About Glenda Farmer

Leading innovative Smartdentist to provide online dental practice accreditation and infection control solutions for SMART dentists and practice managers

Payroll audit for dental practices

Have you ever audited your payroll? No, me neither.
Then I started reading Fairwork decisions. Fairwork has recently awarded against an employer (surprise, surprise) granting a worker holiday pay when the employer thought the worker clearly accepted they were employed as a casual.
This has cost the employer a considerable sum of money.

How do we guard against this type of expensive judgement?

In this case if the employer paid the worker the base rate and a separate casual loading then the employee would not have gained anything. Many of us, however, have traditionally lumped the casual loading into the pay rate. Few of us have clear contracts or well-defined pay slips. This leaves us just as exposed as we would be when a patient complains to AHPRA and we have a less than perfect dental record.

Dental Business risks are more than just Dental records

Just as your dental record keeping needs constant review, it may be timely to do a self audit of employee documents. SmartDentist has recently revised its HR area to bring all staff information in the one page. e.g. policies signed off, forms signed, immunisation records, training records, employee conversation records etc. While not part of SmartDentist, we hear from small business that many people find it difficult to keep up with payroll rules and regulations. Over the next couple of weeks Smartdentist will be include audits and helpful information for practices on self auditing your business. This will follow information available to all in the Fairwork document: Guide to self auditing your business.

Part 1: Auditing Payroll Calculations and Categories (Download)
*These instructions are based on MYOB and may not be relevant for Xero

Check out the calculations used in your software program. Things change over the years and your software may never have been setup correctly.

  1. Current Tax tables – in MYOB you do need to load current tax tables into the program (even the online version of MYOB).
  2. Check sick leave accrual calculations and holiday calculations. You may be under or over entitling staff. Both could be costly.
  3. Understand what employee payments need the superannuation guarantee. Other than overtime, most wages require the 9.5% superannuation. Contractors also should be paid superannuation (to cover you against future claims!)

If you find a difference between my audit % figures and those in your payroll program, call your accountant/bookkeeper and ask why!

Payroll Category List
Within the pay slip you are required to keep a record of any bonus, loading, penalty rate or allowance that is separately identifiable. It is in your best interest to make sure you record the following as separate details on the pay slip:

  • Casual loadings – this is best as a separate entity rather than including the casual loading and hourly rate as the one amount. This reduces the business risk in a dispute.
  • Unpaid leave – record this in your program. All leave, paid and unpaid is required to be recorded by law. Again this is your guaranteed defense in a dispute.

My suggestions: Add time-off-in-lieu as an entitlement and you can start to record this as a + or – for each staff member. While the Health Professionals and Support Services Award allows for averaging time over 4 weeks it is best to have some record when asked. If you include it as an entitlement the payroll program will automate the records.

Employee Contract and Individual Flexible Arrangements

Dental practices tend to think about contracts only in respect to employing dentists but they are just as important for all other staff. The reason for having a contract is to clearly remind every one of the employee/employer relationship and obligations. If you do not have a contract the HP&SS Award effectively becomes your default contract. The benefit of a proper contract is to further expand and formalise obligations. It is never too late to get a staff member to sign a contract. It offers them security and clarity as well. Just as you can get staff to sign policies and procedures as they change, you can ask staff to sign an employment contract at any time (be nice about it).
The cost of getting a lawyer to draw up employment contracts for non-dental staff would be $2-3000 per practice. For a suite of contracts including dentist contracts and Service Facility Agreements the cost would be $4-6000 per practice. [Ask Brad Wright (Dentist and Lawyer/Barrister for advise or direction – Dental Legal Solutions]

The ADA HR has a series of templates contracts that are well worth reading to see what extra’s can be expected to be found in a contract of employment.
If you have traditionally paid a staff member an off-set amount (extra money instead of laundry, uniform and overtime pay) you can place this into contract but it may not be binding. You should consider also having an individual flexible arrangement which can clearly state these off-set amounts. Remember to regularly make sure that the staff member is actually better off with this arrangement. See the Fairwork site for more information on Individual Flexible Arrangements.

Once you have completed Part 1 of the audit have a rest!
More soon.
Glenda Farmer

Posted in ADA

Performance Management – Best Practice

Fair Work says best practice for performance management is to have a Performance Management Policy. In SmartDentist subscribers will find a completed policy on Performance Management that they can use for their practice.
This policy was developed using Fair Work Ombudsman Best Practice Guide: Managing Underperformance.

Performance Management Flow Chart

Each year Fair Work deals with 1000’s of claims for unfair dismissal. In addition I have found Employers are cautious of bullying allegations as both Fair Work and Worksafe have processes for employees to complain about bullying.
With the very wise statement “Criticise in private, praise in public” I know people are wary that when they do performance management in private there are no witnesses to contradict a bullying claim. Don’t fret. Have good documentation. You are far more likely to be seen as a bully if you criticise someone in public. Humiliating someone is never the way to improve their performance.

Good performance management means good documentation. To assist you SmartDentist now has an Employee Reporting Area, that is not seen by staff, allowing you to quickly record:

  1. Great performance
  2. Underperformance
  3. Conversations with staff
  4. Meetings with staff

The last thing an employer needs is to be challenged by Fair Work for documentation of incidents or examples of employee interactions.

Dental Policies and Procedures: practical or dust collectors

Dental Policies and Procedures on SmartDentist are practical and not dust collectors. Smartdentist model for dental practice policies and procedures is seeing more and more subscription from a couple of different types of dental practice.

