be necessary depending on
the location of the practice particularly with respect to traffic or causes of
sudden or annoying sounds. This can be achieved in part by the use of
carpet, acoustic tile ceiling, sound proofing, use of background music etc.
You should note that there are licence requirements if you wish to play
protected sound recordings in public (see Chapter 2 for details of the licences required). A similar requirement exists for the playing of protected
sound recordings on hold music on the telephone.
In practices not located in a building or centre with access to toilet facilities,
you will need to include toilet facilities in your practice design. Consideration needs to be given to the numbers of staff working within the practice at
a given time and the volume of patients. In some instances one toilet for
males and females may be sufficient; in other instances it may be advisable
to have separate facilities for males and females.
There may be sufficient space to set aside for the use of staff during breaks
and for storage of personal effects. The need for such a room will vary
depending on the number of staff at the practice and the location of the
practice.
Furniture and fittings
Attention also needs to be paid to the type of furniture and office fittings
within the practice, noise levels and acoustics and temperature regulation.
Staff need to have seats that are ergonomically designed to ensure comfort
and back support. Similarly heights of desks and layout of the office area
should be considered.
Carpet helps to reduce noise and retain warmth. Carpets and floor coverings need to be selected with attention to their function in high traffic areas,
how easy they are to clean, how safe they are for patients, whether they
provide a suitable surface for optometrist chairs that may be on rollers etc.
Deep-pile carpets can be hard to clean and can present difficulties for
patients in wheelchairs and the elderly.
It is essential that Occupational Health and Safety issues be addressed in the
layout and choice of furniture, ventilation and lighting within the practice.
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In addition to the installation of furniture, office and optometric equipment,
telephone installation, computer installation (with consideration of networking capabilities) and EFTPOS machine installation need to be addressed.
Provision needs to be made to ensure that the telephone system is adequate
for the needs of the practice. Even if you do not anticipate needing more
than one or two lines initially, you should discuss with the telephone company your options for having additional lines installed with the view to
connection at a later date. (Check whether it is less expensive to have a
number of lines installed now and connected later). Ensure that there is an
appropriately equipped first-aid kit.
Sprinkler systems and smoke detectors may already be in place depending
on the premises. If not, have smoke detectors installed and consider whether
a sprinkler system should be added. Be sure that there are appropriate exit
signs, fire evacuation diagrams and fire extinguishers. If there are not, local
requirements for their installation must be met. Alarm systems and video
surveillance may also be installed.
Waiting area and patient reception
The reception area and the waiting room provide the first impression of the
manner in which the practice is run for the patient. These areas need to be
professional and comfortable. Pay attention to which items are to be displayed
and how, what background music (if any) is to be used, which magazines are
selected for the waiting room etc, whether you wish to have pot plants or other
forms of decoration such as paintings within the practice. Some large print
reading materials may be useful if there are a number of older patients or
patients with low vision attending the practice. Some children’s books and toys
may be located in the waiting room, though it is advisable to try to restrict
these to a particular area to save accidents such as tripping. When selecting
furniture for the waiting area seating should be chosen that considers the needs
of older patients or those with health problems—seats in the waiting room are
better as firm high-backed chairs rather than low-slung sofas or chairs. The
latter may be difficult for older people to manage.
Visibility
It is important that patients are observed by reception staff as soon as they
arrive, so that staff can welcome them and determine whether they have
come to make an appointment, to attend for an appointment or to collect
spectacles or other items. There should be a comfortable area where patients can fill in any necessary paperwork.
It is useful to have a slightly raised counter at the reception so that patients
are not able to see any records on which staff are working. You may also
wish to consider the installation of water coolers and a coffee machine.
Office set-up
It is essential that the layout of the office is functional. Because reception
staff perform many other duties in the practice it is important that the area
in which they work is organised and uncluttered so that they can perform
these activities easily and safely. If they are likely to spend significant time
on the computer, they should have suitable seating and should not have to
get up every time the telephone rings or have to move too far to use the
appointment book.
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Access
It should be easy for staff to access patient records, but they must not be accessible to patients. Filing cabinets located behind the reception desk and not in the
waiting area would be an appropriate storage location for patient records.
Consideration should also be given to patients needing to fill out patient information forms and pay accounts. Often it is easier and more comfortable to do
this at a high counter rather than bending down to a lower counter.
The quality and serviceability of equipment and furnishings is important as
you want items to last and be resistant to wear, yet be comfortable. At the
same time the appearance of the furnishings is important to provide an attractive welcoming environment for patients. If you think that you are likely to
change the layout of the waiting room, you should choose office equipment
that allows flexibility for change eg. chairs should be free standing so that
they can be easily and independently moved. Not only are sofas less practical
for elderly patients or those in poor health, they can not be moved or repositioned as easily as free-standing chairs. Also consider the cleaning and
maintenance costs of the equipment and furnishings you select.
Potential growth
Consider whether the office facilities you plan will be adequate for practice
growth. Is there room to have another person working behind the desk; even
if you intend to employ only one receptionist initially, you may find that later
an additional staff member is needed. Remember that remodelling and upgrading costs can be high so attempt to cater for all eventualities initially.
Ensure that the design of the reception/waiting areas and their location with
respect to frame selection areas and consulting rooms is such that the flow
of traffic through the practice is efficient.
As well as being functional, the décor in terms of the furniture, drapes etc
must be appropriate to the expected clientele. Interior designers can advise
how different furnishings will work to project the desired image.
In the office area it is necessary to display a number of signs eg. those
indicating the professional fees and whether there is bulk-billing, a sign to
indicate that patients are entitled to a copy of their prescription etc. Care
should be taken to limit the number of signs as too many signs can look
messy and distract from products displayed.
As many practices will supply contact lens solutions, the reception desk is also
the location for a display of solutions available although supplies of these may
be kept in a cupboard elsewhere (preferably close to the front desk).
If you are intending to establish your practice in a medical or other centre
with other healthcare practitioners sharing a common waiting room and
reception facilities, you will not be in control of the layout and selection of
furnishings and furniture. Determine the say you will have in alterations to
any current set-up. If possible visit the practice at a busy time to determine
whether you are happy with how the current reception staff deal with patients and whether there is adequate waiting room space. Check that there
will be adequate space for you to store your own records and conduct any
financial transactions. Determine whether you will handle these transactions yourself or whether they will be managed by the shared practice staff.
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Consulting rooms, contact lens delivery room,
visual field assessment room
If it is your intention to build a substantial practice it may be necessary to have
two or more consulting rooms (preferably with hand washing facilities)
although not all need to be fitted with optometric equipment from the start.
As well as organising optometric equipment so that it is accessible, you may
like to store reference materials here, display your degree and registration certificates, and keep a selection of low vision devices. This may double as your
office if you do not have the space to have a separate room, so you may need to
include a computer. Depending on how you want to practise you may decide to
take your case history and give advice to the patient whilst both you and the
patient are seated at a desk (you will need an additional chair if the patient
brings someone with them). This can be more comfortable and less clinical
than conducting all aspects of the consultation in the examination chair. To
some extent patients are used to this set-up as many GPs conduct their case
history with the patient seated and then move the patient for the examination.
Advice from suppliers
In setting up your equipment in the consultation room, suppliers should be
able to advise you of different arrangements that are possible and restrictions that apply. Advice regarding this should be obtained prior to any
electrical work that is done so that power points are in the best locations for
the equipment and there is minimal requirement for electrical cords across
sections of the room.
In addition to equipment and furnishings you should have a supply of disposable gloves, face masks if required, tissues etc. You may wish to have
interesting visual displays, posters, three-dimensional replicas of the human
eye, or other educational devices for all age levels in the examining room to
assist in informing patients about their visual status.
You may decide that visual field assessment will be performed in a separate
room from your consulting room. This could be in a small room dedicated
to this function or it could be in a second room eventually intended for a
consulting room. Consider the advantages and disadvantages of assigning a
room specifically for this purpose; the major advantage is that an ancillary
staff member can be administering the field assessment while you see
another patient. Such a room could also be utilised for the discussion of
treatment plans, test results, prescriptions, problems or fees, in privacy.
As with a field assessment room it may be useful to set aside a small room
with handwashing facilities, table, chairs and a mirror to be used for the
instruction of contact lens patients. The same room could act as both a
visual field assessment room and a contact lens delivery room.
Equipment
When establishing a practice it is essential that you have the equipment necessary (not necessarily new) to perform all of the tests that may be required in the
course of an optometric examination. The cost of purchasing, maintaining,
repairing, and operating a special piece of equipment should be weighed against
the expected frequency of use and the fee charged for each use.
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You need to be comfortable with the design of the instrument as you are likely
to be using it for a substantial length of time. To check on different models of
instruments you might consider visiting the practices of other optometrists
and asking if you can look at their equipment, visit showrooms and attend
trade fairs to explore the different options. For smaller items, company representatives may be happy to display them to you at your practice or you may
be able to have certain items on a trial basis. All of these matters need to be
negotiated with the company selling or leasing the equipment.
A list of optometric equipment is contained at the end of this chapter. While
not exhaustive, it provides an indication of the sorts of items that you need
to consider when establishing a practice.
Distance acuity chart
When selecting a distance acuity chart, note that the type of chart you choose
will influence the design and layout of the consulting room. Alternatively the
design and layout of the consulting room will influence the choice of letter
chart. You need to determine whether you will need to use a projection system
to ensure an appropriate distance from the chart, whether you would prefer to
view an internally illuminated chart via a mirror, whether the letter chart
used in the consultation room needs to double up for domiciliary visits etc.
Slitlamp biomicroscope
When selecting a slitlamp biomicroscope determine the magnification options you wish to have, the inbuilt filters you need, whether you want an
applanation tonometer and a camera attached and whether you require
video-image capture.
Dispensary
Not all optometric practices will fit lenses on site as most major laboratories
provide regular couriers. Regardless of whether the practice provides on site
dispensing, there will need to be a storage area for made-up spectacles.
Although it is unlikely that patients will enter the dispensary or storage area,
it is important that it is well-fitted, organised, clean and safe. You or your
staff must be able to locate made-up spectacles for patients so there needs to
be a method (possibly alphabetical) in which jobs are stored individually
before collection. It is advisable that the dispensary be located close to the
frame selection area. It is important to have easy access to the first aid kit.
There must be safety equipment as required by the activities performed in the
dispensary. This may be in the form of eye protection and gloves if lenses are
tinted there. The dispensary may also be the area where cleaning materials
and equipment are stored so it is important that staff who perform those duties
have access to appropriate hand and eye protection.
Frame selection area
To most patients the frame selection area and the variety of frames available will be the most important feature of your practice. It is essential that
this area be well-designed, attractive, uncluttered and organised. Frame
displays should be dust-free. There should be adequate mirrors and lighting
for patients to check the appearance of frames when they try them on (it
may be useful to seek the advice of a professional in the selection and placement of lights in the practice). A number of practices utilise computer programs to indicate to patients how they would appear in a variety of frames.
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It is useful to group frames according to some logical pattern to assist
patients in their selection eg. group the following together:
• Children’s frames
• Rimless frames
• Frames with attachable sunglasses
• Lookovers
• Designer labels
• Frames according to cost
• Sunglasses
It is important that the frames are arranged in such a way that they are
easy to remove and replace. Have manageable sized groupings eg. no more
than 12. You may wish to have the fees (including GST) on individual
frames, although patients must be reminded that the lenses, coatings etc
are an additional cost.
Other displays
Display areas should also have space for demonstration lenses and literature/brochures on different lens types and treatments.
Unfortunately frames and sunglasses can be the target of shoplifting so you
may need to have all frames or at least the expensive range frames locked
in cabinets and shown only to patients when they are assisted by a staff
member. Because of the possibility of shoplifting it is essential that the
frame selection area is visible from the reception area and not located
immediately adjacent to the entrance of the practice. You may consider
installing video surveillance equipment in this area.
Staff room
If you are able to provide your staff with a room to spend breaks, it should
be located as far away as possible from the areas in which there are likely
to be patients, so that sound does not carry. As provision of such a room
will not always be possible (particularly in shopping centres where rental
means that all space needs to be applied to generate income), it is still
necessary to have a place where staff can store their personal effects.
Security
(Parts of this section have been adapted from The Federation of Ophthalmic and Dispensing Opticians: www.fodo.com accessed December 2002)
Any security system that you consider needs to address protection of your
staff and protection against robbery or damage. Potential sources of loss in
optometric practice due to crime include shoplifting, theft by staff, credit
card fraud and criminal damage to the property or the premises etc.
You may wish to obtain advice from insurance companies, police, your local
council, local retailer groups, your accountant and security companies regarding the most suitable security measures and methods of crime prevention for
your practice. You may consider involvement in local neighbourhood schemes
directed against crime eg. Neighbourhood Watch, Commercial Watch or Retail Security programs (contact details for Neighbourhood Watch programs in
each state can be found at the Australian Institute of Criminology website:
www.aic.gov.au/research/localgovt/community.html (accessed February 2003).
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It is essential that you provide satisfactory security for yourself, your staff
and your practice. Consider where you intend to locate staff in the practice.
They are safer if they are visible to patients and customers so a central
location is important. This high visibility can also act as a deterrent to
shoplifting. The design of your practice can make it difficult for someone to
commit a crime, so make it difficult for the would-be criminal to observe all
staff in the practice at one time. Location of the frame display and staff so
that they are easily observed from outside the practice is also a deterrent.
Safety measures
Staff who are alone in a practice can be particularly vulnerable and additional measures may be necessary to ensure their safety. This may mean
that entry to the practice needs to be restricted in some way eg. with locked
doors. Alternatively some form of alarm system can be introduced to indicate when a person enters the practice. Staff need to be aware that if they
are concerned for their safety or about the activities of a person who has
entered the practice they should call the police or shopping centre security
immediately. You may also wish to consider the introduction of panic alarms
or personal attack alarms. These can be located beneath a bench or within
the cash register. It may be possible to have these linked to shopping centre
management so that assistance may be received promptly. You can have
signs to indicate that security measures are in place.
Of particular importance is the management of cash on the premises: keep as
little cash as possible on the premises. Cash should not be handled where it
can be seen easily. Thus high counters between the staff and the waiting room
are useful, provided the staff, when seated, can see what is happening in the
practice. Patients should be encouraged to pay by credit card or EFTPOS to
minimise the amount of cash on the premises. Banking should be done so that
times and routes are not predictable to potential thieves. If possible, two staff
members should transfer money to the bank. If there is likely to be a large
turnover of cash, you may wish to consider employing professionals to cover
this area or consider increasing the number of trips to the bank in particularly
busy periods. Another measure is to transfer cash from the register to a safe.
Screens can be installed around a cash register to make it difficult for anyone
else to reach in to the drawer and staff must be aware of the need to keep to a
minimum the time the drawer is open. Display a sign to indicate that only
small quantities of cash are held in the register.
The practice should be well lit inside and out when not located in a shopping
centre. The latter will assist when staff need to leave the practice in the evening
or at night and may act as a deterrent to criminal damage such as window
breaking, graffiti and other deliberate physical damage to your premises.
Shoplifting
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Shoplifting of designer frames and sunglasses and other items may be
reduced or eliminated by the use of closed-circuit television systems and
electronic article surveillance systems (tags on articles and sensors at the
entrances). The television system needs to be of good quality and recordings
need to be date and time stamped (some systems can be activated when a
burglary is occurring, although this is dependent on a staff member being in
the position to do so). Staff need to be aware at all times when someone is in
the frame selection area. Some practices have frames locked up so that
patients can try them only when attended by a staff member. Other practices have only their more expensive frames locked up.
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Theft by staff may be more difficult to detect, but again a closed-circuit
television system and careful monitoring of stock and cash flow with no one
person responsible for all financial dealings may assist. Ensure that there is
a clear trail from the time of ordering stock, to their receipt and sale. To
avoid misuse of practice credit cards and cheques, ensure that you countersign cheques after they have been made out, unless a trusted staff member is
the other signatory. Know which staff members have a key to the practice
and know the alarm code. Consider changing keys and codes when a staff
member who had access to these finishes at the practice. Change the locks
when keys are lost or stolen.
Sadly staff may also shoplift. In some practices managers check the rubbish
for stolen goods before it is put out. You might consider having a policy
addressing the storage of bags at the office. Remember that you are not
allowed to search staff member’s bags or possessions.
After hours
Determine which other kinds of security you require after hours—this will
differ depending on the location of the practice. Do you need a security system? Do you want to have it monitored? Is there a security system in the
current location? Do you know how to operate it? Is it working? How much
will a new system cost initially and to maintain? You will need to check with
your local council or shopping centre management if you wish to install window or door shutters. Alarms need to be activated when the practice is unattended but it is important that only trusted staff know the code to disarm the
alarm. This can be linked to a security company that will have details of the
person to contact if the premises are opened out of business hours. Although
expensive, a further option is the employment of a uniformed security guard.
The practice should have a policy in writing on the management of staff
when they have committed an offence within the practice eg. shoplifting
(see Chapter 6: Staff). You should ensure that staff contracts address theft
and other serious offences, and that your lawyer has approved these clauses.
It is good policy to report all crimes (even suspected ones) to the police.
Communicate with other retailers in your area. They are likely to experience
similar theft and security problems and you can help and support each other.
Finishing touches
Now that the rooms are completed and the furniture and equipment are in
place, the final details need to be attended to.
• It is useful to develop a system by which the optometrist is notified that
there is a patient waiting (this can be by means of a number of rings or a
buzz on the telephone).
• It is possible to install a master light switch at the entrance (or exit) of the
practice to assist in turning main lights on or off at the beginning and end
of the day. A timer can also be used for display and security lighting.
• Consider the installation of timers to turn equipment on and off (eg. frame
heaters, heating and cooling).
• At the reception desk it is useful to have a clock or other method to indicate
the date to assist patients in writing cheques etc.
• Locate the appointment book, a telephone message pad, sufficient pens
etc at the reception desk.
May 2003
69
• Determine whether it is convenient for your patients to write a cheque at
the desk where the payment is to be made. You may wish to have an area
with a bench and chair to assist elderly patients or those with health
problems.
• If forms are to be filled out make sure there is a comfortable location at
which to do this or provide the patient with a clip board so that they can
sit in the waiting room whilst they fill in the forms.
• Are there facilities for the storage of coats, umbrellas etc in the cold
weather?
• Are there sufficient storage areas so that the practice looks neat and tidy,
orderly and organised?
• Do you want your patients to be easily able to identify staff—one solution
is the use of name tags. These can serve a twofold purpose: to identify the
name of the person and the role of that person in the practice.
• Do you want your staff to wear a uniform—keep in mind that if you have
a turnover of staff, provision of a uniform may be expensive as it is unlikely
that later staff would need the same size as previous staff. Determine
whose responsibility it is to pay for the uniform. It may be more appropriate
to require staff to wear white blouses or shirts and black or navy skirts or
trousers in the early stages.
See Chapter 8: Resources, Legislation and References for further information about reading and contacts.
Optometric equipment list
The tables on the following pages list fixed and portable assets related to
optometric practice. Extra columns are included to assist in your planning.
Items marked ‘*’ are likely to be worth less than $300.
May 2003
May 2003
FIXED ASSETS
Do I already
own it?
Is it still
usable?
Do I need
a new one?
Cost to buy
Cost to lease
Company /
source
Action
Burton lamp (UV lamp)
Case for equipment for domiciliary visits
Chair, patient examination
Contrast sensitivity threshold measuring systems
Eye chart (internally illuminated or projector or computer)
Hand towel dispenser
Instrument chair/stools
Instrument table
Instrument stand
Keratometer/videokeratoscope/corneal topographer
Motorised instrument tables
Ocular fundus camera
Optic nerve head assessment equipment
(eg. Topographic scanning systems/video digital imaging systems)
Pachymeter
Perimeter, automated and table
Radiuscope
Refractor, automated
Refractor head (phoropter)
Slitlamp biomicroscope (may have digital imaging)
Tangent screen
Tonometer (Goldmann/non-contact)
Ultrasound
Vertometer, automated
70
Other
May 2003
PORTABLE ASSETS
Do I already
own it?
Is it still
usable?
Do I need
a new one?
Cost to buy
Cost to lease
Company/
source
Action
Amsler grid test*
Auto-refractor (hand held)
Binocular Equipment, distance (eg. Howell near card, Maddox wing)
Binocular Equipment, near (eg. Howell near card, near phoria cards)
Colour vision tests (some*) eg. Ishihara, D15 etc
Condensing lenses
Contact lens accessories eg. mini-stirrer, tweezers
Contact lens diameter gauge
Contact lens solutions*
Contact lens trial sets for keratoconus and orthokeratology
Cross-cylinders: ±0.25D, ±0.50D
Diagnostic drugs*
Distance acuity chart—
cardboard (eg. 6 meter alphabet, 6m/3m Logmar, Lea for children)
Distance acuity chart – low contrast
Distance acuity chart – portable illuminated
Dust covers
Exophthalmometer
Eyebath*
“Flippers”*
Foreign body removal kits, lavage dilators, tweezers,
lacrimal lavage syringe, punctal dilator
Frame heater(s)
Gonioprism and lenses
Lens coating/tinting systems and solutions
71
Halberg clips
May 2003
PORTABLE ASSETS
Do I already
own it?
