AAPM The Practice Manager Issue 2 2018

IN THIS ISSUE

6

Privacy Act Notification Changes

10

The 8 Characteristics of High Performing Teams

30

How to Get the Best Deal! Negotiation Tips and Tricks

Farewell to the CEO

2018 – Issue 2 | www.aapm.org.au

the practice manager

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Contents

Your Association A message from the President From the CEO’s desk News Bites Privacy Act notification changes My Journey to Fellowship of AAPM The 8 Characteristics of High Performing Teams My Health Record Expansion Why is branding important for your practice?

Cloud Computing – SaaS: Part 2 ‘You can’t what?’ managing and avoiding pitfalls when engaging GPs AAPM 2017 National Salary Survey: Employment Status, Allowances and Benefits Supporting GPs and their patients with chronic conditions Cloud Security What can health care services do about family violence?

How to Get the Best Deal! Negotiation Tips and Tricks A Practice Manager’s Year End Checklist Case Study: “Choosing and changing the practice IT services” How to be more persuasive Practice Profile Kon-Tiki Medical Centre, Maroochydore

1 2 3 4 6 8 10 11 14 16 20 22 24 26 28 30 31 32 34 36

Your Association AAPM Board President Cathy Baynie

Treasurer Jackie Beer

Vice-President David Osman

Chief Executive Officer Gillian Leach

Secretary Fiona Wong

Non-Executive Directors Danny Haydon Cecily Igglesden Richard Evans James Downing

CONTACTS HEAD OFFICE Level 1, 60 Lothian Street, North Melbourne, VIC 3051 P 1800 196 000 F (03) 9329 2524 E headoffice@aapm.org.au VISIT THE WEBSITE www.aapm.org.au LIKE US ON FACEBOOK www.facebook.com/AAPMAustralia FOLLOW US ON TWITTER @AAPM_National

INTERNATIONAL

PUBLISHED BY:

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PMAANZ Practice Managers and Administrators Association of New Zealand

Managing Editor: Sue Guilfoyle Design Team: Andrew Crabb, Arlen Chidzey

W www.pmaanz.org.nz

No part of this publication may be reproduced, copied or duplicated without the written consent of AAPM.

The content of articles and advertisements contained in the Practice Manager Journal solely reflect the personal opinions of the authors or contributors and does not necessarily represent the official position of AAPM.

Thank you to our National Partners

www.aapm.org.au | 1

FOREWORD

A message from the President Cathy Baynie National President

The first quarter of 2018 has seen a busy start to the year for AAPM. State Presidents, AAPM staff and Board Directors met in Melbourne in early March for a National Strategic Planning Day facilitated by John Peacock, General Manager Associations Forum. John led us through a jammed packed day where we were able to re evaluate the 2016-2018 strategic plan to ensure that the five strategic pillars of Advocacy, Education, Operations, Marketing and Networking are being met as intended.

The opportunity was taken to ensure that; • set priorities are still relevant to our member body, • energy and resources are focused where required to achieve strategy, • operations are strengthened where required in order to deliver on strategy, • employees and other stakeholders are working toward common goals, • consensus exists regarding intended outcomes and results between Head Office, Directors and members.

• assessment and therefore adjustments are made where required of the Associations strategic direction in response to the ever changing Primary Health environment in order that we deliver to our members what is required to support them professionally.

As a result of this rigorous evaluation there have been adjustments to our Vision and Mission statements that we believe reflect the Association’s core purpose.

Mission

The role of State Committees Crucial to the Association is the contribution of State Committees, particularly in the key areas of education and networking. State Presidents and committee members are the conduit by which members have a voice in the development of the National Education Framework, Conference planning and hosting and Network group coordination. Our State committees are representative of all Primary Health disciplines from both city and regional practices. This wonderful cross section of talent and wisdom work closely with the staff at head office in a volunteer capacity to represent you, the AAPM members.

It is at this time of the year that State Committee elections take place, there will be several vacancies across all states. If you feel that you are in a position to give of your time and expertise then please contact either your State President or Head Office to find out more about the role requirements, criteria and commitments.

CEO Retirement Many of you would by now be aware that our CEO Gillian Leach has resigned her position at AAPM with intent to retire.

I take this opportunity to thank Gill for her tireless work and commitment to the Association over the last six years in the establishment of a national executive to sustain and grow the organisation.

Our mission is to lead, promote and support excellence in healthcare practice management.

With every change of leadership comes challenges but also opportunities.

Vision

Gill leaves us in a very strong position in order to embrace the next phase of our growth.

Practice management to be universally recognised and valued at the centre of effective healthcare systems and sustainable businesses for optimal patient outcomes.

An updated version of the Strategic Plan will be published on the website for members.

I would like to thank the State Presidents: Kerry (QLD), Fiona (NSW/ACT), Brett (SA/NT), Leanne (TAS), Maggie (VIC) and Claire (WA standing in for Simone) for giving so generously of their time and wisdom in reflecting membership perspective.

Along with the Directors, State Presidents, State Committees and member body we wish Gill and her husband John and their family much happiness as they move into the next phase of their lives.

The position of our next CEO is currently being externally recruited and hopefully by the time this goes to print an appointment will have been made. The Board will keep members informed as the process unfolds.

Until next time

Cathy Baynie National President

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FOREWORD

From the CEO’s desk Gillian Leach CEO

It is with very mixed feelings that I write my final column for The Practice Manager Journal.

It has been an honour to lead AAPM over the past six very interesting, challenging and rewarding years as the CEO. I have greatly enjoyed promoting the interests of our two thousand plus members as well as the profession of practice management. I have decided to retire at the end of July to have the opportunity to spend more time with my family and on some of my other passions which I have not had the time to follow sufficiently.

It has been my great privilege to work with an incredibly dedicated and skilled staff team over this time. We have seen the organisation achieve increasing levels of success. Our membership growth rate has doubled, our education attendance has increased dramatically and AAPM is in the best financial position it has ever been. The staff at AAPM have extensive experience in Association management and are wonderfully dedicated and passionate about the success of AAPM and providing support to all AAPM members.

AAPM is now recognised by the Government as one of the key organisations involved in implementing Health Reform strategies. We now receive funding through the Health Peak and Advisory Bodies Program, and we are represented on over thirty government and industry advisory groups.

We are fortunate to have significant support from our National Partners – AGPAL and QIP, Avant and The Practice Hub, Cutcher & Neale, Care Complete, InSync Surveys, Medibank, MedicalDirector, Medical Media, and University of New England Partnerships. These organisations have worked as true partners assisting AAPM to increase membership, helping to improve the recognition of Practice Management as a profession and providing education and industry information to our members.

We have increased the benefits of membership with regular industry updates, a professional development pathway, access to significant discounts on education and IT hardware, software and support, networking events in all states, advice through the Members Forum and telephone access to Human Resources advice.

Those involved in Practice Management are increasingly aware of the benefits of AAPM membership. I have been very pleased that AAPM’s membership has increased by over 30% during my tenure and the annual growth rate for membership has doubled in that time.

We have developed a National Education Framework to ensure there are uniform education offerings in every state. Members can access education at member rates, through UNEP as well as AAPM seminars, workshops and webinars.

Our flagship AAPM National Conference has always been amazing. Although I had attended many professional health and medical conferences both in Australia and internationally in my previous roles, I was incredibly impressed when I attended my first AAPM Conference in Brisbane in 2012. The quality of the speakers, the extensive trade exhibition and the passion of the delegates at every AAPM conference has contributed to an experience that once attended, you won’t want to miss. Delegate attendance at the National Conference has grown by over 66% and support from our exhibitors has increased by 25% over the past 6 years. This year, the National Conference will be held in Canberra for the first time in many years. Once again, there is a very exciting array of speakers who will stimulate and inspire delegates with great opportunities to increase your skills and knowledge.

Each year, we are pleased to see increasing numbers of Practice Managers become AAPM Certified Practice Managers and Fellows. AAPM’s Professional Pathway provides recognition of the skills, experience and qualifications of members. This professionalism is recognised by the Government and other health bodies who seek practice managers to advise them on the implementation of new programs.

AAPM’s National Board and State Committees consist of many passionate members committed to the success of AAPM and practice management. It has been a wonderful experience to work with these people and my sincere thanks for their generous commitment of time and energy to the association.

I do hope to see many of you over the next two months before I leave AAPM. My very best wishes for the continued success of both the organisation and the profession of practice management.

Kind Regards,

Gillian Leach CEO

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NEWSBITES

Medical Practice Assistant The introduction of the role of the Medical Assistant is a new and exciting employment option for workforce solutions for any practice.

Medical Assistants are flexible members of the Medical Practice team who are formally trained to provide administrative and clinical assistance to health practitioners - able to cover front desk duties, perform a wide range of common treatment room procedures and fulfil the varied administrative tasks required in a medical practice.

AAPM has introduced a new category of membership to support and accommodate this practice team member. If you are currently undertaking or have completed your Certificate IV in Medical Practice Assisting, please visit our website for more information and to join AAPM.

Farewell to our CEO Farewell and thank you to our CEO, Gillian Leach, who will be retiring at the end of July. Gillian has ably led and grown the Association for the past six years and is to be congratulated on leaving AAPM in such a strong position. We wish her all the best for a happy future.

Triennium for CPMs and Fellows Thank you to all our Fellows and Certified Practice Managers (CPM) for your continued membership with AAPM and for being such a valued part of our Association.

You must either update and submit details of your CPD points via your “My AAPM� online self-service portal or submit a Statutory Declaration Form, which will be supplied.

In order to maintain your membership status, each triennium Fellows are required to achieve 300 Continuing Professional Development (CPD) points and CPMs are required to achieve 200 CPD points.

The information must be received by Head Office no later than Friday 31st August 2018 and following this, a random audit will be conducted.

As the current triennium is coming to an end, we ask that you declare your CPD Points for the three-year period from 1 July 2015 - 30 June 2018.

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There are a number of ways you can accrue your CPD Points, through education, contribution and activity, and more information can be found in the Membership Pathway Booklet online.

AAPM Procurement Portal AAPM has launched a new procurement portal. This one stop shop provides AAPM members access to the latest technology to help run a compliant and secure practice.

Members can access not only all of their hardware needs but also a variety of cloud solutions such as back up, security and business management software to run their business more effectively and efficiently.

Please visit the AAPM website for more information. www.aapm.org.au

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EFTPOS | Deposits | Lending

Privacy Act notification changes W

ith so much of our lives and our personal information shared online or stored electronically, trust is a key ingredient for organisations that retain client data. According to the Australian Community Attitudes to Privacy Survey 2017, 69% of respondents are more concerned about online privacy now than they were five years ago. In addition, 61% check website security before giving out personal information; however, 65% also admitted to not generally reading privacy policies.

This limited concern to privacy policies was recently highlighted in spectacular fashion (March 2018) when Facebook founder Mark Zuckerberg admitted the social media giant had violated their own rules after information from as many as 50 million users was provided to a data mining and analytics company. The fallout from the scandal continues with the company losing billions of dollars after a drop in its share price, due to lawsuits, government inquires and user boycotts.

While the scale of the fallout for Facebook is something most health care services will never have to face, it serves as a reminder of the importance of protecting client data and ensuring any significant breaches comply with the Privacy Amendment (Notifiable Data Breaches [NDB]) Act 2017, which became mandatory on 22 February 2018.

Under the amendments, all agencies and organisations, including health care providers, with existing personal information are bound by security obligations under the Australian Privacy Act 1988 (Privacy Act) and are

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required to notify the Office of the Australian Information Commissioner (OAIC - the Commissioner), as well as any impacted clients, about significant data breaches. Compliance is required irrespective of turnover.

