Master Healthcare Excellence in Natural Medicine and Wellness

Master Healthcare Excellence in Natural Medicine and Wellness Working Smarter Not Harder Mark Shoring Master Healthcare – Practice Principle Strategic Project Manager – Endeavour College of Natural Health Acupuncturist and Naturopath §Master of Acupuncture UWS §Master of Health Science (Nutrition Medicine) UNE §Master of Health Science (Herbal Medicine) UNE §Graduate Certificate of Health Science (Human Nutrition – Sports Nutrition) Deakin §Graduate Certificate of Education (Higher Education) UQ §Bachelor of Health Science (Naturopathy) ACNM §Bachelor of Health Science (Acupuncture) ACNM §Bachelor of Health Science (Musculoskeletal Therapy) Endeavour §Certificate IV(Oriental Massage) ACNM §Traditional Chinese Medicine Hospital Internship Guangxi TCM University §Cert. IV A&WT Russo ANTA Melbourne Seminar Master Healthcare 1

Master Healthcare Excellence in Natural Medicine and Wellness Complementary and Alternative Medicine Statistics § Mc. Lennan and Xue report Complementary and Alternative Medicine (CAM) to service somewhere in the vicinity of 11, 415, 166 (52. 5%) (Mc. Lennan et al 2004) – 14, 981, 125 (66. 9%) (Xue et al 2007) of the total Australian population on a regular basis. § Xue further reports that the Australian population currently have an estimated out of pocket expense of $4. 13 billion AUD per year for CAM related products and services (Xue et al 2007). § Bensoussan also reported in 2004 that approximately 1. 9 million naturopathic consultations were undertaken in Australia (Bensoussan et al 2004). ANTA Melbourne Seminar Master Healthcare 2

Master Healthcare Excellence in Natural Medicine and Wellness Activity The CAM practitioners charge per hour survey? Hourly Charge Rate Clinician Number Hourly Charge Rate Free $90 -100 $0 -10 $100 -110 $10 -20 $110 -120 $20 -30 $120 -130 $30 -40 $130 -140 $40 -50 $140 -150 $50 -60 $150 -160 $60 -70 $160 -170 $70 -80 $170 -180 $80 -90 Clinician Number >$180 ANTA Melbourne Seminar Master Healthcare 3

Master Healthcare Excellence in Natural Medicine and Wellness Fee For Service (FFS) What does it Represent? § Covers the ongoing payment of expenses: § Example CAM capital Item expenses: +/- $35, 000. 00 § Example CAM ongoing expenses: +/- $50, 000. 00 (including lease costs) § Example total costs first year of practice: $85, 000. 00 § Provides your yearly income § Don’t forget your tax costs. . ANTA Melbourne Seminar Master Healthcare 4

Master Healthcare Excellence in Natural Medicine and Wellness Fee for Service (FFS) CAM Models As a general rule there are two primary methods commonly employed by natural therapists. They include the following: § Multiple treatment rooms where the practitioner will see 4 -6 patients (or more) per hour via a rotation style format (typically practitioner face to face time 10 -15 minutes per patient). § Patient FFS Cost: $30 -50 per treatment § FFS Potential: $120 -300 per hour or $2. 00 -5. 00 per minute § Therapist utilizing this approach: Acupuncturist, Chiropractors, Naturopaths § One treatment room where the practitioner will provide 10 – 60 minute face to face time with each patient. § Patient FFS Cost: $30 -180 (or more) per treatment per hour (or part there of) § FFS Potential: $30 -180 per hour or $0. 50 -3. 00 per minute § Therapist utilizing this approach: Naturopaths, Massage Therapists, Aromatherapists, Chinese herbalist, Western Herbalists, Nutrition Medicine Practitioners, Tui-Na Therapists, Osteopaths, Musculoskeletal Therapist ANTA Melbourne Seminar Master Healthcare 5