Is it still
usable?
Do I need
a new one?
Cost to buy
Cost to lease
Company/
source
Action
Lens blanks
Lens edging machinery
Lenses, diagnostic eg. 90 D
Lens rack
Low vision devices
Near acuity cards* eg. near test types, LogMAR, Lea for children etc
Ophthalmoscope, direct, handheld
Ophthalmoscope, indirect and associated lenses
PD rule*/ occluder*
Penlight*
Perceptual tests
Perimeter eg. Bjerrum screen
Photochromic lens box
Prism bars: horizontal and vertical
Pupillometer
Red/green glasses*
Reference material eg. text books, grading scales, MIMS annual
Retinoscope
Samples of lens types/lens tints
Screwdriver sets/pliers/screws/nuts/nosepads/temple covers etc
Slitlamp (portable)
Spectacle cases
Spectacle cleaning cloths/solutions
Spectacle frame range
Tearscope
72
Stereopsis tests (some*) eg. Titmus, Randot and polarising glasses etc
May 2003
PORTABLE ASSETS
Do I already
own it?
Is it still
usable?
Do I need
a new one?
Cost to buy
Cost to lease
Company/
source
Action
Tape measure*
Tonometer, handheld eg. applanation, non-contact
Transmission meter: visible, UV
Trial lenses
Trial frame (child/adult)
Ultrasonic cleaner
Vertometer, portable
Video system for assisting people to select frames (eg. Video assistant)
MISCELLANEOUS
Black-out drape
Gloves, disposable
Tissues
73
May 2003
ANCILLAR
Y ITEMS: EQUIPMENT
ANCILLARY
EQUIPMENT,, FURNITURE ETC
Do I already
own it?
Is it still
usable?
Do I need
a new one?
Cost to buy
Cost to lease
Company/
source
Action
Calculator
Computers x 2 (reception and consultation room)
Cleaning materials
Dictating equipment
EFTPOS machine
Fax machine
Filing cabinets
Frame display units
Office furniture (desks, filing cabinets, chairs)
Photocopier
Policy and Procedures manual
Printer
Radio/cassette/CD player
Refrigerator
Stationery (memo pads, telephone message pads, letterhead,
account forms, receipts, Medicare forms)
Software
Telephone/answering machine
Television/VCR/DVD player
Waiting room furniture (chairs, tables, decorations)
s
Miscellaneous (pens, pencils, erasers, correction fluid, batteries,
spare globes)
74
75
Chapter 4
Policies and procedures
This chapter deals with the policies and procedures
that will assist you in the running of your new practice.
• Development of policies and procedures
• Organising day-to-day functioning of your practice
• Areas to consider
Disclaimer
May 2003
POLICIES AND PROCEDURES—Chapter 4
76
Contents
Appointments ....................................................................................... 77
Communications ................................................................................... 77
Computers ........................................................................................... 77
Confidentiality ........................................................................................ 78
Contacts .............................................................................................. 78
Customer relations/service .................................................................... 78
Emergencies and First Aid .................................................................... 78
Equipment ............................................................................................ 78
Filing ..................................................................................................... 78
Finances ............................................................................................... 78
Grievance procedures ........................................................................... 78
Infection control .................................................................................... 79
Locum services .................................................................................... 79
Occupational and recreational requirements .......................................... 79
Occupational health and safety ............................................................. 79
Organisational issues ............................................................................. 79
Patient records ..................................................................................... 79
Practice information .............................................................................. 79
Privacy policy ........................................................................................ 80
Quality assurance issues ....................................................................... 80
Recall for patients with abnormal test results ......................................... 80
Referral letters and reports .................................................................... 80
Risk management ................................................................................ 80
Staff/personnel ...................................................................................... 81
Stationery ............................................................................................. 81
Waste disposal ..................................................................................... 81
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77
Development
Regardless of the number of staff, the development of policies and procedures
is an important component in the management of your business. Having
policies in place can help clarify issues and allow easier enforcement of them.
Clear policies and procedures can safeguard against confusion in handling
routine matters and can help to reduce errors and limit inconsistencies.
A Policy and Procedures Manual can be used to gather written protocols for the
operation of your practice. Consider developing your Policy and Procedures
Manual while you are establishing your practice, or very soon after you open.
You may want to keep a dedicated notebook to write down ideas and concerns
as you think of them, or as issues arise in your practice. Your Policy and Procedures Manual reflects your vision of how your patients and staff experience
your practice. A Policy and Procedures Manual is a time-saving device when
there are new employees if the manual is comprehensive and followed. A manual
may also provide an opportunity to develop and implement new procedures in
an office. When developed in a loose-leaf form via a computer, it is easy to
update policies as the need arises. If you do not decide to develop a Policy and
Procedures manual, it is important for you to consider how you wish to manage certain situations. Putting this in writing helps to clarify procedures and
serves as an aid to practice staff. It can save them interrupting you every time
they want to know how things should be done.
Optometrists Association Australia has worked with the Australian Association of Practice Managers to modify its Policy and Procedures Manual for use
in optometric practice. This will be available through a link on the Optometrists Association Australia website in 2003. Alternatively, the following items
can be used as a template for the development of an office Policy and Procedures Manual. More information about how you might manage the following issues is provided in Chapter 5: General management.
Appointments
Your staff must be aware of how you want appointments scheduled, the
time to be allocated for different types of examination and your availability
and that of other optometrists in the practice. This can be facilitated by
clear written instructions and careful attention to the development of an
appointment book with clear assignment of consultation lengths. Develop a
policy on walk-ins, late arrivals and no shows. Include the requirement for
staff to prepare a list of scheduled appointments for each session.
Communications
Good communications are essential to ensure the smooth day to day running of the practice. Staff must be aware of what you require from them in
their communications with other staff and patients. Communications can
include direct, telephone, e-mail and written methods.
Computers
In developing your policies and procedures, consider the potential uses of
computers in the practice and how you wish to incorporate electronic systems
into the everyday running of the practice. Determine which staff members have
access to different aspects of the computer system and any security requirements, how files are to be backed up, where the backups will be stored, etc.
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78
Confidentiality
Staff will need to have access to information on how they should proceed if
there is contact from a lawyer regarding a patient, or contact from outside
the practice with a request for information about a patient. These policies
must comply with the National Privacy Principles (see later section).
Contacts
Develop a method to gather together contact details of tradespeople, optical suppliers, laboratories, office supply companies, contact lens suppliers,
professionals, staff emergency contacts, bank, lease manager, accountant,
legal adviser, insurance company etc to facilitate communication.
Customer relations/service
Consider how you wish to engage with the general public, and how you
would like your patients to experience their time at your practice. Develop
a policy to help staff deal with patients who have grievances, detailing the
process to be followed. Develop clear protocols about answering the telephone, greeting patients and other duties your staff might be given.
Emergencies and First Aid
For the safety of staff and patients, it is essential that you advise and either
train staff or have them trained in the procedures to be followed in an
emergency. This can include general medical or ocular emergencies, fire
evacuation etc. Written policies assist in the development of staff training.
Equipment
Develop a protocol regarding equipment in the practice: eg. records of
service details and guarantees for equipment; location of equipment manuals; location of spare parts and batteries; cleaning, calibration and maintenance requirements, suppliers etc.
Filing
It is essential that the filing system within the practice can be interpreted by
any new staff members. Details of the filing system should be kept in writing
so that files can be easily accessed. Differentiation between the different
aspects of filing within the practice is necessary eg. patient records, accounts
etc. Develop a policy regarding the security of different types of files.
Finances
Management of the finances within the practice is an area that needs to be
addressed in writing, to cover areas ranging from accounts and receipts to
banking procedures and ledger entries.
Grievance procedures
You will need to develop grievance policies for patients and staff. Resolutions to grievances are achieved more effectively when you have existing
policies, so that you can respond in a considered manner rather than giving
an ad-hoc crisis response. Patient grievances are discussed further in Chapter 5: General management, and staff grievances in Chapter 6: Staff.
May 2003
79
Infection control
For the safety and health of staff and patients it is essential that there are
clear infection control protocols within the practice. These may range from
cleaning of office furniture and disinfection of contact lenses and equipment
to non-attendance by staff with infectious illnesses.
Locum services
Determine how you wish to have your absence covered in the event of
illness or holiday.
Occupational and recreational requirements
Ensure that you have easy access to information relating to driving and
other occupational and recreational requirements for your patients. Gather
information regarding your State or Territory’s safety requirements for
occupations, Federal Vision Standards etc.
Occupational health and safety
You are required by law to meet Occupational Health and Safety requirements
and risk fines and premises closure if you are found to be in breach of the
requirements. Your written policies will need to address safety of the office/
premises, fire protection, chemical hazards, emergency preparation, safety of
electrical equipment, ergonomics, general safety, safety of furniture and floor
coverings, infection control, documentation for the reporting of accidents etc.
Organisational issues
General organisational issues within the practice need to be addressed to
ensure the smooth day to day running of the office and to clarify issues for
staff, for example, office hours, ordering supplies, patient recall, written communications, opening and closing of the practice, security, banking, post etc.
Patient records
Although the information in the patient record card is written by the optometrist, the content of the records must be such that any other optometrist
would be able to interpret or continue the management of the patient. Any
protocols covering patient records need to address the content of the records,
their storage, who is permitted to access the records, what other information is to be stored with the record etc. If the optometrist uses customised
record cards, there should be information on where these have been printed
so that new supplies can be obtained in good time. If computer patient
records are used, include information about security and back-up of files.
You may wish to include samples of a patient record card in the Policy and
Procedures Manual. You will also need to address issues of confidentiality
of patient records.
Practice information
A practice information sheet can be used to provide patients with details relating to the practice. A written policy can be developed to indicate the content of
the practice information sheet eg. contact details, services provided, names of
practitioners, hours of opening; and where this is to be available.
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Further protocols should be developed to indicate which information is to
be displayed to patients eg. charges for optometric services, frame prices,
lens costs, business hours, holidays etc.
Privacy policy
All patient records from 21 December 2001 must comply with the National
Privacy Principles. Staff must have access to information regarding what
the Principles require and the practice’s privacy policy (the latter is a requirement under the National Privacy Principles). The practice policy must
outline details regarding the collection and storage of information, access
to the information and use of the information. Right of access and amendment by the patient should also be detailed, as should corrections and
alterations to the records.
Quality assurance issues
To assist staff who deliver appliances to patients, it is valuable to have
written procedures to be followed in the verification of spectacle prescriptions prior to the delivery of spectacles: acceptable tolerances for lens power,
decentration, prism etc. Written protocols for initial staff training, staff
review and subsequent training assist in the management of the practice
staff.
Recall for patients with abnormal test results
Develop a protocol for recall of patients with abnormal test results, indicating which staff member is responsible for contacting the patient. When a
referral is for a sight- or life-threatening matter, the optometrist should follow up the patient to ensure that they attended their referral visit.
Referral letters and reports
There are a number of methods that can be used when referring a patient to
a specialist. It is valuable for the practice to have written guidelines to
indicate whether the optometrist, another staff member or the patient makes
the appointment and to specify the information to be supplied to the patient.
To assist staff who type referral letters and reports, further information should
be included detailing the practice stationery to be used, the format for the
letters, filing of a copy with the record card etc. Samples of patient referral
letters or reports can be included in the Policy and Procedures Manual to
assist staff. The practice protocol for provision of reports to general medical
practitioners and the content of these reports can be included there.
Risk management
Regardless of the security and safety measures within the practice there is
always the possibility of loss due to burglary or fire. It is valuable to develop a protocol for retaining back-ups of computer records away from the
practice and gathering details of other important paperwork eg. model numbers and serial numbers of equipment, bank accounts details, photocopies
of receipts for items of equipment, photographs and videotapes of items in
the practice.
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81
Staff/personnel
Since you will not be able to answer questions from staff every time a
difficulty arises, it is important that they have access to information about
the practice in a written form. This information can describe restrictions on
activities of staff in the practice, designation of staff members who are permitted to authorise or give refunds, alterations, exchanges etc, responsibilities of different staff members. In addition, in the event of an emergency it is
essential that there is easy access to emergency contacts for staff members.
Stationery
Templates for practice stationery can be included in a Policy and Procedures Manual. Written protocols can be developed to describe what is printed
on practice stationery. The manual could include a list of stationery items
and their suppliers.
Waste disposal
If you use alternative methods for the collection of waste, it is valuable to
include details of the service in your Policy and Procedures Manual. Be sure
to note procedures for the destruction of patient information, as well as
sensitive office documents relating to financial and legal matters. Special
arrangements will need to be made for the collection of ‘sharps’ containers.
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Chapter 5
General management
This chapter addresses a wide range of issues relating
to the general management of an optometric practice.
Consider how you will organise the day-to-day
functioning of your practice and plan accor
dingly
accordingly
dingly..
* Issues are presented in alphabetical order and not in order of
importance.
Disclaimer
May 2003
GENERAL MANAGEMENT ISSUES—Chapter 5
83
Contents
Appointments ....................................................................................... 85
Communication tools and methods ....................................................... 86
Computers ........................................................................................... 88
Contacts .............................................................................................. 88
Customer relations/service .................................................................... 89
Driver vision—colour vision .................................................................... 89
Emergencies and First Aid .................................................................... 89
Equipment ............................................................................................ 90
Filing ..................................................................................................... 90
Finances ............................................................................................... 90
Grievance Procedures .......................................................................... 97
Infection control .................................................................................... 97
Lawyers ................................................................................................ 98
Locum services .................................................................................... 98
Notices to be displayed ......................................................................... 98
Occupational Health and Safety ............................................................ 98
Organisational issues ............................................................................. 99
Patients' occupational requirements ......................................................99
Patient records ................................................................................... 100
Practice accreditation ......................................................................... 102
Practice information sheet .................................................................. 102
Prescriptions ....................................................................................... 102
Price display ....................................................................................... 103
Privacy Policy ...................................................................................... 103
Quality assurance issues ..................................................................... 104
Recall for patients with abnormal test results ....................................... 104
Referral letters and reports .................................................................. 104
Staff/Personnel ................................................................................... 106
Stationery ........................................................................................... 106
Stock management ............................................................................ 107
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84
Time management ............................................................................. 109
Waste disposal ................................................................................... 109
Template for an appointment book. ..................................................... 110
Template for Patient Referral Letter ..................................................... 111
Alternative pro forma for a Referral Letter ............................................ 112
Report pro forma ................................................................................ 113
Template for prescription for therapeutic ocular medication .................. 114
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Appointments
It is important that you and any employee optometrists (particularly new
graduates) are comfortable with appointment lengths. A relatively new graduate may require 45 to 60 minutes for initial consultations without and with
frame selections respectively. More experienced optometrists may require
30 to 45 minutes for the same tasks. As well as long appointments you will
need to slot some shorter appointment times into the schedule to accommodate review visits or deliveries etc.
An appointment book with 15-minute slots that can be grouped for longer
appointments is useful. (See the template for an appointment book at the
end of this chapter.) In the appointment book, there should be sufficient
space for staff to record all of the details necessary to identify the patient, so
that a record card can be prepared prior to the consultation or so the correct
previous record can be retrieved. In some practices the optometrist will ask
staff to indicate in the appointment book whether the patient is related to
other patients or who referred them to the practice. With time, it will also
be necessary to be able to determine whether the patient is new or returning.
There should also be space to indicate the type of consultation required.
After the first few months, consideration of the appointment book will indicate busy times and if patient numbers are increasing. It can also help to
indicate which services are required most often. Appointment time utilisation may lead to a need to review the hours of opening.
It is advisable to post a list of appointments for each optometrist in their
consulting room at the beginning of each day. The reason for the visit or
type of visit can be included. Note that this should not be in a place where
patients can view it. This can be modified through the course of the day.
Determine a practice policy for ‘walk-ins’ and for patients arriving late for
appointments. If there is an appointment booked immediately after a
patient who is more than 15 or 20 minutes late, it is recommended that the
late patient be rescheduled. You must feel comfortable and unpressured by
whatever late arrival policy is in force.
It may be useful to develop a table (see below) with the different types of
appointments and how to schedule them. Ensure that staff check the sort of
appointment required before making an appointment.
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Type of Appointment
T ime needed
Preferred time of day
Diagnostic vision examination, adult, former patient
Diagnostic vision examination, adult, new patient
Diagnostic vision examination, child, former patient
Diagnostic vision examination, child, new patient
Subsequent examination
Low vision examination
Contact lens examination, first time wearer
Contact lens fitting
Contact lens delivery
Contact lens aftercare
Vision training session
Dispensing/delivery/ frame adjustment
Emergency visits
Other
Most patients are likely to have similar questions when they first make
appointments at your practice. These questions might include:
• Do you bulk bill patients?
• How long is the appointment likely to take?
• What happens in the appointment?
• How soon do I get glasses?
• Do you prescribe contact lenses?
• Can I claim for my glasses or contacts with my health fund?
• Is there a discount for pensioners?
• Can I get discounted glasses?
You will need to ensure that you and your staff can answer these common
questions when patients first ring your practice, or when they arrive for
their appointment.
Communication tools and methods
In establishing a new optometric practice you will need to determine which
methods of communication you wish to have available to you. Telephone
and fax machines are considered essential today. E-mail and internet facilities are also becoming commonplace. There should be sufficient telephone
lines to serve the needs of the practice. Consider whether you wish to have
music or information about the practice played when your patients are
placed on hold. Your telecommunications provider can advise you about
the various services available, and can assist you to choose the most appropriate package of services. You may need a licence to play music in your
waiting room or as hold music (see Chapter 2: Business, Legal and Financial Planning).
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87
Good communications are essential between all parties to ensure the smooth
day-to-day running of the practice. Staff must be aware of what the optometrist requires from them. One possible starting point is to have a job description for each staff position and training as staff members commence
their work in the practice. Further information about staff is provided in
Chapter 6: Staff.
Good advice
The next stage is to have good communication between the optometrist,
their staff and the patients. Potential problems may be averted if the patient
is properly advised about reasonable expectations for eg. prescription lenses,
rimless glasses, varifocal lenses etc.
Telephone
Effective and positive telephone communication and face-to-face communication are important factors for patients. When staff answer the telephone, it
is essential that they say the name of the practice so that the patient is immediately aware whether they have reached the correct location.
Likewise, when you or your staff are unable to answer the phone, ensure
that you have an answering machine or voicemail message that clearly
identifies your practice. Consider the impact on patients, other professionals and suppliers if you need to use call waiting during your conversation.
Some businesses require that staff members also identify themselves so that
the person knows to whom they are speaking. This can be useful if followup is needed for further explanation or clarification.
When patients enter the practice, ensure that they are greeted in a friendly,
professional manner. Buzzers, bells and other alerting devices can be offputting, so be careful when you select such devices. If you do not employ
reception staff consider how you will acknowledge new arrivals.
It is essential that you have communicated to the reception staff details of
your availability for appointments and for telephone calls, so that appointments do not have to be cancelled or rescheduled.
Staff need to be trained in an appropriate method for taking and conveying
telephone messages. Current medical practice is to have two copies of messages (one of which can be filed with the patient’s record, the other given to
the doctor.) This is also recommended for optometric practice.
Staff also need to be trained in determining how urgent a case is—whether a
patient should be advised to come to the practice immediately for a consultation or whether they wait. Emergency cases coming directly to the practice
also need to be determined for their urgency in being seen by the optometrist.
Written communications are important in a practice and these will be addressed further, in the sections entitled Referral Letters and Reports, and
Stationery below.
You or your staff must be able to follow up requests for information with
pertinent literature, a list of your services, your hours and a map showing
your location.
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Computers
Consider the potential uses of computers in your practice and decide how
you will incorporate electronic systems into the everyday running of your
practice. However you use computers in your practice, ensure that all
patient-related files are password protected, and back up your systems regularly. Remember to store your back-up copies apart from the computer, and
preferably away from the practice in case of a fire. You must ensure that
you and your staff store your passwords securely. Do not tape passwords to
the side of the monitor, to the computer hardware, to the reception desk or
in the appointment book. It is acceptable to store the passwords in the same
locked, fireproof file as your ledger, cash book, cheque book etc.
In the establishment of a totally independent new practice the idea of providing links between different practices would not be considered. However
for the practitioner who is opening a new branch practice it may be valuable to consider the possibility of establishing connections between computers at different branches and offices. Within a single practice where computers
are likely to be used in a number of rooms, it may be useful to have them
networked to allow the easy transfer of information between them.