This means entities have an obligation to report all data breaches that are likely to result in serious harm to any individual(s) whose personal information is involved in the breach. Any notification must also include recommendations on steps individuals can take in response to the breach.

A data breach occurs when personal information held by an organisation is lost or subjected to unauthorised access or disclosure. This can include: • the loss of a laptop, hard drive or smart phone containing personal client information • if a service is the target of cyber-crime • having an unauthorised person access patient files, or • when personal information is mistakenly given to the wrong person either through human error or a lack of adequate identity verification processes.

The Privacy Act lists personal information as ‘information or an opinion about an identified individual, or an individual who is reasonably identifiable whether the information or opinion is true or not; and whether the information or opinion is recorded in a material form or not.’ Information that is not about an individual on its own can become personal information when combined with other information that results in the person being ‘reasonably identifiable’.

The NDB scheme ensures individuals, and the Commissioner, are notified if a client’s personal information is involved in a data breach that is likely to result in serious harm. Although ‘serious harm’ is not defined in the Privacy Act, when it comes to data breaches, it is categorised as something that can harm an individual physically, psychologically, emotionally, financially, or can damage their reputation.

Notifying individuals affected by the data breach allows them to take proactive measures, if necessary, to reduce their risk of harm. These could include changing passwords and credit card details or simply being aware of possible identity theft, fraud or scams.

A broad range of potential kinds of harm should be considered when assessing the risk of serious harm; the likelihood of a particular harm occurring, as well as the anticipated consequences for affected individuals if the harm materialises, are relevant considerations.

Through the very nature of the work undertaken by health care providers, these organisation types hold significant amounts of personal data.

Patient names, addresses, Medicare or private health insurance details, medical histories, treatment options and referral details are all examples of personal information health care providers need in order to successfully complete their job. While health care providers are able to take steps to protect themselves against obvious breaches, such as being hacked, data breaches can occur in fairly innocuous situations.

A laptop being left on and open for a work experience student, cleaner or contractor to access, the theft of a workbag containing client files from an employee’s car or house, or client details incorrectly being distributed to an external supplier. All of these are examples of possible data breaches which would require assessment and possible notification to the affected individuals and the Commissioner. If a data breach does occur, responding to it has four main steps: contain, assess, notify and review.

Contain: With any suspected or known breach, an entity’s first priority is to contain the breach, where possible, and take immediate action to limit further access or distribution of the personal information, as well as ensuring other information is not compromised.

Assess: All data breaches, including minor ones, are required to be assessed, documented and recorded. If there are reasonable grounds to suspect the data breach is likely to result in serious harm to an individual, an entity must notify the Commissioner and the individual. However, if an entity only suspects this may be the case they must conduct an assessment process that lasts less than 30 days, if possible. As part of this assessment, an entity should consider whether remedial action could rectify the problem. If remedial action is able to rectify the situation, by removing the risk of serious harm, notification is not required and the entity can move to the review step.

Review: The final step is to fully review the incident and take steps to prevent any future breaches. Documenting all breaches allows health care providers to identify where errors were made and contributes to quality improvement purposes. Some health care providers may also have additional reporting obligations under the National Cancer Screening Register Act 2016 (NCSR Act) or the My Health Records Act 2012 (My Health Records Act).

In order to minimise the impact of any data breach, all health care providers should have an up-to-date data breach response plan that all staff are aware of and clearly understand. This plan is in addition to, but is closely interlinked with, a providers existing privacy policy which should form part of each individual practices procedure document.

A well-thought out and thorough response plan can help health care providers meet their obligations under the Privacy Act, limit consequences of the breach and assist with brand and reputation management. This framework should set out the roles and responsibilities of those staff involved in managing the breach along with the steps the provider will take if a data breach occurs. In addition, training should be conducted in-house so that all staff are aware of the data breach, and this can help reduce the likelihood of future breaches occurring.

Response time is critical after a data breach, and being able to refer to a response plan can decrease the impact for affected individuals and reduce associated costs for the provider dealing with the breach. It can also help to retain trust and confidence in a service.

When developing a data breach response plan, health care providers are encouraged to cover the following: • What is a data breach?

• The strategy, steps, time frames and processes for containing, assessing and managing the breach.

• Roles and responsibilities of staff, including who staff should go to if they suspect a possible data breach, as well as how affected clients are notified.

• How your service documents data breach incidents, including those that don’t meet full breach criteria, which will assist in ensuring regulatory requirements are met.

• Review and evaluation of how the breach occurred, the success of your response and how to improve any processes to minimise future breaches.

While data breaches may be an inescapable reality in today’s technological society, the way your health service handles the situation often plays a large part in determining the overall experience for any parties involved. If handled well, your patients will continue to maintain trust in your service and will, ultimately, remain loyal to your health care service.

Notify: Where serious harm is likely, a statement must be prepared for the Commissioner that includes the entity’s identity and contact details, a description of the breach, the kind of information concerned and the recommended steps affected individuals should take in response to the breach.

Affected individuals also need to be notified and advised of the contents of the statement.

Notification can take three forms: • Notifying all individuals whose personal information was involved • Notifying only those at likely risk of serious harm • Publishing and publicising the statement on the entity’s website

Wendy Shephard General Manager, Operations AGPAL Group of Companies

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My Journey to Fellowship of AAPM I

began my career in health as a trained Registered Nurse andMidwife in Brisbane at large metropolitan hospitals. I spent over 12 years in the public and private health systems and was to work with many health care professionals over this time.

In 1998 my husband and I bought a general practice on the south side of Brisbane in the outer metropolitan suburb of Calamvale. This was at the time a solo GP practice with a subleased area to a physiotherapist. Prior to buying this practice we had looked at many around Brisbane and one well established GP practice owner gave us this advice, “If you are serious about running a quality practice, then you better get in touch with these guys.� With that, he pulled an AAPM manual off his shelf for us to peruse.

Although I had a lot of experience in the hospital setting, I had very little exposure to General Practice, other than as a patient, and was naĂŻve about what the role of a Practice Manager would entail.

Early on, it became evident to me that owning and running a business was indeed a serious undertaking, although I was cognisant that my personal career aspirations and satisfaction were an important element to the success of this business.

I enrolled in the Certificate IV in Practice Management at UNEP. I completed this with distinction and gained valuable knowledge that helped during hectic times. We employed our first full time administration assistant six months after buying the practice. I am proud and humbled to say that Cindy is still working with us over 20 years later and two years ago attained her Diploma in Practice Management (highly commended).

Our practice grew quickly and somewhat organically with a doctor joining us who brought a full case load of patients. We became a training practice in early 2000 and have since trained many GP registrars, some of whom still work at our practice. Many of our support and nursing staff have worked with us for well over a decade and I believe this is testament to a healthy, supportive and happy work place. Making sure you have the right team in place is the make or break of a healthy workplace.

As a team, not only have we shared many laughs in and beyond the workplace, but we have grown up together, enjoyed celebrating marriages, births of children and grandchildren, loss of parents and family members and other significant life events. It is important to have a culture where laughs and healthy banter are shared and can bring smiles to many faces: such as the time I needed the hot water in the roof fixed - one brave Doctor went up for me, only to fall through the ceiling in a somewhat comedic manner. He received a Batman cape for Christmas that year!

In 2007 I took the time to upgrade my qualification to a Diploma of Practice Management. I did this through a one week residential course at which I met a fabulous group of Managers from a variety of practices. We studied hard and had a heap of fun at the same time. The timing of this qualification was impeccable as we were going through an expansion and refurbishment of our premises as well as growth in size and style of business.

We are now a ten doctor practice, employing five nurses (including me) and subleasing to a variety of allied health and pathology.

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Over the past decade I have had many unique opportunities through both my management experience and colleagues I have met along the way. I have sat on various Boards as a Director in the not for profit sector, and currently am a Board Director of Brisbane South PHN. I am an AAPM Qld state committee member and am in constant awe of the energy and vibrance my colleagues bring to our profession. I am a current member of Qld Clinical Senate as an APNA rep but am able to use my management career experience to highlight the significant contribution practice management professionals can bring to help shape a better health system.

Joining the AAPM Qld committee made me think hard about what I could contribute and how my contributions would be considered and seen by our valuable members. We meet regularly via teleconference or face to face, and spend much time planning networking and education events for our Qld members. We look at feedback received and take very seriously our roles in representing and supporting AAPM Qld members. We are all available to take phone or email queries from members or non-members who want to understand the value AAPM membership holds.

So – why Fellowship? And why did it take me so long?

An honest answer is that it kept falling off my ‘to do list’ because I wrongly believed the process would be onerous and that I may not be deemed worthy, and - like all working parents – doing ‘something for yourself’ is not often a priority. I had a lightbulb moment, got my act together, applied for my Certified Practice Manager of AAPM and was granted this. It wasn’t hard or onerous.

Late in 2017, and after a number of conversations with admired, senior AAPM Fellows, I set myself the task of gathering the necessary documentation to support my professional career development toward Fellowship (a pleasant trip down memory lane!) and submitted this to AAPM Head Office. They encouraged my application and answered my sometimes seemingly basic questions!

My submission went through and I participated in the final selection process which was a panel interview teleconference chaired by Colleen Sullivan. I was fine in the lead up until about two hours prior to the interview when I became irrationally nervous - almost terrified! - considering what I could possibly be asked and how I would answer these questions.

Needless to say, the nerves were a complete waste of energy. The interview was one of the most enjoyable that I have had over my career and, as expected, Colleen’s chairing was of the highest standard possible. It was an experience that gave me time to reflect on what I have achieved over the years and I was surprised by how much I had not given myself due credit for. To have such professional and encouraging feedback from someone of Colleen’s calibre was certainly a career highlight. I was excited, humbled and very proud to become one of AAPM’s newest Fellows soon afterward and proudly use my post nominals FCPM AAPM. I wish I had done it sooner. It is personally rewarding to be recognised for the level of achievement and experience I have gained over my career.

Attaining Fellowship has made the conversations with other members wanting to achieve CPM and Fellowship much easier.

There are many managers as, or more, experienced and definitely more talented than I am who are worthy and deserving of Fellowship of AAPM. I urge you to consider this process and would be more than happy to have a chat with anyone about my experience and anyone seeking support or guidance.

Patrice Cafferky AAPM Fellow and Certified Practice Manager

The 8 Characteristics of High Performing Teams Sense of Purpose

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e've all experienced, or at least witnessed, high performing teams (HPTs) in action. We've also experienced, or witnessed, low performing teams (LPTs). What's the difference? What are their characteristics?

There are at least eight characteristics of high performing teams. These characteristics are interrelated. In other words, if your team exhibits one of these characteristics, it is likely that the team will display other attributes in the model too.

The reverse is true too: If a team is negligent in one of the attributes, it will negatively impact other attributes.

Continuous Learning

Open Communication Trust and Mutual Respect

Flexible and Adaptability

Building on Differences

Shared Leadership

Effective Working Procedures

Here is the model of high performing teams, exhibiting the eight characteristics:

1.

2.

3.

4.

SENSE OF PURPOSE A HPT knows what to do, when to do it, and how to do it. There is a clarity of purpose and one that everyone is committed to. A LPT, on the other hand, is confused and unclear of its roles, responsibilities and purpose.

OPEN COMMUNICATION A HPT has open, honest and robust discussions and everyone feels they can contribute safely. A LPT has a pecking order. Some members have more say than others and it is characterised by closed channels of communication.

TRUST AND MUTUAL RESPECT The team that is high performing has high levels of trust between members. They respect each other and what they can potentially bring to the team. LPTs are riddled with mistrust and doubt.

