How to Become an Allied Health Private Practitioner in Rural WA

Transcription

1 How to Become an Allied Health Private Practitioner in Rural WA WA Country Health Service October 2006

2 How to Become an Allied Health Private Practitioner in Rural WA October 2006 A publication prepared by WA Country Health Service (WACHS), as part of the Partnerships in Rural Health Project (funded by WACHS and the Australian Government Department of Health and Ageing through the Rural Private Access Program). i

3 Suggested Citation: WA Country Health Service 2006, How to Become an Allied Health Private Practitioner in Rural WA, Government of Western Australia, Perth. Front Page Photographs: Anna McDonald and Chris Vye ii

4 Contents Page Introduction 1 Background 1 Australian Business Numbers & Tax File Numbers 2 What is an Australian Business Number? 2 How to Obtain an Australian Business Number 2 Registering as a Sole Trader, Company or Partnership 3 How to Obtain a Tax File Number 3 Business Name Registration 4 Who Needs To Register? 4 How to Register 4 Cost of Registration 5 Responsibilities after Registration of a Business Name 5 Goods and Services Tax 6 Who Registers for GST? 6 Accounting for GST 6 Tax Invoices 7 Developing a Business Plan 9 What is Included in the Plan? 9 Establishing the Demand for the Service 9 Income Streams 10 Medicare Allied Health and Dental Care Initiative 10 Obtaining a Provider Number 11 Private Health Funds 12 Obtaining a Provider Number 12 Department of Veterans Affairs 12 Obtaining a Provider Number 13 More Allied Health Services 13 Partnerships 14 Considerations for Collaborative Partnerships and Agreements 15 iii

5 Associated Costs of Private Practice 16 Superannuation 16 Insurance 17 Professional Indemnity Insurance 17 Income Protection Insurance/Income Insurance 17 Contents & Building Insurance 18 Marketing 18 Professional Registration 18 Membership to Professional Organisations 19 Appendices 21 Appendix A: Useful Contacts 22 Appendix B: Sample Practice Set Up Costs 23 List of Acronyms 25 References 26 Tables Table 1: Costs Associated With Professional Registrations 2006 (as at 31 st July 2006) 19 Table 2: Professional Membership Fees (as at 31 st July 2006) 20 Table 3: Contact Details for Professional Bodies 20 Table 4: Set Up Costs: Physiotherapy Practice 23 Table 5: Set Up Costs: Speech Pathology Practice 24 Figures Figure 1: Setting out a tax invoice (GST registered) 7 Figure 2: Setting out a tax invoice (not GST registered) 8 iv

6 Introduction This resource outlines information and contact points related to the establishment and planning of a private allied health practice and potential partners and income streams. It is hoped that the information provides guidance and direction to allied health professionals (AHP) who may be considering private practice arrangements, but should not replace independent financial and business development advice. The following information is included in this resource: Obtaining a business number Obtaining a tax file number Goods and services tax Invoicing Superannuation Business planning Income Streams Partnerships Useful Contacts Background In February 2006 WA Country Health Service (WACHS) received funding through the Australian Government Department of Health and Ageing Rural Private Access Program to conduct the Partnerships in Rural Health Project. 1 The primary aim of this project was the development of a strategic plan to identify appropriate public private partnership models to ensure the long-term viability of privately insurable health services in the north west of Western Australia (WA), focussing on allied health services. During the course of the project, enquiries were received from numerous allied health professionals regarding private practice opportunities within the WA Country Health Service (WACHS) catchment. From these discussions a need was identified for a resource to assist AHP considering private allied health work in rural or remote WA. Therefore a How to Become an Allied Health Private Practitioner in Rural WA 1 resource was created. 1

7 Australian Business Numbers & Tax File Numbers What is an Australian Business Number? Any individual/partnership/company should obtain an Australian Business Number before commencing business. The Australian Business Number or ABN is a unique 11 digit number that makes it easier for businesses and all levels of government to interact. It is not compulsory that an ABN is obtained, however it does have several benefits. 2 An ABN makes it easier to deal with the Australian Taxation Office (ATO) and other areas of government. It also enables ease of use when dealing with other businesses. Quoting an ABN on invoices given to other businesses avoids them having to withhold tax from payments made. If an individual/company/partnership is registered for goods and services tax (GST), an ABN must also be on every invoice to make it a valid tax invoice. 2 How to Obtain an Australian Business Number An ABN can be obtained free by accessing the Australian Business Register at and clicking on the Apply for an Australian Business Number link. There are several criteria that must be met to obtain an ABN and these can be viewed on the website. 3 Once the required information is provided, an ABN will be issued automatically at no cost with a certified copy arriving two to three weeks later. 2