Computerised office management
There are several computerised office and record management systems
developed especially for optometric practices. You may wish to investigate
these systems (some information is provided in the members area of the
Optometrists Association Australia website: www.optometrists.asn.au). The
advantages they offer may include:
• Scheduling, including appointments
• Managing patient records
• Managing accounting requirements
• Automatic recall notices
If you decide to use a computerised management system you must ensure
that you have adequate back-up and security procedures.
Contacts
It is essential that you can easily locate the contact details for:
• Local health care practitioners/ophthalmologists (and the area in which
they specialise)/other optometrists/general medical practitioners.
• Optical suppliers, laboratories, office supply companies, contact lens
suppliers, plumber, electrician, cleaning contractors, waste collection agency.
• Details of bank/accountant/legal adviser/insurance/collection agency etc.
• Information staff need to know relating to the lease, for example, contact
details, responsibility for repairs, method of payment etc. (There may be
circumstances in which you may not wish staff to know details of the lease.)
This information can be kept in a folder specifically for important contacts.
You may also wish to keep a copy in your locked, fireproof file or at a
separate location.
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Customer relations/services
It is important to consider how you wish to engage with the general public,
and how you would like your patients to experience their time at your practice. This area overlaps with telephone and face-to-face communications.
Train your staff to provide the level of customer service you expect, and
lead by example. Have clear policies for your staff about returns, exchanges
and grievances; however allow yourself the flexibility of responding to these
on a case-by-case basis.
Driver vision—colour vision
The colour vision screening requirements for drivers have recently been
amended. The document will be titled ‘Assessing Fitness to Drive for Commercial and Private Vehicle Drivers’ and is due to be released in August
2003. Members who have the equipment necessary to undertake the appropriate colour vision testing (Medmont C-100 or OSCAR) should advise
National Office, as other members and the general public frequently call
National Office and State Divisions requesting a listing of optometrists in
their area able to provide these services. Ensure that your reception staff are
adequately advised about this aspect of your practice so that they can
answer questions from GPs and members of the general public.
Emergencies and First Aid
An emergency is defined as an incident requiring immediate action to avert
a life-threatening or sight-threatening event. In contrast, a crisis requires an
urgent response, but is not immediately life- or sight-threatening. You must
develop appropriate policies relating to emergencies and crises and train
your staff to respond appropriately. You can assist staff by keeping emergency contact telephone numbers at the reception desk, and developing a
protocol by which they may interrupt you during an appointment without
unduly distressing your current patient. The most likely emergencies you
need to plan for are:
• Ocular emergencies eg. patients presenting with foreign bodies, contact
lens complications, other eye-related injuries, adverse reaction to
prescribed medication
• Fire
• First aid emergencies or crises e.g. a patient requires CPR, an elderly
patient falls etc.
Evacuation
Develop an evacuation procedure in the case of fire or other emergencies. It
is a good idea to hold the occasional evacuation drill or at least review the
procedure regularly with staff.
You will also need to ensure that you keep an up-to-date and well-equipped
first aid kit. Consider including a valved face mask for CPR. In addition to
the first aid kit, ensure that your first aid certificate is current, and ideally at
least one other staff member who is in the practice during normal office
hours should also have a current first aid certificate.
Further information and resources regarding emergencies is located in this
chapter under Occupational Health and Safety.
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Equipment
Details relating to equipment should be stored in an easily accessible location:
• Service details and guarantees for equipment
• Equipment manuals
• Spare parts and batteries
• Cleaning, calibration and maintenance requirements
• Suppliers contact details
Consider storing the original guarantees together with serial numbers in a
separate location.
Filing
The storing of patient record cards is discussed in the section Patient Records.
For other documentation, including invoices, literature from suppliers, correspondence unrelated to patients etc, you will need at least one filing cabinet. Ideally this filing cabinet should be locked after business hours, or
whenever the reception area is unattended.
It is essential that you protect your financial records against theft and fire.
Important details should be kept in a locked file insulated against fire. Such
a security file should contain:
• General ledger
• Accounts receivable records
• Payroll records
• Chequebooks, cheque stubs, blank cheques
• Records of cash receipts and payment and day sheets
• Petty cash
• Appointment book
Finances
Several of the issues relating to finances were introduced in Chapter 2:
Business, Legal and Financial Planning. You must develop clear systems
for your staff relating to:
• Generating accounts
• Taking payment and giving receipts/information for patients regarding receipts
• Refunds/exchange
• Payment of bills incurred by the practice
Over time, you will need to keep records of daily receipts and daily expenditures (carbon copies if paper record), general ledger or computer record. Draw
graphs to give an indication of the monthly gross income, monthly expenditure, the number of eye examinations, numbers of spectacle, contact lens and
low vision device prescriptions. This visual presentation will reveal trends in
practice patients and their needs. Keep statistics on the types of service delivered: number of contact lens consultations, initial consultations, vision therapy
patients etc. Prepare a monthly summary sheet to show the number of
patients, their ages, type of prescription or vision problem, and so forth. By
checking the summary each month you can see, for example, whether your
patient ratio is healthy, whether certain types of patients are increasing, etc.
With time, you will be able to determine whether you are having patients
return to the practice for second and subsequent visits.
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Fees
Fees for appliances should be included in the prices list as far as is possible.
With computers it is not difficult to regularly update price lists so that the
costs of all frames in the practice can be included. Include the prices of
different types of lenses, both spectacle and contact lenses; the cost of tints,
coatings, and so on. (You may wish to consult an accountant or tax adviser
in setting fees for appliances. You could check the rate charged for similar
items in your community to serve as a comparison. When establishing fees
for spectacles, contact lens, solutions etc, consider that the charges need to
cover staff time, handling, rent, power and money tied up in stock).
Costs may be calculated on the basis of formulae such as:
• Frame cost to the patient is: sum of the cost to the optometrist for the frame
and (eg.) 100% of that cost plus a percentage (eg. 40%) of the cost of an
initial consultation. Alternatively setting costs for frames can be based on a
formula involving the cost of materials, insurance premium, dispensing
fee. Remember that you will need to stock a variety of frames to meet the
needs of your patients. Some frames will sell easily and may attract a
higher profit margin, while with others the margin will be lower.
• Cost of lenses to the patient is: sum of the cost to the optometrist for the
lenses and (eg.) 60% of this cost plus a percentage (eg. 60%) of the cost of
an initial consultation. Setting costs for contact lenses could be based on
a formula involving: cost of materials, starter-kit of solutions, insurance
premium.
Invoices
Invoices must have all of the necessary features to identify the practice (see later
section on practice stationery), they must be tax compliant and should include:
• The patient’s balance prior to the current visit
• A record of services currently provided to the patient (use appropriate
item numbers where necessary, optical item numbers are available from
the website: www.optometrists.asn.au)
• A record of the fees incurred for these services
• The amount of payment received and a receipt for this payment
• The amount the patient currently owes you
• The date and time of the patient’s next visit
• Invoices can also be used to educate patients about all of your services,
the benefits they received during their visit, and the services for which
they were not charged.
Invoices should be explained to patients so that they are aware of the cost of
the consultation (and whether this has been claimed from Medicare or is to
be claimed by them), and the cost of any appliances and whether this cost
may be claimed through health insurance funds.
The time when you give invoices to the patient is a matter of personal
preference, eg. at the time of the visit (at least for the consultation fee), at
the time of the delivery of any spectacles etc, or at the end of the month.
However, consider the load on staff if all invoices are left until the end of
the month and consider the difficulties associated with chasing invoices that
have not been paid if the patient leaves the practice with their new spectacles and an unpaid account.
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Some practices collect a deposit from patients to ensure that they return to
collect spectacles and contact lenses that have been ordered; the balance is
then collected at the time of delivery.
Other practices request full payment at the time of the delivery of service.
Thus the consultation fee (if it is not bulk-billed) could be expected to be
paid at the time it is received. If spectacles are prescribed, it may be reasonable to defer the payment for the consultation until the time for the payment
for the spectacles. Similarly, it is reasonable to expect payment for other
appliances at the time they are delivered; this means that accounts have to
be prepared regularly, so that they can be presented to the patient at the
time of delivery for the account to be paid. This process also helps to ensure
that there is an even cashflow and reduces the cost of postage. If it is not
your practice to request payment at the time of delivery, you will need to
decide whether the account is to be presented to the patient at the delivery
for later payment, or whether it is to be sent to the patient. If the latter
option is chosen, the accounts should be sent out regularly to foster a steady
cash flow. You should also consider the additional cost of 50c per invoice
when you mail invoices.
Time of payment may be open to some flexibility for different patients, and
this should be indicated in the policy. There should also be acknowledgment of which individuals in the practice have the right to make alterations
to this policy in special circumstances. Also, it should be indicated whether
spectacles can be removed from the premises if payment has not been made
when it is the policy of the practice to require full payment at the time of the
delivery.
It is also important to decide whether any complaints by patients about
their accounts are to be resolved before they leave the practice.
Methods of payment accepted
Under Medicare there are three methods by which the payment of benefits
can be organised:
• Patient pays account, then claims from Medicare
• Patients receives account, then has cheque drawn in favour of the optometrist
(then forwards this and any balance to the optometrist)—the receipt issued
must indicate that a Medicare payment was included in the payment
• Optometrist bills Medicare (in this case the optometrist receives the
Medicare benefit and may not charge the difference to the patient)
Bulk-billing
The practice should have a clear policy on bulk-billing eg. whether all
patients or no patients are bulk-billed or whether bulk-billing is restricted
to particular groups of patients. Many practices choose to bulk-bill all
patients for their consultations. Some practices restrict bulk-billing to pensioners and patients on health care cards and request payment of the full
schedule fee for all other patients, allowing them to claim their entitlement
from Medicare (note: Optometrists Association Australia makes no recommendation on whether members should bulk-bill).
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There are advantages and disadvantages to both methods:
• With bulk-billing of all patients staff do not have to chase accounts that
have not been paid.
• With bulk-billing the optometrist receives only 85% of the schedule fee.
• With bulk-billing there is a delay before the optometrist receives a payment
from Medicare.
• With bulk-billing, in the event that the patient has consulted an optometrist
at another location within a particular time-frame, there is a possibility
that the optometrist at the second location will receive a reduced fee for
their service and be out of pocket for the balance of the fee for service.
There is no recourse for the optometrist to be able to obtain the difference
between the fee and the rebate in this case. Optometrists could ring the
Medicare hotline to determine if there has been a claim for optometric
services within the time frame although there is always the possibility
that a claim has not yet been lodged.
• With payment directly to the optometrist, the optometrist receives full
payment for their service and the patient has to claim through Medicare.
In this situation it may be advisable to request payment for services at the
time of the consultation so that staff do not have to chase payments.
Some optometrists feel uncomfortable with charging fees without bulkbilling (there has been a culture in optometry to bulk-bill—approximately
96 percent of consultations are). Each optometrist needs to determine how
their patients would react to the situation. If you are in a shopping centre
where there is a Medicare office, it should be fairly straightforward for
patients to take their receipt straight to the office for their claim.
Electronic claims for services and products
In addition to the ability to claim for consultations from Medicare directly
through their service, there are two further means for the optometrist to
gain electronic payments.
HICAPS (Health Industry Claims and Payments Service) (www.hicaps.com.au),
enables claims relating to ancillary insurance with a number of health funds
for costs associated with the purchase of spectacles, contact lenses etc. With
this service, optometrists, as well as other health care professionals, can make
electronic, real time claims for their patients with participating health funds.
This means that the patient pays only the difference between the rebate to
which they are entitled for their spectacles and other optical appliances, whilst
the balance is paid to the optometrist. The benefit to patients is that they do
not have to fill in claim forms, send their claim or go to their health fund; the
service is provided at the optometrist’s practice.
ELPC via IBA HealthPoint is the Electronic Lodgement of Patient Claims.
HealthPoint (through IBA) allows both Medicare claims and claims for ancillary benefits but with fewer health funds. With this system optometric practices can electronically lodge Medicare claims and receive HIC reports. Rebates
can also be directed to patients by Electronic Funds Transfer (EFT) or cheque
with no need to complete forms or visit a Medicare Office. This system can
also be used for HealthClaim (claims for ancillary services to private health
funds) with the patient paying the gap between the rebate and the charge.
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Credit card/cash/cheque payments
With the cost of spectacles, it is unusual for patients to pay in cash. There is
a need for patients to be able to pay by credit card or cheque or EFTPOS.
The optometrist needs to determine their rights and responsibilities in relation to these methods, fees and bank charges associated with each and special equipment required.
The advantages of EFTPOS are:
• Money goes straight to the optometrist’s bank account
• It is convenient for patients
• It eliminates the process of following up accounts
• It minimises bad debts, dishonoured cheques and risks associated
with keeping cash on the premises
Note that there is a cost for EFTPOS and a percentage fee for transactions.
Optometrists Association Australia members are charged merchant rates
that at February 2003 were between 1.3 and 1.8% for credit card transactions through National Australia Bank through HICAPS, with no fees on
debit card transactions and an $85 per month fee for the HICAPS terminal.
With the Commonwealth Bank, fees at December 2002 were 1.5% of transactions for credit cards with monthly rental $25, and 0.5% of the transaction on debit card transactions. At February 2003 the AMEX fee was 2.8%
and the Diners Club fee was 2.95% (the optometrist may use the same terminal as for the other cards).
You may also wish to develop a proforma credit card payment authorisation to attach to or include on your invoices for patients to pay their
accounts by credit cards. The template below is an example of such a proforma. Please contact your bank manager to ensure that your bank will
honour such arrangements.
Practice details (Name, address etc)
Please charge my:
Visa Card
Bankcard
Diner’s Club Card
AMEX
Card number:
-
-
-
Total amount $ ........................................ Expiry date ........................................
Signature ..............................................................................................................
Cardholder's Name ...............................................................................................
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Policy on accepting assignment of payment from third parties
With minors, it is important that you are aware who is responsible for the
payment of the account. Attach these details to the record card.
Discounts
Indicate to employees that you are happy to serve their family, friends and
neighbours, but that it will not be possible to offer discounted services to all
of them. Thank them for any referrals.
Determine your policy regarding discounts, and who amongst your staff (if
anyone) is entitled to offer a discounted price and to whom they are able to
offer the discount. It is advisable to put this policy in writing. Do you wish
to offer discounts to other optometrists and their families, to your staff and
their families, clergy, health professionals and others? What flexibility do
you intend to have for those people who may have difficulty paying yet are
not entitled to low cost eye-wear schemes.
Debt collection
Any person in business needs to be aware that not all people pay their
accounts promptly and that some people will not pay accounts at all. To
avoid this, some optometrists will not provide spectacles or contact lenses
to patients unless the patient pays for them at the time of their delivery. If
for some reason, a patient has an outstanding bill and has not responded to
a reminder notice or a final reminder notice indicating that a collection
agency will become involved, it may be necessary to utilise the services of
such an agency. The optometrist should determine the fees associated with
this service and whether it would be better to write off the account as a bad
debt and attach a note to this effect to the patient’s file so that no further
services are provided to the patient unless the account is finalised.
Possible procedures for reminder notices for outstanding accounts:
Initial account at the time of delivery.
30 day account
Send copy of the initial account indicating that it has been outstanding for 30 days.
45 days after initial account
Send letter indicating that there has been no payment of the account.
60 day account
Send copy of the initial account indicating that it has been outstanding for 60 days.
66 days
Telephone reminder giving the patient the opportunity to specify a payment date
(or to organise instalments).
90 days after initial account.
Letter indicating that despite statements, telephone calls and a letter, there is still
no record of payment of this account, and requesting them to contact the office
by a certain date regarding the outstanding balance.
Letter indicating that the account will turned over to a collection agency if payment is not received within a particular time (eg. 10 days).
Telephone call stating that the account will be turned over to a collection agency
if payment is not received immediately.
135 days after initial account
Turn over to collection agency and attach a sticker to the patient’s file or account
indicating this.
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Accounting procedures/payments
The optometrist may wish to utilise the services of a bookkeeper or an
accountant or alternatively employ a receptionist with experience in this
area to manage the finances of the practice. It is essential that appropriate
accounting procedures are followed so that the optometrist is aware of the
financial state of the practice at any time. Important elements to track and
responsibilities to uphold include:
• Cash books
• Cheques
• Payment of accounts eg. at end of month only, not necessarily when
they come due
• Recording on overdue accounts of any contacts made requesting
payment of the account
• Rental agreements
• Loans and interest
• GST
• Taxation
• Banking
• Handling of overdue accounts
- Patients who have not paid
- Accounts the practice has not paid
Template for an account
YC Wright,
Telephone: ..................................................
Optometrist,
Fax: ............................................................
105 William St,
Provider number: .......................................
Surrey Park,
Date: ..........................................................
Vic 3XXX
Account to: Mr/Mrs/Ms .......................................................................................................................
.......................................................................................................................
.......................................................................................................................
Consultative services
Date
Description
Item number
$
Item number
$
Optical Appliances
Date
Description
Prescription details:
R
/
x
a
L
/
x
a
Addition: R
/
x
a
L
/
x
a
Total Amount Due
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Refund policy
You have obligations relating to refunds, repairs and exchanges. Check these
obligations with your accountant and/or lawyer, and ensure that your refunds
policy meets the requirements. It is essential that the practice staff have access
to a written policy regarding refunds/exchanges/replacements/warranties.
Grievance procedures
Grievance procedures for patients, staff and patients of other optometrists
are necessary for the smooth operation of your practice. Grievances are a
constant, although minor, component of the management of a practice. A
calm and conciliatory manner considerably eases the grievance process.
Patients
Patients may present grievances relating to your treatment, their glasses or
contact lenses, other products (eg. contact solutions) or your staff. It is important that you have considered your response to such grievances before they
occur, as you may not feel confident making a decision whilst managing a
potentially aggressive or distressed patient. You might resolve a grievance by:
• Offering an apology
• Offering to make the changes to glasses free of charge, or at a reduced rate
• Refunding or replacing the item
• Another solution
Developing firm policies relating to patient grievances, including when staff
are to refer the matter to you, will considerably reduce the patient’s stress.
Staff
Staff grievances are addressed in Chapter 6. Once again, a calm, supportive and conciliatory manner will assist in a satisfactory outcome.
Other optometrists
There may be an occasion where a patient consults you regarding a grievance with another optometrist. The manner in which you manage such an
occurrence may impact on your relationship with the patient, the original
optometrist and potentially other optometrists. Each of the State Divisions
has procedures to assist optometrists in this situation, so it is best to contact
your State Division or National Office.
Infection control
It is essential that the practice is not just visibly clean, but that surfaces and
equipment are cleaned regularly. It is recommended that surfaces of optometric equipment with which the patient’s skin may come into contact eg.
behind the refractor head, the chin rest and the forehead bar of the slitlamp,
the trial frame etc are wiped with an alcohol swab between patients.
Tonometers and contact lenses should be cleaned/disinfected in accordance
with the guidelines described in Cockburn DM, Lindsay RG. Infection control guidelines for optometric practice. Clin Exp Optom 1995; 78: 110-112.
See section on Waste Disposal in this chapter.
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Lawyers
If a lawyer calls to discuss a patient over the telephone, decline to do so and
either offer to make an appointment for them to come to your office or instruct them to write a letter and submit their questions to you in that manner.
In either event you should also advise the lawyer that you can neither discuss
the patient nor answer their letter until you have received an authorisation for
the release of optometric information, signed by the patient.
If a lawyer has written to you with proper authorisation from the patient
permitting you to release information about them, and you respond with a
letter answering their questions, in many cases, you may want to have your
solicitor review the letter before it is sent. This may appear to complicate
your office routine, but is in the interest of protecting your patients and your
practice.
If a lawyer contacts you to discuss a patient, you may wish to consult the
Optometrists Association Australia article What do you do if a lawyer calls?
This article is in the member’s area of the website: www.optometrists.asn.au.
Locum services
There will be times when you are ill, must attend continuing education
events, have family commitments or simply need a holiday. When you
own your own practice, taking the time that you need can become very
difficult, especially if you are a sole practitioner. You may chose to close
the practice for these periods, or alternatively employ a locum. Locums
are available for times from half a day to weeks or even months at a time.
Your State Division keeps lists of optometrists who work as locums, or
you may wish to advertise in the classified section of Australian Optometry (a free service for Optometrists Association Australia members—
contact National Office).
Notices to be displayed
Notices should be clear, concise and an appropriate font size for your practice (eg. larger fonts if you see low vision or elderly patients).
• General notices for patients can be displayed on a notice board.
• Other notices that could be displayed in the practice include fees schedules
and Medicare bulk-billing policy—these can be displayed in picture frames.
• Practice information sheets can be loose leaf.
