How to start up a medical office. So you think this is all you need How to start up a medical office. So you think this is all you need? What about all those OSHA requirements? What about physically challenged patients? Does your staff know how to correctly care for them. Do you know the requirements for the office?? The process of starting a Medical Office can be a difficult task but with the proper planning, you can have your Medical Office up and running effectively. Organizational Items Select a date to begin practice Legal representation, accounting firm and medical practice startup consultant selection Determine organizational structure Entity name selection and formation Obtain federal, state, and local tax identification numbers Develop employment agreements and physician compensation model Determine startup budget Prepare furniture & equipment budget Obtain financing

Access To Medical Care For Individuals With Mobility Disabilities   Is it OK to examine a patient who uses a wheelchair in the wheelchair, because the patient cannot get onto the exam table independently? Can I tell a patient that I cannot treat her because I don’t have accessible medical equipment? Is it OK to tell a patient who has a disability to bring along someone who can help at the exam? If the patient does bring an assistant or a family member, do I talk to the patient or the companion? Should the companion remain in the room while I examine the patient and while discussing the medical problem or results?

1. an accessible route to and through the room; 2. an entry door with adequate clear width, maneuvering clearance, and accessible hardware; 3. appropriate models and placement of accessible examination equipment (See Part 4 for detailed discussion of accessible examination equipment.); and 4. adequate clear floor space inside the room for side transfers and use of lift equipment.

Accessible Scale Accessible Scales How are you going to weigh the physically challenged patient? 1. Sloped surface provides access to scale platform -- no abrupt level changes at floor or platform. 2. Edge protection at drop off. 3. Large platform to accommodates various wheelchair sizes. 4. Provide maneuvering space to pull onto and off scale

Designate Primary & Secondary Exits No Emergency Exits in Restrooms Exit Away From Rooms with Hazardous Materials No Emergency Exits into Narrow Passages Exit Signs Indicating the Nearest Emergency Exit Designate an Assembly Area No Use of Elevators to Reach an Emergency Exit Indicate Exits with Wheelchair Access Indicate the Employee's Current Location An evacuation plan should be posted in a central location within every office typically in the employee break area, and possibly other areas also.

What does cycle time mean? Do you let the sick patients sit with the patients there for well visits? What about toys and items in the waiting rooms? Are they cleaned regularly? Are the charts placed so that patients cannot see other patients names on the charts? What law does this violate if this is not the case? What does cycle time mean? What is meant by referring to CAPITAL EQUIPMENT? How important is your medical equipment record? Incident reports for malfunctioning medical equipment are just as important as an incident report about a fall What are some common situations that must be managed in the office?

State licensing board’s rules are concerned with obvious things like the proper storage, tracking and labeling of prescription medications. Labeling typically requires that the patient name, drug name and strength, quantity provided, directions, date dispensed, and drug expiration date and lot number be affixed to the packaging. Everyone needs to follow these regulations to minimize their legal liability. Overview of the Regulations and Recommendations made by various organizations and state licensing boards concerning the handling of Drug Samples by physician offices and clinics Medications are dispensed safely. Note: This standard is applicable to all practices that dispense medications, including those practices that dispense sample medications. Quantities of medications are dispensed and minimize diversion yet are still consistent with the patient’s needs. (Standard MM.4.40 B1) Procedures supporting safe medication prescribing or ordering address the following: (next slide) What about those wonderful drug samples the drug reps bring? There are some very important rules anyone in the physicians office should know.

2) Identifying the source of the medication Medications dispensed by the practice are retrieved when recalled or discontinued by the manufacturer or the Food and Drug Administration for safety reasons. (Standard MM.4.70) B 4. The practice has procedures for retrieving and safely disposing of recalled medications including the following: 1) Identifying each patient who is receiving or has received recalled medications 2) Identifying the source of the medication 3) Providing for the retrieval and safe disposal of medications subject to recall 4) Providing for external reporting of medication product defects The organization responds to actual or potential adverse drug events, significant adverse drug reactions, and medication errors (MM.07.01.03). If the patient is transferred to another Provider, setting, level of care, a complete list of current medications, must be communicated (National Patient Safety Goal 8B). Look-alike/sound-alike drugs are identified (NPSG 3, Requirement 3C). Drug Sample uses tall man lettering Some of the procedures anyone in a responsible role in the physicians office should be aware of.

The National Coordinating Council Recommendations for Avoiding Medication Errors with Drug Samples are found at http://www.nccmerp.org/council/council2008-01.html A few of their recommendations are; 6. Multiple doses should be packaged in a manner that preserves labeling for each dose (e.g., the label or backing of each dose should contain the drug's name, strength of medication, lot number, and expiration date). Here is a web site with more information and something to remember about multi dose packaging.

7. Unique National Drug Code (NDC) numbers should be assigned to each drug sample to facilitate electronic documentation and tracing of products. 12. For each drug sample, the patient instructions should be written in language appropriate for the patient. At a minimum, a drug sample should be labeled to include: the name of the patient; the brand and/or generic name of the drug; the strength of the drug per dosage unit; clear directions for use by the patient; and any necessary cautionary statements or use instructions such as, 'May cause drowsiness' or 'Take with food'. 17. Prescribers should document in the patient's medical record drug samples given to patients as they would any other medication. 18. Drug samples should be included in any list of medications that is communicated to another provider

Ordering, procuring, storing, controlling, labeling, preparing, and dispensing medications according to law or regulation (Standard MM.5.30 B1) Medication orders must be written clearly (MM.3.20) Medication orders or prescriptions are clear and accurate (MM.04.01.01) The patient record contains information that reflects the patients care, treatment or services (RC.02.01.01) Medications are appropriately labeled, Element of Performance #3 at a minimum - this information is usually included on the container (MM.4.30) The organization follows a process to retrieve recalled or discontinued medications (MM.0501.17).