SHARED LEADERSHIP A leader of a HPT is willing to share leadership. They are willing to defer to members of the team and use collaborative leadership practices when they are required. Leaders of LPTs are autocratic and distrust displays of initiative and shun collaborative decision-making.

FURTHER INFORMATION Tim Baker will be presenting at the 2018 AAPM Conference in Canberra.

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5.

6.

7.

8.

EFFECTIVE WORKING PROCEDURES The HPT looks for better, faster, and quicker ways to get their work done. If a procedure isn't working, they look for another way. LPTs will continue to use frustrating cumbersome methods, even when there is scope for change.

BUILDING ON DIFFERENCES HPTs value diversity. They use people's strengths and preferences to enhance results. LPTs value homogeneity.

They are suspicious of new ideas and alternative perspectives.

FLEXIBLE AND ADAPTABILITY HPTs are agile and adaptable. They focus on the end result and are open to how that goal can be achieved. LPTs are rigid and work to rules.

CONTINUOUS LEARNING HPTs are always learning. They will debrief after projects and make necessary changes from their learning. LPTs will stick stringently to the procedures manual.

Dr Tim Baker Director, WINNERS-at-WORK Pty Ltd

My Health Record Expansion

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hy should your practice care whether it is ready for opt out?

By the end of 2018 every Australian will have a My Health Record, unless they choose not to. That means that the vast majority of people you see in your practice, hospital, clinic or other setting, will have a My Health Record and most likely they will expect their healthcare providers to be using it.

The results of the opt out trials conducted in Nepean Blue Mountains and Far North Queensland showed that less than 2% of their populations chose not to have a My Health Record. While there is no guarantee this will be repeated in the expansion to the rest of Australia, it shows the uptake will be comprehensive.

Access to information One of the great benefits of being connected to the My Health Record is access to information that you may not already have access to. One example of this is the discharge summary for a patient who had an unplanned admission to hospital.

As Cairns GP, Dr Sharmila Biswas put it recently “The best thing about the My Health Record is letting me access the Discharge Summary from the public hospitals in my locality and from the city following admission.�

The opt-out period Individuals are being provided with a three month window from 16 July 2018 to 15 October 2018 to notify the Agency if they do not wish to have a My Health Record created for them. This does not mean that a patient cannot choose to opt-out at a later time should they wish to do so, or to opt-in.

During this time, patients do not need to wait to have a My Health Record and may still register if they wish to in the same way they can register now. This means practices may continue to offer assisted registration for their patients.

Following the three month opt-out period, there will be a 30 day reconciliation period to allow time for processing paper forms. These forms will be from hard to reach and hard to service communities such as Aboriginal and Torres Strait Islander communities, people in prisons and defence personnel serving overseas.

A number of options will be available for patients to opt-out.

These are being publicised in a variety of ways during the optout period. This will ensure all the necessary systems are in place to ensure those people who choose to opt-out are well supported in making their choice.

What happens after opt-out?

Record creation If an individual opts out during the three month window in 2018, a My Health Record will not be created for them.

Record creation For those who do not opt-out, a My Health Record will be created.

However it will not have any content.

Activation The My Health Record activates when it is accessed by a health provider or the individual. Two years of Medicare and PBS is added to the Record.

Cancellation An individual can cancel their My Health Record at any time.

It will be archived in accordance with legislation.

Re-activation Individuals who have opted out, or cancelled can choose to re-engage with the My Health Record system.

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A collaborative approach

General Practice Support

The Australian Digital Health Agency (the Agency) is supporting a range of education activities around the country to raise awareness of the My Health Record expansion for all healthcare providers. As well, the Agency is engaging with national and state peak health and consumer organisations, such as AAPM, to work directly with their members to understand their differing needs.

PHN engagement and education activities with 100% of general practices. Awareness and education activities include webinars, practice visits, practice support and communication material for practices and consumers.

For example, the Agency is working in partnership with AAPM to enlist a group of practice manager digital health champions and has already recruited a group of allied health digital champions. The Agency will work directly with these champions to understand their particular digital health requirements and how best to offer support.

General practice Many general practices have been digitally enabled for some time and have been successfully using not only the My Health Record but other digital tools such as telehealth and secure messaging to great effect.

Working with peak bodies Engagement with RACGP, ACCRM and AMA to support education, adoption and peer-to-peer activities, including communication and education materials with CPD points.

Registration authority AHPRA communication to all registered practitioners providing high level information around the My Health Record and upcoming expansion with links to more detailed information and support from the Agency.

Communication channels National communication strategy to provide content packs to GPs in readiness for the opt out to better understand the expansion and to support consumer questions; includes other contract channels such as DHS communication to general practitioners.

Informing your patients

The Agency continues to offer education and updates to ensure that your practice gets the most out of digital health.

From a practical perspective, the period leading up to the creation of My Health Records for all Australians is a perfect time for you to ensure your practice is prepared.

Specialist and allied health practices There are many benefits for specialist and allied health practices in using My Health Record, in particular having access to information you may not otherwise have access to, such as up to date medicines information, recent pathology results or the latest hospital discharge summary.

Whilst incentives are available for general practices to create and upload shared health summaries, specialists and allied health may reap the benefits of using the information in the My Health Record. For example, by saving time not having to call around for test results or when a patient is unable to remember their medications.

National, regional and local communication strategies targeting consumer awareness and FAQs that align with overall provider education and communication to ensure messaging that reaches general practitioners is consistent and appropriate.

Working with software vendors Close work with GP software vendors to ensure alignment and support to GPs through enhanced software functionality and support. Increased use from expansion is a core driver to supporting clinical workflows.

Tips for success • Use a team-based approach to design a workflow that works for the whole practice team.

• Design a dialogue with your staff so they know what to say to patients.

• Use the On Demand Training to ensure everyone knows how to do what they need to do. Assisted registration for receptionists or how to access or upload documents for healthcare providers.

• Add information on your new patient form/TV screens/website

Sometimes information contained in a referral has been superseded in the time taken for the patient to have an appointment. Viewing the patient’s My Health Record allows treatment to be made with access to the most recent information ensuring an increased opportunity for improved health outcomes.

• Identify patients who may benefit from a My Health Record – children, pregnant women, the elderly, patients with chronic and complex disease.

National Provider Portal Healthcare providers without access to software that automatically connects to the My Health Record system (conformant software) may use the alternative of a web-based National Provider Portal (NPP).

Healthcare providers and the organisations they work for, including as a sole healthcare provider, will need to register in the usual way, including applying for a Healthcare Provider Identifier (HPI-I) if they are not registered through AHPRA. As shown in the sample fictional record (right), the NPP provides access to a patient’s My Health Record and allows providers to view the information that is held there. Information can be printed and scanned or downloaded and saved into the practice’s local patient record.

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Sample fictional record

Quality data When patient information is being shared with other providers using data extracted from your local system, it is essential the information is up-todate and accurate. Ensuring that local clinical information systems contain quality data is key to the provision of good health care and also saves time checking which information is current. The data quality checklist shows five key areas where a practice may start ensuring information is current.

A reminder about compliance Practices are required to be able to demonstrate compliance with legislation such as the Privacy Act, My Health Records Act, Healthcare identifiers Act and My Health Records Rule, by keeping up to date records, policies and procedures about: • How the need for a healthcare provider to access the My Health Record is identified and authorised • How they are trained to access and use the My Health Record and comply with the practice’s policies and procedures • Revoking access to My Health Record such as when someone leaves the practice • These records must be auditable, updated at least annually, contain unique version numbers and dates and should also outline the practice’s security measures regarding: º Passwords º Not sharing log ins º Token security º Clinical information system access controls º Record keeping including signed agreements º Management of intellectual property A strategic approach to My Health Record There are a few simple strategies that practice managers may use to easily support uptake and understanding of the benefits of My Health Record across the practice team: • Make it a team sport, there is a role for everyone in digital health, from assisted registration and data cleansing to uploading information.

• Help all members of the team to understand the benefits: • Clinical benefits – with access to up-to-date accurate information; • Time benefits – saving time finding and getting access to information that is not in the patient’s record in your practice; • Financial benefits – from time saved that means improved use of staff time because they are not chasing the test results needed for the next patient’s consultation; • Incentive payments – for general practices that upload Shared Health Summaries.

• Make My Health Record a regular agenda item for all practice team meetings.

• Use the Agency’s On Demand Training “sandpit” to support My Health Record training.

• Set realistic targets for uploading Shared Health Summaries. Monitor the results and then raise the bar! This way uploading Shared Health Summaries becomes part of the usual work flow.

• Identify specific patient cohorts that will benefit from a My Health Record with an up-to-date Shared Health Summary.

Approaching the use of digital health and My Health Record using simple step-by-step strategies allows practice managers to seamlessly introduce digital health into the daily practice workflow.

Data Quality Checklist

1

Demographics are the contact details up-to-date?

• Double-click on the patient’s telephone number to check and update details

2

Medication List is the Current Meds list accurate?

• Right click to delete/cease medications no longer relevant [they can then be found in the Old/Past Scripts thereafter] • If none, tick No medications

3

Past History List does it contain only significant conditions that a hospital or specialist would need to know?

• Right click to edit, delete or add new • If none, tick No significant past history [PMH] box

4

Allergies have you also recorded adverse reactions?

• Double-click in allergies box and Add, Edit, Delete • If none, tick No Known Allergies/Adverse Reactions/Nil Known

5

Immunisations have immunisations been recorded?

Take your practice to the next level!

Government funded training and incentives may be available Call us today!

1800 066 128 www.practicemanagement.edu.au

Marina Fulcher Life Member FAAPM CPM Senior Clinical Reference Lead Australian Digital Health Agency

The Education & Training Company of the University of New England • RTO 6754

www.aapm.org.au | 13

Why is branding important for your practice?

A

lthough you may know you have a fantastic practice and provide an excellent service, the reality is there is also plenty of competition for patients to pick and choose from. All it takes is a quick google search, and the endless options are at their fingertips. That is why branding, and maximising your brand presence is so important to ensure you stand out and keep patients coming back and referring.

Let’s start by asking the question-what is branding?

Branding goes way beyond just a logo. When you think about your brand, you really need to think about your entire patient experience…everything from your logo, your website, your social media experiences, the way you answer the phone, to the way your staff and practitioners interact and follow up with your patients.

When you look at this broad definition of branding, it can be a bit overwhelming to think about what is involved in your brand. It helps to run through the entire patient experience and identify all its touch points, that is every time a patient or prospective patient has contact in relation to your brand.

In short, your brand is the way your patient, who is primarily also your customer, perceives you. See below reasons why your brand is important and how it can make or break the success of your practice.

7 REASONS WHY BRANDING IS IMPORTANT FOR YOUR PRACTICE: 1. Defines who you are and what you will deliver It is important to remember that your brand represents you…you are the brand, your medical practice team is the brand, your marketing materials are the brand. What do they say about your practice, and what do they say about what you’re going to deliver (promise) to your patients?

3. Helps tell your story Your full brand experience, from the visual elements like the logo to the way that your phones are answered, tell your patients about the kind of practice you are.

4. Inspires, motivates and helps direct your team A clear brand strategy provides the clarity that your team needs to be successful. It tells them how to portray your image, and how to meet your business goals.

5. Helps you connect with your patients A good brand connects with people at an emotional level, they feel good when they choose the brand. Selecting a healthcare provider of choice is often an emotional experience and having a strong brand helps people feel good at an emotional level when they engage with the practice.

6. Makes it easier to refer People love to tell others about the brands they like and respond to. People wear brands, eat brands, listen to brands, and use brands and they’re constantly telling others about the brands they love. On the flip side, you can’t tell someone about a brand you can’t remember. A strong brand is critical to generating referrals and interest.