  1. Dental Practices who have rarely looked at their printed Dental Policies and Procedures.
    These dental practices are very aware of Dental Board legal requirements for an Infection Control Manual. Dentist like to see themselves running “best practice”. On a practical level these dental practices are time short; have long-term staff who are skilled in doing their job, not writing about it!
    These are Dental Practices aware that having current policies and procedures is GOOD RISK MANAGEMENT. SmartDentist Templated Policies and Procedures are in “bite sized” chunks and written with a normal dental practice in mind. Anyone can modify these ready-made policies to fit their own practice model (if necessary).
  2. Multi-site or bigger dental practices are becoming a big part of SmartDentist content management for policies and procedures. Often experienced Dental Practice Managers have become very aware that policies and procedures can be useful for:
    a) Efficiency: reducing variations in multi-staff environments
    b) New staff orientation: professional and quick orientation programs were written lists make for better training.
    c) Communication: using email to let staff know about changes.
    d) Convenience: One place; online for 24/7 access
    e) Cost saving and time-saving: Most office managers love to work with teams and not spend days on paperwork.
    Smartdentist content management has features not available anywhere else. Smartdentist is a solution rather than a system!

Why SmartDentist Content Management Solution for Policies and Procedure

SmartDentist constantly works towards making usefulness the focus of policies and procedures. Our innovations are things we want for our own practice, and we keep improving to make using policies and procedures practical and worthwhile for big or small organisations. Rarely do you get insights into other dental practices policies and procedures: In SmartDentist you will find an expanding range of policies and procedures which can be adapted to serve regulation compliance and practical solutions. User friendly!

For dental practices by dental practices.

How to make your own workable Infection Control Manual

I have heard dentist say they do have an infection control manual because they have the ADA  Infection Control Guidelines!
It’s a great start but it is not what the Dental Board or the ADA wants you to consider as your OWN Infection Control Manual.
However if you want to do your own manual you can’t start at a better place than the ADA guidelines. Try the following to make your own practical manual –

  1. Print off the whole of the ADA Infection Control Guidelines
  2. Cut the guidelines up into sections representing work zones in your own clinic.
    e.g. What part of the guidelines gives insights into the actions of what part of your clinic?
  3. Label pieces of paper according to work zones or work procedures.
    e.g. cleaning up after patients.
  4. Put the heading “Policy” onto those labelled pieces of paper and then stick the printed part of the ADA guideline onto that paper.
  5. Follow the policy with the word -“Procedures”.
  6. Get the staff to write down “point form” (e.g. as a list) what actions they take. You can also video with your iPhone instead of writing and have an online procedure.
  7. Do the same with the ADA practical guides and then the Standards Australia reprocessing standard.
  8. Congrats you have a practical procedure manual. (alternatively subscribe to SmartDentist)

What does the Dental Board of Australia and other regulators want?

The DBA wants you to DO what your policies and procedures say you do!
SmartDentist helps with small readable, discussion type training exercise’s in the areas of infection control where we get the most questions.
SmartDentist encourages the use of practical procedures which are linked to; but separated from lengthy formal policies.

Changes in Dental Practice

Dental practice moves forward with the times. Computers are common place. Each staff has a smart phone. Often it is an iPhone. Gone are the days when dental practices were advised that the best manual was a printed dust collector.
Dentists time is best spent in the clinic doing what they are trained for.
Consider SmartDentist…it’s just the smart way to go.

Induction-dental-employees

A new dental staff member excitedly turns up on their first day. What sort of induction do you offer? Are you stressed or flustered trying to find forms you haven’t seen for some time? – Employee detail forms; tax declaration form; confidentiality form; Super choices form. Is it possible for New staff induction to be made easy?

Where did we find those forms last time we employed someone?
What are our legal obligations now?

We don’t employ new staff very often so it is fantastic to know that SmartDentist has just re-vamped the New Staff Induction page so it works both as a checklist and to link us to all the documents we want!

SmartDentist New Dental Staff Induction

SmartDentist.com.au New staff induction page. This is customisable or you can use it as you find it. Add your own new employee forms or check off items and use the links to print off all the documentation you could want…or send the staff member to the page and they can resource everything online.

Printed New Staff Induction Checklist

Print the page from SmartDentist and this is how it looks. What a fantastic checklist – with a space for sign off and dates.

I am so excited!
This feature wasn’t designed with you in mind! It was designed with me in mind.
We have a maternity leave replacement and we are employing a new trainee. With the SmartDentist induction page we have link to printable resources:

  1. ATO and Super forms (compulsory)
  2. New Employee details form
  3. Immunisation forms for staff to take to their GP to fill in
  4. Confidentiality form
  5. Fairwork letter of engagement template
  6. Fairwork Information statement (compulsory)
  7. Job description for a role e.g. DA
  8. Links to any compulsory policies e.g. Code of conduct; Uniform and Dress; Social Media and Mobile phone use etc (all available as templates for you to use)

Did you know that you only have about one week to be a major influence in a new employee’s life! That means you start straight away with the things that are incredibly hard to “train-out” of a person. Don’t rush with the hand hygiene policy etc. You will teach that as it is new. But the mobile phone and uniform and social media are already part of this persons DNA so you need to concentrate on them first.

I am sure SmartDentist subscribers will feel the same as me – confident in appearing as professional employers on the new employee’s first day.