• You may wish to develop a protocol for timing and method for notification
of office closure eg. for public holidays.
Occupational health and safety
Federal and State legislation governs Occupational Health and Safety
(OH&S) requirements. Information regarding your obligations is detailed
(state by state) in the document Unravelling the threads: Who is and who is
not an employee? developed by the Department of Employment, Workplace
Relations & Small Business, www.industry.gov.au. You must ensure that
you meet OH&S requirements; you risk fines and premises closure if you
are found to be in breach of the requirements.
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It is recommended that you contact your State Government’s Small Business
Advisory Service for more information about OH&S requirements.
Risk management
A more general area to consider is risk management. This incorporates the OH&S
issues you ought to consider but is more general, also assessing liability risks.
The document Quality Assessment and Improvement: A Manual For Optometric Practices by Lyman C. Norden, O.D., Coordinating Editor discusses risk
management (p18) and can be accessed at the American Optometric Association
website: www.aoa.org/clincare/pdf/qa-manual.pdf. Areas to consider are:
• Disease related risks: ensure adequate history, testing, management,
referral, review, follow-up, continuity of care, urgency of care, informed
consent, timeliness of actions etc.
• Patient satisfaction (services provided or devices prescribed—the latter
includes product liability)
• Employee training and responsibilities
• Safety of the office/premises
- Chemical hazard (storage, use, disposal, exposure, protective clothing)
- Emergency preparation (drills, evacuation procedures)
- Safety of electrical equipment, ergonomics (moving/lifting heavy objects,
furniture design)
- General safety (spills, smoking)
- Safety of furniture and floor coverings to minimise the risk of falls etc.
- Infection control (protective clothing—gloves, eyewear)
- Fire protection (fire drills and evacuation plan; installation, checking
and maintenance of smoke detectors and fire extinguishers etc). You
may be able to seek advice from your local fire brigade or check their
web pages. In NSW commercial fire safety courses are available for
the health care industry, see www.nswfb.nsw.gov.au (select safety, then
commercial fire safety). In SA, visit: www.samfs.sa.gov.au, select
Community safety and then Commercial
• Reporting: documentation for the reporting of accidents.
Organisational issues
There are a number of organisational issues regarding the day to day tasks
that you will encounter early in the establishment of your practice. You
need to develop procedures relating to:
• Office hours
• Responsibility and systems for ordering of frames/office supplies/equipment
• Opening/closing the practice/setting the alarm/security
• Banking/collection of post etc
• Delivery of spectacles
• Cleaning and maintenance of office, consulting rooms and laboratory
• Utilities management (phones and electricity)
• Insurance form handling
• Personal use of telephone/internet
• Company cars/mobile telephones
Patients’ occupational requirements
Be familiar with your State or Territory’s requirements for safety spectacles
etc for different occupations, and be aware of any State and Federal Vision
Standards. Your State Division and National Office will be able to advise
you of these respectively.
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Patient Records
This section provides an overview of the issues relating to patient records
that must be considered as you are establishing your practice. Your approach to clinical record keeping must be consistent and considered; ad hoc
patient records are unsafe, unprofessional and unacceptable. This section
provides an overview of the important aspects of patient records, however it
is not intended to replace the clinical guidelines Guidelines for optometric
clinical records in the members’ section of www.optometrists.asn.au.
Poor records are the single greatest reason that malpractice cases are lost.
Patient records are the legal documentation of the adequacy or otherwise of
service provision and should provide a defensible position for optometrists
in the case of any legal action. If your records are subpoenaed in legal
proceedings, then they must meet reasonable standards of record keeping. If
actions taken by an optometrist are not recorded in the patient record, it is
assumed in law that they have not been done.
However, it is not only the fear of litigation that should cause optometrists
to be diligent in their approach to record keeping – the record should be
easy for them or another optometrist who may assume the management of
the patient at a later date to interpret, so that they are sure of the findings
and the management resulting from the previous visits.
Patient records must meet the requirements outlined in the National Privacy
Principles (see Privacy Policy this chapter) and must include the following
information where relevant:
• Identifying information
• The patient history
• Date of examination(s)
• All of the tests performed and their results, include the time of day and
instrumentation where necessary
• The use of any diagnostic drugs
• Indicate the management options and the one chosen
• Details of the prescription and recommendations for further assessments
• Referral letters or reports resulting from the examination
• Any written communications with the patient
• Notes from telephone contacts with the patient
• Notes or documentation from secondary consultations (e.g. case
discussions with other optometrists, ophthalmologists or other professionals
regarding the patient)
Using record cards
Although it was thought that the paperless office would soon be achieved
with the general use of computers, this is not yet the case. Most practitioners in a variety of health care professions still take notes on a patient record
card. Some may transfer this to a computer record, but generally there is a
need to develop and maintain paper copies of patient records.
In optometry, record cards are used to record the details of the consultation;
they should be formatted in such a way that your receptionist could quickly
check all the information when the patient comes in.
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There should be space on the record cards for brief notations about the
patient’s family history, occupation, hobbies etc. A glance by the optometrist at the record card should provide all the necessary information about
patient visits, types of prescription, age, third party payer, new or returning
patient etc. If any codes are used, they should be easy to remember and used
consistently. There should be lists in appropriate places in the practice to
indicate what the codes mean.
When patient record cards are to be used it is important that rather than just
recording information on a blank card, the optometrist has some design
that assists them in recording their data. Such a design would assist another
optometrist needing to refer to the records, to determine the information the
previous optometrist obtained. Consideration needs to be given to:
• The size of the record card
• The inclusion of check lists and boxes so that you or your staff are sure to
obtain full names, Medicare numbers, health fund details, address, date
of birth etc
• How much space (with lines) is to be devoted to the case history: do you
want to divide this into presenting reason, personal and family general
health, personal and family ocular health, current medications etc
• Background diagrams to be included (eg. optic nerve head so that the
optic cup can be drawn and labelled with cup/disc ratio etc)
• A section with the details of the prescription
• Sufficient space to record all information obtained
It is essential that where there is more than one record card for a patient (eg.
when their care has been given over a number of visits), there is a secure
means of attaching the record cards together so that they do not become
detached when they are filed. In some practices, cards are stapled and then
placed in plastic envelopes prior to filing. Where there are multiple cards,
number the cards sequentially so that rather than having to study the dates
of consultations the optometrist can follow the management of the patient
over time easily.
Storage of record cards
There are a number of methods used for the storage of patient records.
Amongst these are specially designed drawers, filing cabinets and compactus
systems. The style best suited to a practice will depend on the size of the
practice and on the style of record card used. Whichever system is used, it is
essential that files can be retrieved and filed quickly, and that there are no
ambiguities about where a file is meant to be. Records are usually filed
alphabetically.
Clear labelling of the alphabetical range in a particular section will assist
in accurate filing. Initially, it will not be important to have a method to
differentiate active from inactive files, but over time this may become necessary. You may choose to attach different coloured stickers to record cards
to indicate patients wearing contact lenses, those receiving vision therapy,
those attending for low vision consultations, those with allergies etc. You
may also wish to attach a marker with the date of the last visit to different
files to indicate when they are due for a recall; alternatively this can be
done via computer.
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You will need to determine whether you wish to keep accounting details
with the record cards, or whether you wish to keep the two separate. If you
choose the latter, you need an appropriate method of cross-referencing.
Computerised patient records
You may decide to store your patient records electronically. Some optometrists take notes by hand during the consultation, and later the optometrist
or other practice staff transfer this information to computerised records. If
you choose this method you must give careful consideration to the confidentiality issues relating to a staff member inputting this data, to the issues of
accuracy and relevance and to careful storage or disposal of the original
notes. Alternatively, you may like to input your notes directly into the computer during the consultation, however you may have difficulty recording
diagrams without specifically designed software. Utilisation of computer
records does not remove the need to adhere to all of the points above relating to content of patient records, and the issues in The National Privacy
Principles relating to amendments.
If computerised records are used, it is essential that the optometrist ensures
that the computer system is backed up at regular intervals (preferably every
night). It is essential that staff members are aware of the need for this backup so that if one person is away, the back-up still occurs. Storage of back-up
tapes over a number of days at a location removed from the computer is
usually recommended. Do not forget to store your passwords to patient files
in a secure location separate from the computer.
Practice accreditation
You may also consider whether to develop your practice in accordance with
the requirements for Practice Accreditation as offered by Quality in Practice
(QIP), a subsidiary of Australian General Practice Accreditation Limited
(AGPAL) (see www.qip.com.au).
Practice information sheet
The practice can have a practice information sheet with contact details,
services provided, names of practitioners, hours of opening. A business card
that could be given to a third party by the patient, can be attached to the
practice information sheet. The practice information sheet is discussed in
more detail in Chapter 7: Marketing.
Prescriptions
Prescriptions are the property of the patient and under the Medicare agreement a copy must be provided on request (see Chapter 1: Getting started).
Patients should be advised of their right to obtain a copy of their prescription before any dispensing. This requirement can be met through a notice in
the practice. If you consider that the prescription is no longer valid or past
its expiry date at the time when a patient requests a copy of their prescription, you could provide a prescription noting that the expiry date is past.
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A prescription is an order to a third party to provide the goods described. A
prescription for an optical appliance must contain all parameters necessary
for the correct fabrication of the appliance, and be signed and dated by the
prescribing optometrist. It must include details to identify the practitioner
and the practitioner’s address, the name and address of the patient and an
expiry date. In the case of contact lenses, the optometrist must be satisfied
that they have satisfactorily completed their fitting before writing a prescription.
In the case of the prescription of therapeutic drugs, all details needed to
identify the medication and its use, together with the names and addresses
of the patient and the optometrist need to be included together with an
expiry date. It is useful for the pharmacist who is to fill the prescription for
the optometrist to indicate their therapeutic licence number so that this can
be checked with the appropriate registration board. A suggested pro forma
for therapeutic medication prescription is shown at the end of the chapter.
Price display
All charges for optometric services should be displayed prominently. If you
plan to dispense, ensure that frames are clearly marked with their price, and
that the lens costs are available in your frame selection or dispensary area.
More information about pricing is provided in Chapter 3: Location, Premises and Practice Fit-out, and in this chapter in the section: Stock Management.
Privacy policy
On 21 December 2001 new federal privacy legislation controlling information held by health care providers came into effect. All patient records from
21 December 2001 must comply with the National Privacy Principles. More
information about the principles can be found at the website for the Privacy
Commissioner (www.privacy.gov.au).
In keeping with the Privacy Act, patient records should be clear and legible,
free of abbreviation and popular terms, unless they are widely known and
used in optometry, and must be signed and dated by the person who wrote
them. The person who signs the record, vouches for its truth and accuracy.
Recorded information is to be:
• Objective and non-judgemental; value judgements should never form part
of a record
• Able to demonstrate the source of information (eg. GP letter, practice staff
observations, parental report)
• Able to demonstrate that professional opinions and prognoses are based
on objective data or observations that are factual, relevant and devoid of
any unnecessary intimate details
• Entries are dated and kept in chronological order
• Pages of records are numbered sequentially.
The National Privacy Principles require that optometrists develop a privacy
policy for their practice. This policy must outline the practice policies relating to the collection and storage of information, access to the information and
use of the information. The Association has developed a sample privacy policy
for use by members. This policy can be downloaded from the members’ section of the Optometrists Association Australia site: www.optometrists.asn.au.
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The National Privacy Principles give patients the right to access and to amend
their records. If a patient wants to change or amend their records, the proposed
amendments should be placed in writing and attached to the record. At times it
may be necessary to make corrections or alterations to patient records. The
following guidelines relate to corrections and alterations to the patient record:
• Where a mistake has been made, a correction should be placed clearly
above or below the erroneous words.
• Corrections to contents are signed, initialed and dated by the writer unless
they are made immediately beside the mistake. If the record is in
chronological order, an additional sheet is added for the purpose of
correction. This additional sheet must be signed and dated and a note
made on the original that the addition has been made. The note itself
should also be signed and dated.
• Original mistakes are not obliterated and are legible.
• Correction fluid should not be used in any circumstances.
• Records should be accurate and may need to be amended as necessary to
maintain accuracy.
Quality assurance issues
There are a number of issues relating to quality assurance in your practice.
Consider the following areas that you might need to address:
• Checking of appliances delivered to patients to ensure that they have been
accurately dispensed.
• Procedures to be followed in the verification of spectacle prescriptions;
acceptable tolerances for lens power, decentration, prism etc.
• Ongoing staff development
• Staff training
• Staff reviews
Recall for patients with abnormal test results
It is important that you develop a system for recall of patients with
abnormal test results. Many office software packages can track recalls for
you, otherwise you need to develop a system for recall. Initially, you might
dedicate a diary to recalls, noting when a patient is next due for examination or when they were to attend for a review or a specialist consultation.
You or your reception staff can then check the diary once a week and contact those patients requiring re-examination. A more sophisticated system
will be required as your practice grows.
Referral letters and reports
When you refer a patient to another health care practitioner, the best procedure is to make an appointment for the patient with a telephone call, follow
the call with a letter, then document the referral in the patient’s records. If
you have not been careful in selecting the specialist, you may be liable for
improper treatment provided by them. When the referral is for a sight- or
life-threatening matter, the optometrist should follow up the patient to ensure that they attended their referral visit.
Any report or referral letter must be written on practice letterhead unless it
is an emergency situation where this is impossible. Whether a report or a
referral letter is being written, ensure:
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• That the spelling of the names of all parties (patient, GP, specialist) is correct.
• That correct titles and addresses are used for all parties.
• That you have stated clearly and concisely all of the necessary information
using appropriate language (not too technical, but not too simple). Avoid
abbreviations that could be confusing.
• That you do not give a definitive diagnosis except when it is necessary.
Give your diagnosis and express your opinion, but do not be too forceful
when referring for confirmation or a second opinion.
Be sure to proof-read your letter. Keep a copy of the report or referral with the
patient’s record card. If the referral is typed on a computer, ensure that it can
be retrieved easily by saving in a designated folder(s). Adopt a standard format for typed referrals (written referrals are acceptable but be sure that the
recipient of the letter is able to read your handwriting). Follow telephone
referrals with a letter, log the time, date and doctor of the telephone referral
in the patient’s history. Refer to the patient as Mr XXX or Ms YYYY.
Referral letters
Include:
• An introduction to the patient incorporating the patient’s full name, address
and telephone number.
• The patient’s presenting complaint and reason for referral.
• Pertinent clinical findings—these are the findings that relate directly to
your conclusion that a referral is necessary and will assist the doctor in
his or her diagnosis. Do not list the results of every test performed.
• A reiteration of the presenting symptoms.
Reports
When you see a patient you may wish to provide them with a written report
on their vision and ocular health. On this report you could also include
details of the services the practice provides and contact details both during
and after business hours. A business card that could be given to a third party
by the patient can be attached to the report. (Templates that can be used for
patient referrals or reports are shown at the end of this chapter).
It is essential that you provide the patient’s GP with a written report if the
visit has occurred through the recommendation of the GP, but it is also
useful to provide reports as a general rule for patients who regularly visit
their GP for management of a condition with ocular implications eg. hypertension, diabetes. The report needs to be concise and focus on the key issues,
with clear recommendations. Include:
• Visual acuities
• The type of refractive error if any—but not the refraction
• Whether glasses have been prescribed
• Intra-ocular pressures
• The health of the ocular fundi
• The advice you have given the patient and details of any treatment
you have instigated
• If arranged, the time and place of the patient’s appointment with
the doctor
• Any other significant finding.
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If your recommendations include a referral to an ophthalmologist, you may
wish to liaise with the GP first to make sure he or she is happy with the
ophthalmologist you have recommended.
Staff/personnel
Issues relating to staff and personnel are addressed in more detail in Chapter 6:
Staff. For purposes of general management, you will need to ensure that:
• Emergency contacts for staff members, other staff details are stored in an
easily accessible location.
• Responsibilities of different staff members for different aspects of the
practice are clearly delineated.
• Restrictions on activities of staff in the practice are clearly understood eg.
no personal phone calls except in emergencies or with permission, no
chewing gum, no eating at the front desk or whilst working with patients,
no giving of discounts without the permission of the optometrist.
• Designation of staff members who are permitted to authorise/give refunds,
alterations, exchanges etc.
• Details of who has responsibility for organising servicing of equipment
and ordering of spare parts.
• Information to be given to patients by different staff members eg. reception
staff may advise patients about how to clean their spectacles, but may not
make recommendations to alter contact lens cleaning systems without
first consulting the optometrist.
Stationery
Practice stationery comprises the practice letterhead, envelopes, accounts
and receipts, fax template, business and appointment cards, practice information sheets etc. These may be used for communications with patients and
other health care professionals or for reports for legal matters. Frequently
people refer to their last account, statement or receipt for the contact details
of your practice. Ensure that these details are clear on the paperwork given
to patients after their consultation. Practice stationery letterhead, accounts
and receipts, business and appointment cards should include:
• The name of the practice (with an indication that it is an optometric practice)
• Practice location and postal address, telephone number and fax number
• The ABN of the practice
They may also include:
• The practice logo
• An e-mail address
• The names of the optometrists at the practice
• Business hours (although if these are complicated, they can occupy a
significant portion of the space available)
• The services provided
• The Optometrists Association Australia logo that must be reproduced
according to specifications. (Logos and logotype are available from
Optometrists Association National Office. If you would like further
information or clarification on the use of the logo and logotype, please
contact National Office. Alternatively, Optometrists Association members
can visit the members’ area on the Optometrists Association website:
www.optometrists.asn.au, select the Practice management section and view
the document Identifying your practice.)
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Although printed envelopes are not essential and can be replaced by envelopes with a return address stamped, printed or written on the back, the
former is desirable as it provides a more professional impression.
In the design of accounts and receipts, consider the information the patient
will require if they wish to be able to claim for these services from their
health fund eg. inclusion of the patient’s prescription, appropriate item numbers, details of the practice from which the service or appliance was obtained.
Your accountant will be able to assist you in designing receipts and
accounts.
Ensure that you have sufficient Medicare and DVA Stationery.
General stationery
You will need to ensure a ready supply of:
• Note pads
• Printer paper
• Labels: address; sales; file labels etc
• Pens, pencils, highlighters and other writing implements
• Scissors and utility cutters (for receiving deliveries)
• Removable notes (eg. Post-it)
• Adhesive tape
• Paper clips
• Postage stamps
• Self-inking message stampers with eg. ‘Date Received’, ‘Account Overdue’ etc
• Stapler
• Hole-punch
• Other every-day items (e.g. tea and coffee requirements, toilet paper, hand
towels, soap, tissues etc)
It is important to ensure that you have these items, as it can look very
unprofessional to be without them when you first open your practice. It is a
good idea to keep a list of your office stationery needs, and to ensure that
one member of staff is responsible for ordering stationery.
Stock management
When a practice offers both consulting and dispensing services it is essential
that the cost of frames and lenses is appropriate to cover costs of materials,
salaries of any staff involved in edging, fitting and delivery of spectacles
and the generation of some profit. Patients should be able to choose from a
wide variety of frames. Frames need to be varied to cover the needs of
everyone, so work out who is likely to constitute the majority of your patients and try to have a range to suit different shaped faces and different
complexions. Remember that you are not buying to suit yourself so vary
your colours, remember different prescription needs, consider differences in
budget for your patients, and don’t forget fashion.
Try to meet optical company representatives eg. once a year to see their
range: you can ask how well an item has sold etc, ask them for information
on other matters. Work out how often you wish to meet with them to see
new products.
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Do you want to always reorder stock once it is sold—consider your criteria
for re-ordering (eg. if it sells but you have had it 6 months do you want it
again, determine criteria for exchange of stock that does not move etc).
Have an inventory (calculate turnover, determine cost of goods sold, keep
track of which goods are selling: cost range, colours, shapes etc). Ensure
that you have a process in place for the return of damaged stock and check
the possibilities of return of stock that does not move within a certain timeframe. Alternatively, have sale items.
Consider spectacle cases and lens cleaning cloths with practice address and
contact details printed.
Bar-coding
Bar-coding of stock assists in the generation of accounts and allows a computerised record of stock moving out of the practice that assists with both reordering and determination of the amount of stock at stock-take time. This
assists in determining which items move quickly and which are slow movers. You may wish to consider the value of monthly stock audits that can be
computerised, to assist in determining any losses through shop-lifting.
Monthly stock audits will also assist in monitoring how close contact lens
solutions are to their expiry date. Quantities reordered will need to be reviewed every few months initially and approximately six-monthly later to
ensure that they keep pace with the growth of the practice. It is also important to determine how many months supply are to be held and stock should
be regularly updated to reflect new needs, brands, and suppliers. Other
factors to monitor are: supply costs, price increases, discount opportunities,
contract buying, alternative suppliers. Ensure that supply quantities are
checked against the packing slip or invoice on delivery and that all invoice
prices are checked against the price list.