Master Healthcare Excellence in Natural Medicine and Wellness CAM General Practice Capital Item Expenses Computer $1, 000. 00 Printer, Copier, Fax Machine (or equivalent) $500. 00 mypractice network software (one license) $900. 00 Label printer for consumables (eg. Brother QL-570) ($179. 00)* $179. 00 Consultation Tables - Charelston Desk with One Draw x 4 ($129. 00/unit) $129. 00 Practitioner Office Chair ($89. 00/unit) $89. 00 Patient Consultation and Reception Chairs x 4 (office cantalever vistor chair) ($69. 00/unit) $276. 00 Art / Theming for the Clinic $250. 00 Business Card Holder & Business Brochure Holder $50. 00 Professional Website Development, Search Optimization and Hosting $5, 000 Motorised Massage Tables - Firm and Fold Body Contour x 5 ($2257. 00/unit) $2, 257. 00 Linen - Towel ($3. 47/towel) (requiring minimum of 40 towels to cmmence trading) $138. 80 Gas Lift Stool ($99. 00/unit)* $99. 00 Bolsters/Pillow (Knee) (50. 00/unit) $50. 00 Bolsters/Pillow (Head) (40. 00/unit) $40. 00 Kimberly Clark Towel Dispensers 49. 5 cm x 4 ($48. 82/unit) $195. 00 Kimberly Clark Towelette Dispensors to Dry Hands x 5 ($52. 29/unit) $261. 45 Glove Receiptical x 4 ($50. 60/unit) $202. 40 X-Ray Box x 4 (185. 90/unit) $185. 90 Setup facility costs if they are not already established (eg. Paint, Walls, Cabling, Plumbing, zoning etc) $25, 000. 00 Total Capital Item Costs ANTA Melbourne Seminar Master Healthcare $34, 094. 55 6

Master Healthcare Excellence in Natural Medicine and Wellness Example of Some Ongoing Costs (What about insurance, professional development, etc) HICAPS/EFTPOS $600. 00 None Latex Gloves ($8. 30/unit) $373. 50 Paper Towelette to Dry Hands ($54. 88/unit carton) $651. 36 Paper Towel Large Versa 49. 5 cm ($16. 06/unit) $199. 20 A 4 Laser Printing Paper $84. 00 Business Cards ($130. 00/1000 Card) $780. 00 Laundry Costs $600. 00 Business Internet Connection (For Wifi Connection) $360. 00 Business Telephone Connection $360. 00 SMS credits to notify patients ($0. 10/patient) $240. 00 Brochures ($540. 00/1000 Order) $3, 240. 00 Yellow Pages Online (without search boost)* $2, 400. 00 Yellow Pages - Print (1 x Full Colour 1 PI)* $4, 200. 00 Signage Budget to Promote Clinic (Building and Facility)* ($5148/year) $5, 184. 00 Media Budget to Promote Clinic (eg. Radio, Newspaper, etc)* (eg. local paper cost $350. 00/month) $4, 200. 00 Conference and Event Budget to promote clinic to potential clients ($3600. 00/year) $3, 600. 00 Lease Costs (Minimum $15, 000. 00 PA) $15, 000. 00 Total General Clinical Expenses ANTA Melbourne Seminar Master Healthcare $50, 565. 66 7

Master Healthcare Excellence in Natural Medicine and Wellness Further Modelling Considerations ― Business ethics (patient perspective) ― ‘Conflict of interest’ (providing product can this exclude treatment? ) ― ‘Delivery of service/expertise’ is the patient receiving quality service? ― Consider HAQ ‘Health Appraisal Questionnaires to reduce consultation time; and ― Consider reducing the individual consultation time (eg. 30 and/or 15 minute consultations) ― Consider dividing out your services (eg. consultation, iridology assessment, etc) ― Business development (practitioner perspective) ― Time vs Fee ― Am I actually generating an income from my practice? ― Can I use benchmarks to assist me towards success? (eg. Australian Division of General Practice (ADGP) figures? ) ― Do I generate sufficient income to develop and grow my business? ― Do I generate enough income to continue the business practice (ie. do I make ANTA Melbourne Seminar Master Healthcare 8