8 Registering as a Sole Trader, Company or Partnership When registering for an ABN, it is possible to register as a sole trader, company or partnership. Below is a short description of each registration type. Sole Trader A person running a business as an individual. 4 Private Company A company that is not listed on the stock exchange and is not included in the description of an Australian company or cooperative. 4 Public Company Includes listed companies, non-profit companies, statutory corporations and their subsidiaries, also includes friendly society dispensaries and mutual life assurance companies. 4 Partnership Family Partnership A partnership where two or more members are related. 4 Limited Partnership A partnership where the liability of at least one of the partners is limited. 4 Other Partnership A partnership of two or more people carrying on a business or in receipt of joint income. 4 More information can be sourced from the Australian Business Register at and clicking on ABR Help Topics or phone How to Obtain a Tax File Number Sole traders use their own individual tax file number for their business. However companies, partnerships and trusts need a separate tax file number and can apply for a tax file number when they register for an ABN from 3 or telephone

9 Business Name Registration Who Needs To Register? A business name is the name under which business activities are carried on. That is, the name which someone is known by through their business trade or service provision. 5 Any person(s) or companies that are carrying on business under a name other than their own personal name in Western Australia are required to register that name. An individual may trade under their own name (i.e. John Smith), but must register a business name if adding additional information to that name (e.g. John Smith s Speech Pathology). 5 Carrying on business under an unregistered name is an offence and penalties apply. 5 How to Register An application form must be completed and the original form lodged together with a fee at an office of Consumer Protection. An application form can be downloaded from or telephone Before completing the application, a search of the National Names Index should be performed to check if the name intended to register has already been allocated. A name not previously registered, is not necessarily available for registration. Upon lodging the application, Consumer Protection conducts an assessment to determine the availability of a name prior to registration. 6 Registering a business name means no other person or company can trade or carry on business under that name. It does not however give a person or company the exclusive right to use any word or phrase within that name. Protection of a word or phrase may be achieved through the registration of a trade mark. 6 Consumer Protection does not check the registration of trademarks when issuing a business name. Therefore applicants are encouraged to contact IP Australia on , to check whether a trade mark has already been registered. 6 4

10 Cost of Registration The registration fee for a business name is currently $90.00 and must be renewed every three years at a fee of $ Responsibilities after Registration of a Business Name The Business Names Act 1962 requires the owner of a business to: Within two months of registration commence business under the registered business name. 8 Continue to carry on business under the registered business name at all times. A business name cannot be registered to reserve it for future use or protection. 8 Display a sign showing the registered business name in a prominent position on the outside of the principal place of business and any other places of business. 8 Ensure all stationery, advertising or correspondence clearly displays the registered business name. 7 Use the correct registered business name. Proprietors should not abbreviate or alter the name. A new name should be registered if necessary. 8 Display the business name certificate. 8 If a business has decided to stop trading it must notify the Department of Consumer and Employment Protection and cancel their business name within one month of the cessation of business trade. 8 5

11 Goods and Services Tax Goods and Services Tax (GST) is a broad based consumption tax charged at the rate of 10% on the sale of most goods and services in Australia. GST is charged on the price of goods and services sold and must be included on all tax invoices. 9 You must be registered for GST to charge GST on an invoice. Who Registers for GST? You must register for GST if you are in business and you have an annual turnover of $50,000 or more per year. You may choose to register for GST if your turnover is less than $50, 000 per year. 9 More information can be found at or telephone Accounting for GST It is a requirement that the GST collected by a business is paid to the Australian Taxation Office (ATO) on a regular basis. The total amount payable to the ATO is reduced by the amount of GST credits claimable from products/equipment purchased for the business. This is reported through a Business Activity Statement (BAS). 9 GST obligations are accounted for in the BAS at the end of each tax period. Small businesses normally have quarterly tax periods (as their annual turnover is less than $20 million), but it is possible to use monthly and annual tax periods. 9 More information on BAS and lodgement details can be found at: 6

12 Tax Invoices A tax invoice is a document, which records the sale of all goods and services and complies with GST law. Figure 1 depicts information that is required on a tax invoice for businesses that have registered for GST. 10 Figure 1: Setting Out a Tax Invoice (GST registered) (Source: Australian Taxation Office 2004) 7