7. Provides value to your business A strong brand will provide value to your organisation well beyond your physical assets.

Branding is highly important and being consistent with your brand and how it is conveyed is just as important. Have clear guidelines about what your practice offers and stands for – and then make sure that message gets communicated to your team and patients in everything you do.

Your brand should immediately tell a patient something about the quality or service and what to expect.

2. Differentiates you from your competitors Today more than ever, it is critical to stand apart from the crowd. Your brand is ultimately your promise to your patient. You want to create a brand that not only helps your patients identify you, but helps you create a connection with them – and ideally, you want them to choose your brand over your competitor’s. Understanding your brand positioning and identifying and leveraging how you are different from competitors is a key element in successful branding.

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Leonie Arnebark CEO, Reality Marketing

www.aapm.org.au | 15

Cloud Computing – SaaS:

Part 2 I

n Cloud Computing Part 1 we determined that for most medical clinics in Australia the relevant type of cloud computing is called “Software as a Service” (SaaS) or “…a software licensing and delivery model in which software is licensed on a subscription basis and is centrally hosted [in a public cloud infrastructure]. …sometimes referred to as "on-demand software".

Medical software vendors with SaaS offerings are recommending that practice managers ditch the so called “legacy” on-premise server-based software programs and data and move the practice data to their new SaaS model. The claimed benefits of SaaS clinical and practice management software systems compared to “legacy” software is quite a long list; “no upfront capital costs”, “no need for expensive servers”, “reduce maintenance and IT support costs”, “super-reliability”, “high data security”, “improved efficiency”, “more available”, “real time access”, “accessible by any device from anywhere (i.e. mobile and multi-location access)”, “worry free computing”, “automatic updates”, “maintenance free”, “interoperable”, “collaborate and share information with other practices”, “time saving”, “will transform healthcare”, etc Hmmm, impressive claims indeed... Fact Checking required here! Some claims are definitely overblown e.g., PCs, tablets, routers, and printers etc. still need maintenance and IT support, all of which will continue to be a cost.

Nonetheless, because SaaS developers have had to start from scratch with the latest programming tools and methodologies as the old “legacy code” can’t be used for the new browser-based SaaS products, opportunities have emerged to re-imagine everything and to incorporate many improvements and fixes, e.g.; a cleaner user interface, reduce the number of clicks for workflows, optimising for tablet and smart phone usage, etc.

Changing clinical/practice management software is not a trivial exercise however, proceeding with all due care and diligence is advised. For example, investigate the Service Level Agreements (SLAs), availability should be five “9s” (99.999% availability), other critical factors include data conversion from your “legacy” software, must have clinical and administrative features and functionality, (and nice to have features too), compare workflows, reports, billing, support for peripheral and medical devices, training, technical support, and also compare all subscription and internet costs over a 3 to 5 year period vs retaining existing “legacy” software, etc.

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Moving your practice to SaaS however necessitates meeting the big elephant in the room: It all hangs on internet availability: NO INTERNET = NO ACCESS TO THE SaaS SOFTWARE AND YOUR DATA. PERIOD. Internet connectivity is absolutely critical so reliable ‘business grade’ broadband is the minimum recommended (i.e. ADSL2+ and better). Many areas in Australia have unreliable and slow internet, and yes, even with NBN… And remember, internet outages do happen. Backhoe drivers dig up cables, telephone exchanges catch fire, telecommunications systems get hacked, downing entire networks, vehicles smash into communications cabinets on the side of the road, etc. Internet outages can be from minutes to days and weeks.

Not being able to access the SaaS and practice data may have more economic impact if the practice is say a large GP practice with many doctors and staff members than for a specialist practice with only one doctor and few staff. Compliance risks, clinical risks and any concomitant medico-legal risks must also be fully considered. GP practice managers are reminded that the RACGP 5th Edition Standards require GPs to “have all patient health information available and accessible when needed”.

If any un-availability to SaaS and data is unacceptable for your practice, I consider implementing these fail-over measures to be mandatory to at least mitigate as best as possible against the risks of internet outages: 1. Install business grade modems/routers with automatic failover to 4G mobile internet or use 4G Wi-Fi routers, complete with an active 4G SIMM card and with an adequate data account.

NB: – a) internet performance may be reduced on 4G but at least provides some level of access to your SaaS software and data. b) 4G data costs are significantly higher than standard internet data costs 2. Have available an identical and fully configured redundant modem/router ready to swap in case of failure 3. Have a separate connection to another internet provider company with modem/router configured for automatic failover to the alternate internet link (as well as failover to 4G) 4. Make sure that your clinical data hosting is compliant with Australian Privacy and Data Sovereignty requirements and fully hosted in Australia 5. Confirm that all your data will be given to you in the event you don’t continue to use the product

Four of the leading SaaS based clinical/practice management products currently on offer were reviewed: Clinic to Cloud, Gentu, MedicalDirector Helix, MediRecords. An overview from each vendor (in alphabetical order) is listed below, as well as a table providing an at-a-glance comparison.

Clinic to Cloud Clinic to Cloud is a secure, scalable clinical and practice management platform. The platform has mobile apps for doctors and powers a connected care ecosystem through which healthcare professionals can securely share relevant information with care teams.

The platform features user configurability, intuitive workflow automations and seamless integrations that are designed to save time, improve processes, optimise a practice’s operations, and reduce costs, improving its financial performance and delivering better patient experiences.

Clinic to Cloud fully integrates with Medicare Online, Defence Veterans Affairs (DVA), Eclipse,

Tyro payments and ANZ HealthPay allowing for easy claiming and verification of information to ensure all patient details are up to date and correct.

In the Clinic to Cloud platform, waiting lists or waiting rooms provide full knowledge of where the patient is in the practice. Integrated SMS messaging is supported with scheduling capabilities and e-tasks that allow staff to share information internally. Tasks can be created that are saved to the patient’s file, which creates an audit trail of patient information.

Through the patient portal, patients can register with the practice ahead of a visit and manage their checklists. After their initial

appointments they can manage their recalls and checklists. This means less paperwork to complete when they arrive, which in turn reduces the time the doctor needs to spend waiting for the documentation. The patient portal also supports document-sharing and gives patients access to critical aspects of their clinical file and financial history, thus reducing printing costs.

Other Clinic to Cloud features include automated appointments and reminders as part of its smart scheduling system, integrated speech recognition for software control and dictation, integrated document scanning, multi-tray printing, multi doctor configurability, multilocation capability and much more.

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Gentu

Helix

MediRecords

Gentu by Genie Solutions came from a vision to re-imagine a new cloud-based platform with improved administrative and clinical efficiencies through better and automated workflows, a compelling user experience for medical practitioners and to improve patient outcomes.

MedicalDirector Helix is a time-saving, cloud platform that transforms clinic and practice management and is hosted exclusively on the Microsoft Azure Australian platform across two data centres in Sydney.

MediRecords was developed from the ground up to harness the power of the cloud for GPs, Specialists, Allied Health providers, Nurses, Practice Managers and Patients managing appointments, waiting rooms, prescribing and billing, and is available as a SaaS solution for SMB’s or as a dedicated platform service for larger corporates. Hosted on Amazon Web Services Sydney data centres, and accessible in real-time from anywhere, across multiple practice locations. It is easy to switch between multiple locations from anywhere within MediRecords.

MediRecords is provided as an integrated MediRecords Product Suite or eco-system: • MediRecords: As the core product, MediRecords is a fully integrated and modern cloud based clinical and practice management solution for GPs, Specialists and Allied Health Professionals.

• MediRecords App: giving patients greater access to their health records, available on both iOS and Android, and allows providers to share information with their patients in real-time.

• MediRecords Arrivals: A self-service waiting room kiosk.

• MediRecords Appointments: 24/7 online appointment bookings.

Gentu operates exclusively on the Australian infrastructure of a major worldwide cloud provider. Practice data is protected on four fronts: physical, network, server and data encryption security. High Availability is ensured with redundancy and backups across multiple Australian data centres.

Gentu is very responsive even on lean 4G hotspot internet connectivity. An intuitive user experience enables users to get things done faster, smarter, more accurately, making work more enjoyable. Options include fully customise letterheads, letter templates, quick lists, billing sets and electronic correspondence integration. eDelivery of pathology and radiology results are supported with no additional software installation required. A mobile app is planned for the future.

Billing in Gentu is simple and efficient, automatically batching, retrieving reports and receipting payments for Medicare, DVA and Eclipse. Staff only need to interact with online claiming if exceptions occur, improving cash flow and end of day reconciliations. Gentu performs intelligent billing on the complex calculations for surgical procedures, including multiple procedure rules, calculating gaps, and assistant billing at the click of a button. Fee schedules are updated for all practices and legacy schedules are maintained. With some fee schedule updates released on a monthly basis, Gentu’s fees by service date feature removes the need for manual calculations.

Onsite implementation training is offered, as well as email and phone support, access to a knowledgebase and in-application help. Gentu is offered as a monthly subscription per billing provider with no lock in contract. A full copy of practice data will be provided at no additional cost if Gentu use is discontinued.

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Helix has a completely new interface based on the concept of three moveable “panels”; the left panel is the patient timeline or “history”, the centre panel contains the patient health summary or “present” with the right panel being the “consult” area. This is a modern, ‘clean’ look that is very intuitive to use with improved usability and more efficient workflows. Anyone familiar with using smartphone apps will ‘get it’ quickly.

The smart movement of pages for specific modules for data entry is done with just a click of a button. Helix has removed the clutter of “legacy software” and is designed and optimised for use and easy accessibility from anywhere and anytime with any device: smart phones, iPad, laptops and desktops, and on any OS including Apple MACs. Being patient centric, Helix offers clinicians in-depth consulting with access to extensive trusted healthcare sources, automatically updated drug databases, real-time health trends and medicines information. Patient insights, analysis and reporting tools are available anywhere, anytime, including drug monographs and Product Information (PI). Warning screens are combined in one screen and are prioritised by significance and are colour coded Red, Yellow, Orange and Blue. Care plans and assessments are based on smart forms. The full list of MBS items is included. Helix also fully integrates the MyHealth Record. Appointment types are very flexible. (as a sidenote, the demonstration of Helix was accessed via 4G and was very fast).

MediRecords also has a fully integrated and automated General Ledger and double entry Journal linked to Bank Accounts created in MediRecords to provide greater transparency of all financial activity.

MediRecords integrates with Medicare Online for all Bulk Billing, DVA, PCI and PCS claims, as well as Medicare ECLIPSE for Private Health Insurance Claims. In addition, MediRecords has also recently implemented sophisticated line item rules to allow rebates for multiple services, providing comprehensive Medicare billing capability.

References: 1. Cloud Computing Part 1, The Practice Manager, Issue 1 2018, pages 18, 19 2. https://en.wikipedia.org/wiki/Software as a service, accessed April 2018 3. Criterion C6.2B, RACGP Standards for general practice, 5th Edition, July 2017, page 67 4. https://www.clinictocloud.com/, accessed April 2018 5. https://www.geniesolutions.com.au/gentu/, accessed April 2018 6. https://www.medicaldirector.com/products/helix, accessed April 2018 7. https://www.medirecords.com/, accessed April 2018

Is SaaS right for your practice?

Some real options are now available in SaaS cloud based clinical and practice management solutions. Practice managers have to consider many factors to determine if a SaaS cloud-based solution is right for their practice. Internet broadband availability and reliability are critical factors in the evaluation process and the real risks of unreliable or inadequate internet or indeed complete outages may rule SaaS out for your practice in spite of some mitigating measures that can be taken such as 4G failover.

product releases. Monthly subscription pricing models are for the most part standard, though Helix is offered with some twists that may be attractive to some practices.