Master Healthcare Excellence in Natural Medicine and Wellness Working Smarter Not Harder Health Appraisal Questionnaires (HAQ) ANTA Melbourne Seminar Master Healthcare 9

Master Healthcare Excellence in Natural Medicine and Wellness Benchmark Considerations Australian Division of General Practice Staff cost/s – Estimated Cost: $50, 400 / year (GP benchmark) § Reception 1. 0 -1. 5 FTE (full-time equivalents); § Roughly $28, 000 / year (base salary) x 1. 0 -1. 5 FTE + 20% on-costs (eg holiday leave etc); and § Total yearly practice costs: $50, 400. Practice non-staff costs – Estimated Cost: $62, 800 / year (GP benchmark) § Examples: practice management software, HICAPS/IBA/EFTPOS, stationary, advertising (eg. signage, brochures, business cards, etc), equipment (eg. needles, stock, printer ink, etc), lease/repayments, practice maintenance, computer, office needs (eg. desk, chairs, towels, massage table, etc), accountant, internet, phone, etc. Professional costs – Estimated Cost: $18, 550 / year (GP benchmark) § Examples: conferences, further education, insurance, association, periodicals. Total yearly cost (GP): $131, 750 / Year (excluding capital items) ANTA Melbourne Seminar Master Healthcare 10

Master Healthcare Excellence in Natural Medicine and Wellness Working Smarter Not Harder Cost Breakdowns Total Practice Costs (based upon GP benchmarks)? § Practice with no staff: $81, 350. 00 (52 week year) § Practice with staff: $131, 750. 00 (52 week year) Per hour and minute practice costs (assuming you have 100% patient attendance) § Practice with no staff (total potential cost / hour): $44. 60/hour or $0. 74/minute § Practice with staff total (total potential cost / hour): $72. 23/hour or $1. 20/minute What does this mean for CAM? As clinician we could reduce these proposed costs (eg. cut the professional development, business costs, reduce our holiday time, work more hours, etc), however, will this grow the business? Will our patients acquire the level of healthcare they expect? Can I afford to live or do I need a second job to fund my business/hobby? ANTA Melbourne Seminar Master Healthcare 11

Master Healthcare Excellence in Natural Medicine and Wellness Working Smarter Not Harder Australian Division of General Practice VS Retail Employment Typically the yearly/hourly rate of pay for a CAM employee within a retail environment is: § Per Year Income: $34, 500* - $59, 280* (further value adds + holidays, + sick pay, etc) § Per Hour Income: $17. 50 - 30. 00 / hour § Example One (CAM practice with no staff operating 38 hours per week | 48 weeks per year) § Expense per hour with 100% patient attendance 48 weeks per year: $44. 60 § Total minimum hourly FFS rate (based upon employment rate): $62. 10 - 74. 60 / hour § Total minimum minute FFS rate (based upon employment rate): $1. 04 – 1. 24 / minute § Total practice income for the year to benchmark with retailer: $34, 500* - $59, 280* § Example Two (CAM practice with staff operating 38 hours per week | 48 weeks per year) ANTA Melbourne Seminar Master Healthcare § Expense per hour with 100% patient attendance 48 weeks per year: 12

Master Healthcare Excellence in Natural Medicine and Wellness Working Smarter Not Harder FFS Advice to Consider § § The following table has been designed for you all to re-assess your FFS charge rate. Remember the Australian public spent $4. 13 AUD billion on CAM in 2007 ANTA Melbourne Seminar Master Healthcare 13

Master Healthcare Excellence in Natural Medicine and Wellness Working Smarter Not Harder Practice Income Per Year (48 week year) § § § The above table has been designed for you to re-assess your yearly income subject to further costs. Remember patient come to clinicians for service (not product). Place value in the consultation process and the service that you offer. ANTA Melbourne Seminar Master Healthcare 14