 

Is Dental Practice Accreditation about to get harder?

Anyone who has spoken to me about Dental Practice Accreditation will know what I think. Accreditation is a great idea in theory but in practice it loses out.
Unfortunately it is easy to pass accreditation without actually committing to the systematic focus (or any change whatsoever). How easy is it for “accreditation” to  just becomes a lovely poster on the wall and a stress in 2-4 years about “having to start all over again”.

Latest news about Changing Accreditation

The latest news in the accreditation world is that the ACSQHC (the organisation which sets all the rules for accreditation) has totally re-written the healthcare accreditation standards. All healthcare organisations* who were using the present standards will switch to the newer, clearer standards from Jan 2019.  * Except for dental practices who are advised not to consider the new standards because the ACSQHC is developing a new set of standards for primary care. Reading the discussion paper October 2017 Patient safety and quality improvement in primary care Consultation paper.

The consultation paper from ACSQHC includes a number of interesting propositions:

  1. Just because we don’t have quantitative records documenting lack of safety or quality, does not mean that there are not issues. e.g ACSQHC thinks there are problems but they just not sure what they are!
  2. “A systems focus, which involves making changes at an organisational level within services and reorganising care delivery systems, will help support improvements in the quality of primary care and ensure it is sustainable, efficient and effective.” According to the ACSQHC.
  3. “Private Health Insurance funds are one of the drivers for improved safety and quality and are driven by the need to ensure care provided represents value for money, and that care is clinically appropriate and in line with best practice.” – or so reports the ACSQHC!

The ADA has made a submission toward this Primary Health Care paper. The ADA will be a party to the development of Primary Health Care standards. As the PHI is now recognised in this paper as a primary stakeholder towards safety and quality by the ACSQHC it will be interesting to see how involved they become in dictating the new standards.

The Best of Accreditation ideals

Following are my recommendations for practices wishing to explore the ideals of accreditation.(With or without paying QIP for the accreditation certificate):

  1. Start using an incident reporting system so you can actually track incidents or near misses. Yes that would include stuff ups at the front desk; appointment mix ups; broken files; fillings failing too early; staff running over their feet with their chairs etc and it would also include compliments from patients – use them in marketing yourself.
  2. When you have any incident, then objectively review it from a systematic perspective. Can we devised a system, at work, that would make this incident less likely or impossible. Don’t expect staff to be hero’s in the smooth running of the practice. Risk Management is the name of this analysis. If you decide to do nothing – document it.
  3. Have policies (yes generic feel good policies) but also look at practical procedures. Video what happens with your iphone if quicker (put it on a private youtube acount – no cost). This is an excellent training resource or new staff induction resource.

SmartDentist supports an easy way to support practices with these processes.
Easy systems = Good systems = Practical systems.

Environmental Cleaning: Neutral detergents, barriers and disinfectants for dental practice

Environmental cleaning is a term used to describe how we clean up after we see a patient in the dental surgery. It also refers to how we clean in general around our dental practice. Making a decision on whether to use neutral detergents, plastic barriers or disinfectants can cause stress for dental assistants and dentists alike.

SmartDentist’s latest online training addresses the questions and provides practices with both the legal requirements from the ADA Guidelines for infection control and the NHMRC Prevention and Control of Infection in Healthcare. Our training also has a link to some interesting research on the power of wiping!

I predict that if you come from Victoria (but more than 4 years since graduating) then you will love to barrier. We love to barrier! If you come from NSW it is likely that you prefer to wipe. SA -barriers; Queensland – both. I predict that your original training will dictate your preferences. No doubt you will come across arguments about what should be done at some stage.

Environmental cleaning is a large component of the review of the NHMRC document. If you wish to read about the latest developments in new antimicrobial surfaces take a look at the review papers.

If you don’t have a subscription to SmartDentist you are missing out. Both staff and dentists can do online training exercises which go towards their CPD. For those that are missing out go and check out what you are using in your practice. Read the manufacturers instructions and make sure your procedures align with what you are using at present.

Posted in ADA

Employee dentists and employing dentists: a dummies guide

UPDATE: You can now go into the ATO website and get a WRITTEN opinion to help you work out if you can pay an independent contractor.

You can get an online written opinion from the ATO website which indicates that you have acted on the basis of ATO advice.
“This is a record of your genuine attempt to understand your obligations for your worker and would be considered if we review this working arrangement in the future.”

BE AWARE that this only means you might not receive a fine if you are found to do “the wrong thing”. This doesn’t mean the ATO will not charge you any tax or superannuation which it believes should be owing if the arrangement is not deemed appropriate.

TYPES OF ARRANGEMENTS

1. Service Facility Agreements
In order to avoid some questionable arguments about whether a dentist is a true contactor it is becoming more common for practices and dentists to work under Service Facility Agreements. Instead of a practice bringing in a contractor, the dentist virtually “hires” a facility to work!
Hence the dentist is self employed and pays a fee for an entity (e.g. company) which provide all the services needed in order to practice dentistry. e.g DA’s, room, materials etc etc. In this structure the dentist is not technically employed by the practice.

If the income/payments received from clients (patients) are paid to a service company then
this can be seen as a employee, contractor or employment agency agreement which can then be contested as a sham arrangment or subject to payroll tax grouping.
In order to avoid this, income payments are received into a trading trust account which has the sole role of receiving payments. From this trust money is distributed to the dentist and to the service company as per the service facility agreement. Trust distributions and company dividends are not subject to payroll tax.