Careful consideration of the most suitable SaaS product is recommended to ensure best fit to your practice requirements. Happy SaaS investigating…

On the positive side, mobile access and multi location capabilities will be fantastic for some clinics. SaaS developers offer new products with re-imagined interfaces, improved workflows and have added many smart features and functionalities compared to “legacy” on-premise serverbased software. The brave new world of SaaS has also opened the way for the entrance of new vendors such as Clinic to Cloud and MediRecords which should not be a surprise as SaaS means that all developers start from scratch. Watch this space as other vendors are also planning SaaS

Miroslav Doncevic Managing Director Digital Medical Systems

SaaS Clinical/PMS comparison

✔ ✔

True SaaS cloud Specialist General Practice

✖

Coming late 2018

✔ ✔ ✔ ✔ ✔ ✔

Allied Health Integrated SMS Mobile App User Customisable templates Voice Control & Dictation All Data will be returned if usage stopped

✔ ✔ ✖ ✖ ✔ ✖

Coming 2019

✔ ✔ ✔ ✔

✔ ✖

Coming: No ECLIPSE billing Currently

✔ ✔ ✔ ✔ ✖ ✔ ✔ ✔

Coming

✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔

SNOMED CT coding

✖

Lock in contracts?

Yes 2 years minimum

No

Yes 1 year minimum

Monthly subscription plans:

Monthly subscription plans:

Option A: is billed monthly $0.40c per billed consultation

(NB: only unlimited user costs shown)

$100 per Admin user per month.

Free for Admin & clinical support staff.

Clinical @ $60 per user

$50 per Allied Health practitioner per month

Tiered pricing structure is offered for practices with multiple billing providers.

Option B: is per annum in advance, and per clinician and based on size of practice.

Costs: (inc GST)

Coming late 2018

$250 per practitioner per month.

$30 per allied health admin per month.

SMS is $0.18c per message

$330 per clinical provider per month.

ECLIPSE billing is an additional cost of $100 per practice per month for an unlimited number of providers.

SMS costs based on quantity purchased: 500+ credits: $0.22c per SMS 1000+ credits: $0.20c per SMS 2500+ credits: $0.18c per SMS

Contact Medical Director to discuss Option B SMS is $0.22c per message

No Monthly subscription plans: GP plans:

Prac. management @ $50 per user Integrated @ $95 per user

Specialist plans:

Clinical @ $75 per user Prac. management @ $65 per user Integrated @ $115 per user

Allied Health plans:

Clinical @ $35 per user Prac. management @ $25 per user Integrated @ $45 per user SMS is $0.18c per message

‘You can’t what?’

managing and avoiding pitfalls when engaging GPs Proud partner of:

A

new GP’s first day of work may bring with it a few ‘surprises’ when they drop the bombshell that they cannot perform specific duties due to personal, religious or health reasons. We outline your legal obligations and provide practical tips to help you successfully manage or avoid these surprises in your practice.

“I can’t prescribe the oral contraceptive pill for personal reasons” On her first day, Dr Smith advises the practice manager that she cannot prescribe the oral contraceptive pill for “personal reasons.” The practice manager is shocked, particularly because it was made clear during the interview that she was expected to see mothers and children.

In this situation, the practice manager should ask Dr Smith about the nature of her personal reasons. If the reasons are due to her religious beliefs, the practice should act cautiously in

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Limitations on a GP’s usual practice may also arise in the context of: • refusal to prescribe the morning after pill; • refusal to give a referral for a pregnancy termination; • refusal to prescribe S4 and S8 drugs; and • refusal to complete a conscientious objection to vaccination form.

Future tips:

making any demands on her to prescribe the oral contraceptive pill as this may be considered unlawful discrimination.

Rather than having to manage the situation when it arises, it is best to avoid the situation in the first place.

The practice should consider any practical adjustments that can be made to accommodate the situation. For example: • the practice could ask patients when they book whether the appointment is for family planning purposes (this may not be practicable in many practices); • another GP at the practice could see Dr Smith’s patients who have requested a prescription for the oral contraceptive pill (this may cause complaints from patients about the waiting time); or • the practice could have a discussion with Dr Smith about how it can best manage her refusal to prescribe the oral contraceptive pill (for example, Dr Smith may be agreeable to doing visits to retirement villages as the main part of her practice).

A practice could: • Consider amending the GP position description to specify that prescribing the oral contraceptive pill is a requirement of the position.

• Specify the position requirements (including, for example, the requirement to prescribe the oral contraceptive pill) at the interview and ask if “there are any issues with prescribing.”

“I’m pregnant and I can’t see kids” A few months later, Dr Wang commences employment at the practice on a part-time basis – and has a surprise of her own in store.

When she first arrives, she advises the practice manager that she is 18 weeks pregnant and non-parvo virus B19 immune. Therefore, she is unable to see sick children who might be contagious for the next six weeks.

The practice manager takes the immediate step of making a note in the booking system to ensure children are not booked in to see Dr Wang. However, she cannot guarantee that other patients won’t bring their children with them.

The practice then needs to keep the following issues in mind: Discrimination laws It’s generally unlawful for an employer or a supervisor to discriminate against an employee on the grounds of pregnancy or disability. The practice cannot dismiss Dr Wang because she is pregnant or has not previously advised them of her pregnancy.

Workplace health and safety obligations The practice has an obligation (under legislation, common law and the contract) to ensure Dr Wang’s health and safety at work.

This obligation may extend to the safety of the foetus.

Transfer to a safe job A pregnant employee has a right to transfer to a safe job in certain circumstances. If no safe job can be found, the employee is entitled to unpaid leave.

In this case, the practice offered Dr Wang the opportunity to be absent during the period of risk and made it clear that it’s her choice, and their way of supporting her. Dr Wang agreed

and a locum was brought in to cover that period.

If Dr Wang chose to continue working, the practice would need to proceed in light of medical advice from her treating doctor. A practice should not make its own clinical assessment of the situation.

“I can’t employ a female GP ever again!”

Understandably, the practice is unhappy about the situations that have transpired with the two female GPs and is tempted to refuse to employ female GPs to avoid potential problems in the future. The practice runs the risk of a discrimination claim if it decides not to employ a GP because she is female.

Also, consider the benefits to patients of having female GPs in the practice.

FURTHER INFORMATION Visit Avant’s website: avant.org.au/mlas/ or call Avant’s Medico-legal Advisory Service (MLAS) on 1800 128 268 for expert advice, 24/7 in emergencies.

Sonya Black LLB, B.Com, Special Counsel – Employment Avant Law, QLD

Hassle-free patient feedback for your accreditation Practice accreditation is stressful and occupies the valuable time of busy practice staff. Let us lighten the load and help you improve the service you provide your patients.

We can co-ordinate and help you complete the patient feedback component of your practice accreditation. Insync’s survey tool and method are approved by RACGP. Insync is a leader in healthcare patient experience and engagement research. We’ve been delivering patient satisfaction surveys for over 20 years.

To find out more, contact our team on: 1800 143 733 vop@insyncsurveys.com.au www.insyncsurveys.com.au/vop

AAPM 2017 National Salary Survey:

Employment Status, Allowances and Benefits Practice manager profile: Employment Status and Allowances and Benefits

T

his is the third report based on the 2017 AAPM National Survey of Practice Managers conducted on behalf of AAPM by Insync surveys.

The previous reports have focussed on an overview of the surveys, qualifications, practice type, size and salaries or salary ranges. This report looks at employment conditions that might influence salaries and allowances and benefits that may be received by practice managers in addition to a standard salary.

This report focuses on conditions that may influence salary such as a detailed job description, staff reviews, job title, and employment status, and the latter part of the report looks at benefits that are received or could be received by practice managers in addition to salary and expenses that could be recovered by practice managers.

The approach is similar to previous articles – the suggestion is that each practice manager reading this article compares their own conditions or employment and allowances with the figures reported by the respondents.

Job description documented by staff It would be expected that the detailed job description for a practice manager is standardised and this is the obvious starting point for identification of responsibilities and tasks of the practice manager.

The last report in this series looks at what are called Core Responsibilities which are documented by AAPM and seen as essential for effective and efficient practice managers. Perhaps it is therefore surprising that the survey indicated that 91.1% of those responding had a detailed job description. This has increased from 86.7% in the 2015 survey Practice managers who currently do not have a detailed job description may wish to document their work in this way and have the job description approved by their employers. The AAPM Core Principles allow practices to determine the Core Responsibilities for the Practice Manager and the specific tasks involved for each.

Staff performance reviews documented This can be seen as a somewhat controversial issue and there is a lot of debate regarding the value and effectiveness of performance reviews.

However, for practice managers who are serious about making a strong contribution to practice development, staff reviews – not only for the practice manager but also for other staff in the practice –should be seen as an opportunity to improve outcomes for all stakeholders.

22 | www.aapm.org.au

There is a slight decrease in the numbers responding who indicated that staff performance reviews were in place in their practice. It is now 49.5% down from 52% of the respondents in the 2015 Survey who have performance reviews. A positive outcome of this article could be for practice managers to do some homework on staff performance reviews. Many examples and options exist, and practice managers could determine the extent these can be applied to their own practice.

Staff performance reviews need to be positive. If they are approached in such a way, they can have a very significant influence on practice management performance.

Job Title and Employment Status These two are linked here because they are to some extent related, and they can have a significant influence on salary levels. As might be expected, the majority of respondents to the survey are classified as “practice managers”. In spite of this, some 28% of those responding had other job titles – business manager, administration manager, general manager, nurse manager for instance. For example, almost 20 % of participants have the title of business manager, general manager or CEO. This is an increasing trend as practice structure and size changes. Some might argue that the title is not significant or relevant whereas others might argue that it is important to have a job title that reflects the work being undertaken by the manager. Think about your own job title and decide whether there should be a change implemented in the practice.

There is also a relationship between the job title and the salary The second part of the exercise here is employment status – 71% indicated that the managers were employed full time, with 24.1% part time. A small number of participants either work on a casual basis or as practice consultants. Obviously, this employment status will have an impact on salary levels and those reading this article might like to give some thought to whether their own employment status is an important factor in determining salary level. Of course, there are likely to be many factors which would influence employment status – not everyone acting as a manager can operate on a full-time basis for family or other personal reasons. Flexibility of working hours is also becoming more important to some respondents. Those involved with part time or casual work need to consider the proportion of the time that is being allocated to management tasks and whether this is in the interests of the practice.

Employment Full-Time Part-Time Casual Consultant Contract

2015 (%) 69.30% 26.60% 1.80% 1.40% 0.80%

2017 (%) 71% 24.10% 2.70% 1.40% 0.80%

Benefits other than salary and expenses recovered It is interesting to see changing trends in the benefits received by practice managers and staff of practices. Superannuation at 9.5 % is compulsory but only 7.9% of those responding indicated that superannuation available to them was higher than 9.5% and this figure has now been declining since 2009. Similarly, 13 % indicated that bonuses based on performance were available and this is another declining trend. The payment of bonuses has more than halved since the 2013 survey. Other benefits included car, mobile, laptops, iPad percentage of profit and time off for personal development.