13 Businesses that are not registered for GST should follow the guidelines outlined in figure 2. These invoices only contain the word Invoice, not Tax Invoice as they are not registered for GST. Because they are not registered for GST the statement No GST has been charged must be included on the invoice. Businesses who do not register for GST cannot claim GST credits, nor do they submit a BAS. 10 Figure 2: Setting Out a Tax Invoice (not GST registered) (Source: Australian Taxation Office 2004) 8

14 Developing a Business Plan A business plan is a summary and evaluation of a business idea. A business plan shows the probability of success of the business and the ability to make it work. It provides the tools to consider all facets of a business and its services in addition to examining the consequences of a range of strategies relative to finance, marketing, management and people. 11 When developing a business plan it is also important to determine the need and demand for the service. What is Included in the Plan? The body of the business plan has a number of sections. Listed below are headings which may be of use when developing a plan Executive summary 2. Introduction 3. Marketing analysis 4. Marketing plan 5. Operations plan 6. Management plan 7. Financial plan The Small Business Development Corporation (SBDC) or your local Business Enterprise Centre can provide information on all aspects of setting up and running a business. Offices are located throughout metro and regional Western Australia. The SBDC can be contacted on (free call) or by visiting their website and the Business Enterprise Centre website Business plan templates and information on writing a plan can also be found at Establishing the Demand for the Service Before purchasing equipment and establishing a private practice it is important to establish whether there is a demand or need for the service. 12 This can be achieved by considering several factors including access to existing services, health needs of the community, gaps in services and potential partnerships. Information can be obtained from a number of sources including the local health service, health centres, other private practitioners and community members. 9

15 Income Streams There are a number of potential income streams a private practitioner may investigate. These include Medicare, private health funds, the More Allied Health Services (MAHS) program and the Department of Veterans Affairs (DVA). Developing partnerships with a range of organisations including the public sector and private business may also provide additional sources of income. Medicare Allied Health and Dental Care Initiative The Medicare Allied Health and Dental Care Initiative pays for a selection of services provided by AHP. It covers patients with a chronic condition and complex care needs who are being managed by their general practitioner (GP) under an Enhanced Primary Care (EPC) plan. The patient can claim up to a maximum of five allied health services in a calendar year from eligible AHP. The five services can either be a combination of different allied health services or five visits to the same service. An exacerbating dental illness allows three dental care services per calendar year. 13 More information on the incentive can be viewed at: act_sheet_medicare_allied_health_and_dental_care_initiative.pdf. There are a number of criteria points that must be met for service eligibility. These include: The service is provided by an AHP registered with Medicare for this initiative. 13 The service provided is on referral from a GP. 13 The service is specified in an EPC allied health referral form. 13 The person receiving the service is being managed under an EPC plan. 13 The patient is not an admitted patient of a hospital or a day-hospital facility. 13 Services provided must be at least 20 minutes in duration. 13 Services provided must be individually provided and in person. 13 The AHP must provide a written report to the referring GP (if more than one service then on the first and last service or more often if clinically indicated). 13 The service cannot be State or Commonwealth funded

16 Obtaining a Provider Number The following professionals are eligible for registration under the initiative: 13 Aboriginal Health Workers Audiologists Chiropractors Diabetes Educators Dietitians Exercise Physiologists Mental Health Workers Occupational Therapists Osteopaths Physiotherapists Podiatrists/Chiropodists Psychologists Speech Pathologists The AHP must be in private practice and the services provided to clients must be performed whilst in a private capacity. Eligibility is also granted if employed by or under contract to an Aboriginal or Torres Strait Islander Community Controlled Health Service or State/Territory clinic that has been granted an exemption under subsection 19(2) of the Health insurance Act For the majority of disciplines, practitioners must be registered with their national registration board for eligibility. For those disciplines without a registration board, membership of the relevant professional association is generally required. Provider/registration numbers can also be allocated, at no cost, to a physiotherapist, osteopath, chiropractor or podiatrist to enable them to request certain diagnostic imaging services as set out in the Medicare Benefits Schedule (MBS). 13 Further information on eligibility can be found at: eligibility_fact_sheet_ pdf. An application form can be downloaded from: care_provider_registration_number_for_allied_health_professional.pdf. 11