If you are unable to keep all examples of eg. colours of a frame, you should
attempt to be aware of what is available and consider obtaining spectacle
frames on approval when your patient likes a frame but is not satisfied with
the colour or needs a different size. (It is useful to keep frame catalogues to
assist with this and these can be kept with the price list).
Frame selection
One method to manage frame selection is to create a master file for frames—
this would include details of the supplier, the model number, size and colour
of the frame in stock, alternative colours and sizes for the frame, date of
initial purchase, number of times reordered and when, etc. When a frame is
purchased a coloured sticker could be attached to indicate the month in
which the frame had been purchased (this will assist to determine how quickly
a frame moves and whether it is worth reordering). The coloured sticker
could also have details of the model number, colour, price and manufacturer.
It is recommended that you seek financial advice or advice from other optometrists regarding the mark-ups you wish to make on the materials you
supply to patients. Patients may stop purchasing contact lens solutions from
you if they find that the same item is cheaper elsewhere. They are also more
inclined to ‘shop around’ to check the price of frames in other locations.
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Stock management need not be an overwhelming task. Once you have developed your stock management systems with the help of your accountant
you will be able to delegate most of the tasks to your reception and other
staff.
Time management
Good time management skills are essential for the successful and profitable
management of a practice. Estimate the time each task will take and schedule your time accordingly. Remember that as you become more proficient
in your various tasks, you will also become more efficient. The old adage
that time is money holds true; delegate those tasks you can safely leave to
another, prioritise tasks according to urgency, importance and profitability.
An important policy to develop in conjunction with your staff is the rating
of urgency. These may be the first things with which you have to deal,
possibly at the expense of other activities eg. all patient consultations would
be considered urgent. However, regular appointments may have to be interrupted for a patient or family emergency. A staff crisis requires urgent management although it may need to be deferred until after patients are seen.
This policy may need to be revised on a regular basis as your practice
develops and you gain management experience.
Waste disposal
Most waste generated in optometric practice can be removed by the usual
shopping centre contractors. For practices located outside of shopping centres, contact your local council to ensure that you can dispose of waste via
the council services. Care should be taken in the disposal of dispensary
waste, as well as sensitive information, including patient files, medical,
financial and legal documents. A small shredder can be useful for destroying this information easily.
In optometric practices where sharps are to be used, eg for the removal of
foreign bodies, it will be necessary to obtain a suitable sharps container that
is collected by appropriate contractors. Local council or state regulators
(including Environment[al] Protection Authority regulations) must be considered. The National Health and Medical Research Council (NH&MRC)
has National Guidelines for Waste Management in the Health Care Industry, March 1999, available at www.health.gov.au/nhmrc/publications.
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Template for an appointment book
This template could be modified to suit the hours your practice is open. When
a number of optometrists see patients at the same time you can develop a book
with a page for each optometrist facing each other, with the date, the name of
the optometrist and the hours of their attendance at the practice on that day.
Day:
Date:
Optometrist:
Hours at practice:
T ime
Patient’
s name
Patient’s
Reason for visit
Contact details
9:00
9.15
9:15
9.30
9:30
9.45
9:45
10.00
10:00
10.15
10:15
10:30
Hold space
10.45
10:45
11.00
11:00
Mor
ning T
ea
Morning
Tea
11.15
11:15
11.30
11:30
11.45
11:45
12.00
12:00
12:15
12.30
12:30
12.45
12:45
Lunch
1:00
Lunch
1.15
1:15
Lunch
1:30
1.45
1:45
2:00
2.15
2:15
2:30
2.45
2:45
3:00
3.15
3:15
3.30
3:30
After
noon tea br
eak
Afternoon
break
3.45
3:45
3.30
3:30
4.15
4:15
4.30
4:30
4.45
4:45
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Template for patient referral letter
(based on a template developed by Nelson Oliver)
Middle Hill Optometrists
10 William Street
Middle Hill 3XXX
Ph: 9XXX XXX
Referral to: ..................................................................
Date of examination: ...................................................
Referral for: .................................................................
DOB: ...................................
Address: ........................................................................................................................
......................................................................................................................................
......................................................................................................................................
Full eye examination
(vision, refraction, binocular vision, ocular fundus assessment, slitlamp assessment, glaucoma)
Glaucoma Check
(Intraocular pressure, optic nerve examination and visual fields)
Foreign body removal
Dilated pupil fundus examination
(complete retinal examination, indicated for suspected retinal detachment and all suspected retinal disease)
Diabetes Work-up
(vision test, dilated pupil fundus examination and slitlamp examination)
Slitlamp biomicroscope examination
(Anterior eye examination for cataract, corneal or conjunctival disease, uveitis etc)
Binocular Vision work-up
(especially important in children’s vision problems)
Other
Notes ...........................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
Referring optometrist: .............................................................................
Signed: ...................................................................................................
If you require after hours assistance, my mobile phone number is 04XX XXX XXX
If you require it, and if possible, I am happy to see patients after hours.
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Alternative pro forma for a Referral Letter
10 William Street
Middle Hill 3XXX
Ph: 9XXX XXX
Dr
10 King St,
Wilfred Park
xxx xxxxxx
,
Dear Dr
,
The following is a report for Mr/Ms XXXXXX of (address) who was seen at this practice on (date) and who has an
appointment with you on (date).
(Patient) presented complaining of ...............................................................................................................................
....................................................................................................................................................................................
External examination revealed no abnormalities.
Visual acuities were R
A near addition of
and L
with correction of R
D enabled (patient) to read N
and L
.
print
Dilated ocular fundus examination revealed
in the right eye
and
in the left eye.
Intra-ocular pressures were R
mmHg and L
mmHg with (method) at (time).
Visual field assessment with (method) showed ____________________________________________________________
An appointment has been arranged with you on ......................................................... at
.................................................................................................................. to investigate
.......................................................................................................................................
Yours sincerely
Joanna Citizen
Optometrist
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Report pro forma
(based on a template developed by Nelson Oliver)
10 William Street
Middle Hill 3XXX
Ph: 9XXX XXX
Report to: .........................................................................
Date: .................................................................................
Date of examination: .........................................................
Report concerning: ...........................................................
Vision
DOB: ......................................................
Uncorrected (or with previous prescription)
R ____________ L ____________
Best corrected
R ____________ L ____________
Refraction
Distance
R ____________ L ____________
Reading
R ____________ L ____________
Eye health examination
Normal
Suspect
Other
.....................................................................................................................................................................
.....................................................................................................................................................................
.....................................................................................................................................................................
Glaucoma assessment
Intraocular pressure
R ____________ L ____________
Visual fields ____________________________________________
Binocular vision (Eye co-ordination and focussing)
Normal
Problem requiring glasses
Problem requiring exercises
Other
.....................................................................................................................................................................
.....................................................................................................................................................................
Recommended follow-up ..............................................................................................................................
......................................................................................................................................................................
Did you know we provide the following products and services?
• Prescription sunglasses
• Fit and supply contact lenses
• Vision Training
• Free cleaning of all optical appliances
• Children’s vision examination
• Glasses and contact lenses to suit all sports
Signature: _________________________________________________
Name of optometrist: _______________________________________
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Template for prescription for therapeutic ocular medication
Optometrist’
s pr
escription for ocular medication
Optometrist’s
prescription
Optometrist’s name: ....................................................................................................................................................
Optometrists Therapeutic Licensing endorsement number: .........................................................................................
Practice address: ........................................................................................................................................................
........................................................................................................................................................
Telephone number: ......................................................................................................................................................
This optometrist is endorsed to prescribe approved prescription only medications under the [Include the name of the Act
that is relevant]. Confirmation of this endorsement number can be obtained by contacting the State Optometrists
Registration Board. [The optometrist should include the name of their State Optometrists Registration Board, and the
contact telephone number].
Patient name: ...............................................................................................................................................................
Patient address: ...........................................................................................................................................................
Telephone number: ......................................................................................................................................................
Prescription details:
Include: name, dose, frequency of use, timing of use, method of administration, duration of treatment (course, package
size), repeats, special instructions and any other relevant information.
[Indicate if brand substitution is permitted/not permitted].
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
Signature of prescriber
..................................................................
May 2003
Date
...............................
115
Chapter 6
Staff
This chapter outlines some of the choices involved in
staffing your practice.
• Hiring and training staff
• Managing their needs and yours
Disclaimer
May 2003
STAFF—Chapter 6
116
Contents
Information for employers about their obligations to their staff ............... 117
Staff positions ..................................................................................... 118
Hiring Process .................................................................................... 119
Information for staff ............................................................................. 122
Employing another optometrist ............................................................ 123
Training your employees ...................................................................... 124
Staff management .............................................................................. 126
Staff records ....................................................................................... 126
Staff meetings .................................................................................... 126
Staff grievances and personal difficulties .............................................. 127
Staff evaluation ................................................................................... 128
Dismissing employees ......................................................................... 128
Relief staff ........................................................................................... 129
Termination of employment ................................................................. 129
Sample contract for employing staff ..................................................... 130
Sample acceptance of offer of employment ......................................... 133
Sample staff appraisal form ................................................................. 134
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117
When to employ
When you first establish your practice, you must decide whether you need
to employ staff immediately or whether you can manage to delay this until
the practice becomes established. If you think you need staff, determine
whether you will be able to afford them. At first it is unlikely that you will
employ staff other than yourself and possibly a receptionist, but it is important that eventually clear guidelines are developed on the roles and responsibilities of staff and the terms of their employment. It is essential that even
at the commencement of your practice, you hire qualified, competent staff
for whatever position you wish to fill. Employing junior staff initially in an
attempt to reduce costs may not be a saving in the long term if they make
mistakes. You will also need to invest considerable time in training. Staff
must be attuned to the professional philosophy of patient care and must be
patient-oriented, as their actions enhance or detract from your professional
reputation. The hiring process (with advertising, interviewing and training)
is costly, so seek advice from other people to assist in your selection to
avoid continually changing staff. If patients see different staff every time
they come to the practice they may question both your ability to attract and
retain qualified staff and your professional ability.
Some practitioners, particularly in the early stages of a practice will employ a spouse or a relative. This is a personal decision with advantages and
disadvantages. A spouse or family member is likely to have a personal
interest in the practice and may be a more effective worker. Salaries, especially initially, may be more open to negotiation with family members.
However, family members may be more likely to question your decisions
and there may be additional strains in the employer-employee relationship.
Information for employers about their obligations to their staff
Before you employ staff in your practice, you need to be aware of your
obligations to them. These obligations are detailed (state by state) in the
document Unravelling the threads: Who is and Who is not an employee?
developed by the Department of Employment, Workplace Relations & Small
Business: www.industry.gov.au.
Information about wages and conditions of employment for federal and
state awards can be obtained from the WageNet website by selecting Wagenet
at: www.workplace.gov.au. This information is valuable when determining
salary and leave entitlements for staff. Links are included for information
related to each state. The website also provides access to fact-sheets
addressing awards and agreements, recruitment and related issues, good
employment practices and other employment issues eg. unfair and unlawful
dismissal. Optometrists Association Australia has an agreement with the
Service Industry Advisory Group (SIAG) for quality information provision
to members in all the areas of Human Resources and Industrial Relations.
More information is available from the association website:
www.optometrists.asn.au.
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118
Staff positions
Receptionist
One of your most important staff members is the receptionist. Even when
you are starting your practice, it is important that you do not have to
interrupt your consultations to answer the phone and deal with other matters, so you will need to employ someone who can do so. Initially this may
be a family member, but ultimately you are likely to need to employ a fulltime receptionist. The receptionist is the person who gets to know the patients and the office routine. Patients come to associate the receptionist with
the practice. The receptionist can be crucial in increasing patient retention
if a practice changes hands. If you intend to be open in the evening or on
weekends, you may need to consider employing one full-time and one parttime receptionist.
Office staff
After the receptionist one of the usual areas where an optometrist needs
additional assistance is in the business area for the management of accounts and other financial matters. Initially this need not be a full-time
position, but as the practice becomes busier, so does the need for further
assistance. If you are assigning considerable time to this area at the expense
of time spent with patients generating income, consider the need for an
additional staff member.
Optical dispenser
If you wish to establish a practice that provides dispensing services, unless
you are prepared to fill this role yourself, it will be necessary to employ an
optical dispenser. In some practices, the dispenser also fills the role of
receptionist.
Optometrist
At some stage, you may wish to employ another optometrist at the practice,
either as a locum when you take leave, or as a part-time employee or a fulltime employee. Alternatively you may have a partner optometrist in the
practice. In any of these circumstances, it is essential to remember the
autonomy of the optometrist in their professional decisions. See section
Employing another Optometrist later in this chapter.
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Hiring process
Whatever the position to be filled, it is essential that adequate time is allocated for the hiring process. Your patients’ perception of the style of your
practice will be based on the presentation, behaviour and service of your
staff. You may choose to manage the hiring process yourself or you may
wish to use an employment agency. Whichever alternative you choose, when
you are seeking to hire someone you will need to consider the following:
• Develop a title for the position
- Determine the duties for the position to be advertised and write a job
description
- Consider how and why functions are performed
- Determine the level of responsibility to be assigned to the position
- Determine how this position fits (will fit) in with other functions of the
practice
- Consider the physical demands of the position
- Consider the stimulating and interesting aspects of the position
- Consider whether the position is likely to remain the same or whether
there is a chance for extended or broader responsibilities later
• Determine minimum hiring standards for the position
- Qualifications, abilities, attitudes and knowledge
- Experience, education, training and specialised skills necessary to
perform the duties
- Appearance, voice, manner, temperament
- Ability to get along with children and adults
If you are to manage the hiring process yourself, you can place a detailed
advertisement in the positions vacant section of your local newspaper (a
blind advertisement can be used where applicants send their resumés or
letters to a post office box so that they do not directly contact the practice).
Advertisements for optometrists, optical dispensers, receptionists etc can
also be placed in Australian Optometry newspaper at no cost for Optometrists Association members. The association can also provide a blind service. Instead of, or as well as, running advertisements, you may wish to
indicate to colleagues, friends or optical company representatives that you
are seeking a new employee.
An alternative to managing the entire hiring process yourself is to consider
using an employment agency, or a database of people seeking employment
or advertising on the web. An employment agency can perform many of the
early activities such as filtering of applicants, but you will still need to
develop a job description and indicate the skills and knowledge necessary
for the position and you will need to be part of the final interview process.
You will need to be clear about the costs associated with these alternatives,
and exactly which services are covered by these fees.
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Advertisements
In your advertisement:
• Be specific about the position you are advertising particularly if you require
someone with previous experience eg. a receptionist for a health care
professional.
• List the major duties of the job, some of the secondary duties and major
fringe benefits; the salary may be included if you wish.
• Instruct applicants to respond by sending in either a resumé or a letter of
application. The neatness, style and clarity of thought in applications can
provide information about potential employees. A standardised application
form can serve as a screening tool as it provides a standarised record of
each applicant’s personal data, and allows comparison of applicants’
education, training, salary level, experience, and aptitude. How the
application form is completed can also reveal the applicant’s ability to
follow directions and willingness to be open about their background.
Acknowledgement of applications
Acknowledging receipt of applications is a courteous and appropriate step in
the employment process. Hopefully, your applicants have made an effort with
their applications, and so a brief letter of acknowledgement is deserved. Using
the mail-merge application in Word for Windows (select Tools, then Mail Merge
from the toolbar) allows you to send first the acknowledgement and then later
the letter to unsuccessful applicants addressed personally, and will generate
labels for the printing of envelopes. If you are unfamiliar with the mail merge
application, this is a useful tool for business and worth learning to use.
Assessment of applications
Rank resumés according to: education, skills, experience, and overall
impression from the appearance and organisation of the letter. Note any
areas where you will require further information during the interview. Note
stability of employment history (also note gaps in employment).
Interviews
In a new practice you are unlikely to have other staff to assist in the interview process. If you are forming a partnership both optometrists should be
involved in the interview process. You may decide to hold a second interview if the first round of interviews results in a short-list of applicants rather
than an obvious choice.
• Phone applicants with highly rated resumés to assess comparative telephone
personalities and to arrange an interview at a mutually convenient time.
• Plan the interview in advance: review the resumé and telephone rating
beforehand and determine any areas for clarification, prepare questions.
• Start with some ‘small talk’, then explain why you are seeking an employee.
• Assess each applicant’s personality, neatness, character, level of motivation,
and attitude toward optometry and work and whether this is compatible
with your style and philosophy. Take notes.
• Ensure that the applicant does most of the talking by using questions requiring
more than a ‘yes’ or ‘no’ and by giving ample time to reply. Take notes
about their replies and their general appearance, alertness, intelligence,
sense of humour, tactfulness, enthusiasm, self-confidence, maturity, and
willingness to communicate openly.
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Questions may be variations on:
• Their main reason for wanting the position and why they are seeking
a new position.
• Why they think this position will be better than their previous position.
• What they liked about their previous position and what a typical day
was like.
• Whether they received any salary increase(s) in their previous position
and what, if any, new duties were assigned to them during their previous
position and whether they had liked assuming the new responsibilities.
• Where they see themselves in five years.
• If they were given the position, how long they would want to continue
if everything were satisfactory.
• Whether working evenings or Saturday mornings would be a problem.
• Whether they prefer an employer who gives a lot of responsibility or
someone who supervises all of the time, and why.
• Their understanding of what an optometrist does.
• What they think their duties in this office would be.
• Why they should be hired.
• Their greatest strengths and weaknesses.
Long unexplained gaps in work history may be a cause for concern, as are
applicants who criticise previous employers and co-workers or who are not
presented appropriately for a job interview. Avoid hiring applicants who
chew gum, smoke or who talk compulsively during the interview. Take note
of anything that annoys you as often first impressions are correct.
If an applicant seems to be a good prospect, outline in detail the job and its
primary duties and responsibilities. Answer any questions. Without offering
the position, establish if the candidate is still interested and observe the enthusiasm of the reply. Those who still seem promising at this stage should be
given tests to assess their aptitude and skills eg. typing or writing skills for a
secretary or receptionist. The testing can be conducted after the interview.
End the interview session on a friendly note. Let the applicants know that you
will inform them soon whether they have been chosen for the position.
Offering the position
Weigh up all the information you have gathered about the suitable applicants and see who would be most compatible with you and your style of
practice. Check references given by the applicant and talk to at least one
previous employer by telephone.
Once you have decided to hire an applicant, make a job offer over the phone
and specify the starting salary. Follow-up with a written confirmation of the
terms of the offer including a welcome, verification of the terms of the job:
salary, hours, starting date, fringe benefits etc. Before commencing, the new
staff member should be given a written list of the employment policies you
expect to be adhered to together with a description of the philosophies and
aims of the practice. Indicate any additional training that they are likely to
need. Alternatively, the new employee could read the Policy and Procedures
Manual and sign a letter to verify that they are familiar with your rules.
Agreeing on rules in advance may help avoid problems later.
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Templates for a letter of offer and acceptance of the offer are included at the
end of this chapter. Have the applicant sign a letter of acceptance/contract.
As a matter of courtesy notify unsuccessful applicants.
Information for staff
Information relating to staff can be included in a personnel section in a
Policy and Procedures Manual and can cover a wide range of areas of
importance within the practice. This section will contain rules and policies
for employees to ensure good communication and attempt to prevent disputes and misunderstandings. Some areas to consider are:
• Procedures for advertising for new staff and interviewing
• Employment agreement checklist: the checklist can be modified for use
with any employee. Employer and employee optometrist may wish to
sign and date the agreement, and each should keep a copy for reference.
• Job descriptions
• Format and content of the letter of appointment/contract with details of
the award(s) under which staff will be paid, an agreed trial period and
performance review; agreed written minimum standards of performance;
holidays; the requirement for a copy to be signed by the employee.
• Salaries
- Commencement salary, frequency of payment, method of payment
- Rostered days off/payment of overtime/time off in lieu
- Payment of normal salary for gazetted public holidays for full-time
employees and for permanent part-timers where the public holiday falls
on their day on
- Date and basis for review of salary
• Leave entitlements
- Sick leave: eg. five (or more) paid sick days in the first year of
employment. After that, up to eight ordinary days of pay should be
allowed per year. This may accumulate. Special allowance may be
made for illness and injury on rostered days off; this is not necessarily
relevant for optometrists.
- Annual leave: four weeks annual leave at ordinary pay after 12 months
- Compassionate leave: up to two days compassionate leave should be
allowed for bereavements in the immediate family
- Jury duty: The employer must reimburse an employee drafted for jury
duty the difference between their jury service payment and their normal
salary. The day absent is not regarded as a day from annual leave.
