Employee dentists and employing dentists: a dummies guide

Having dentists working for a dental clinic as a contractors rather than employees is fraught with risks.*  For practices worried that they should not be paying dentists as contractors, for dentists looking to find a job, or practices looking to take on a dentist, there is a lack of practical information to help them understand options available or how to actually manage the employee dentist payments.

When to switch a dentist from a Contractor to an Employee
It is unwise to leave the decision of moving a contractor dentist to an employee dentist for another time! From an owner viewpoint the worst time to look at this issue is when you are selling your practice.

Over the past couple of years we have employed a dentist under an employment arrangement that I would not recommend because it is so messy to manage. Hopefully my thoughts and learnings will give dentists (employee and employer) help in their discussions with their own accountant. This article is for general discussion and is not intended as advice – don’t act on it as it may be totally misleading or incorrect (that my disclaimer!)

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.
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

 

 

Dental Equipment Register and Maintenance Recording

You don’t need a Dental Equipment Register if you can remember the date of each purchase and the cost!
You don’t need maintenance recording if nothing ever breaks down!
I, however, do not remember the make and model of my dental chair, nor the reason we last had it fixed (so many reasons to remember) so I developed a solution. Yes and my solution has been improving.

Check out how Dental Equipment Register works for my practice in the latest youtube video. If you have an asset register in MYOB or Xero and want to use it so start off in SmartDentist please let me know. The accounting package asset registers lack the detail you need to call and get something fixed and they don’t have the ability to keep track of the repairs and maintenance to equipment. If you are using Simplified Small Business Depreciation you might even find you don’t have much of an Assets register at all!

Try out the SmartDentist’s Asset register for your dental practice today!

Both our small and big equipment are high costs for the practice. We don’t want to keep paying for the same sort of repair and we need to know whether a piece of equipment is close to its used by date before we pay for expensive repairs.
The SmartDentist.com.au Equipment Register and Maintenance recording gives practitioners a level of control and understanding that has not been available before now to the small business owner.

Flu shots and immunisation for dental staff

Time for Flu shots and immunisation checks for dental staff

Get the flu shot immunisation today

It’s never too late to vaccinate/ immunisation for health

There is nothing that bonds all the dental team together better than having your flu shots at work!

Why now?
April is the ideal time to arrange your flu shots. The peak season for flu is late July August so having the flu shot now means you will build up immunity by the time the risk of catching the flu is greatest.
Flu vaccinations are one of the recommended vaccinations for healthcare workers (or anyone in contact with the public!)

Immunisation for Dental Staff

The ADA’s latest News Bulletin outlined the requirements for Dental Staff immunisation. SmartDentist subscribers have an easy way to meet staff immunisation obligations. To find out more you and your staff can do an online training course on the flu and your immunisation obligations. This will earn you CPD points as well!
Dental practices with accreditation need to fulfil staff training obligations so encourage each staff member to learn and join in the conversation about immunisation, the flu and infection control.

SmartDentist is the easy solution to fulfilling all your immunisation requirements with:

  • a practice policy that includes management of staff refusal;
  • employee and pre-employment immunisation forms;
  • an immunisation register;
  • information for staff on vaccine preventable diseases

Mandatory immunisation of healthcare workers

Queensland Health now require job applicants for dental roles to supply evidence of vaccination or evidence that they are not susceptible to prescribed vaccine preventable diseases.

Dental practices would be wise to follow the lead of Queensland health and use their pre-employment forms and their evidence criteria (all available online).
SmartDentist has pre-employment forms and recommends dental practice adopt this vaccination requirement for new staff. It helps streamline the practices obligations and reduces stress if a sharps injury occurs.

PRODA set up for Dentists made easy with SmartDentist | CDBS | DVA payments

PRODA (Provider Digital Access) for the dental practice

Now you will need a PRODA login* to claim payment immediately for Child Dental Benefits Schedule and Veteran’s Affairs. Online claiming is easy and brings enhanced cash flow to your dental practice. At our practice all our receptionists have become familiar with HPOS, checking out CDBS eligibility and claiming payments straight away from the government.
[Go to the Dept of Human Services web site now to find out more]

SmartDentist is helping dental practice get their the new PRODA system up and running.
Record your PRODA ID in your staff profile on Smartdentist AND Smartdentist  creates a PRODA ID list that can be printed or emailed so people can easily ‘delegate’ to each other. This is a great place to keep these details and as staff come and go you don’t have to try and remember where you placed your PRODA ID.

SmartDentist Staff Profile also allows you to record an additional email address.
We use this additional email address for the PRODA 2 step verification (so reception staff don’t need their mobile phones or to access their home email while working at reception). The SmartDentist Staff profile allows me to let the staff know what email address they should setup for their PRODA login.