As an example for Service Facility Agreements, money received in fees is held in a trust account and the dentist is able to take 34% (for 40% commission) of these fees and the practice receives payment of 66% (including GST) for providing the service facilities. As the dentist is seen to have paid the 66% including GST as a business expense they can claim back the 6% in their BAS statement.

ADVANTAGES DISADVANTAGES
Owner Dentists earning are not included within practice wages so not counted towards payroll tax.
Dentists are self employed so more clearly legal responsibility for own work. Easier to manage once set up.
High set up costs and on going accountant fees;
Experienced lawyer and accountant needed for correct legal entities.
Dentist (worker) Control own superannuation. e.g. don’t really have to have any.
Own GST claimable deductions
Company ABN needed
Own GST reporting (BAS). Need to claim back GST so some minor delay in money received.
Paying your own tax /own superannuation so good record and cash management is required.
Higher Accountant fees than if employees

[About Payroll Tax
Once wages rise to a certain leave in a business, the business needs to pay the state government payroll tax. This of course increases the cost of running a business.
Payroll tax is a state based tax on wages (including superannuation and contractors wages) and it is about 5% of the wages bill once a certain threshold has been reached. The threshold where payroll tax occurs varies greatly from state to state.
Anyone starting a practice or buying a practice might be wise to set up the business structure to allow for dentists to be employed under a Service Facility Agreement so payroll tax remains unlikely. Service Facility Agreements require very specific business structures and should be setup by lawyers very experienced in this field. The benefit for dentists working in this arrangement is that the complexities of retained Fairwork entitlements and retained Long service leave entitlement are not an issue. Dentists are able to decide on whether they consider superannuation a good investment for their particular stage of life. Superannuation is not compulsory for the self employed.]

2. Employee – Only Commission based calculation
This is the arrangement that I am familiar with. I would never recommend it because it is quite complex to manage.
Example: The dentist gets 40% commission (or whatever is agreed upon) which is to include all entitlements such as superannuation, holiday pay, sick pay and long service leave.
Practices (owners) paying with this system need to have an extremely clear idea of all entitlement rules and keep very good records and supply excellent pay slips.
Practices will be retained money from the dentists commission to pay for entitlements. Until entitlements are used the money stays with the employer. Employees dentists need to have a good grasp of the entitlement requirements so they can minimise the money retained by the practice owner. The money retained by the practice for future payment to the employee dentist may be higher than 20% of their total wages.

ADVANTAGES DISADVANTAGES
Owner Retain employee’s money for future entitlements so good for business cash flow Difficult to work out and keep track of entitlements.
Need to have a great understanding of entitlements. Need excellent documentation.
Dentist (employee) No accountants fees – simply employee.
Superannuation paid
More earnings are unavailable as the practice protects itself unless all holidays and sick pay are used each year.
GST costs are not tax deductible unless the practice agrees to include them in costs.

Understanding entitlements:
1. Sick pay is cumulative and can’t be paid out. Personal leave and carers leave accrues at a rate of 10 days (2 weeks) per year (full time). To gain access to withheld entitlements employed dentist should say they want personal, sick or carers leave for the first 2 weeks (for full time worker) of time taken off per year. There is no legal requirement for a medical certificate if the practice does not require this. By taking sick leave rather than holidays the employee enables the practice to reduce the withheld entitlements. (e.g. the employee dentist can access more of the money they are owed)
2. Holiday pay – it is possible to pay out holiday pay once a worker has more than 4 weeks owing. At any time the minimum retained amount of holiday pay needs be 4 weeks. Holiday pay in excess of the 4 weeks can be paid out if the employee asks for it.

If the employee dentist takes all sick time (2 weeks) and all holiday time (4 weeks ) then the practice would only need to retain 1 weeks pay per year against future long service leave requirements. The complexity of the calculations makes this system of employment annoying to manage.

3. Employee – Base salary + Bonus = Commission %
The best option for minimising money retained for entitlements and for simplier calculations is employing a dentist on the minimum wage and paying bonus payments to achieve a commission equivalent payment..
In this arrangement dentists can take advantage of the fact that there is no award for dentists. 
The simplicity of using a fixed low hourly rate to determine entitlements liability, means the employed dentist has minimised the dollar value of retained entitlements and the practice has minimised their liabilities. This is most attractive to both the employee dentist and employer dentist.

Other considerations to benefit employee dentists
Tax deductible expenses incurred by the employee dentist, which include GST, can be paid by the practice and the non-GST cost can be deducted from the overall commission (as with Lab fees). There should be no problem with the practice doing this and will save the employed dentist money.
Employee dentists should remember to ask for personal/carers (sick) leave when they take time off. This helps the employee keep retained entitlements to a minimum. Holiday pay can be paid out (subject to restrictions ) but sick pay will be an accumulating liability so it is important to minimise accrued sick leave.

How employee dentists can gain access to all accumulated entitlements
Resigning from a practice should release all accumulated entitlements. Practices can then re-hire the employee dentist with a zero entitlement balance.
The benefit to employee dentists is they can have their money “now”.
Practices should NOT do this if any personal/carers (sick) leave is owing. Termination payments must include superannuation (which is not generally required for termination payments). Termination payments must clearly state what the entitlements are for: e.g. Holiday pay and long service leave.
RISKS: it can be argued that re-hiring someone without a 3 month break constitutes continuity of service so all their entitlements still stand. In the worst case scenario if this was found to be true then all that will have happened is the holiday pay will be seen as have been paid in advance (which is legal) and long service leave will have been paid before due (also legal). Sick pay accumulates and can not be “paid out” so any “payout” of sick pay would not be recognised by law and the practice would still owe it!
You can not set up fixed length employment contracts e.g. yearly, and reset the entitlements each year as this is seen as manipulating the system.