17 Private Health Funds Individuals with ancillary private health insurance may be able to claim a portion of their out of pocket expenses for private allied health services from their health fund. The majority of health funds will pay a benefit for allied health services, depending on the type of cover held. Individuals with private health insurance may choose to access private health services to gain the maximum benefit from their fund and benefit from reduced waiting times. Obtaining a Provider Number There are a number of conditions or criteria, which must be met in order to gain a provider number from a private health fund. The majority of funds require the AHP to provide evidence of qualifications and also registration with their appropriate state or national board, or professional organisation. A provider number will only be issued for one location. If a practitioner works from several locations a provider number will need to be obtained for each location of work. There may be other eligibility criteria specific to each health fund that need to be met to receive a provider number. Provider numbers need to be obtained separately from each fund although if a number is already held from one fund, another fund may be able to use the same number if the provider meets their requirements. As there are many small private health funds throughout Australia, if provider numbers have been obtained from the major funds then other funds may also accept this number retrospectively. Check with health fund providers if you are not certain of their position. There is no cost to obtain a provider number. There may be some difficulties in obtaining a provider number when a practitioner works from a location that receives local, state or federal funding from the government as there may be a perceived conflict of interest. Department of Veterans Affairs In terms of health care, DVA members can access a wide range of allied health services at a determined fee. Members are given DVA cards, which determine their service provision. Three cards are available to veterans and include: cards for all conditions (gold card), cards for specific conditions (white card) and a pharmaceutical benefits card (orange card). The gold card entitles veterans to access health care and related services for all conditions and needs and a comprehensive range of medical, hospital, pharmaceutical, dental and allied 12

18 health services for which DVA has arrangements with registered health care providers, in addition to travel assistance to and from the nearest health care facilities where treatment is being provided. 15 The white card enables the holder to access health care and associated services for war or service-related conditions and entitles veterans to receive, for specific conditions, treatment from registered medical, hospital, pharmaceutical, dental and allied health care providers with whom DVA has arrangements. 15 The orange card enables the holder to access the range of pharmaceutical items available under the Repatriation Pharmaceutical Benefits Scheme. 15 Obtaining a Provider Number AHP may be eligible to obtain a provider number, free of charge from the DVA. Practitioners must meet the requirements set out by the DVA and complete an interim deed of agreement, along with an application for provider registration. If the practitioner plans to work in more than one location a separate provider number must be obtained for each work location. On acceptance, the provider must adhere to the Deed and carry public risk/liability insurance for not less than $10 million per claim and professional indemnity insurance for not less than $5 million per claim. 16 More Allied Health Services The More Allied Health Services (MAHS) program aims to improve the health of people living in rural areas through allied health care. A major outcome of MAHS is to better link the GP with the allied health sector. MAHS funding is managed by eligible rural Divisions of General Practice to provide clinical care by AHP to rural communities. 17 The MAHS guidelines in relation to funding and coverage can be accessed from: More information on the MAHS Program can be found by contacting the free call rural health enquiry line on or ing ruralhealth@health.gov.au. 13

19 Partnerships Partnerships need to be developed not only as a source of income, but also to provide sustainability to a private practice. A partnership may simply provide referrals to your service e.g. a partnership with a general practitioner or another allied health professional. Other partnerships may require an agreement to be written up, for example a contract for you to provide a service to clients in the community or perhaps a program for employees of a large business or organisation. Documentation of the terms of the agreement is important to ensure that the roles and responsibilities of all parties are clearly defined. Some examples of potential partners include: Local and regional public health services Division of General Practitioners Schools/child care facilities/playgroups Aboriginal health services Community organisations e.g. sporting clubs Rehabilitation providers Other private allied health/complementary health practitioners Local government e.g. recreation facilities Other government organisations e.g. Department of Sport and Recreation, Disability Services Commission Large employers in the area e.g. mining companies General Practitioners Actively seeking to develop partnerships and/or relationships with the above entities may provide an ongoing source of referrals, access to funding sources, access to professional development opportunities and provide marketing/advertising opportunities. 14

20 Considerations for Collaborative Partnerships and Agreements As part of the development of a more formal partnership, several principles should be documented and where applicable adhered to. Because a number of clients may be receiving both public and private allied health services, it may be necessary to document the finer details and logistics of a working partnership whereby both parties work in achieving the same desirable outcomes. A collaborative service arrangement or agreement would aid in achieving this. Collaborative agreements provide a flexible and practical approach to service delivery and minimise the disruption to the continuity of care. They also ensure a wider range of service options and provision of services in an effective and timely manner. In addition they provide the opportunity for a more responsive and tailored service. In order to gain the maximum benefit from the agreement it is best to define roles and responsibilities of all parties. This ensures that each party understands their role and responsibility in relation to client service provision and there are no conflicting views. Once the roles and responsibilities are agreed to, it is important that open communication remains evident throughout the agreement. This ensures that the client is receives a high quality service, the use of resources from both sectors is maximised and the potential for conflict or misunderstanding is minimised. 15