Master Healthcare Excellence in Natural Medicine and Wellness Working Smarter Not Harder HICAPS and IBA (i. Soft) Systems § The client will automatically access their health fund subsidy prior to paying your full fee for service charge – it therefore reduces the overall cost of the consultation for the patient. § ANTA has currently arranged for Naturopathy, TCM (Acupuncture and Chinese Herbal Medicine) and Remedial Massage therapists to have access to this service. ANTA Melbourne Seminar Master Healthcare 15

Master Healthcare Excellence in Natural Medicine and Wellness IBA (i. Soft) ANTA Melbourne Seminar Master Healthcare 16

Master Healthcare Excellence in Natural Medicine and Wellness Working Smarter Not Harder Practice Management Software Solutions § § Patient management programs can be of major assistance towards managing your practice and time. These solutions can automatically managed some of your manual business operations thereby increasing your potential FFS and down-time. What do they do? § They can manage patient bookings (eg SMS, email), provide financial and business reports, provide patient notes facilities (medico legal perspective). § Many programs exist, however, the following list I have found to be more natural medicine practitioner friendly: § Front Desk - http: //www. smartsoft. com. au/free_demo/ § Healthquest - http: //www. healthquest. net. au/ § Mypractice - http: //www. mypractice. net. au/Home. aspx § Visual Outcomes - www. visualoutcomes. com. au/index. php ANTA Melbourne Seminar Master Healthcare 17

Master Healthcare Excellence in Natural Medicine and Wellness Product Charging Considerations This has historically been a set cost process: § Example: § $17. 00/100 m. L (inclusive of preparation and labelling) § + $3. 00/10 m. L of expensive herbs § Thus the total charge for the below formula is $29. 00 CODE ITEM Cost/m. L Volume Prescription Preparation and Storage Cost $10. 00 1 $10. 00 Prescription Labelling $1. 00 1 $1. 00 TBB 100 C AMBER BOTTLE/CAP 100 ML $0. 65 1 $0. 65 MH 5 FALSE UNICORN ROOT 1: 2 $171. 05 $0. 34 40 $13. 68 MH 5 PAEONIA 1: 2 $34. 85 $0. 07 30 $2. 09 MH 5 SHATAVARI 1: 2 $40. 75 $0. 08 30 $2. 45 100 $29. 87 Total Cost $29. 87 GST Charge $2. 99 Cost + GST $32. 86 50% Mark Up $44. 81 GST Charge $4. 48 50% + GST $49. 29 Gross Revenue $14. 94 75% Mark Up $52. 27 GST Charge $5. 23 75% + GST $57. 50 Gross Revenue $22. 40 100% Mark Up $59. 74 GST Charge $5. 97 100% + GST $65. 71 Gross Revenue Cost $29. 87 ANTA Melbourne Seminar Master Healthcare 18

Master Healthcare Excellence in Natural Medicine and Wellness General recommendations for clinicians: § Clinician should aim to charge $2. 00/minute or $120. 00/hour § Reduce the duration of your consultations (consider a thirty minute consultation) § Consider using HICAPS/IBA to reduce your patients perceived consultation costs § Consider charging your product out at a per gram/m. L charge with a 75% mark-up § Consider charging your time for the manufacture of extemporaneous products Mark Shoring Acupuncturist and Naturopath Master of Acupuncture. UWS Master of Health Science (Nutrition Medicine)UNE Master of Health Science (Herbal Medicine)UNE Graduate Certificate of Health Science (Human Nutrition)Deakin Graduate Certificate of Education (Higher Education)UQ Bachelor of Health Science (Naturopathy)ACNM Bachelor of Health Science (Acupuncture)ACNM Bachelor of Health Science (Musculoskeletal Therapy)Endeavour ANTA(F 5956 IE 06) AACMA(1480) Master Healthcare Excellence in Natural Health and Wellness Deagon Practice, 71 Loftus Street, Deagon, QLD, 4017 Tel +61 0410 033 215 Web www. masterhealthcare. com. au Email mark@masterhealthcare. com. au ANTA Melbourne Seminar Master Healthcare 19