Using MYOB with an employee dentist payment
a) Minimal wage + bonus
1. Make sure Holiday pay; Sick pay and Long Service leave are enabled and the rate per hour is correct and ticked as enabled for this dentist. For example:
LSL = 1.6667% of gross hours for Victoria (some states have different rates)
Holiday pay = 7.6923% of gross hours (leave loading is not required)
Sick leave = 3.84615% of gross hours
(Check MYOB help to see if this is correct for your practice)
2. Set up a standard pay
Set the standard hours and the minimal hourly rate (make sure you adjust this whenever the minimal pay rate increases)
3. Pay the dentist at the same time as other staff e.g. fortnightly.
Immediately after the first payrun into a new month you will make an additional payment of a bonus. As this dentist now received a fortnightly minimal wage they will be $2800 ahead in payments compared to the old system of end of month payments. Hence if their bonus is a bit late it is hardly a point for complaints!
At this point you will need the following:

  1. Your record of Net earnings since they started. e.g. ( Total Fee Income minus lab + other expenses) X Commission %
  2. MYOB report of payments since they started (this will show Wages (including tax) + tax + superannuation payments)
  3. MYOB report of entitlements owed
  • (Entitlements money you need to keep Z): Multiple their Entitlements owed by their hourly rate (minimum wage rate). Add 9.5% of that total to account for super that will be payable. This is the total amount that the practice should keep aside to pay for future liabilities (Z).
  • (What the practice really owes the dentist X): Calculate the total commission payment that they would have been entitled to since they commenced work (X).
  • (How much the dentist has already been paid V+Y): Use MYOB report of individuals total payments to see their total payments (make sure their most recent payment is included in this total). This will be all payments (V) + all superannuation (Y).
    Note: Find transaction for their card only shows what they were received with tax and super removed so be aware what you are looking at. REPORTS is the best place to source this.
  • Bonus = X -( Z + V+ Y) . Remember your Bonus Gross must include superannuation and tax. You can make a bonus payment by doing an individual employee pay run in MYOB. You will need to adjust (increase) the tax paid for this single payment, as MYOB will not work this out correctly. (hence you will need to adjust the actual bonus figure you place in MYOB)

b) Wage solely worked out on the commission only basis
MYOB can help with this way of working out payment and recording payment as well. It is important that your employee dentist receives a payslip clearly stating what pay was for e.g.  holidays and other entitlements. It is worth the time to get MYOB to generate a correct pay slip so there is no option for future disputes.
1. Set up MYOB for a Salary worker so holiday pay; Personal leave and Long service leave are calculate on a “hours” per year or month basis. You will need to set these up as separate new payroll categories as you can not change MYOB’s payroll categories per individual. Instead of new payroll categories you can use the hourly basis as above and pay wages rather than a salary but you will find you need to adjust the hourly rate each pay period.
Long Service leave : 32.9335 hours per year for a full time dentist
Holiday pay = 152 hours per year (4 weeks x 38 hours) or 12.67 hours per month (152 hours / 12 months)
Sick leave = 76 hours per year (2 weeks x 38 hours) or 6.333 hours per month (76 hours / 12 months)

While the dentist on a “salary” you will still need to make calculations to determine how much money to keep aside for entitlements. Your legal obligations are to pay entitlements for hours taken and not as a percentage of money earned.
You will need to record any entitlements taken on a hourly basis to avoid disputes of money owed.
MYOB (or equivalent) is handy as it will keep a total of hours owed and will be used to produce pay slips clearly stating entitlements paid out.

At this point you will need the following:

  1. Your record of Net earnings since they started. e.g. ( Total Fee Income minus lab + other expenses) X Commission %
  2. MYOB report of payments since they started (this will show Wages (including tax) + tax + superannuation payments)
  3. MYOB report of entitlements owing
  • Calculate the total commission payment that they would have been entitled to since they commenced work (X). Use MYOB report of individuals total payment to see their total payments (make sure their most recent payment is included in this total). This will be all payments(including tax) + all superannuation (Y).
    Note: Find transaction for their card only shows what they were received with tax and super removed so be aware what you are looking at. REPORTS is the best place to source this.
  • Calculate the total number of hours worked (including all sick and holiday time taken) this month (since the last pay) (A). Calculate the hours of entitlements remaining  (MYOB + current months figures) (B).
  • X – Y = Z (remaining money owed). The remaining money owed (Z) needs to cover this months pay (J) + any entitlements owing (K).
    Total hrs that need to be financed = Hours since last pay(Q)(including any entitlements) + hours of entitlements owed (M).
    Z divided by total number of hours = hourly rate (W). So payment this month would be hours this month Q multiplied by hourly rate W. This would be a gross payment which includes superannuation. (Q*W*0.913242 = payment without super. Super would be Q*W*0.095)
  • Make sure as you may double check what you are paying:
    1. Total that the dentist is due via commission since starting = (total paid out (including taxes and superannuation) + entitlements (including superannuation) that they haven’t yet taken.)

