11. Business Aspects of Practice

As health care and service delivery evolve, reflecting on how we can continue to meet the needs of our clients and society AND continuing to evolve as clinicians to ensure we are delivering relevant services and best practice…

requires us to incorporate new methods into our practice.

• create or bring these innovations to others to solve problems.

• take a novel idea and translate this idea into a tangible reality by launching a business that will bring it to the world.

entrepreneurs

how is entrepreneurship a form of advocacy?

because they aim to meet the needs of a client whose needs aren’t being met by the current model

purposes of developing specific OT businesses?

• To directly meet the needs of a specific population or group

  • Adults s/p CVA

  • Teens with ASD

• To clearly focus evaluation and intervention efforts and activities on a specific area of occupation

  • Driving

  • Social skills

OT roles

• Direct care provider, consultant, educator, manager, leader, researcher, advocate

  • Where does entrepreneur fit? (manager? Leader? Combo?)

OT settings

• Traditional (school based, hospital; theres a system in place, have to do what the sys

  tem requires)

• Non-traditional (home based, community, mental health, hippotherapy)

• Role-emerging (creating OT led position in a company that doesn’t have an OT led position)

what are some ways OTs can be entrepreneurs?

• direct care provider in a traditional setting

• direct care provider in a non-traditional setting

• consultant for parents, teachers

• Medical/ legal consultant – evaluator and expert witness

• Speaker- In-services, courses, podcasts

• Developer of products to sell

• Evaluator for new assessments (Pearson, WPS) – BOT3, DASH-2

• Educator at a university (COTA, MOT, OTD)

• Program director of a summer camp

OTs don’t usually go into entrepreneurship to start a business, it’s usually to:

help people

4 basic steps of program development

• Needs assessment

• Program planning

• Program implementation

• Program evaluation

1. Describe the target population’s demographics, disorders, functional levels, and presenting problems

2. Identify specific needs of the target population

   • Perceived needs of the population as reported by others (family, physicians, other professionals)

   • Felt needs as stated by the individual members of the target population

3. Identify resources available for program implementation

   • Formal or institutional resources such as staff, supplies, money, and space

   • Informal resources such as family, friends, cultural or religious figures, and self-help/consumer groups

4. Resources to help us design the program

5. Methods of conducting a Needs Assessment include:   

   • Survey and/or interview of target population

   • Review of existing secondary quantitative data (census data, public health records, research)

Needs Assessment

• Define a focus for the program based on the needs assessment results

• The priority focus could be problem areas, functional limitations, and unmet needs that are relevant to the majority of the target population

• Adopt a frame of reference that is most likely to successfully address and meet the program’s focus

• Establish goals specifically related to the primary focus

• Describe how the program  could be integrated into existing systems of care

  1. Establish a realistic timetable for program implementation

  2. Define staff roles, responsibilities, and assignments

  3. Determine the physical setting and space requirements

  4. Consider potential barriers to program implementation and develop methods to effectively deal with identified obstacles before program implementation

     1. Potential barrier: money, getting clients (marketing), trust in the people you’re hiring

• Develop a system of referral for entry into, completion of, and discharge from the program

  • Criteria for acceptance into the program and for movement through program levels

  • Evaluation protocols to standardize information to be obtained from each person referred to the program

  • Discharge criteria to determine when an individual has achieved maximum gain from the program

• Describe the fiscal ($) implications of program plan

  • Determine projected volume or service demand to estimate revenue ($ made)

  • Identify projected expenses to estimate costs ($ spent for space, equipment, paying employees)

  • Directly compare estimated revenue and estimated expenses to determine financial viability of the program ($made - $ spent= $ sustainability)

Program Planning

• Initiate program according to timetable and steps set forth in the program plan

• Document program activities, procedures, and use

• Communicate and coordinate with other programs within the system

  • Continue/initiate relationships with referral sources

• Promote the program to ensure it reaches the target population

  • Ongoing marketing campaign

Program Implementation

• The review and analysis of care provided to determine if the care is at an acceptable level of quality

• Purposes of program evaluation:

  • To gather information on the implementation of the program

  • To measure the effectiveness of a program (Were the program goals accomplished?)