Creating individual staff emails using your domain name (email aliases)
For those practice managers unfamiliar with creating an “email alias” you can actually have glenda@yourpractice.com.au, jan@yourpractice.com.au, and cat@yourpractice.com.au all as email aliases for admin@yourpractice.com.au. e.g multiple email names for the same email address.
Depending on your email system it may cost up to $7 per user per month for additional emails, but not if you are using an email alias!

*PRODA login for the HPOS on the Dept of Human Services site is not compulsory yet but the USB connections for our reception computers have been damaged by “USB stick in – USB stick out” and we want our system up and running BEFORE they close down the PKI certificates.

Facts and Myths Infection Control

infection control myths and facts

Facts and Myths of infection control (heard or read in 2016)

  1. Via “tracking” you can demonstrate a patient hasn’t got an infection from your practice (controlling infection control!)
  2. An ultrasonic is needed even if you have a washer-disinfector.
  3. It’s quicker to ask the ADA than seek the answer yourself.
  4. No-one has ever got an infection from a dental practice.
  5. Ever Sterilisation cycle needs a PCD (Helix or Bowie Dick)
  6. An ICMP (infection control management plan) replaces your sterilisation manual.

Let’s look at the statements –
1. Tracking instruments
Tracking is required to keep dentists and their staff “on the ball”. Tracking tries to demonstrate that a particular pack of instruments has been through a particular steriliser cycle. BUT unless your tracking system takes a picture of the pack with the steriliser tape color changed you aren’t even really demonstrating the pack went through a cycle!
Most systems only tell you that you know the number of a cycle that has been completed.

However that doesn’t mean I disagree with tracking. We track all our instruments because I think it is good idea. However personally I would be cautious about investing a lot of money into a scanning tracker system at this stage because I think they will improve in the future. I imagine a time when the scanner picks up the changes in the packaging that occur with sterilisation rather than just reading a bar code that remains unchanged in the steriliser.

Of course sterilisation is a theoretical practice. When we sterilise we do so with an assurance that the possiblity instruments have one viable bacteria on them is one item in one million. However we know that if instruments are not cleaned properly then this figure is incorrect and people have been infected via instruments that have been through sterilisers (not dental instruments) at correct time, temperature and pressure.
If stats were taken literally:
21,000 dentists in Australia  X 48 sterilisation cycles = 1 million cycles
So does that mean that you never want to be the 49th patient a dentist sees because you are likely to have THE VIABLE micro-organism!
Nahhh… but it isn’t that simple.

Track all your instruments for convenience because simple systems are the quickest and the best.

2. Ultrasonic Cleaners
Ultrasonic cleaners were basically introduced for staff occupational health and safety (safe non-scrubbing). They are designed to reduce operator error in instrument cleaning. However in dentistry we all know that unless you remove composite and cements from instruments immediately chairside then an ultrasonic cleaner nor a washer-disinfector are not going to work.
Washer-disinfectors are used similarly to ultrasonics in dental practices so generally if you use one then you dont need the other. You should speak to other dentists who use washer-disinfectors or ultrasonics when you are looking to buy a new one. Some washer-disinfectors have an ultrasonic mechanism built in.

Testing ultrasonic cleaners each morning is for the benefit of the practice. It is of no use placing instruments into an ultrasonic cleaner that is not working!!!
Also remember that research has shown if you place instruments into dirty ultrasonic cleaning liquid they will be dirtier than when you put them in.

3. ADA versus Google
It’s always nice to speak to a person at the ADA but for many issues it is quicker googling and asking the source. Examples: Fair Work – look up the staff award and read it yourself. You are supposed to have an award accessible for the staff anyway; Long Service leave – this is a state based function and Victoria has a really helpful help line.
The ADA committee members have a wealth of knowledge but you need to allow time to get onto the correct person.
Other options of information:
Generally some of the facebook groups for dentistry are interesting for different opinions and you can often get a quick response as dentists play online. The ADA Inc site has helpful HR resources but check that they are current and applies to your own state.

Remember the ADA in Australia is a professional group of dentists and have no power to set “rules”. Even the ADA infection control guidelines can be seen as an “interpretation” of AS 4815 and the NHMRC guidelines. The Dental Board resources should be looked at first for clinical advice. The Oral Therapeutic Guidelines are also important for conventional requirements. The ADA has representatives on the Therapeutic Guidelines Committees and on Standards Australia committees.
For SmartDentist subscribers check out your “Clinical Guidelines” [Resources > Clinical Guidelines] first as this is a group of documents to help you make effective clinical decisions.