Public holiday pay
Employee dentists also need to be paid for public holidays. Neither system above using MYOB accrues public holiday pay but as both rely on monthly reconciliation of payments this amount will not greatly alter payments. If you wanted to be really accurate with retained liabilities then a MYOB payment category for public holidays would be added and the accruing rate would be similar to the sick leave payment. It will vary from State to State and depend on the actual working days of the employee dentist. As the long service leave liability only occurs after 7 years the practice owner will already be accruing a liability that may never occur (so you are retaining one week of pay per year for long service and you may never need it if they dont stay that long).

MYOB and Journal entries
While MYOB will not do calculations for you it is possible to keep a running tab of both total “commission due” and “payments made” to employee dentists in your profit and loss or balance sheet via journal entries. The logical place for money earned is the profit and loss while the running total of payments and remaining entitlement money is on the balance sheet. MYOB will do totals and subtotals to help with the running tab. The benefit of doing this is for clear reporting so excel spread sheets don’t need to be accessed by multiple business owners (but you will need them for easy calculations).

NOTE: If following my calculations you need to be certain that they work correctly for your situation and let me know if you find something incorrect so I can alter them. While both these options look more complicated than simply paying a contractor you will find they are manageable for whoever does your normal pays. Owners should, however check that the results are correct by returning to the basic total fee X commission rate and compare it to the total payments (including tax and super).

*Victorian Dentists Dec 2017. ADA Human Resources advice.

Posted in ADA

How staff learn or why policies and procedures don’t seem to work

Nothing has frustrates me more than introducing a new process at work, or streamlining an existing process. Why haven’t staff followed my very comprehensive, written procedures!

Since starting SmartDentist I have gained a greater understanding of what Policies and Procedures are good at; how to make them better; and what they wont do for the practice.
The following hints and learnings aim to help others who have suffered similar frustration. Consider:

  1. What Policies and Procedures are good for
  2. What Policies and Procedures wont do
  3. Better printing of Policies and Procedures (SmartDentist)
  4. Great understanding about our staff and how people learn

What Policies and Procedures are Good for!

1. Making sure AHPRA doesn’t ‘get’ you! Yes you need an Infection Control Manual (made of policies and procedures) because the Dental Board requires one. In Q’LD you also need policies and procedures so you have an Infection Control Management Plan. Dentists don’t really learn about this aspect of practice management in University yet we are legally responsible for what happens in our dental practice reprocessing. Practitioners benefit by considering creating a set of policies as worthwhile learning tool. The procedures used by your DA might not be correct or efficient. (The way we were shown in the past is the greatest predictor of what we do in the present. ) A good set of policies can help a practitioner understand and streamline or update procedures. They are a great insurance policy guarding against the stress of the loss of a knowledgeable staff member.

2. Having a procedure where everyone does the same thing the same way. Not only is this a safety precaution but it means life actually becomes easier for everyone (saving time and money). Established policies can sit on the SmartDentist website (untouched) until a new staff member needs them as a teaching aid. It is very handy to have good written procedures in case a significant staff member leaves. These need to be refreshed every so often. DON’T expect staff to look at these policies once everything is running well.

3. Performance management. When there is a communication breakdown or dispute about staff actions there needs to be formal written procedures in place in order to evaluate future staff actions or performance. Staff cannot refuse to do something that is reasonable, part of their normal work or customary. In regards to infection control practices, a staff member can not engage in conduct that causes serious and imminent risk to the health and safety or a person or the reputation, viability or profitability of a business. Of course staff would need adequate counselling, education and help to undertake their performance tasks. (see below – How staff learn)

What policies and procedures wont do

  1. Policies wont work without work.
    Policies and procedures should be living documents of excellence /efficiency. Often people are just too busy doing the job they have been given to actually question the processes of the job. Give some time to considering if processes are necessary and are efficient. Not every policy needs changing, not every task needs explaining but some processes will need more complex explainations or reviewing. Each policy review is the opportunity to get rid of old fashion inefficiencies or streamlined procesess.
  2. Written policies and procedures wont save a practice from workplace disputes. Just because you have a policy in place doesn’t mean you can discipline someone for not following it. You need to educate, tell, do and find out why they aren’t doing something. Workplaces are gigantic relationship centres and relationships require work and tolerance and give and take.

Better printing of policies and procedures (SmartDentist)

In developing better policies it can be helpful to consider what you find useful in instruction manuals. Many people only use instruction manuals when they can’t work out how to use the system or object. Instruction manuals that include relevant pictures are easier to follow and instruction manuals written in short point form are easier to read.
Hence it has been found that most used policies /procedures are:

  • short
  • easy to read
  • and help staff when faced with an uncommon process or problem

Consider developing two different types of policies. One could be for practical use and one for legal requirements or complex justification (e.g. infection control policies).
We only print policies if they have instruction for unusual or stressful processes, or if constant reminders of their content need to be seen by staff.
[For example I have the following policies located at our reception: Start of Day Reception; Middle of Day Reception; End of Day Reception; Payments and Hicaps.
These are separate laminated, two-sided documents printed out from SmartDentist. I have found longer policies are best divided into 2 separate policies (if they need printing and laminating). When a policy is updated it is easier to simply change a single sheet of paper.

How to print more useful polices from SmartDentist
Each SmartDentist policy has a small icon next to the name which reduced the “guff” off the policy. It also has the date on the top of the policy.
(Guff = resources; links; National standards etc. When submitting for accreditation please include the “guff.”)
Using the icon to gain a shorter version of the policy will also print better lists and save paper.