Benefits Working from home Superannuation - more than 9% Bonus paid on performance Car Phone/Mobile Laptop/iPad Percentage of profit Conference Care Bonuses Time off for personal development Flexi-Time Additional leave Other, Please Specify

2015 (%) – 17.20% 23.50% 12.70% 39.30% 30.80% 9.20% – – – 67.80% – – 12.90%

2017 (%) 35.80% 7.90% 13% 8.30% 27.60% 25.20% 3.90% 52% 2% 19.90% 51.40% 36.20% 11.80% 6.30%

Note: responses may not add up to 100% as respondents could select more than one option

The profile of benefits received is changing. In 2017, new benefits such as working from home (35.8%) and flexi-time (36.2%) were added in as options, and a high percentage of respondents indicate having access to these benefits. Conference (52%), phone/mobile (27.6%) and laptop/ iPad (25.2%) are also common benefits. Opportunity to recover expenses appears to be slightly down on previous years, except for when it comes to professional development costs, which have remained relatively stable.

Major items of expenses only are discussed here. One that is most common is a uniform and there certainly are real advantages in having standard uniforms attractively designed. Uniforms have become a very important part of the practice identification and are almost standard practice today.

Other expenses recovered which could be significant to the practice manager include phones, either home or mobile, car allowance, costs associated with professional indemnity, and costs associated with internet. There was a minor group of practice managers who received an allowance for entertainment and health fund premiums for dental or medical expenses.

In considering these expenses recovered, practice managers should give some thought to the impact of certain expenses on the image of the practice and impact on patients. It would perhaps be an interesting exercise for practice managers to consider factors influencing in a positive way patient attitudes to the practice and the extent to which this might influence expenses. For example, business cards might be seen as an important innovation and signage in general, including names on uniforms or just name tags.

In today’s world, Professional indemnity costs for the practice manager are often paid by the practice and are a very important cost/benefit for both the practice and the practice manager.

The full Report of the AAPM 2017 National Salary Survey includes a detailed breakdown of salaries, benefits and allowances for practice managers and of the salaries for all other practice staff including enrolled nurses, registered nurses, clinical assistants, receptionists and administrative assistants. The full report is available for purchase from the AAPM Shop.

Our next article looks at the link between practice fees, billing and salaries as well as the link between the core principles of practice managers and salary levels.

Professional Development Costs Recovered Professional Development Training Membership of professional organisation Subscription to journals Conference expenses Other

2015 (%) 82.80% 73.40% 18.70% 66.80% 3.20%

2017 (%) 48.30% 57.30% 16.10% 65.90% 3.50%

Note: responses may not add up to 100% as respondents could select more than one option

Colleen Sullivan OAM FAAPM Life Member

www.aapm.org.au | 23

Supporting GPs and their patients with chronic conditions O

ne of the biggest challenges the Australian health system faces today is the rising number of Australians living with chronic disease and the associated demand on healthcare. Half of Australians have at least one chronic condition, and the four leading chronic conditions account for over 1/3 of health expenditure in Australia.

General practitioners and nurses are often at the forefront of caring for these patients, however it can be difficult to integrate chronic condition management into your practice while you juggle a growing workload, competing demands on your time and lack of funding.

The CareFirst program has been specially designed to address these challenges by providing your practice with additional support, training, resources and revenue to support individuals living with a chronic condition in one of five key disease areas: chronic heart failure, chronic obstructive pulmonary disease, osteoarthritis, Type 2 diabetes and cardiovascular disease. CareFirst is a six month secondary prevention program delivered within existing primary care clinical practice without disrupting existing workflow and processes.

Here’s how it works: • A dedicated team member works with your practice to identify suitable patients, coordinate program, facilitate on-boarding, training and resources, and provide ongoing support for your team.

• We provide a two-day training course in HealthChange® Australia behaviour change methodology (17.5 CPD points) to your practice nurses at no cost, equipping them with the knowledge, resources and confidence to successfully deliver CareFirst within your own practice.

• Patients who opt into CareFirst receive: º A new or updated health plan º A series of health coaching sessions delivered by your endorsed practice nurses º Phone support and access to a health advice line º Health education and disease-specific materials and resources.

Results to date CareFirst was initially piloted in Qld in 2015, involved 106 participants and achieved positive outcomes, including improvements in blood pressure, physical activity, waist circumference, and quality of life. On average, participants with diabetes experienced improvements in their blood glucose readings, and also decreased their risk of hospitalisation.

On this basis, CareFirst was expanded to all States across Australia, and we continue to collect data to monitor program outcomes. Because most participants have a lifestyle related goal, our data collection focuses on these areas of potential change. The program uses a clinical and lifestyle indicators assessment to collect a range of relevant measures at the beginning and end of the program.

As at mid-April 2018, 1205 participants have graduated from the program* and their results are below: • The number of people engaging in 150 minutes or more of physical activity per week increased from 54% at baseline to 68% at graduation.

• 9 out of 41 smokers successfully quit by the end of the program.

• 45% of participants lost weight and 29% maintained their weight. The average weight loss was 3.8kgs. Weight change of less than 1kg in either direction is excluded.

• 44% of participants reduced their waist circumference, losing an average of 4.8cms. Waist measurement change of less than 1cm in either direction is excluded.

• The number of graduates confident in taking a proactive approach to managing their health doubled from 21% at baseline to 48% at graduation**.

What our practices are saying We’re proud to be working with over 2500 GP practices across Australia to support over 15,000 participants.

Here’s what some of our practice partners have to say: I am really getting to know my patients on this program …I love the time it gives me to work with them.

A comment from a Practice Nurse delivering CareFirst HCM (Health Change Methodology) will be useful in all aspects of life and makes us think about how we interact with our patients for the better.

A comment from a Practice Nurse after CareFirst training I am inspired by CareComplete… I also reviewed PN training content and glad that the program offers the complementary training for my clinical staff which will refresh their knowledge in Chronic Disease management.

A GP practice in NSW

FURTHER INFORMATION CareFirst is available across most states and territories. For more information or to chat to one of our friendly health professionals: Visit: www.carecomplete.com.au Email: care.programs@carecomplete.com.au Call: 1300 729 684

Footnotes: *While 942 people have graduated, complete data sets vary for each indicator ranging from 59% for waist circumference to 78% for weight. **This is based on PAM (Patient Activation Measure) results – the PAM survey is a widely used measure of patient activation and reflects an individuals knowledge, skills and confidence to manage their own health care.

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You can help people with diabetes stay on top of their condition

Monitoring

Eating Well

Services Support Information Products

Keeping Healthy

Taking Medication

Self-Care

Just five minutes of a GPs time can give a person with diabetes a lifetime of help and support.

The National Diabetes Services Scheme (NDSS) offers a huge range of information, support and education for people with diabetes.

Register a person with diabetes with the NDSS today and give them the basic building blocks they need to keep healthy and stay on top of their condition.

Go to ndss.com.au for more information.

ndss.com.au | NDSS Helpline 1300 136 588 The National Diabetes Services Scheme is an initiative of the Australian Government administered with the assistance of Diabetes Australia.

Cloud Security A

ll of the following have happened in the 24 hours prior to writing this article.

1. My two-year-old had a mega-tantrum at being refused access to Peppa Pig on YouTube 2. A hasty exchange was had with my sister on Whatsapp to ask her to arrange a present I should have bought weeks ago 3. I used my mobile phone to pay my sister and keep her from blowing her lid 4. I collected an abundance of strange looks at traffic lights singing along to the personalised playlist Spotify had created for me 5. My son video called his grandparents in the UK, for free 6. When my partner and I finally got to sit down for the night we spent half an hour arguing over Netflix before purchasing a movie through Foxtel Like it or loathe it, our lives are already online.

Without giving too much away, I am just about old enough to remember a life without the internet‌ but mine will be the last generation that does.

Millennials are the first digitally native generation. They were born and raised on the convenience and anywhere, anytime access of life online. And like it or not, millennials matter. In fact, they have just overtaken Generation X as the largest group in the Australian workforce.

That puts pressure on businesses.

Cloud computing is not new and we all know the efficiency gains and convenience it delivers. But more fundamentally, your next generation of clients, and staff, are simply going to expect that as many manual processes as possible are conducted online.

Failure to adopt and embrace cloud computing, is going to increasingly impact how desirable your practice is to potential new patients and employees.

So if the risks of not moving online are so clear, why is everyone not already there?

So how do you balance the demands of market forces with the fear of online security?

The first step is to understand one simple truth – The majority of online security breaches are the users fault. In fact, predictions indicate that by 2022, at least 95% of cloud security failures will be user error.

Businesses who implement appropriate cloud visibility and control tools are already experiencing a third fewer security failures than those using offline methods.

Once you understand that in the vast majority of cases you have control over online security it becomes much easier to implement strategies to help protect yourself and your clients: 1. Regular Security and data assessments Conduct periodic reviews of data usage and storage strategies.

2. Technical security Implement technical protection measures like a business grade firewall, anti-malware, anti-virus and email filtering software, 2 Factor Authentication, data encryption, back up and a disaster recovery plan.

3. Physical security Ensure employees require key cards to access data, that visitor logs are kept, and that access to data is controlled.

4. Admin security Align access to data with an individuals role and an understanding of what they need access to and when. Someone accessing data from a work laptop in the office may not need the same level of access from their phone in a cafe.

5. Employee training and education Ensure that employees understand how data is protected, why and what their roles and responsibilities are in that protection. Match levels of training with the level of access required.

You cannot prevent the wheels of progress from turning. You cannot reverse the flow of our lives online. And you definitely cannot change the way a millennial chooses to live and work.

What you can do is ensure that as you adapt to these changes you maintain the same vigilance you would over data kept in physical files in your office.

Control your security mindset and you can, to a large extent, control the risk.

Well, for some at least, there are still some concerns over online security.

Preventing and responding to identity crime in Australia in 2016 cost $2.6 billion. Around 5% of Australians experience financial loss as a result of one of these crimes, while nearly 10% experienced misuse with relation to their personal data.

With recent developments at Facebook, it feels like the 2 billion or so users are finally waking up to the realities of why their favourite social media platforms are free and how their personal data is being shared, collected and commoditized.

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MYOB provides secure online cloud solutions for your practice. For more information, visit myob.com.au or call 1300 730 921

Paul Tancell Content and Campaign Marketing Manager Client and Partner Division, MYOB

1300 865 977 WWW.DMS-IT.COM.AU DIGITAL MEDICAL SYSTEMS CONFIDENT IT

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As a hands on GP principal and Manager with experience in using computers innovatively in every day clinical and management applications since 1987, including 5 different clinical IT applications, I am confident in our business continuity because of the DMS real time monitoring and proactive management of our IT systems.

I can sleep at night not worrying about IT disasters and can take leave confident that our IT is in the best hands. That’s why I choose DMS.” Dr Wes Jame Berwick Medical Centre

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What can health care services do about family violence?

F

amily violence is a significant social and health problem in Australia contributing to more death, disability and illness in women aged 15 to 44 than any other preventable risk factor. Every three hours a woman is admitted to a hospital due to family violence and on average, one woman per week is killed by a current or former intimate partner.

Because family violence is so common and has such devastating consequences, we all have a responsibility to not tolerate or make excuses for family violence and support those who are impacted by it.

Health care services have an important role to play by providing safe environments where people can talk about family violence and seek assistance. A visit to the GPs office may be the first and only chance someone might have to get help. It is important that these services know how to safely identify and respond to family violence.

What is family violence?

Family violence encompasses abusive, threatening and controlling behaviours occurring in family (or family-like) relationships.

What differentiates family violence from interpersonal conflict is that the abusive behaviour is patterned and ongoing, limits a person’s own decision-making and choices, and causes them to feel unsafe and afraid.