21 Associated Costs of Private Practice There are several costs associated with the establishment of a private practice. Costs to consider may include: Building costs (purchasing or leasing) Discipline specific equipment and assessment tools (these can vary dependant on discipline and services to be provided) Employee/personal wages and superannuation Administration and office equipment including computer, software, furnishings Insurances Utilities i.e. power, water, telephone Vehicle/transport Consumables Professional registration and membership Accounting and financial advice An example of possible set up costs for a Physiotherapy and a Speech Pathology practice can be seen in Appendix B. Superannuation It is important to consider superannuation when self-employed or starting a business. Selfemployed business persons are not required to contribute to a superannuation fund. However they may wish to consider superannuation as a form of retirement savings and may be able to claim tax deductions for these contributions. 18 A list of available super funds can be located by visiting the Register of Complying Superannuation Funds (ROCS). ROCS is a publicly available list of complying superannuation funds, approved deposit funds (ADFs) and eligible rollover funds (ERFs) regulated by the Australian Prudential Regulation Authority (APRA) and self managed super funds (SMSFs) regulated by the ATO. 18 ROCS can be accessed by visiting: 16

22 If you employ any staff you are usually required to pay superannuation on their behalf. There are a number of publications available from the ATO s website at in relation to paying employee superannuation. These publications outline the legal requirements for the reporting of superannuation, the steps to take for a new employee or for an employee who is terminated/resigns, and other general superannuation information for employers. Insurance There are a number of insurances a private practitioner must consider when establishing a private practice. These include professional indemnity insurance, income protection insurance, building and contents and public liability insurances. Professional Indemnity Insurance Private practitioners are strongly recommended to carry professional indemnity insurance. Depending on the policy, this covers breach of professional duty, public liability, goods sold and advice on goods sold (product liability) and legal fees for disciplinary and coronial inquiries. Different levels of insurance are recommended for different professional groups e.g. $5, $10 or $20 million dollars for physiotherapy or $2, $5 or $10 million dollars for speech pathology. The cost of insurance varies depending on the number of hours worked and discounts for members of professional organisations. For $10 million cover a physiotherapist could expect to pay approximately $1000-$1400 per annum if working more than 15 hours a week in private practice, or $835-$980 per annum if working less than 15 hours per week. The cost to a speech pathologist for the same level of cover would be approximately $540 if working more than 16 hours per week and $380 per annum if working less than 16 hours per week in a private capacity. The Department of Veteran s Affairs (DVA) specifies that a practitioner who registers as a DVA service provider must have public risk/liability insurance for not less than $10million per claim and professional indemnity type insurance for not less than $5 million per claim. Income Protection Insurance/Income Insurance Income protection insurance pays a proportion of an individual s salary for a period of time if they are unable to work due to injury, sickness or disability. The period of time the person s salary is paid depends on the level of cover and the contract term. Usually income protection insurance will pay approximately 75% of a salary and the cost of premiums depend on a number of factors such as an individual s age and health status. 19 Other types 17

23 of disability policies such as trauma insurance may pay a lump sum in the event of major illness. When you are self -employed you are not covered by workers compensation insurance, as you are when someone else employs you. If you employ any staff you must have a worker s compensation policy that covers all workers. Contents & Building Insurance It is advisable that practitioners carry both contents and building (if the owner of the premises) insurance. The premiums depend significantly on a number of factors including geographic location, value of the building, and the amount and value of equipment. There are a number of insurance companies who offer attractive packages and insure allied health practices. Marketing As mentioned on page 14 partnerships with a variety of organisations in the community can provide a source of referrals as well as opportunities for marketing and advertising. In small communities marketing and advertising can be relatively cheap with options such as community/organisation notice boards and newsletters, local papers and radio stations and through free listings in the local community telephone directory. Sponsorship of community organisations and events can also be used to promote your service. Professional Registration Some AHP are required to have professional registration with their relevant registration board to practice within Western Australia. There are no registration boards for speech pathologists, dietitians and social workers, however these disciplines are encouraged to become members of their professional organisation. Table 1 outlines the costs associated with professional registration. 18