How our staff learn

Most of our staff are kinesthetic learners. They learn by doing. Learning should follow the following sequence – Tell; Show; Do; Review…and do this over and over again.
Do you know that changing a habit generally takes two months? That is two months of constant persistent reinforcement – do and review; do and review.
We communicated changes via:
1. Staff communication book
2. Verbal communication
3. Emails from SmartDentist – using basic communication form or the policy communication.

Consequences :- If there are no consequences for not changing, learning will take longer and reinforcement will need to be more persistent and regular. What consequence can staff introduce to remind them of the need to make procedural changes?
Self-care: – Find a mentor or supporter to encourage and reminding you about 1) your own inability to change 2) about the great things the staff do everyday without instructions!

 

Tracking and Tracing – What is the difference?

Do the terms “tracking”, “tracing”, “traceability” and “batch control identification” confuse you? You are not alone. Even the experts have trouble agreeing on what these terms mean. Because we use these terms in relation to reprocessing (sterilisation) of Reusable Medical Devices (RMD) in dentistry and medicine, it is very important that we have a clear idea about their purpose.

Where do the terms come from?
The terms tracking and tracing have logistical origins.
Tracking is a process where you know where any item is at any time.
Tracing is being able to tell the history of where an item has been.

Why does it matter?
1. In the event of a failure in your reprocessing system you need to know how to do a recall of instruments (tracking) or recall of patients who were exposed to those instrument (tracing).
2. In the event of a patient acquiring an infection only attributed to their healthcare experience/treatment (HAI) then it is important to be able to determine whether reprocessing of RMD (tracing) played a part in the HAI.
[3. Accreditation requires these processes are in place because they are important aspects of safety and quality systems.]

Why is the confusion with terms?

Dentists traditional are more familiar with the term “batch control number” or “batch control indentification (BCI)” (AS 4815:2006). Using BCI, RMD are linked to a sterilization cycle batch (tracking) and if the RMD are used, then traced to a patient.

In newer AS/NZS 4187:2014 and National Standards (used in accreditation) the term “Traceability” is used instead of “tracking and tracing” or Batch Control identification. This is because traceability is no longer just concerned to items going through a steriliser “batch“, but include any RMD’s reprocessed in high level chemical disinfection system. Batch Control Identification is just considered a version of “traceability”.

Unfortuately ADA Guidelines for Infection Control (Third Edition) 2015 says that traceability has no place in dental practice!

What!
Don’t misinterpret this statement.

The ADA guidelines make that statement about “traceability” ONLY because the ADA guidelines authors took a very specific view/interpretation of the meaning of  “traceability”.  In fact the ADA Guidelines fully supports the use of BCI, which is the form of traceability required by the standards for general dental practice.
The version of  ‘Traceability‘ which is considered unnecessary by the ADA in dentistry involves high levels of instrument identification and high levels of tracing history. e.g. being able to trace individual instruments (laser or otherwise uniquely identified) each time they are used on patients and then each time they are reprocessed. Imagine the pointless data bloat if we traced the history of patient use and sterilisation cycles for each identifiable individual instrument, over a compulsory 7 year period. e.g. 10 instruments in your cons kit X 3 sterilisations per day X 3 patients treatment X 5 days per wk X 52 wks per year X each 7 years = 163800 individual records for one cons kit.

How traceable does traceability need to be?

“As a minimum, the traceability system shall be sufficient to enable the identification of a patient(s) where a nonconforming product has been used in an event that a recall is necessary.” [AS/NZS 4187:2014]
Procedures need to be in place to detect a nonconforming product before they are used on a patient.

A. What needs to be traced when we reprocess a RMD?

AS 4815:2006 AS 4187:2014 ADA Guidelines RACGP Standards!
Patient R R R O
Steriliser Batch R R R O
Semi-critical# RMD  R^
Critical# RMD R R* R O
R – Required
O- Optional but recommended
* Individually identifiable RMD if implantable and reprocessed
^ If undergoing high level chemical disinfection
# Semi-critical RMD are those that come into contact with mucous membranes or non-intact skin.
# Critical RMD are those that come into contact with the vascular system or sterile tissue and that shall be sterile at the time of use. e.g. surgical instruments.
! RACGP Standards for General Practice July 2017 (medical drs)

B. Where is the Traceability information recorded?
The Traceability system forms part of the release and quality assurance management of RMD. The system of traceability could vary depending on whether an electronic system or paper system is used.

Where to start

Any healthcare organisation who packages instruments can set up an extremely simple system for traceability and quality control.
A. Sterilisation log
All practices are required to keep a sterilisation log book. This can be a paper book; a paper log that is scanned into a computer; or an electronic logging system. The record requirements are the same in each case (see table). Each sterilisation load has a separate sterilisation load (or batch) number. This load number must be unique especially if you have more than one steriliser.
B. Recording information on the packaging of RMD’s
By recording the sterilisation cycle + date we have a link back to all the respective data on the sterilisation log for that cycle. The date helps us use the oldest pack first and if necessary an expiry date. The packaging staff member initals the pack so if the pack instruments are incorrect or nonconforming (not clean) then we can consult; educate and correct this process. The external chemical indicator allows the end user (dental practitioner) to check themselves as to whether the instruments went through the steriliser. The stage of examining and opening the package is a “release” phase in reprocessing and would be the responsibility of the operater or assistant.
(Est time to do this. 2 second with a self inking date and cycle stamp – cost $110 for 1000’s of prints)
C. Patient records
The steriliser cycle number is added into the patients records which will already include a date. This cycle information allows us to find the patient should a future recall of instruments from that particular sterilisation cycle occurs.
Time to do this: 2 seconds.