Family violence constitutes a range of behaviours, including: • Sexual, reproductive or physical violence • Verbal, emotional or psychological abuse • Financial abuse or coercion • Technology-facilitated abuse • Immigration-related abuse • Isolation or social violence Family violence includes child abuse that directly impacts a child’s safety as well as a child being witness to violence or aware of the effects. A child might not see acts of violence but they might see damage in the house or a distressed parent. This can impact a child’s physical, emotional and developmental wellbeing.

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As the statistics show, there are strong linkages between gender inequality and family violence. Indeed, family violence occurs most often in intimate partner relationships and is primarily perpetrated by men against women and children.

At the same time, it is important to know that anyone can be impacted by family violence and it can occur in other relationships, including as Elder Abuse, in carer relationships (such as paid carers for persons with disabilities), in gender-diverse and samesex relationships, and in cultural family groups, such as Aboriginal kinship networks.

What are the signs to look for?

In health care services, you might see signs of family violence for adult or child victims such as: • unusual delays in seeking medical attention • physical injuries (including repeated injuries) • symptoms of acquired brain injury • signs of emotional abuse, depression and anxiety • signs of sexual or reproductive abuse (such as miscarriages, pelvic pain, restrictions from using contraceptives) • eating and sleeping disorders • substance or medication misuse You might also be aware of someone who is possibly using family violence. The patient might be evasive when answering questions or appears uncomfortable in the presence of their partner/family member. Other signs include the partner/family member: • doing all the talking and explaining for the patient • excessively monitoring or being overly attentive toward the patient • discouraging treatment or making decisions on behalf of the patient What can I do as a Practice Manager?

Getting started with addressing family violence can seem like a daunting task, however there are some key steps you can take and plenty of helpful resources available.

3. Prioritise training and professional development on family violence Professional development and training about family violence helps build confidence to understand and respond to patient safety. Training should be delivered by a registered training provider with expertise on family violence.

Look for courses that provide: • an overview of the different types of family violence • information about how to identify and inquire about signs and risk factors • resources for creating basic safety plans and making referrals to family violence services • guidance for documenting family violence disclosures and the actions taken to respond Introductory professional development resources are available through 1 800 RESPECT, https://www.1800respect.org.au/professionals/ Nationally recognised training is available through DV-Alert. http://www.dvalert.org.au/ 4. Set up family violence policies and procedures

1. Take a whole of organisation approach When addressing family violence in a professional service, it is important to think broadly and take a whole of organisation approach. Participating in a training session or making one person the ‘go-to’ expert on family violence is not enough to create a safe and sustainable family violence responsive service.

Taking a holistic, organisational view considers how family violence interacts with all parts of the service: patients, staff, the physical environment, policies and procedures, and professional development.

There are resources available for health care services to support an organisational approach to addressing family violence: Abuse and violence: working with our patients in general practice, 4th edition, (White Book) https://www.racgp.org.au/your-practice/guidelines/whitebook/ The White Book is an excellent resource developed by GPs and family violence experts for clinical health care settings. It covers a range of topics and provides tools and resources for implementing new policies and procedures.

Strengthening Hospitals Responses to Family Violence https://haveyoursay.thewomens.org.au/shrfv-project SHRFV is a Victorian initiative resulting from the Royal Commission into Family Violence. Aimed at hospitals, this program provides open source materials that can be adapted to other health care settings.

As mentioned above, the White Book and the SHRFV resources provide information to develop family violence policies and procedures in health care services.

Typically, such policies and procedures include the following components: • Definition of family violence and key risk factors • Statements promoting zero tolerance of family violence and prioritising victim safety • Expectations that all staff and managers are trained in identifying, responding and making referrals for family violence • Procedural steps such as: º routinely and sensitively enquiring about family violence with patients on their own (not in the presence of a partner or other family members) and where applicable, using professional interpreters (foreign language or Auslan) º identifying risks and undertaking basic safety planning º making referrals and a plan to follow up with the patient º factually documenting the disclosure, related medical/health issues and actions taken º debriefing family violence matters with a manager and having access to employee assistance counseling for further support 5. Implement a workplace family violence leave policy for staff Many victims of family violence worry about losing their jobs and being financially disadvantaged because dealing with the impacts of family violence can result in absences to recover and seek support.

Because family violence is so widespread, employers are increasingly implementing policies to ensure that staff know it is safe to disclose family violence and will be supported with paid leave to seek help, implement a safety plan and attend appointments.

2. Get connected to the family violence service system It’s important that you know about family violence services to develop an organisational approach and make appropriate referrals.

FURTHER INFORMATION 1 800 RESPECT (1 800 737 732) is the national sexual assault, domestic and family violence counselling and information referral service. https:// www.1800respect.org.au/ There are a range of specialist family violence services across local areas and regions that provide crisis and outreach support. 1 800 RESPECT provides information about local services in your state. https:// www.1800respect.org.au/services//.

You can also check this directory by Domestic Violence Resource Centre Victoria. https://www.dvrcv.org.au/talk-someone/services-other-states

Advice about family violence leave entitlements can be found at: http://www.dvworkaware.org/policy/

Erin Davis Policy Advisor Domestic Violence Victoria

www.aapm.org.au | 29

How to Get the Best Deal!

Negotiation Tips and Tricks T

he classic Hollywood one-liner you will all be familiar with is, “we do not negotiate with terrorists!”. Unfortunately, the reality of that statement means that you have to negotiate with everyone else! In day to day business, negotiation is unavoidable and critical. Therefore, in managing a practice, it is essential that you understand how to negotiate and how to negotiate well.

There is no doubt, negotiations can be tricky. On the one hand, you are unlikely to be looking to ruin a business relationship, however, on the other, you don’t want to be stuck fulfilling a contract or agreement that is not satisfactory to you in one way or another. We have set out below some useful tips and tricks that you may want to consider implementing before you engage in your next negotiated outcome: 1. Be Prepared: Knowledge is power and you should be thoroughly ready each time you negotiate. The more you are armed with, the more likely you will be able to persuade the other side. Do your research on the topic or areas relevant to your negotiation. For example, you should know what the average price of a product or service is prior to negotiating the specifics of your contract with a third party supplier. That way, if the other side tries to offer you an inflated price or include something below the industry standard, you will have a robust counter argument.

2. Win-Win Outcomes: It is a common misconception in a negotiation that one side is the “winner” and the other is the “loser”. Heading into a negotiation with this mindset is unlikely to foster the best outcome for either party. Instead, try to consider an outcome that is mutually beneficial for everyone involved. That way, there is more likelihood of it being accepted. One party may leave the negotiation with a more favorable outcome, however, if all parties gain more from the outcome of the negotiation, a win-win is usually achieved. Be creative about the results. Is there a non-monetary compromise you can request or give to the other side which could be used in formulating a win-win solution?

Always try to enlarge the pie rather than divide it up.

3. Be Willing to Walk Away and Mean It: It is essential in any negotiation to have the ability to walk away when the offers are at a point where the outcome would be too unfavourable for you to proceed. Before you start negotiating, establish what Harvard professors Roger Fisher and William Ury call the Best Alternative to a Negotiated Agreement (or BATNA found in the following diagram). This means establishing the most advantageous alternative course of action a party can take if negotiations fail and an agreement can not be reached. In other words, this is the last and final offer you will accept before the offers become so unfavourable that it is better for you to walk away from the negotiation entirely. If the other side does not accept that last and final offer (your baseline), it is important that you walk away and feel satisfied to do this. There is always another option open to you and keeping that in mind when you negotiate will often allow you to improve the quality of the deal you strike.

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ZOPA=Zone of Possible Agreement The above diagram was taken from an article written by Mary Russell and found on the following website: http://stockoptioncounsel.com/blog/negotiation-rhythms-2/2012/12/30

4. Don’t Act Like a Bully: A common misconception is that behaving aggressively and in a bullish manner increases your power and your results in a negotiation, however, instead, the research suggests that behaving like a bully actually reduces your skills in negotiation. It has the effect of blocking your ability to see, understand and appreciate the other person’s point of view and, therefore, decreases your chance of reaching a mutually beneficial outcome. Instead, convey professionalism, courtesy and always try to respect the other person’s point of view, even if you don’t agree with it. Finally, if you do encounter a bully on the other side in any negotiation, it is best that you rise above their level.

FURTHER INFORMATION Please contact Meghan Warren or Stewart Davis of Burke & Associates Lawyers on mwarren@burkes-law.com or (03) 9822 8588 for further assistance on the issues discussed in this article.

Meghan Warren Principal Burke & Associates Lawyers

Stewart Davis Lawyer Burke & Associates Lawyers

A Practice Manager’s

Year End Checklist

RECONCILIATION REQUIRED AS AT 30 JUNE:

Bank Accounts Credit Cards Receivables (Debtors) Payables (Creditors) GST/BAS Payroll Liabilities YEAR END PAYROLL & SUPERANNUATION:

Pay all outstanding super for employees before 29 June 2018 Calculate any employee bonuses payable Print Payroll Summary Print Superannuation Summary Reconcile Profit & Loss to Payroll Reports Print PAYG Payment Summaries - Due to Employees by 14 July 2018

30

June 2018 is fast approaching so it’s time to review your records and start getting organised! Here is what you need to know to properly prepare.

Running a Medical Practice you need to stay organised, we have put together a list of “To Do’s” to assist you as a Practice Manager

Send Payroll File to ATO (EMPDUPE) or via Xero - Due by 14 August 2018 STOCK/INVENTORY:

Complete stock take at 30 June (if applicable) Make stock adjustments

What’s New for FY2018?

Print Stock Valuation Summary Report (if applicable)

• Rental Inspections for Investment Properties are no longer tax deductible • For NSW Small Businesses, consider whether your insurance policies (car & indemnity) are due for renewal you can save on stamp duty!

• From 1 July 2018, Single Touch Payroll reporting starts for Employers with more than 20 staff. Will your computer software allow you to comply with these measures? The lead up to 30 June is also a great time to consider if your tax structure is the most efficient and effective for you.

Contact Cutcher & Neale’s Specialist Medical Services Division to discuss how we can help you.

Write off obsolete stock on hand REVIEW THE FOLLOWING ACCOUNTS TO ENSURE EXPLANATIONS ARE CLEAR:

Entertainment Fines Insurance (i.e. Public Liability, Workers Compensation, Business) Legal Fees Plant & Equipment / Low Cost Assets Repairs & Maintenance

FURTHER INFORMATION:

Travel Expenses

Visit www.cutcher.com.au

Review Receivables for any Bad Debts to write off Clear the Practice Clearing Account and ensure all Doctor Payments are made by 29 June 2018 Jarrod Bramble Partner Specialist Medical Services, Cutcher & Neale

Review Depreciation schedule for obsolete Plant and Equipment and advise write off Review rental agreements and ensure that annual rent reviews have occurred Print a snapshot of all Practice loan and bank account balances at 30 June 2018

www.aapm.org.au | 31

Fellowship Case Study - Heather Farlow A case study is a description of a real-life problem or situation which requires you to introduce and analyse the main issues involved. These issues need to be discussed and related to your research on the topic, conclusions made about the situation and how you have responded to the situation.

Heather Farlow attained her AAPM Fellowship in 2017, submitting three case studies for approval.

Heather has kindly agreed to share one of these here to show that we all have many situations in our own daily practice lives that could form the basis of a great case study.

Case Study:

“Choosing and changing the practice IT services” Introduction:

Discussion:

The purpose of this case study is to explain the process undertaken to select a preferred Practice IT service provider to replace the current provider, ensure Internet security is met and implement upgrades of our current IT needs and existing server set up.

After meeting with the directors of the practice and bringing to their attention issues regarding how their current IT service was structured, I provided them with a copy of the RACGP Computer and Information security policy book - a requirement for accreditation purposes -and an example of how their Network system should look. We all agreed it was critical to find and appoint a new IT service provider.