4. No-one has ever got an infection from a dental practice (other than the contriversial HIV dentist)
This is not correct. There have been documented cases of infection transfer.
The recent 4 cases of Infection control breaches in 4  NSW practices has had a review and they know 26 people from the practices have now newly discovered they have BBV.
http://www.health.nsw.gov.au/Infectious/reports/Documents/dental-investigation-report-2016.pdf
Check out this most recent review on dental transmission.
https://www.cdc.gov/oralhealth/infectioncontrol/pdf/pathogentransmission.pdf

5. Every sterilisation cycle needs a PCD
Helix or Bowie Dick devices are required at the start of each day for an empty steriliser. They aim to “challenge” a Process – hence the name Process Challenge Devices. The process they “challenge” is the ability of the steriliser to remove all air from the steriliser so it can fill up totally with steam. You can use a specific device made to test this in your normal cycles but these tend to be slightly different in nature. While this is heavily promoted by a particular supplier of these consumables (yes, they sell them) the evidence for their use has not been declared manditory by AS 4815.
The requirement by Australian Standards is to have the device used at the start of the day.

6. An ICMP (infection control management plan) replaces your sterilisation manual.
No your sterilisation policy manual is only part of the infection control management plan. The idea of a “management plan” is that you:

  1. Work out what you need to manage.e.g. what are your infection control risks? Name and sham each one of them. Use a Risk analysis tool to document the risks and have them in your risk register so you can review them at a later date.
  2. Document how you are managing these infection control risks. e.g. this is via your policies and procedures so this is where your infection control manual fits in. You cant just use the ADA guidelines as that document isn’t a procedure manual and says in some parts…”you can do this….or you can do that”.
  3. Plan staff training so everyone is part of implementing your plan

SmartDentist subscribers have an online Infection control management plan – easy!

practice validation and the ADA

Have you read the ADA News Bulletin Aug 2016- Practice Validation and infection control
Glazed eyes? Confused? Yes infection control is an unromantic topic.
Here is my attempt in trying to explain what the author might have meant by “Practice validation and infection control” –

In your dental practice you need to consider what you do about infection control because it has to be:

  1. as required by law
  2. written down (computer is ok)
  3. what staff actually do

Your procedures must include the collection and saving (storing) of some physical evidence that staff have actually done what they are supposed to do in particular areas of procedures.

The topics you need to cover with written procedures may best be sourced from the list in “The ADA guidelines for infection control”. The ADA Guidelines list was the basis for SmartDentist template procedures. You can use these as for your own procedure manual (e.g. Go to the template library and press +add. Then change as required)
The Accreditation standard 3, quoted in the article as a reference source for appropriate policies and procedures, does not ONLY cover infection control but includes preventing infections – hence the confusing inclusion of antimicrobial prescribing etc. (check out SmartDentist for policies and procedures in these additional accrediation areas)

The ADA News Bulletin article goes on with detailed information specific to the validation of autoclaves (moist heat sterilisers).
[I wonder if this is because I have recently seen sales info. that says you can buy a sterliser that comes supplied with a validation certificate! That is a big no no! (except if you are in a remote area)]

For practices that think they need to conform to AS/NZ 4187 be warned that the information in this article falls well short of the requirements for validation in AS/NZ 4187 but most of us will use AS4815 as discussed in the article.

It seems a bit odd for the ADA to state in writing (for others to quote later) that it is the dentist’s responsibility that steriliser validation is properly conducted. It is a bit onerous to need to be the expert instead of the technician.
Instead here is a quick checklist for you to pick a suitable technician:

  1. Do they also service and repair sterilisers?
  2. Do they provide a validation certificate and records?
  3. Will they remind you when validation is due again?
  4. Do they require staff to supply a range of “usual packs” of instruments?
  5. Do they require biological indicators to be incubated over time so they DO NOT provide immediate certification?

Rather than push responsibility back to the dentist for being a steriliser technician the ADA could consider an “ADA approval” process for those who service and do validation on office based sterilisers.

New to SmartDentist: You can upload your validation certificate into SmartDentist.

HOW TO SAVE YOUR VALIDATION CERTIFICATE:

  1. Add your Steriliser to Equipment Register
  2. Set up a Service timetable
  3. When the service is due and completed upload the validation certificate and the service timetable will re-date to the next service time.

EOFY and Dental Accounting

In July 2015 I took over the accounting at our practice. As you can imagine I delved in deep and set up new systems for efficiency. Here is what I have learnt in the past 12 months.

BANKING

  • Use different accounts for money in and money out. This doesn’t cost more and makes it easier to see and track errors.
  • No petty cash – give the reception a debit or credit card. NO CASH.
  • Pay all accounts online – either direct or with credit cards. Apart from being easier it also leaves an easier to see audit trail.
  • Bank Feeds into MYOB or XERO are an absolute MUST. Saves time (and money) and is more accurate than you or your book-keeper. XERO feeds from Credit Cards may be incorrect.

PATIENT SOFTWARE BANKING – TO THE BANK

  • Bank Summaries each day from your patient software should always line up with your bank deposits. If they regularly do not match then you need to change the way your staff close off your patient banking. Yes we now have ours so they match.
  • Never close off Medicare until it is in your bank!