- Long service leave: The Industrial Relations Act provides for 13 weeks
long service leave on the completion of 15 years continuous employment,
and an additional four and one third weeks on the completion of each
additional five years. Workers are entitled to pro-rata long service leave
if employment is terminated after 10 years. The Act also prohibits
contracting out of long service leave. It would be unusual for an
optometrist to be employed on a salary basis for this long. If they were,
the employer would probably make more favourable provisions.
- Maternity leave: maternity leave after 12 months of continuous
employment.
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• Work hours: The ordinary days and hours of work or attendance should
be specified, eg. 9:00 am until 5:30 pm, with normal meal and tea breaks.
The minimum meal period is 30 minutes, and should be taken within five
hours from the commencement of work. Meal periods are not included in
the hours worked. A ten minute rest period in both the morning and
afternoon should be scheduled if possible. In practices where the midday
(lunch) hours are busiest, the employees and optometrists may agree for
breaks to be taken outside conventional lunch hours.
• Notice for holidays eg. negotiate one to three months, determination of
times when leave cannot be taken.
• Staff training requirements, who provides this, how and when is it accessed,
recording of training.
• Staff details (name, address, methods of payment, next of kin).
• Conditions of employment (eg. no smoking in the practice, no chewing
gum, no consumption of alcohol until completion of the day’s work,
confidentiality of patient information, uniforms/dress code, job descriptions,
training requirements, any qualifications required, hours of work, overtime,
punctuality etc).
• Grounds for dismissal and procedures to be followed.
• Locums in the practice during the absence of the optometrist or at other
times.
• Methods of communication between staff members (is there a particular
person with whom staff can communicate any problems or concerns or
does everyone come to the optometrist?).
Employing another optometrist
In addition to general staff conditions, when you employ another optometrist you need to consider the following (see the members’ area of the association website: www.optometrists.asn.au):
• Employee optometrists should be at the practice fifteen minutes before
their first appointment.
• Appointment lengths should be made with consideration of the experience
of the optometrist eg. if they are a new graduate they may require additional
time initially for consultations.
• The employer should be responsible for the payment of all fares, board
and lodging expenses where country trips are required.
• Travel between locations is in the employer’s time (ie. not in the employee’s
lunch or rest times), determine travel allowances based on eg. Taxation
Office information. Employers generally pay all costs if they are providing
the vehicle.
• Depending on the number of optometrists and receptionists, specify nonconsulting duties in an employment agreement, eg. frame selection, clerical
work, spectacle deliveries, ordering and cleaning of contact lenses,
preparation of professional correspondence, practice-building activities
within the local community.
• Specify equipment the employee is expected to provide for their personal
use, and the policy of the practice for purchasing small items of equipment,
for example vision training equipment.
• Determine any restriction or special requirements on special interest areas
eg. domiciliary visits and on-site vision screenings.
• Address payment of registration and membership of professional bodies
by the practice.
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• Consider the following with respect to continuing education:
- Allowing employee optometrists to leave early if necessary for continuing
education
- Treating business hours missed because of continuing education as hours
worked
- Providing up to one week’s paid conference leave (independent of normal
holiday leave) per year for interstate conferences, or at least allowing
employees to take one week’s leave of absence for conferences
- Paying registration fees for conferences where possible, if not air fares
and accommodation
• There should be full professional autonomy of employee optometrists.
Employers may wish to discuss and instruct their employees in some aspects
of practice, but ultimately employee optometrists must still be free to
make their own decisions.
• There should be full payment of salary even if the appointment book is not full.
• Determine whether employee optometrists are permitted to make variations
to fees for friends/relatives.
• The best approach to overtime in the professional situation is where
irregular overtime is compensated by small amounts of time taken away
from the practice for personal matters. This works well as long as neither
the employer nor the employee abuses each other’s good will.
• Disability insurance.
Training your employees
Every new employee, regardless of previous experience, needs to be trained
in the way things are done in your practice. Part of the training of staff
comes from your attitudes to your work, your staff and your patients—are
you cheerful and courteous? are you punctual? do you arrange your time off
far enough in advance to allow staff to adjust the appointment book? are
you casual with office routine or do you follow the same procedures that
you demand of your assistants? Other aspects of training are more formal.
• Train staff to recognise that they represent your profession whether in the
office or on the phone with the bank, suppliers, colleagues, office
neighbours, the community. They are the first point of contact for your
practice and represent your professionalism and concern for patients.
• Make sure that employees know about the profession they are in and are
familiar with the full scope of services that optometry provides, the value
of optometry to patients and its role in the health care field. Address the
technical aspects of optometry and how the optometrist relates to other
providers of vision care. Help non-technical employees understand clinical
procedures and why they are done.
• Advise staff that the goal of your practice is to give patients the best optometric
care possible and that the most important concern is the well-being of patients.
Discuss the difference between professionalism and commercialism.
• Train staff to recognise that patients expect and have the right to convenience,
professionalism, politeness, friendliness, respect, and availability from their
optometrist. Staff need to be friendly and competent, show an interest in
patient’s needs, attempt to arrange a convenient appointment and must not
make patients feel rushed. The patient should feel that they are listened to
rather than merely tolerated. Staff should answer questions clearly and
patiently, politely ask patients to fill out forms and advise them if there is
likely to be a long wait before seeing the optometrist.
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• Instruct employees in what they can and cannot do and say—for your
protection and theirs, as mistakes made by your staff can be considered as
your mistakes as well, and you can be held liable. Where a staff member
other than an optometrist performs testing on a patient, they must be
trained in this role and told not to make any comments about the results
of the tests to the patients. Staff must not make diagnoses or give out
solutions without direct instructions from you. Train staff to avoid giving
verbal guarantees inadvertently by making offhand remarks assuring
patients of good results.
• Discuss patient confidentiality: that patients should never be discussed
outside the office and that violation of confidentiality is grounds for
immediate dismissal.
•Discuss the importance of careful record-keeping as records, both financial
and clinical, are official and vital legal documents. Warn against altering
any records. Make sure your staff know which information you want
recorded and how, so that there can be no misunderstandings later.
In a new practice, you are likely to be the person to train new staff.
• List the tasks that need to be done in different areas of the practice: the
office, the consulting room, the dispensary, reception eg. performing
consultations, making appointments, talking with sales people, dispensing
glasses, cleaning or polishing contact lenses, verifying credit information,
taking patient history, recall, filing and collections, etc.
• Distinguish between those activities that require the full participation of
the optometrist, those that require some of their attention, those that require
only their general supervision, and those that can be delegated totally.
Determine which staff member is to be responsible for each task.
• Although it may be difficult prior to the opening of the practice it can be
useful to estimate how often each task needs to be performed, at what
particular time, and how long the task takes so that you can have
reasonable expectations of staff performance.
• Prioritise areas of training so that you address the areas that are most
significant in the running of your practice first. Prepare a list of the things
you want to teach your new employees in each training session. Determine
the amount of time you wish to allocate to training sessions (fifteen minute
sessions are useful), the frequency of training sessions and when these are
best provided. Go through the list systematically in the training session.
• When teaching staff a new procedure, begin by explaining the reason
behind it and explain each step. Instruct them to take notes and to ask
questions as they arise. Questions are feedback on how well you are
explaining the steps. Have them do the procedure under your supervision,
explaining it to you as they proceed.
• Supervise new employees so that they do not get into bad habits from the
start.
• Remember that in a newly established practice, there may be few staff, so
that many types of responsibilities fall to staff members.
• Where there are a number of staff members, train staff to perform the
duties of others so that they can cover their absences during holidays or
sick leave.
Courses for optometric support staff are available through ProVision and
may be available through optometry schools.
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Staff management
Successful delegation depends on adequate training and staff understanding
of their tasks. Tell staff when you expect jobs to be completed and what the
result should be. Spread the pleasant and not so pleasant jobs between staff
and remember that there may be other ways to do a job properly other than
your way. Show appreciation for jobs well done. Be clear in your communications to staff and deliver your instructions directly to the people who are
to carry them out.
Ensure that staff are aware of who is supervising them and those staff to
whom they report or who report to them. Make any criticism impersonal by
criticising the behaviour, not the person. Do not embarrass employees by
criticising them in front of patients or other staff. Ensure that you have all
the facts before pointing out any faults with the employees’ work. Ensure
that there is adequate communication between staff, and as the practice
becomes busier, make time when staff can report and/or ask questions. A
regular staff meeting can be valuable in facilitating communication.
Attempt to build into the schedule a specified lunch break for every employee and consider setting aside a special location for storing bags, coats,
and other personal items and including kitchen facilities eg. a refrigerator,
microwave oven.
Staff records
Maintain a staff record for each staff member that cannot be viewed by
other staff members. This should include emergency contact details, tax file
number, commencement date, position title, hours worked, sick leave, accumulated long service leave, holidays, payroll. You must provide appropriate details to staff, eg. in a payslip, at the end of each pay period.
Staff meetings
Staff meetings should be scheduled frequently for airing grievances, instituting improvements, solving problems, and sharing ideas. (It should be noted
that even though this avenue is open to employees, there will be times when
they will need to speak to the optometrist privately, particularly if there is a
difficulty with another staff member or a personal problem—see section
below on staff grievances). Regardless of the number of staff, a regular time
when practice policies and procedures can be discussed eg. even for fifteen
minutes, can be valuable. Meetings should not be scheduled in staff time off
(unless you are prepared to acknowledge this through overtime payments/
time in lieu etc). Scheduling meetings during office hours indicates to staff
that meetings are important and that staff are expected to attend. Set an
agenda; allow employees to contribute to the agenda and take notes at the
meeting. Venues for meetings can vary eg. consider lunch at a café.
Educational meetings may also replace staff meetings when staff training is
necessary.
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Staff grievances and personal difficulties
Because your practice is likely to employ a small number of staff it is important that everybody is able to work harmoniously and feel supported in
their roles. From time to time staff may need to discuss problems, either
work related or personal, which are affecting their performance on the job.
Such problems might include:
• Performance and development
• Setting or altering work objectives
• Concern about aptitude and ability for particular duties
• Personal matters
Staff should be able to approach you, or another designated employee at
such times for informal and confidential discussion. If you have an existing
rapport with your staff it will be easier for them to approach you to discuss
issues as they arise. Simple things, like asking your staff how they are in the
morning, regularly asking how they are managing their tasks, and offering
support, reassurance and praise as needed will have a positive effect on
your relationship with your staff.
In some cases, the concerns may be easily managed, but in other cases,
particularly where there are difficulties between two staff members in a
small practice, the issues will require very careful management. It is wise to
develop a policy for the management of staff grievances so that there is a
process in place if the need arises. You should take care to note whether
there are personality conflicts between different staff members and attempt
to address this before problems arise.
There is an assumption here that grievances can be resolved informally,
however you may need to develop a formal grievance process for when
issues appear to be irreconcilable, especially where you have staff conflicts.
You might like to contact other optometrists to discuss their approaches.
You will need to:
• Arrange a meeting between the parties, and ensure that all parties agree
to the meeting. If one member refuses to attend, you will need to consider
the costs and benefits of requiring a member of staff to attend such a
meeting.
• Allow both (or all) parties to present their grievances without interruption,
and encourage an issue-based rather than emotive discussion.
• Negotiate a solution to the problem that is acceptable to all parties
(including yourself as owner) and set a time for review of the issue eg.
four weeks.
If a solution cannot be negotiated, or the negotiated solution is not successful on review, then you as the practice owner may be required to make a
final decision. Obviously, it is preferable that staff members resolve their
conflicts directly however you cannot allow conflict to continue in your
practice—this will cost you money and could cause irrevocable harm to
staff morale.
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Staff evaluation
To prevent uncomfortable dismissals it is advisable to hire new employees
on a probationary basis. It is essential that you evaluate the performance of
new staff at the end of their probation period in order to make a decision
about whether they will continue in your employment. It is also useful to
provide feedback and performance reviews every six months. To assist in
the smooth management of this process, it should be clear who is to conduct
the performance review, how long after the commencement of employment
the evaluation is to be performed, what time of day the review is to be
conducted (as a rule, reviews should not be conducted during a staff member’s break or after hours etc). It is also important that both parties are
aware of what is to be covered in the review, so the development of a written protocol is valuable and this can be kept in the Policy and Procedures
Manual or similar.
The written protocol should contain forms on which the staff appraisal interview can be summarised so that this can be kept in the staff member’s
file. The interview should be based on the job description for the staff member.
• Discuss how the activities in the job description have been managed in
the time period, are there any areas of ongoing difficulty?
• Discuss how these activities could be better performed eg. is there a need
for further training, is the work load such that it is time to employ an
additional person in this position?
• Are the current facilities adequate for the satisfactory performance of the
job?
• Has the staff member’s role expanded to include other activities?
• Has the staff member undertaken additional training related to their job,
or that can enhance their role in the practice?
The role of the supervisor is to provide guidance to junior staff by assisting
them to develop their skills. The supervisor provides feedback related to
good performance as well as areas where performance needs to be improved.
The supervisor may make recommendations of methods to assist in the
enhancement of job performance.
The staff member in the review process is to complete a review form with
comments on:
• How the responsibility associated with the position is being met.
• Where goals established have been met.
• The contributions of the staff member in areas identified in previous
reviews.
Dismissing employees
Staff must be aware of the grounds for immediate dismissal without warning, for example, theft of property, embezzlement, mishandling of funds,
breach of patient confidentiality. These must be included in your employee
policy manual, and must be adhered to. Be sure that employees have a clear
understanding of severance arrangements. Spelling out your policy in your
employee manual is the best way to prevent misunderstandings.
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In every situation it is necessary for you to document your reasons for dismissing employees and it is essential that you keep your notes on record in
the employees’ files. Be specific. However, don’t mention embezzlement or
other criminal acts unless you can prove them in a court of law. In any
decision consider the strength of evidence, the length of service with the
practice, the reason for the theft or other activity, the amount stolen or
value of goods stolen. In some instances it may be necessary to seek legal
advice.
Dismiss employees at the end of the day or week and in an appropriate
setting. Dismissed employees should clean out their desk and leave immediately. Be sure to supervise their final activities in your practice, collect keys
and any other practice property.
Relief staff
Determine how you want to cover staff when they take leave or are sick;
you may wish to employ relief staff or have other staff cover their workload
in their absence. Consider the current workload of your staff – is it reasonable to request that they fulfil additional roles on top of their existing workload? Develop (with each staff member) a list of their tasks that must be
completed while they are on leave, and a list of tasks that can safely wait
until their return. Remember to budget for additional casual salaries if you
are to employ relief staff. Don’t forget that you will need relief from your
role from time to time—see the discussion of locums in Chapter 5: General
Management.
Termination of employment
Information about termination payments and long service leave can be found
in the document Unravelling the threads: Who is and Who is not an employee? developed by the Department of Employment, Workplace Relations
& Small Business at www.industry.gov.au. Information about termination
and unfair termination can also be obtained from the WageNet website by
selecting Wagenet and then the fact sheet on ‘Unfair dismissal’ at:
www.workplace.gov.au.
Optometrists Association members may contact the Service Industry Advisory Group (SIAG) for information on the termination of employment. (See
the Association’s website for details. www.optometrists.asn.au.)
Important things to remember about terminating staff appointments:
• Staff and employers need to be aware of the notice period to be given by
either party.
• Date of termination and reason for termination are be included in the
staff member’s file.
• Details of termination payments made eg. unused leave are be included
in the staff member’s file.
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Sample contract for employing staff
As with other information in this manual, this sample contract document is
intended to provide guidance to members. It is not a substitute for specific
legal, business or industrial advice. Optometrists Association Australia accepts no responsibility for any loss or damage arising from or connected
with the use of this information by any person. The Association strongly
recommends that members obtain their own specific advice prior to acting
on any matter in connection with their employment or the employment of
another person.
Note—a copy of the contract should be kept at the practice in a file with
other details relating to employees.
PRIVATE AND CONFIDENTIAL
(to be typed on practice letterhead)
[Insert date]
Dear [Insert name of the person to whom the offer is being made]
OFFER OF EMPLOYMENT
I am pleased to confirm the offer of employment in the position of [Insert name of position eg. Optometrist/Receptionist/
Dispenser/other] with [Name of practice].
The terms and conditions of employment, if you decide to accept this offer, are below.
1. Position and duties
The position being offered to you is [Name of position].. This is a [Insert whether: full time/part time/casual] appointment.
A position description and accountability statement outlining the duties and responsibilities of the position is attached.
2. Location
Initially you will be located at our premises at [insert address], but you may be required to work at other branches of our
practice in [insert suburbs] from time to time.
You must also undertake travel, if and as the practice may reasonably require from time to time. The practice will meet
your reasonable expenses for this travel with prior approval.
3. Probationary period
Your employment is subject to the satisfactory completion of a probationary period of three (3) [maybe even up to 6 for
an optometrist] months from the date you commence employment with the [Insert name of practice]. During the probationary period, either party may terminate the employment on giving one week’s notice to the other party.
or
[Name of the Practice] reserves the right to terminate this arrangement at any time during the probationary period without
advance notice.
4. Salary and superannuation
Your salary package on commencement will be a total amount of $[Insert amount] per annum. [Specify if pro rata payment
for part-time or hourly rate if casual]
This amount includes the employer’s superannuation contributions that [Insert name of practice] is required to pay by law.
[Insert name of practice] will pay an amount equivalent to 9% [insert percentage if different] of the above amount into an
approved superannuation fund on your behalf. The payments will be made fortnightly into an approved fund chosen by
you. Please provide details of your preferred superannuation fund when you return this letter. Included in the salary
package amount are the amounts that will have to be paid in tax and any other statutory charges or deductions.
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STAFF—Chapter 6
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5. Payment of salary
Your salary will be paid into a bank account nominated by you in 26 equal fortnightly instalments in arrears. You will be
required to provide details of an appropriate bank account for these payments. [For part-time and full-time employees;
specify if different for casual]
[The employer may also wish to indicate here whether they will consider requests to repackage salary subject to
compliance with tax legislation. Any consequent taxes or fringe benefits costs would be costed into any arrangement].
6. Performance/salary reviews
It is the policy of [Insert name of practice] to review the performance of all staff regularly.
Your performance will be reviewed toward the end of the probationary period referred to in paragraph 3 of this letter.
Presuming that you satisfactorily complete the probationary period of service, thereafter, it will be reviewed annually,
around the anniversary of the commencement of your employment.
You are required to participate in any appraisal scheme that the firm operates for your position. You may also be involved
in appraisals of other staff members.
Your salary initially will be reviewed three (3) [or other] months from the date of the commencement of your employment.
Thereafter your salary will be reviewed on an annual basis.
7. Hours of work
Your normal hours of work are [Insert times and days of the week, eg 9am to 5pm on Mondays to Fridays; and also each
second week from 6pm to 9pm on Thursdays and from 9am to 1pm on Saturdays or other] with 1 hour to be taken for
lunch. During this time you are required to devote all of your time and attention to the job and to the discharge of your
duties. You may be required to perform work outside of your normal hours as the needs of the practice’s operations
require. You are not entitled to claim paid overtime in relation to any additional hours worked as an allowance for this has
been made in your salary package. If you are required to work for an extended period in excess of your normal hours on
any working day you may be granted time off in lieu in recognition of your additional efforts. [Insert name or position of
responsible person] must approve all time off in lieu before it is taken. [Make alterations to the above paragraph as
necessary for payment of overtime/rostered days off/time in lieu]
Any credits on account of approved time off in lieu that are unused will not be paid out on termination of your employment.
8. Annual leave
You are entitled to four (4) weeks paid annual leave. Annual leave accrues on a pro-rata basis and is cumulative.
Annual leave after each completed year of service is to be taken at a time mutually agreed to by yourself and the [Insert
name or position of responsible person]
[Indicate whether there is leave loading associated with pay for periods of annual leave. Indicate whether there is a limit to
the amount of leave that may be accumulated.]
9. Long service leave
Long service leave entitlements are in accordance with the relevant [Indicate state] legislation. Your entitlement is [Insert
number] weeks long service leave for every [Insert number] completed years of continuous service. Pro-rata entitlements
will be paid out after [Insert number] completed years of continuous service on termination of your employment.
10. Sick leave
You are entitled to sick leave of five (5) [insert number of days if different] days in the first year and eight (8) [insert number
of days if different] days per year in each year of service after the first. You will be required to provide a medical certificate
for consecutive sick days of more than [Indicate length of sick leave for which a medical certificate is required] days. Your
entitlement to paid sick leave accrues on a pro-rata basis and is cumulative. However, untaken sick leave will not be paid
out on termination of your employment.
[Indicate if there is a restriction on the number of years over which sick leave may accumulate].
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Any entitlements to sick leave beyond the basic entitlements set out above will be at the discretion of [Insert name or
position of responsible person].