  • To measure the program’s impact

  • To identify program problems/limitations and to resolve them (talk to the staff, clients)

  • To use information obtained in the evaluation to improve services and assure quality (whole goal of why we want feedback to make sure our program is providing best service and best experience of service)

• Methods of program evaluation include:

  • Select methods to collect data, which can include:

  • Direct observation and/or review of client charts

  • Safety checklists, incident reports, and/or client/family complaints

  • Surveys of clients, families, and/or staff

  • Review of treatment sessions and missed treatments

  • Initial, discharge, and follow-up assessments

  • Review of statistics on costs and service volume

    • Volume=amount of clientele we’re seeing

  • Evaluate and analyze results and limitations of the study

  • Use results to initiate appropriate program actions

    • Continue and/or expand programs

    • Change or modify programs

    • Discontinue programs

Program Evaluation

• Easy to form; business and personal assets and liabilities are blended.

  • You can be held liable for debts or obligations of the business.

  • Be wary of this since if you are sued in your business, your personal assets are vulnerable (car, house, etc.)

sole proprietorship

• Simplest structure for 2+ people (Limited or Limited Liability Partnership). Shared ownership and decision-making.

  • Work out percentages, maybe one as 40% and the other has 60%

partnership

Different kinds (C-Corp, S-Corp, nonprofit, etc.) that protect personal assets from liability of the business, with different kinds of tax advantages.  

corporation

• Protects personal assets from business liability. Do not need to pay corporate taxes. May need to pay self-employment taxes (depends on structure you have under LLC)

  • No one can sue you for negligence and come after your house

  • Can hire sub-contractors that work for you, pay them by the hour, get 1099 and don’t take out any taxes so the employee is responsible for their own taxes

limited liability company (LLC)

purposes of fiscal/financial management

• To ensure quality services and programs are planned and implemented in a cost-effective manner

• To meet the demands of a managed health-care system and the press for cost-containment

• To remain competitive in a market-driven practice environment

• specific one-time or project-based service with payment based on the completed work

  • Heres this home, do this mods, heres the budget, fee for services

fee for service

involves ongoing services or a relationship over an extended period with a fixed price of payment schedule

long term contract

Major fiscal/financial management tasks include:

• Developing a financial plan including revenue ($ a business brings in) and expense ($ a business spends) projections

• Developing and manage payroll and staffing budgets

• Scheduling staff in a cost-effective manner that meets quality standards

• Planning for short- and long-term program needs including operating expenses and capital expenses

• operating expenses

• Meeting the organization’s revenue ($ a business brings in) expectations

• Permanent or long-term purchases such as an ADL kitchen or for new facilities, such as a new wing for a work hardening program

• Typically, any item or action above a fixed amount (ex: $50,000) with a lifespan of more than a year is considered this

  • Expected to last longer than a year!

• Usually a budget, everyones is different

• Ex: new wing for heart program

capital expenses

• The daily financial activity of a program or service

• What does it take for me to run the business day by day

operating expenses

what is required for a private practitioner to receive 3rd party payment?

provider number

who can file malpractice suits?

individuals and/or their caregivers if the OTP is viewed to be personally responsible for negligence or other acts that resulted in harm to a client

• failure to do what other reasonable practitioners would have done under similar circumstances

  • The end result is harm to the individual because of your care

  • Every OTP is liable for their own

negligence

when will supervisors assume liability?

if they provided faulty supervision or inappropriately delegated responsibilities

when does the institution assume liability?

•  if an employee was incompetent of not properly licensed

  • SRBs, CPR cert, license renewal

things to consider for financial management?

• How will you pay your employees or sub-contractors?

  • Quick books

• Will you rent or lease space?

• How will you keep your books?  Hire a bookkeeper, accountant?

• Reimbursement depends on the system (school, early intervention, hospital, clinic, parent pay)

  • MA #

  • NPI # (National Provider Identifier)

  • OT License #

  • Different kinds of identifiers based on practice settings

• Will you work In-Network or Out-of-Network with Insurance Companies?

  • In network = super expensive

• Liability: malpractice insurance

process in which an organization's leaders define their vision for the future and identify their organization’s goals and objectives

strategic planning

strategic planning benefits

• Defining an overarching vision to align efforts

• Fostering motivation and collaboration among your team

  • Service leadership management

• Developing flexibility to navigate dynamic environments

• Carving out a distinct identity to capitalize on your unique strengths

questions to ask yourself in the strategic planning process

• Where is your business today?

• Where should your business be in the future?

• How should your business get there?

• How will you measure success?