Packages of RMD Steriliser Log Patient Record
Cycle Number Cycle Number (unique) Cycle Number
Date processed Date processed Date of use
Packing person Load and release person/s
Contents * if not obvious due to packaging Contents of load: RMD name or set and number
Chemical indicator Parameters printout
Functional tests e.g. Bowie Dick/Helix

Traceability can be simple or complex. You can trace each load or only critical instruments. The best, quickest and easiest system is one that is consistent for all instruments and staff at the practice.

References:
Guidelines for Infection Control 2015 Australian Dental Association
RACGP Standards for General Practice Jul 2017

dental equipment needs sterilising

 

 

Oasis software Banking reconciliation

Lining up your daily bank feed with daily practice payments is an easy task if you understand the basics. Bank reconciliation should be done each day so errors are picked up and investigated straight away. With bank feeds via MYOB or XERO this should be a quick task which takes no more than 2 minutes.
Regular reconciliation makes end of month calculations a simple quick task.

1. Send all your income to the one bank account and set up another account for payments. This makes it clean and easy to see. (If this is not your current practice then set up the second account for payments and leave your income coming into your existing account.)

2. Print off a bank statement and look at the entries. Become familiar with how and when you are paid. The following relates to NAB but will be similar for any bank. These are the credit entries in my online bank transaction area in NAB:
2.1 Deposits – this is our total of cash + cheques together. If these are banked daily life is easier. (Banking of cash and cheques is done the day following the payment.)
2.2 Eftpos – this is banked daily via our hicaps terminal which settles at 8.45 pm each night and is banked on the day they are processed at our practice (Practices can manually select to “settle” if they want a different time.). Note: refunds are not processed until the following day and are separate to credits.
2.3 Hicaps – this is banked the day AFTER they are claimed by our practice. If a reversal is made then this is included in that days’ claims. Claims made after about 9pm may not appear until the day after.
2.4 DVA – Vet Affairs are claimed online by our staff and are paid in 1-2 days usually. The bank entry will have the provider number in the bank entry. The totals are somewhat unpredictable but always just for a single dentists. Once paid the statements can be accessed from the HPOS or PRODA accounts.
2.5 CDBS – This is paid per practitioner and will be paid 2 hrs to 2 days. Usually the next day. The bank entry will have the provider number in the bank entry. Payment or refusal reports are available at HPOS or PRODA accounts.

3. Oasis software – Closing off of banking
Closing off of banking is a process undertaken by reception. It clears off that part of banking and payments which is considered correct and “finished with”.

[Learn how to “keep” and “release” banking in Oasis – you can do this for individual transactions and for whole pages of transactions. You can also set a default for each type of banking. Learn how to only view certain types of banking in Oasis e.g. find only cash and cheques.]

3.1 Deposits – Cash and cheques are “released” and closed off each end of day (Oasis task). The money and cheques are put in a deposit slip/envelope and our petty cash is counted to make sure no errors have occurred. A deposit slip is printed.
The deposits are checked the next morning and then taken to the bank and deposited with a teller. This is done via tellers because we got tired of disputed amounts when we placed money in “night banking”. Our staff need to be accurate when they are standing with a teller! Daily banking helps with reconciling Oasis and the bank. If you banked less frequently you would NOT close this off until you were ready to bank it.
3.2 Eftpos – This is closed off with Cash and Cheques at the end of the day. If a reversal has occurred during the day this MUST be released and closed off separately. Staff are NOT permitted to do a reversal except on the day it occurred. e.g. they can not have the HICAPS password.
3.3 HICAPS – This is closed off the next day. (first thing before we start with patients). Staff go onto the HICAPS website and print off the relevant days transactions and compare it to our HICAPS total and if it is the same the HICAPS is released and closed off.
3.4 DVA – any invoices to Veteran Affairs are held in the Marked Payment area of the Veterans Affairs account in Oasis. As the payment appears on the bank feed the payment is marked off as a DirectDebit. This direct debit can then be closed off as a distinct payment.
3.5 CBDS – These payments appear in the Oasis banking screen for Eclaims but are always placed on KEEP until they appear in our bank feeds as paid. As long as CDBS payments are NOT released from Oasis they can be altered. e.g. if they don’t get paid we can alter then and then they do not appear as incorrect on individual dentists monthly summaries.
As CDBS payments appear on our bank feeds they are “released” and closed off. Closed off totals must match a bank feed entry. i.e. Dr X get paid $240 from CDBS in one bank entry and Dr X gets paid $47 in another bank entry. Each of the bank entry totals are closed off separately so $240 is closed off, then $47 is closed off. This way we can relate each bank entry with a Oasis close off.

After the HICAPS close off each morning staff also print off the Daily Oasis Bank summary for the previous day and this is used for bank reconciliation. Except for Cash and Cheques (totaled together), each figure is entered as a separate sales amount in MYOB and it will be matched with a separate bank feed entry.  (takes about 2 minutes. Remember to put them in as Paid Sales or the bank feed in MYOB wont find them)
Easy.