11. T
ermination of employment
Termination
Either party may terminate this agreement at any time by the giving of notice in accordance with the following requirements [Insert amount of notice if different from table eg. either party needing to give one month’s notice: check whether
there are any state legislative requirements]:
Employee’
s period of continuous service with the employer period of notice
Employee’s
Not more than 1 year
1 week
More than 1 year but not more than 3 years
2 weeks
More than 3 years but not more than 5 years
3 weeks
More than 5 years
4 weeks
Any employee who is over 45 years of age and has completed at least two (2) years of continuous service with the
practice is entitled to further notice of one (1) week. [Omit sentence if not required]
The practice may elect to pay an appropriate amount of salary in accordance with the above table in lieu of notice.
This clause does not in any way affect the practice’s right to terminate your employment summarily in the event that you
are guilty of serious or wilful misconduct in the performance of your duties. In the event that the employment is summarily
terminated you will not be entitled to any notice. However, any salary or benefits due but unpaid at the date of termination
and any amount required by law will be paid.
12. Confidentiality
In the course of performing your duties you may be provided with information relating to the business affairs of the
practice. Unless required to do so by law, you must not divulge to any person or entity outside the practice, whether
during your employment or after your employment with the practice has ended, except in the proper course of your
duties or as permitted by the practice, any information of a confidential nature relating to the practice’s business. This
includes details concerning patients.
This restriction includes, but is not limited to any information relating to the financial affairs or any of the dealings,
transactions or affairs of the practice or any other party with whom it is dealing.
13. Compliance with office policies
It is important that you agree to comply with all practice’s policies whether currently implemented or put in place at some
time in the future. This includes compliance with Equal Opportunity and Anti-Discrimination policies set down by the
practice. Failure to comply with these policies may result in termination of employment. The practice’s premises is a nonsmoking work environment.
I understand you will be available to commence work with [Insert the name of the practice] on [Insert commencement
date].
Please confirm your acceptance of this offer by signing and returning one copy of this agreement
We look forward to having you join us.
Yours sincerely
Xxxxxxx Yyyyyy
Practice Manager
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133
Sample acceptance of offer of employment
I ................................................................ declare that I have read and understood the terms and conditions of
employment set out in the above offer and the attached position description and accountability statement and agree to
accept the offer and abide by the terms and conditions of employment set out.
Signed: ................................................................. Date: ...............................................
Employee
In addition to the above it is advisable to include:
• A job description with the duties of the role
• Where the position is for an optometrist include details relating to maintenance of optometric registration, Medicare,
Paylink, professional and other duties
• Who their supervisor will be
• Firm policies relating to privacy, violence at work, sexual harassment, discrimination
• Your general obligations as an employer
• Limits on roles and responsibilities of different employees
• Policy on computer and telephone use
• Statement concerning how you deal with the public
• Policies on the handling of confidential information
• The rights and responsibilities of people in other positions
• Policies on the return of the firm’s property (uniforms, keys, resources, etc)
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Sample staff appraisal form
To be stored in the staff member’s file
Staff member’s name
Position held
q
Appraised by
Period under review
q
Date of appraisal
q
Details of responsibilities and workload
The staff member should provide details of the responsibilities, workload and activities based on their job description and
indicate additional duties required.
Activities determined from job description
Role 1. ______________________________________________________________________________________________
Role 2. ______________________________________________________________________________________________
Role 3. ______________________________________________________________________________________________
Activities additional to those indicated on the job description
Role 1 . ______________________________________________________________________________________________
Role 2. ______________________________________________________________________________________________
Role 3. ______________________________________________________________________________________________
The staff member should provide details of their performance for the period under review for the responsibilities above,
including details of achievements or difficulties encountered.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
The reviewer should comment on the performance of the staff member and include information to assist in determining
salary increases, promotion etc.
The reviewer’s information will cover;
Objectives for staff member:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Means by which such objectives and goals may be facilitated:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Performance considered outstanding/satisfactory/not satisfactory
Comments of staff member being appraised:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Signature of staff member _______________________________________ Date ___________________
Name of staff member in full _____________________________________
Signature of supervisor _________________________________________ Date ___________________
Name of supervisor in full ________________________________________
May 2003
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135
Chapter 7
Marketing
This chapter addresses the need to promote your new
practice.
• Different marketing avenues
• Effective ways to reach potential patients
Disclaimer
May 2003
MARKETING—Chapter 7
136
Contents
Promoting your practice to your community ........................................ 137
Promoting your practice to local health care professionals and
general medical practitioners ............................................................... 137
Patient newsletters and brochures ...................................................... 139
Practice information sheets ................................................................. 139
Optometrists Association databases .................................................... 140
Other methods of practice promotion .................................................. 140
Telephone listing ................................................................................. 141
Template for a practice information sheet ............................................ 141
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Promoting your practice to your community
When you commence a new practice you need to make people in the surrounding community aware of the services you can offer. Promotion of the
practice may be achieved in a number of ways. Any advertising (whether in
print, or via other methods) must be in accordance with state registration
board requirements and the Medicare agreement.
Consider placing advertisements in local newspapers, making letter-box drops
or using television and cinema advertisements to advise of the opening of a
new practice.
Network by establishing contact with sporting groups and advising them of
vision testing and specific sports vision services to clubs, or by joining a
local business association (eg. a retail traders association) or a service
organisation (eg. Rotary). Talks at local primary and secondary schools,
senior citizens’ organisations and nursing homes can be used to describe to
the broader community what optometrists do and the services provided.
If you live in the area in which your practice is located you will have social
contact through living and working in the area. (Keep in mind that there are
advantages and disadvantages to living in the area near the practice, for
example, people may consider that they can approach you at home if they
have any concerns).
One of the best methods by which your practice is likely to be promoted is
through the recommendations made by your patients, staff and relatives.
Practice promotion is not only important when you open a practice, but is
an ongoing activity. Consider sending press releases and photos to your
local newspaper about new developments and research in vision science;
submit articles about vision health and new techniques to magazines; consider opening your practice for school excursions or providing an opportunity for a work experience student. You may like to develop an on-going
relationship with the local schools and kindergartens in your area through
consultations, public speaking, careers fairs and parent education.
Ensure that you have a listing in the Yellow pages, particularly in the area
section. More information about telephone listings is provided at the end of
the chapter.
Promoting your practice to local health care professionals
and general medical practitioners
Visits to local health care practitioners, particularly general medical practitioners, community nurses, maternal and child health care workers, physiotherapists, occupational therapists, and to teachers and school health officers
are another way in which you can inform the local community about your
practice and your services and specialities eg. children’s vision, binocular
vision, contact lenses, domiciliary visits. Initially any approaches should be
by letter or phone with an appointment made for a follow-up visit. Ensure
that you leave the GP or other health care practitioner with sufficient information so that they would be able to direct people to your practice.
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Networking need not stop with medical and paramedical professionals.
You may wish to advise local social workers of the services that you offer,
or school counsellors, personnel officers in business, student affairs officers
at tertiary education facilities, managers of retirement communities and
nursing homes, and fellow members of community groups, social and sporting
clubs, unions, businesses, professional groups, and police and fire departments. Explore how you could become involved with those groups through
services, visits, speeches, literature distribution and so on in a way that
could generate referrals.
You may decide to arrange an appointment with your local general practitioners (GPs) to promote your practice. When you meet with GPs, dress
appropriately and introduce yourself as a member of Optometrists Association. Areas to address at these meetings include:
• The need to better educate the public about the need for regular and
preventative eye care.
• The role of optometry in the delivery of this care.
• How GPs are in the ideal position to help as many Australians as possible
to obtain optometric vision screenings for diabetes and glaucoma as GPs
are the first to see these patients.
• What you have to offer in terms of vision care.
• How long patients may need to wait to obtain an appointment.
• The referral process and how the patients will remain under the GP’s
care. Outline the reporting process back to the doctor.
• What an optometric examination involves, how optometrists can help
people with functional disorders of vision, the purpose of tests such as
tonometry, ophthalmoscopy and biomicroscopy, stress that optometrists
are able to do more than carry out refractions.
• That optometrists are educated in a four or five-year degree course with
a thorough grounding in the bio-sciences.
• That benefits for optometric consultations are part of the basic health
cover provided by Medicare.
• That eligible veterans are entitled to free optometric care.
• That optometric fees are fixed by the Government with restrictions against
over-servicing.
• That referral is not necessary for optometric examinations.
• That optometrists can provide domiciliary visits.
• That optometrists are capable and obliged, both legally and morally, to
detect the presence of ocular disease or systemic disease which manifests
itself in the eye and must refer patients appropriately.
• That a large proportion of patients with ocular disease can be more than
adequately handled by the GP/optometrist combination. Suggest that
anterior eye diseases, and diseases of the adnexa in many instances, do
not require ophthalmological intervention. The GP, with the optometrist’s
assistance, frequently can provide all the care necessary.
• That optometrists provide a local, relatively inexpensive and convenient
one-stop service and are in a position to help maximise the control the GP
has over the care of the patient.
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You may wish to leave general medical practitioners with the following:
• A referral pad to be used by the GP when referring patients to your practice.
Although these are not necessary when referring patients, they act as a
reminder of your practice to the GP.
• Copies of the handout The GP and Optometry (available from Optometrists
Association Australia National Office).
• Copies of your Practice Information Sheet (see Practice Information Sheets
later in this chapter).
• Your business card.
You may wish to invite the GP to visit your practice (and possibly undergo
a full eye examination) to see the scope of your service and your professional approach. A guided tour demonstrating your equipment and explaining what it does for the patient is one of the best ways of convincing the GP
that you do more than sell spectacles.
As part of your networking with local GPs routinely inform the relevant GP
of any patients whom you refer to an ophthalmologist. It is good patient
care and good public relations. (Note that it is necessary to obtain the
patient’s permission for the transfer of such information. It may be useful to
give the report to the patient to take to their GP).
Patient newsletters and brochures
Promotional information may be in the form of newsletters, brochures and
information sheets. These vary in cost and initially you may wish to produce your own. Options such as All About Eyes are available from Optometrists Association Australia National Office for use as a mail-out (these can
have your practice address over printed or you could stamp your address on
each).
Newsletters can be:
• Sent to patients between recall notices
• Displayed at the reception area of your practice
• Handed to patients visiting the practice
• Given to local general medical practitioners, health care practitioners
and local hospitals
• Placed in a carry-bag with purchases
• Left at local sports centres, senior citizens clubs, youth groups, nursing
homes etc
Optometrists Association National Office also has a range of brochures
that can be displayed in your practice and made available to patients seeking information on a specific topic.
Practice information sheets
A practice information sheet is another way in which you can provide information to people who visit your practice. Initially the practice information
sheet would contain all information relating to the new practice, but would
be changed over time to reflect changes within the practice, for example,
new staff members, changes in opening hours.
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The information sheet should contain:
• The name and address of the practice together with phone numbers, fax
numbers and any other relevant contact details, after hours contact details
or information about where after hours emergency care is available.
• The name(s) of the optometrist(s) at the practice.
• The hours of opening.
• Services offered at the practice (eg. contact lenses, dispensing, children’s
vision, low vision care, sports vision).
• Names and positions of other staff at the practice may be included.
• E-mail and web addresses may be included.
You may wish to create your own practice information sheet on computer
or alternatively you could have this done professionally. Consider the use of
colour or black and white. A template for a practice information sheet is
provided at the end of this chapter.
Optometrists Association databases
Ensure that you keep the National Office of Optometrists Association up
to date with your practice address details, as members of the public can
access the Optometrists Association website or telephone National Office
for information about optometrists practising in certain areas.
Other methods of practice promotion
Other methods for promoting your practice are through the use of business
cards and appointment cards. Business cards can be left when you visit
other health care professionals, businesses or schools etc. Appointment cards
remind the patient of the appointment they have made and allow a means
for them to tell other people about your practice.
Indirectly you can also promote your practice through the referral letters
and reports you write. The professionals who receive these referrals and
reports may need to advise their own patients of an optometric practitioner
at some stage, and their receipt of professional reports from your practice
may be to your advantage. Care must be taken that reports and referrals are
always presented on appropriate practice stationery and that they contain
all of the necessary information to identify the practice, the optometrist
writing the report and the identity of the person for whom the referral or
report is written and the date of the report. Ensure that the letter is addressed to the correct person, that the content of the letter addresses all
relevant details and that it is grammatically correct with no spelling errors.
Lack of attention to these details may give an impression of a lack of professionalism. Do not rely on the spell check on the computer and always read
through any report or referral before you sign it.
Further promotion of the practice can be achieved by the signage you display outside your practice (remember any registration board and Medicare
restrictions), your window display, how your premises are fitted out and
maintained, and how your staff are presented.
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Telephone listing
To ensure that your telephone number appears in the Yellow Pages check
the website: www.yellowpages.com.au for closing and issue dates as these
vary between states and regions within a state. Dates included on these
websites are for advice only and are subject to alteration without notice.
(NB: in some areas there are also local directories restricted to a specific
region within the metropolitan area of a larger city, such as Melbourne or
Sydney, and these also have varying closing and issue dates). As well as
print products Yellow Pages also has provision for online advertising.
Template for a practice information sheet
10 William Street
Middle Hill 3XXX
Ph: 9XXX XXX
Middle Hill Optometrists is a new optometric practice that aims to provide eye and vision care for members of the
local community.
Services:
•
•
•
•
•
•
General optometric consultations
Contact lens consultations
Low vision assessments
Sports vision
Spectacle prescriptions filled
Domiciliary visits can be arranged
Hours of opening:
Monday to Wednesday:
Thursday:
Friday:
Saturday:
9.30
9.30
9.30
9.30
am
am
am
am
to
to
to
to
5.30 pm
7.00 pm
9.00 pm
12.00 midday
Optometrists at the Practice
Xxxxxx Xxxxxxx graduated from The University of New South Wales in 1989 and has special interests in low vision
and domiciliary care.
Yyyyyy Yyyyyyy graduated from The University of Melbourne in 1990 and has a special interest in contact lenses and
sports vision.
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Chapter 8
Resources, legislation
and references
This chapter provides information on resources and
legislation relevant to optometric practice and
references that may be of use in the establishment
of a new practice.
Disclaimer
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RESOURCES, LEGISLATION AND REFERENCES—Chapter 8
143
Resources
National Office
Optometrists Association Australia
204 Drummond St,
CARLTON, VIC 3053
(PO Box 185, CARLTON SOUTH, VIC 3053)
Phone: (03) 9663 6833
Fax:
(03) 9663 7478
Email: [email protected]
State divisions
New South Wales
Mr Andrew McKinnon
Executive Director
130 Great North Road
(PO Box 33)
FIVE DOCK, NSW 2046
Phone: (02) 9712 2199
Fax:
(02) 9713 2452
E-mail: [email protected]
Website: www.optometristsnsw.com.au
Tasmania
Mr Keith Mackriell
Executive Director
4/12 Ellerslie Road
BATTERY POINT, TAS 7004
Phone: (03) 6224 9996
Fax:
(03) 6224 9996
Queensland
Mr Greg Johnson
Executive Director
58 St Pauls Terrace
SPRING HILL, QLD 4000
Phone: (07) 3839 4411
Fax:
(07) 3839 4499
Website: www.optomsqld.com
Victoria
Mr Ben Harris
Executive Director
1st Floor, 600 Nicholson St
(PO Box 1045)
FITZROY NORTH, VIC 3068
Phone: (03) 9486 1700
Fax:
(03) 9486 1944
Website: www.vicoptom.asn.au
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South Australia
Ms Sarah Werfel
Executive Officer
PO Box 971
CLARE, SA 5453
Phone: (08) 8843 4190
Fax:
(08) 8843 4193
Western Australia
Mr David Stephens
Executive Officer
PO Box 7
WEST PERTH, WA 6872
Phone: (08) 9322 6526
Fax:
(08) 9321 9036
Optometry schools
Queensland University
of Technology
School of Optometry
Victoria Park Road,
KELVIN GROVE, QLD 4059
Phone: (07) 3864 5739
Fax:
(07) 3864 5665
University of New South
Wales
School of Optometry and Vision Science
North Wing, Rupert Myers Building
SYDNEY, NSW 2052
Phone: (02) 9385 4639
Fax:
(02) 9313 6243
The University of Melbourne
Dept of Optometry & Vision Sciences
Cnr Keppel & Cardigan Sts,
CARLTON, VIC 3053
Phone: (03) 9349 7408
Fax:
(03) 9349 7498
Other optometric organisations
ProVision Eye Care Pty Ltd
107 High Street, PRAHRAN, VIC 3181
(PO Box 2043, PRAHRAN, VIC 3181)
Phone: (03) 9533 8033
Fax:
(03) 9533 8058
website: www.provision.net.au
Victorian College of
Optometry (VCO)
Cnr Keppel & Cardigan Sts,
CARLTON, VIC 3053
Phone: (03) 9349 7400
Fax:
(03) 9349 7498
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145
National Vision Research
Institute of Australia (NVRI)
386 Cardigan Street,
CARLTON, VIC 3053
Phone: (03) 9349 7480
Fax:
(03) 9349 7473
Cornea and Contact Lens
Reseach Unit (CCLRU)
Rupert Myers Bldg,
The University of New South Wales,
SYDNEY, NSW 2052
Phone: (02) 9385 7400
Fax:
(02) 9385 7401
The Contact Lens Society
of Australia
1st Floor
5 Hunter Street
SYDNEY NSW 2000
Phone: (02) 9247 3397
Fax:
(02) 9231 6499
Australasian College of
Behavioural Optometrists
(ACBO)
204 Canterbury Rd
HEATHMONT VIC 3135
Phone: (03) 9729 5822
Fax:
(03) 9729 5612
Health Professions Licensing
Authority
2nd Floor Harbour View Plaza,
Cnr McMinn & Bennett St,
DARWIN, NT 0800
Phone: (08) 8999 4157
Fax:
(08) 8999 4196
Royal Australian and New
Zealand College of
Ophthalmologists (RANZCO)
94–98 Chalmers Street,
SURRY HILLS, NSW 2010
Phone: (02) 9690 1001
Fax:
(02) 9690 1321
Resources for information about establishment and
management of a small business
Australian Bureau of Statistics
Choose: ‘Products and services’, ‘Consultancy and Information Services’
‘Customised ABS Information’
www.abs.gov.au
Australian Securities & Investments Commission
www.asic.gov.au
Australian Taxation Office
www.ato.gov.au
May 2003
146
Australian Workplace
www.workplace.gov.au
Business Entry Point
www.business.gov.au
Business Licence Information Service (BLIS) (all states)
www.bli.net.au
Department of Employment and Workplace Relations
www.dewr.gov.au/
WageNet (information about all states)
www.wagenet.gov.au
Australian Capital Territory: ACT Business Gateway
This site has access to the Business Licence Information Service
www.business.gateway.act.gov.au/
Australian Capital Territory: Canberra Business Advisory Service
www.canbas.com.au
The National Occupational Health & Safety Commission
www.nohsc.gov.au/SmallBusiness/
Queensland
Queensland: Department of State Development
www.qld.gov.au/
South Australia
South Australia: Centre for Innovation, Business and Manufacturing
www.cibm.sa.gov.au/
Tasmania
Tasmania: Department of EconomicDevelopment
www.tdr.tas.gov.au/
Victoria
Victoria: Business Access
businessaccess.vic.gov.au
Victoria Business Licence Information Service through the Business Channel
www.business.channel.vic.gov.au/BLIS
Victorian Workcover Authority
www.workcover.vic.gov.au
May 2003
147
Western Australia
Western Australia Business Licence Information Service through the
Small Business Development Corporation
www.licence.sbdc.com.au/
Western Australia (Business Name Registration):
Department of Consumer & Employment Protection
Telephone: (08) 9282 0777,
Advice line (toll free): 1300 304 014
219 St George’s Terrace PERTH WA 6000
www.docep.wa.gov.au
Western Australia (Legal Assistance)
Law Access (Law Society of WA)
89 St Georges Terrace, PERTH WA 6000
Telephone: (08) 9322 4911
www.lawsocietywa.asn.au
Western Australia (Small Business Information And Assistance): Small
Business Development Corporation
Ph: (08) 9220 0222 WA regional callers: 1800 199 125
553 Hay Street (Corner Pier), PERTH WA 6000
www.sbdc.com.au
Western Australia (Trade Practices):
Australian Competition and Consumer Commission
3rd Floor, East Point Plaza,
233 Adelaide Terrace, PERTH WA 6000
Telephone: (08) 9325 3622
www.accc.gov.au
Western Australian Business and Investment Gateway
www.big.wa.gov.au
ProVision
ProVision Eye Care Pty Ltd (www.provision.net.au) was established in 1989
as an autonomous division of the then Australian Optometrical Association. It was known as Australia’s Independent Optometrists (AIO). Membership allows access to a range of member services:
Practice management
May 2003
•
•
•
•
•
•
Business planning
Business advice and advocacy
Practice audits
Assistance with setting up a new practice
Network information groups
Human resources
- Position descriptions, employment contracts, workplace agreements, staff
dismissal, redundancy or misconduct procedures, performance appraisals
and management
- Recruitment (advice on advertisements and interviewing)
- Practice policy and procedures, Privacy act, Internet and email policy, OH&S
- Personality profiling
148
•
•
•
•
•
•
•
•
Information Technology
Practice Policy and Procedure Manual
Practice staffing and operational reviews
Staff attitude surveys
Network information groups
Leasing and valuation advice
Practice management manual
Risk management
Professional education
•
•
•
•
ProVision management series
Professional education program
Optometrists’ assistant certificate and staff training
The ProVision library
Marketing
•
•
•
•
•
•
Marketing advice and assistance
Marketing programs
Practice building products
Signage and brand identity
Other marketing products and services
Secret shopper program
Product management
• Preferred suppliers and discounts
• Exclusive products
Legislation
There are numerous pieces of legislation that apply to you and your
practice, some state-based and others federal. Acts relevant to optometric practice can be accessed through the Optometrists Association
Australia website: www.optometrists.asn.au.