BOOK-KEEPING – ACCOUNTING

  1. Excel Spreed sheets – you need one for each of the following
    Long service leave – As a minimum do it at the end of each year. MYOB will not give accurate figures. The premise of MYOB’s calculations is incorrect.
    Depreciation schedule/Assets: this can be a third party addition to XERO but not really worth the expense? You need to do this yourself. Your accountant may lump equipment together and this makes it really hard to write off single items. e.g if you buy a chair and an xray unit and etc together.
    Partners distribution: We do this monthly on excel just because it is easier but it is then entered into MYOB so we can see it at any stage; auditing is better via MYOB.
    Other excel sheets: If your book-keeper or accountant uses excel for BAS or wages then they probably don’t know how to use the software you are paying for.
  2. Profit/Loss; Balance Sheet; Depreciation; BAS and GST
    You are an intelligent dentist. You need to get your head around these terms. I bought the “Dummies guide to Accounting”. It helped with some of the basics. I also bought the “Dummies guide to MYOB” and found that I then knew lots more than my accountant and their book-keeper (very annoying!). People don’t necessarily keep up with the software changes so they do things the old long way.
    Profit and Loss – Money in and Money out. This is the most basic concept. Your expenses are listed without GST (the system takes it out for you!).
    Use Subtotals in MYOB and XERO for a better picture.
    You need to add in depreciation to this concept as not everything you buy can be claimed as an expense in the year it was bought. ! IMPORTANT – this means that your “profit” and the money you have in the bank will not necessarily match.
    Balance Sheet – Go to the Balance Sheet to make sure your bank totals match your MYOB or XERO bank totals. The Balance sheet is also where you will find how much GST you OWE at any time. If your accountant has to give you an end of year adjustment to get this correct then you are not using MYOB or XERO correctly.
    Depreciation – Yes this is an odd thing to understand. Spend time on it. You will also then find you should be keeping an asset register etc. Depreciation is really important. It means that you are paying tax on money you have already spent on depreciating items.
    BAS and GST – all your payee accounts in MYOB/XERO should be set so it automatically gives the correct GST rating and correct expense category. If not then you need to spend 1 hour setting this up. It will save many hours later.
    XERO and MYOB give you the BAS information very easily. Do an online lodgement and it will take you 10 minutes to do a BAS statement.
  3. Register for and AusKey and do your BAS online -very easy to do both of these. If you are a MAC user – use Firefox as your browser.
  4. Expense accounts
    The expense accounts are YOUR expense accounts. If the accountant is moving things around  – they are just stuffing you around to justify their fees. Your system should be set up so it is automatically correct.
  5. Income accounts
    Our income accounts match our bank entry categories – so you can chase problems (which we of course never have 🙂 ).
    Our partner totals are also entered, in addition, so you can match the patient software totals with the bank totals.
  6. Journal entries
    This is fun. Learn how to do them.
  7. MYOB vs XERO
    XERO is better for bank feeds, much much better. MYOB has better reports and easier to find information. MYOB has better year to year comparison (especially if you leave the previous year open)
  8. DO NOT use Spend Money or Receive Money in MYOB or XERO unless absolutely necessary. These are not helpful for reporting etc.
  9. Difference between an Accountant and a Book-keeper
    An accountant is what you need for “higher” level information. e.g. setting up trusts; tax fraud etc. A book-keeper is the one who needs to know how to set your systems in place for easy entry and monitoring. They wont necessarily think about easier ways of doing things, and why should they if they are being paid by the hour.
  10. Borrowing your watch to tell you the time
    Consultants are defined as people who “borrow your watch to tell you the time”. We have MYOB set to show accurately our OASIS totals, monthly and yearly. If you need an accountant to audit the obvious then your systems might be better set up.

Glenda Farmer is not an accountant and hasn’t even done a book-keeping course but is happy to come out to your practice and help you understand and set up good systems that work for you. (Melb Metro area – unless you want to fly me somewhere!)

Dummies guide to uploading into QIP AccreditationPro

I am probably one of the most experiences people at uploading documents, for Dental Practice Accreditation, into QIP AccreditationPro. ( A service offered by SmartDentist as it is a really time consuming task)

Yet, I have only just realised that I can make the upload system better for both QIP and myself.
In the past I have named the upload documents according to their content. This results in a messy document list on QIP because QIP sorts the uploaded documents alphabetical.
(see below – very messy)

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To create a useful document list
Try naming the document by the action number e.g. the Governance policy becomes ‘1.1.1 Governance Policy’. Then you have a document list in QIP that can be checked against the ADA document evidence list (available as a handy cheat sheet on the ADA website).
This also will help QIP as they do a check to see all your documents are present. Remember that 1.7.1 needs to be listed as 1.07.1 or the sequence wont be correct when you come to 1.15.1 !!

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