Description: We are a very large medical practice situated in the inner-city Sydney suburb of Darlinghurst. When I joined the practice in May 2016, they had an IT provider who had been servicing them for five years. I had previously worked at a large medical practice where there was a close relationship with the IT service provider. Together we regularly strategized over implementing new systems and upgrading the old. We provided the principal with a projected forecast on planning for future needs regarding updates, new hardware such as programs to facilitate downloads from other providers in line with being a paperless practice, and provision for the pending eHealth integration.

It soon became apparent that our current IT provider was not used to having regular contact or communication from a manager. They preferred to work ‘autonomously’ and held control of protocols, passwords, logins for our server’s hosting. They were slow in responding to calls when our machinery failed or broke down, which was extremely frustrating and disruptive to an extremely busy practice. It is essential for the Practice Manager to be up to date with how the practice IT services operate, understand how the current system is set up, who provides firewall security and antivirus protection, and also be able to perform basic skills in case of emergencies, if a server were to crash or go off line.

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It was also agreed there were certain points regarding our current system we needed addressed when undertaking the process to select a new IT provider for the practice.

They were that the preferred provider would: • have experience with implementing and maintaining systems to the correct standards of a medical practice, similar to our size.

• be able to conduct a survey of our current system, server, back up, antivirus and all other hardware and assess order of upgrade, and/ or renewal.

• provide a structured projected plan for works needed over a 6-12 month period in line with financial budgeting for the practice.

• have access to external providers for Internet services and telephone providers if required for change over or upgrade.

• include set up costs in their initial plan for services to be provided to our practice.

• provide details of ongoing service provider monthly retainer costs, if applicable.

• provide updated IT structure in line with accreditation needs.

Implementation: I contacted the IT provider for my previous practice and this company put together recommendations for us. They included firmer security protection, an upgrade of our server and email-hosting, migration to the cloud for emails and backups, and further portable backup systems for our clinical data. It was advised that our current set up was ‘old technology’ and that the upgrade would also help our programs operate more efficiently, reducing unexpected system crashes.

By July 2016 the proposal from the chosen IT provider had been received, reviewed and accepted as a result of my meeting with the directors. By August 2016 they were onsite preparing for the first part of our projected works - the decommission of our discontinued/out of date server and upgrading to a new current operating system. This was a very big process due the size of our practice. It was also discovered that our current Internet provider’s plan was insufficient, so this was also of high priority as high-speed Internet service is an integral part of having an efficient fast working server. The new IT team were conscious that this and other areas were a top priority in line with our impending accreditation cycle and associated needs of compliance.

supported in providing up to date services in an effort to make their days run smoother. They have less interruptions, so it is less stressful for them and their patients.

Conclusion: I believe that the introduction and implementation of a new IT service provider for this location has proved to be most successful. All practices should be aware of the importance of up-to-date operating systems, regular upgrades and maintenance of these, and a highly experienced practice manager who can provide immediate solutions for every day issues if and when they may arise. I look forward to working closely with our new IT service provider and being part of the implementation of future changes when and where needed.

This new provider has become a part of our team. They address our projected forecast business planning needs into the future and provide valuable support to each team member of the practice.

In November 2016 we successfully had our new system up and running on target. The staff were grateful that they could work more smoothly with increased internet speed and capacity to open patients’ files, etc, much faster, thus showing the new systems in place were reliable and effective. We had less ‘down time’ with system or program crashes and I was able to perform quick fixes in times of emergencies, something the practice and staff had not previously experienced.

Moving well into 2017 and having implemented new systems and new upgraded hardware, the general consensus from our doctors is that they feel privileged to be working in a practice which is continually

Heather Farlow AAPM Fellow and Certified Practice Manager

Do you want recognition for your experience, qualifications and professional development in Practice Management?

Take the next step on your career pathway and become a Certified Practice Manager!

To find out how, visit www.aapm.org.au

How to be more persuasive L

et’s say you want to initiate a change at the Practice. A new phone system. New shelving. A change in how you re-order supplies. A new website. How can you create a convincing ‘argument’ to senior management? The Doctors? Let me explain a wonderful strategy with this story.

How does that statement sound to you? Is it good? Is it convincing? Does it sell the idea to them? 20 minutes is a great amount of time that can be saved everyday. Very beneficial. It could go into improving customer service or of course increasing revenue.

Last year I spoke at a large International Association Congress for consulting engineers. I was asked to present ‘A Global Shift In Customer Services’ The audience was the senior leaders of Engineering firms. CEO’s. Managing Directors, Principals..

Firm Size

As you would, I conducted a lot of research beforehand, and found several problems effecting the industry. A significant problem currently for engineering firms is the quantity of work on hand combined with a shortage of qualified staff.

Income/Profit

3000

$27,301,887

1000

$10,598,444

100

One of the points I wanted to make was how they could easily improve productivity. The statement I wanted to say was this: “If you have staff trained on email shortcuts they can free up at least 20 minutes a day”.

$2,042,071

11

$129,911

20 Minutes a Day; 45 Week Working Year Billable Hour Increase Principal

Productivity Increase

Engineer

Admin Staff

Firm Size

Fee

Staff

74 Hours

Fee

Staff

74 Hours

Fee

Staff

74 Hours

11

$290

2

$42,920

$160

7

$82,880

$50k

2

$4,111

200

$290

16

$343,360

$160

140

$1,657,600

$50k

20

$41,111

1000

$290

100

$2,146,000

$160

700

$8,288,000

$50k

80

$164,444

3000

$290

200

$4,292,000

$160

1900

$22,496,000

$50k

250

$513,887

34 | www.aapm.org.au

1. 1-2 hrs per 2 weeks time freed = $24 salary; = 51*$24*2 = +$2448 2. 1/2 -1 hr Supplier help = 51*3/4*$24 = +$1632 3. $8000-$10,000 less tied in stock = +$9000 4. Free storage fittings +$3,000 5. Freed space = two consult rooms = 10m appts *51*$55 = +$28,050

Fluff Walks Money Talks $2,448 $1,632 $9,000 $3,000 $28,050

$44,130

It’s not a good statement. It’s fluffy.

How you can present it to the Management is this way:

I’d like to introduce a concept to you that I call Fluff walks. Money talks.

These are busy, bottom line individuals. What really does 20 minutes mean anyway?

• Quantify the number of hours per week per nurse that is freed up by centralising the ordering (she can be put to more productive work) • Add it the value of the preferred supplier’s assistance in-house • Quantify the amount of money freed up, not being invested in excess supplies waiting to be used • Quantify the amount they give you in free storage fittings • Freed up space (from keeping the right amount of supplies) might equal one or two available consult rooms which you can then add in the extra revenue of additional patient visits

Instead I flipped to the slide (Firm Size, Income/Profit) and said “depending on the size of your firm, this is how much you can increase business income by simply training staff on several easy email shortcuts”.

Instead of giving them a number which doesn’t really mean anything – I showed them what the outcome of that number was. The fluff was removed by quantifying what 20 minutes would mean in improved productivity; increased billable hours and customer service.

So how did I come up with these figures?

I picked up the phone and called a principal at one of the engineering firms I had worked with in the past. “Charles, what is the average billable hour fee for principals , engineers as well as the average administrators salary” I asked. Next I asked him the approximate number of each - principals, engineers and administrators that would be employed by different sized firms. Finally I quantified. 20 minutes a day times a five day working week for 45 working week year. That was 74 hours per annum freed up per person at their respective income producing ability.

I next flipped to the slide which had all the figures to prove the point I was making. I also showed within the tips how customer service could be improved within seconds.

So how does this fit in with Practice Managers? Let’s say you currently order your medical equipment, supplies and consumables from 20 different suppliers. You or perhaps the nurse(s) have to keep track of when to order, how much stock to keep, maintain records. You need space for storage. Money tied up in perhaps excess quantities of some stock (bandages, speculums, etc). What you’d like to do instead is set up a preferred supplier agreement.

The end result would be “I have an idea to improve practice profit by $45,000”. No matter what the final figure is, $25,000, $10,000 or more – put in this light, you’ll get their full attention.

Creating a bottom line persuasive discussion can help get the changes you want implemented.

FURTHER INFORMATION Debbie Mayo-Smith will be presenting at the 2018 AAPM Conference in Canberra.

Debbie Mayo-Smith Motivational Speaker & Trainer

www.aapm.org.au | 35

Practice Profile

Kon-Tiki Medical Centre, Maroochydore T

he owners, practitioners and staff at KonTiki Medical Centre are proud to be the first practice on the Sunshine Coast to achieve accreditation through AGPAL for the 5th edition standards. We are especially proud that we are the second practice nationally to do so and were accredited without any corrective actions.

Our staff found the accreditation process very beneficial as it develops staff skills and engages all staff members in quality, improvement and compliance procedures. Our patients feel secure in the knowledge that an accredited practice provides a high level of care.

The Kon-Tiki Medical Centre has been created as a “centre of excellence” for both patients, practitioners and the community. We are a new, modern general medical centre focused around technology and innovation. In addition to being a contemporary, fully-fitted and equipped medical centre, Kon-Tiki boasts onsite pathology, imaging (coming soon) and pharmacy.

Located in the new Kon-Tiki building, the centre has a stunning and fresh interior design with plenty of space for seven doctors. It is situated in a high-foot and wheeled traffic area, within easy walking distance to local hotels, shopping malls, cafes and restaurants, and right next door to the new Maroochydore CBD which is currently under development.

Establishing a new practice, getting to know both team members and patients and bond with them has been an interesting journey. We have had to plead with two very camera-shy nurses to say ‘cheese’ so that our practice advertising could be completed. However, we never have to go without our coffee as we are surrounded by great coffee shops and I make sure everyone gets away on time to get their fix.

36 | www.aapm.org.au

Kon-Tiki Medical Centre places a strong emphasis on culture, values and teamwork and has been established according to simple, guiding principles. These principles underpin the philosophy of the centre with a genuine focus on patients and staff: Quality Achieve world class standards of Medical Care and maintain them by continually updating knowledge and measuring performance Service Exceed patients’ expectations Compassion Demonstrate commitment to care by providing a sympathetic and supportive environment for patients, their families and for each other Integrity Adhere to the highest professional standards and moral principles with a commitment to trust, honesty, confidentiality, respect and transparency Teamwork Collaborate and share knowledge to benefit patients, colleagues and the wider community

We also provide Care plans, Home medication reviews, Employment medicals and regular Health Awareness Weeks.

Within the medical centre we have two general practitioners, paediatric care (supported by our specialist paediatrician), allied health services including a Dietician, Exercise Physiologist and Psychological and Counselling Services.

We have had celebrities present with a minor emergency at closing time and we have graciously stayed open to see them. As a caring and community minded team we would also re-open for non-celebrities as well! Some of our more interesting presentations have included a child who swallowed a one inch nail and an electrocution. We quickly established a close rapport with our regular patients who now bring us gifts such as honey, home made jams and chocolates just to name a few (not that we are bragging).

Our staff number is small but efficient and this number will increase as our practice grows.

Who could resist wanting to join a modern facility on the beautiful Sunshine Coast!

Innovation Welcome change and encourage innovation, continually seek to develop more efficient ways to achieve goals We aim to provide a first-class experience for patients by focusing on service delivery and enhanced communication systems. The many and varied service offerings at Kon-Tiki Medical Centre will include: skin cancer diagnosis and minor surgical procedures; chronic disease care; specific health care for men, women, children and the elderly; indigenous health; sports medicine; musculoskeletal disease treatment; weight management and pain management.

Tania Gannon Practice Manager AAPM Member

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