Federal
Health Insurance Act 1973
Health Insurance Commission Act 1973
ACT
Optometrists Act 1956
New South Wales
Optometrists Regulation 1995
Optical Dispensers Act 1963
Optical Dispensers Regulation 1997
Optical Dispensers Regulation 2002
Northern Territory
Optometrists Act
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149
Queensland
Optometrists By-Law 1996
South Australia
Optometrists Regulations 1996
Tasmania
Optometrists Registration Act 1994
Victoria
Optometrists Registration Act 1996
Optometrists Registration Regulations 1997
Optometrists Registration (Amendment) Regulations 2001
Western Australia
Optometrists Registration Board Rules 1941
Optical Dispensers Act 1966
Optical Dispensers Regulations
Other relevant federal legislation includes:
Trade Practice Act 1974: scaleplus.law.gov.au/cgi-bin/download.pl?/scale/
data/pasteact/0/115
Privacy Act 1988: www.privacy.gov.au/act/#2.1.1
Workplace Relations Act 1996: www.aph.gov.au/Senate/dept/ses_awa.pdf
Other state-based legislation that may be relevant includes:
New South Wales
(www.legislation.nsw.gov.au )
Poisons and Therapeutic Goods Act 1966, No 31 (updated 30 May 2003)
Poisons and Therapeutic Goods Regulations 2002 (commenced 1 Sept 2002)
Queensland
(www.legislation.qld.gov.au )
Health Act 1937 (reprinted as in force on 28 Mar 2003)
Health (Drugs and Poisons) Regulation 1996 (reprinted as in force on 7
Mar 2003)
South Australia
(www.austlii.edu.au/databases.html#sa)
Controlled Substances Act 1984 (with all amendments in force at 19 Aug 1999)
Controlled Substances Act (Exemptions) Regulations1989
Controlled Substances (Poisons) Regulations 1996 (incorporates amendments in force at 8 Oct 2000)
Tasmania
(www.thelaw.tas.gov.au)
Poisons Act 1971 (consolidated as at 13 Jun 2003)
Alcohol and Drug Dependency Act 1968 (consolidated as at 13 Jun 2003)
Criminal Code Act 1924 (consolidated as at 13 Jun 2003)
May 2003
150
Victoria
(www.dms.dpc.vic.gov.au)
Drugs, Poisons and Controlled Substances Act 1981 (effective from 24
Apr 2002)
Drugs, Poisons and Controlled Substances (Optometrists )Regulations 1998
Western Australia
(www.wa.gov.au/government.html)
Poisons Act 1964 (produced 30 April 1998)
Poisons Regulations 1965 (produced 30 April 1998) Division 5 [Drugs],
Division 6 [Medicines and disinfectants] and Division 7 [Manufacture of
therapeutic substances] of Part VIIA of the Health Act 1911 (as at 30 April
1998)
Health (Drugs and Allied Substances) Regulations 1961
National Occupational Health
and Safety Commission
www.nohsc.gov.au/ Select Small Business and then OHS guide for employers for state by state information
Access to legislation
Australasian Legal Information Institute: www.austlii.edu.au/
Occupational Health Safety and Welfare Act 1986 (SA)
Occupational Health and Safety (Commonwealth Employment) Act 1991 (Cth)
Occupational Health and Safety Act 2000 (NSW)
Occupational Health and Safety Act 1984 (WA)
Occupational Health and Safety Act 1985 (Vic)
Occupational Health and Safety Act 1989 (ACT)
Safety Rehabilitation and Compensation Act 1988 (Cth)
Workplace Health and Safety Act 1995 (Tas)
Workplace Health and Safety Act 1995 (Qld)
Work Health Act (NT)
Acts relating to consumer protection and consumer affairs
Partnership Acts
Partnership Act 1958 Victoria: www.dms.dpc.vic.gov.au/l2d/P/ACT01083/
5_0.html
Partnership Act 1892 No 12 (NSW): www.legislation.nsw.gov.au/
Partnership Act 1963 (ACT): www.legislation.act.gov.au/a/current/p.asp
Partnership Act 1985 WA: search at www.austlii.edu.au/au/legis/wa/
consol_act/
Partnership (Limited Partnerships) Regulations 1997 (SA): search at
www.austlii.edu.au/au/legis/sa/consol_act/
Partnership Act 1891 and Partnership (Limited Liability) Act 1988 (QLD):
search at www.austlii.edu.au/au/legis/qld/consol_act/
Partnership Act 1997 (NT): search at www.austlii.edu.au/au/legis/nt/
consol_act/
Partnership Act 1891 (TAS): search at www.austlii.edu.au/au/legis/tas/
consol_act/toc-P.html
Australian Government Publishing Service (1992) Small Business and the Law
Bennett, I. Optometric Practice Management 2nd edition, Burlington MA,
USA: Butterworth–Heinemann; 2003.
May 2003
151
References
Association of Optometrists (UK) Starting an optometric practice—A guide
for optometrists; 2002.
Clark I. Designing a new practice. In: Practice; Feb 1995: 9.
Cockburn DM, Lindsay RG. Infection control guidelines for optometric practice. Clin Exp Optom 1995; 78: 110-112.
Hanks, AJ. The Optometry Team
Department of Employment, Workplace Relations & Small Business. Unravelling the threads: Who is and who is not an employee?’ 2002,
www.industry.gov.au
Hall & Wilcox, Avoiding Common Lease Problems. In Legal News for
Business; Dec 2001: 2.
Levoy B. 201 Secrets of a high-performance optometric practice. Woburn
MA, USA Butterworth-Heinemann; 2002.
McBeath, IJ. Legal responsibilities of optometrists. Aust J Optom. 1981;
64:1:9–14
Medicare benefits for consultations by optometrists, Commonwealth Department of Health and Family Services, 1996, Australian Government Publishing Service, Canberra.
National Health and Medical Research Council (NH&MRC), National
Guidelines for Waste Management in the Health Care Industry, 1999,
www.health.gov.au/nhmrc/publications.
O’Donnell K, Coppin M. Avert common lease problems. In Practice; May
2002: 2.
Oliver, N. Personal communication.
Optometrists Association Australia: www.optometrists.asn.au.
• Guidelines for the optometric management of patients with cataract.
• Guidelines for dilated ocular examination in optometric practice.
• Guidelines for visual field testing in optometric practice.
• Guidelines for the optometric management of patients with glaucoma.
• Guidelines for gonioscopic examination in optometric practice.
• Guidelines for the optometric management of patients with systemic
hypertension and arteriosclerosis.
• Guidelines on informed consent by patients.
• Guidelines on the measurement of intra-ocular pressure in optometric
practice.
• Guidelines for the optometric management of patients with diabetes.
• Patient rights.
• Guidelines for the use of photography in optometric practice.
• Guidelines for optometric clinical records.
May 2003
152
• Guidelines for the referral of patients by optometrists.
• Guidelines on the release of spectacle and contact lens prescriptions by
optometrists.
• Guidelines for the writing of reports by optometrists.
• Guidelines for the use of unpreserved saline.
• Vision and learning disabilities.
• Vision therapy.
• Contact lenses are not a welding hazard.
Optometrists Association Australia, NSW Division, Starting (Or ReLaunching)Your Own Optometric Practice, 1999
Optometrists Association Australia, Practice Standards, 1st edition, 2001.
Roddis D. Stop Thieves: how to cut the risk of theft and burglary. In Practice; Feb 2001: 8.
Seeking the Substance of Practice Valuation. Optometric Economics Summer 1995; 5: 42.
Stanbury D. Australian Optometry Jun 1995: 9, Aug 1995: 7, Sept 1995: 16.
The Optometry Council of Australia and New Zealand: Examination and
Accreditation in Optometry: Competency in Optometry Examination: Supplementary Materials for Candidates 1) from the website:
www.ocanz.org/.
Williams A. So…You want to start your own business? Setting up a small
business in Australia. McGraw-Hill; 2002.
May 2003
153
Chapter 9
Checklist and index
This chapter provides an index to topics covered in this
booklet, as well as a checklist of issues to contemplate
as you consider establishing a practice
Disclaimer
March 2003
INDEX AND CHECKLIST—Chapter 9
154
Chapter 1: Getting started
!
Page
Professional matters .................................................................. 11
Optometric registration .............................................................. 11
Optical dispensing ..................................................................... 12
Medicare .................................................................................. 12
Department of Veterans' Affairs ................................................. 14
Health funds ............................................................................. 15
Professional Indemnity Insurance ............................................... 15
Optometric organisations ........................................................... 15
Therapeutic medications licensing ............................................. 15
Low cost spectacle schemes .................................................... 17
Chapter 2: Business, legal and financial planning
Type of practice ........................................................................ 21
Solo, group, partnership or employer ......................................... 21
Services .................................................................................... 24
Hours of opening ....................................................................... 25
Financial matters ....................................................................... 25
Accountant ............................................................................... 26
Employer obligations ................................................................. 27
Business plan ........................................................................... 27
Taxation office: ABN / TFN / BAS / GST / FBT /
Superannuation / Payroll tax ...................................................... 27
Insurance ................................................................................. 28
Banking .................................................................................... 28
Financial plan ............................................................................ 29
Lease/purchase of property/equipment ...................................... 30
Practice modifications/salaries/overheads .................................. 32
March 2003
155
Contingencies ........................................................................... 33
Financial policy .......................................................................... 36
Legal matters ........................................................................... 37
Legal adviser ............................................................................ 37
Lease/purchase agreements ..................................................... 37
Refunds, replacements, alterations ............................................ 39
Occupational health and safety/workcover ................................ 39
Employer obligations ................................................................. 41
Music licences .......................................................................... 41
Permits ..................................................................................... 41
Business name registration ....................................................... 41
Partnership agreement .............................................................. 41
Superannuation ........................................................................ 42
Insurance ................................................................................. 42
Business Licence Information Service ........................................ 42
Chapter 3: Location, premises and practice fit-out
Location—City/Suburbs/Rural .................................................... 50
Patient demographics ............................................................... 53
Type of building and surrounds .................................................. 54
Choosing your premises (type of premises, size,
modifications needed, permits, security) .................................... 55
Practice fit out .......................................................................... 58
Exterior/interior .......................................................................... 58
Occupational health and safety issues ....................................... 62
Consulting rooms, reception and waiting room, frame
selection area, office(s), dispensary, record storage .................... 64
Equipment ................................................................................ 64
Security .................................................................................... 66
March 2003
156
Chapter 4: Policies and procedures
Appointments ........................................................................... 77
Communications ....................................................................... 77
Computers ............................................................................... 77
Confidentiality ............................................................................ 78
Contacts ................................................................................... 78
Customer relations/service ........................................................ 78
Emergencies and First Aid ......................................................... 78
Equipment ................................................................................ 78
Filing ......................................................................................... 78
Finances ................................................................................... 78
Grievance procedures ............................................................... 78
Infection control ........................................................................ 79
Locum services ........................................................................ 79
Occupational and recreational requirements .............................. 79
Occupational health and safety ................................................. 79
Organisational issues ................................................................. 79
Patient records ......................................................................... 79
Practice information .................................................................. 79
Privacy policy ............................................................................ 80
Quality assurance issues ........................................................... 80
Recall for patients with abnormal test results ............................. 80
Referral letters and reports ........................................................ 80
Risk management .................................................................... 80
Staff/personnel .......................................................................... 81
Stationery ................................................................................. 81
Waste disposal .......................................................................... 81
March 2003
157
Chapter 5: General management
Appointments ........................................................................... 85
Communication tools and methods ........................................... 86
Computers ............................................................................... 88
Contacts ................................................................................... 88
Customer relations/service ........................................................ 89
Driver’s vision—colour vision ...................................................... 89
Emergencies and First Aid ......................................................... 89
Equipment ................................................................................ 90
Filing ......................................................................................... 90
Finances ................................................................................... 90
Grievance procedures ............................................................... 97
Infection control ........................................................................ 97
Lawyers .................................................................................... 98
Locum services ........................................................................ 98
Notices to be displayed ............................................................. 98
Occupational Health and Safety ................................................ 98
Organisational issues ................................................................. 99
Patients' occupational requirements .......................................... 99
Patient records ........................................................................ 100
Practice accreditation .............................................................. 102
Practice information sheet ........................................................ 102
Prescriptions ............................................................................ 102
Price display ............................................................................. 103
Privacy policy ........................................................................... 103
Quality assurance issues .......................................................... 104
Recall for patients with abnormal test results ............................ 104
March 2003
158
Referral letters and reports ....................................................... 104
Staff/personnel ......................................................................... 106
Stationery ................................................................................ 106
Stock management ................................................................. 107
Time management ................................................................... 109
Waste disposal ......................................................................... 109
Chapter 6: Staff
Employer obligations to staff ..................................................... 107
Receptionist ............................................................................. 118
Office staff ............................................................................... 118
Optical dispenser ..................................................................... 118
Optometrist ............................................................................. 118
Hiring Process (hiring process, acknowledgement of
application, assessment of applications, interviews,
offering the position .................................................................. 119
Information for staff .................................................................. 122
Employing another optometrist ................................................. 123
Training employees ................................................................... 124
Staff management ................................................................... 126
Staff records ............................................................................ 126
Staff meetings .......................................................................... 126
Staff grievances and personal difficulties ................................... 127
Staff evaluation ........................................................................ 128
Dismissing employees .............................................................. 128
Relief staff ................................................................................ 129
Termination of employment ...................................................... 129
March 2003
159
Chapter 7: Marketing
Promoting your practice to your community ............................. 137
Promoting your practice to local health care
professionals ............................................................................ 137
Practice literature ..................................................................... 139
Optometrists Association database ........................................... 140
Other methods of practice promotion ....................................... 140
Telephone listing ....................................................................... 141
March 2003
160
Index
A
abnormal results recall 80, 104
accountants 26
accounting, 29
procedures 37, 96
template 96
advertisements 137
appointments, 77, 85, 86
template 110
Australian Business Number (ABN)
25, 42, 44
Australian Taxation Office (ATO)
27, 42
B
employer obligations,
27, 40, 42, 45, 117
optometrists 24
equipment, 64, 69, 78, 90
lease 31, 33, 37
office 34
purchase 33, 37
expenditure 33
fees, 91, 92
filing 78, 90
financial matters, 8, 25, 78, 90
plan 29
policy 37
franchises 24
Fringe Benefits Tax (FBT) 42, 45, 47
C
H
debt collection 37, 95
Department of Veterans’ Affairs (DVA)
14
depreciation 37
discounts 37, 95
dispensing 12, 24
displays 103
driver vision 89
E
EFTPOS 94
Electronic Lodgement of Patient
Claims (ELPC) 93
emergency,
evacuation 89
first aid 78, 89
employee obligations 40
March 2003
notices 98
O
G
D
N
F
banking 26, 28, 37
bulk-billing 92–93
business,
plan 5–6, 27
registration 41, 44, 45, 46
Business Licence Information Service
42, 46
career satisfation 5
‘chair cost’ 36
children’s vsion 24
colour vision 89
communication 77, 86–87
computers, 77, 88
back-up 77
confidentiality 78
contact details 78, 88
contingencies 33
Continuing Professional Development
(CPD) 5, 37, 51, 124, 148
customer relations 78, 89
Medicare, 12, 13, 14, 46, 92, 93
Provider Number 13, 41
modifications 32
Goods and Services Tax (GST)
42, 44, 47
grievance procedures, 78
P
health funds 15
Health Industry Claims and Payments
Service (HICAPS) 93
Health Insurance Commission (HIC)
13, 41
I
income 34
industrial screening 24, 54
infection control 79, 97
insurance, 15, 28, 34, 37, 42
brokers 26
invoices 91, 92
L
landlords 38, 39
leasing, 30
agreements 37, 38, 39
equipment 31
period 38
sub-leasing 31
legal matters, 8, 34, 37, 98
fees 37
legislation 148–150
licences, 34
music 41, 43, 47
locums 34, 79, 98, 123
Low Cost Spectacles Schemes 17
M
marketing 33, 137, 148
Occupational Health and Safety (OH&S)
47, 79, 98, 150
occupational requirements 99
Optometric,
organisations 144
registration 11, 46
Schools 144
Optometrists Association Australia,
15, 143
database 140
organisational issues 79, 99
overheads 32, 37
Partnership, 21
Acts 23
agreement 22
information 41
legislation 150
reasons to establish 22
patients, 34
communication with, 77
brochures 139
newsletters 139
grievance procedures 78, 97
language difficulties 54
recall 80
records, 79, 100
cards 100, 101
computerised 102
filing 90
storage 101
referral and reports 104
Pay As You Go (PAYG) 47
payment,
bad debts 37, 95
cheques 28, 94
credit cards 28, 94
methods of 92
policy 95
Payroll Tax 28, 42, 45
permits,
building 41
plan of action 6
policies and procedures 77
practice,
access 63
accreditation 102
commuting to 51
161
dispensary 65
equipment
62, 63, 64, 69, 70, 71, 90
establishment, 3, 7
as a new graduate 4
delays 25
exterior 59
filing 78
finances 78
hours of opening 25, 46, 123
information sheet
79, 102, 139, 141
interior, 60
consulting rooms 64
design 59, 61
display areas 66
entrance 60
finishing touches 68, 69
floor space 57
frame selection area 65
furniture 61
office set-up 62
reception area 62
staff room 66
location, 50
city 52, 53, 54
converted house 56
demographics 54
factors in choice of 50–51, 55
medical centre 56, 57
professional rooms 57
rural 53
selecting premises 57
shopping centres 56, 57, 60
sources of information 52
street front 56
suburban 52, 53, 54
type of building 54, 55
management, 10, 147
computers 77, 88
modifications 58
negotiation 57
newsletters 139
Privacy Policy 80
promotion, 137, 138, 140
security 33, 58, 66, 67, 68, 80
solo 21
stationery 81
theft 68
toilet facilities 61
visibility of 55
waste disposal 81
premises, 9, 33
choosing 55, 57
modifications 33
purchasing 30
prescriptions, 102, 103
therapeutic prescription template
114
Privacy Policy 100, 103, 104, 125
professional matters, 9, 11
March 2003
fees 29, 34
indemnity insurance 15
proprietary companies 24
ProVision 29, 147
purchasing, 30, 37
agreements 30
equipment 31
property 30
theft by 68
training 124
wages 117, 122
when to employ 117
stationery 33, 106, 107
stock,
bar-coding 108
frames 108
management 107
superannuation 28, 42, 45, 46
Q
quality assurance 80, 104
T
tax,
adviser 26
Tax File Number (TFN) 42
telephone, 87
listings 141
therapeutics, 15–16, 149
prescription template 114
time management 109
R
referral letters and reports,
80, 104, 105
template 111, 112, 113
refund policy 37, 39, 97
Registration Boards 11, 12
rent 37
repayments 29, 33
resources,
small business 145–147
retailers associations 30
risk management 99
U
utilities 34, 37
V
S
Veterans’ Affairs 14
salaries 37
security 33, 58, 66–68, 80
services 24
shoplifting 67
staff, 34, 106, 122
acceptance,
template 133
advertising for 119, 120
appraisal, 128
template 134
communication 87, 123
confidentiality of patient records
125
dismissal 128–129
grievance procedures 97, 127
hiring process, 119
applications 120
contracts 30
interviews 120, 121
information for 122
leave 122
management 126
manuals 81
meetings 126
morale 127
positions, 118, 119, 121
dispenser 118
office staff 118
optometrist 118, 123
receptionist 118
sample contract 130
records 126
relief 129
W
waste disposal 41, 109
Workcover 39, 45, 47

Starting a practice TABLE OF CONTENTS May 2003

Transcription

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