Ilya Anfinogenov Director of Archimed+
… 09.06.2021
Opening a clinic is difficult. You need a bunch of permits, expensive equipment, special premises and much more. Only a select few can do this; they need acquaintances and a lot of money.
Have you read it? Now forget it. With our instructions, you will start a medical services business easily and quickly. Go!
Features of taxation
All medical services, in accordance with current legislation, are not subject to VAT. This must be taken into account in financial reporting and when creating a price list. Most clinics operate under a simplified taxation system, which is the most profitable option.
Accounting in dental clinics has a number of features, which require special skills and knowledge from the specialist maintaining financial statements. Working in this area, you cannot do without special software and knowledge of the documentation that is used in medical institutions. That is why many clinics implement accounting through an outsourcing system, attracting specialists with experience in the medical industry.
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Accounting documents
In order to legally accept payments from customers, even in cash, you need to install an online cash register. You can avoid this if you are an individual entrepreneur and pay taxes under the patent system. You can also postpone the purchase of a cash register for a grace period and issue checks to customers that are subject to strict accounting.
The online cash register is registered with the Federal Tax Service. This is also done in at least 3 steps:
- We issue a cash register management system (account card for a cash register).
- We conclude an agreement for the purchase of media that stores and transmits fiscal data.
- Connecting to the Internet
If you open a clinic as an LLC, you will have to limit the amount of cash allowed to be kept in the cash register. The rest of the cash should be delivered to the Central Bank. To do this, you will need to enter into an agreement for the collection of funds.
Basic accounting documentation will appear after the opening of dentistry. These are documents confirming the provision of services to clients and receipt of payment from them. This group also includes orders for consumables and equipment, certificates for them, acts of acceptance and transfer of purchased equipment, registration cards confirming the placement of equipment on the balance sheet (if you have opened an LLC), reports to the tax office
These documents, with the exception of certificates for equipment, are not needed to open a business, so we include in the “accounting” group the package of papers required for registering a business.
When registering as an individual entrepreneur, you need to provide only four documents:
- Application with a request to register you as an individual entrepreneur (filled out in the prescribed form).
- A copy of a document confirming the identity of the future entrepreneur (usually a passport, the original is presented, a copy is submitted);
- A receipt confirming payment of the established state contribution;
- individual tax number (TIN).
To register the Society, you will also need a receipt for payment of the contribution to the state, an application for business registration and passports of all members of the society.
In addition, you should prepare:
- a document confirming the voluntary creation of a company - the decision of the founders and the Voting Protocol (if there is more than one founder);
- Statutory documents;
- an order appointing the first person of the clinic (this can be either an employee or the owner of a private practice);
- a document confirming that the clinic has a legal address (letter of guarantee from the landlord, card for the delivery of the premises to the balance sheet).
A certificate of authorized capital or other documents may be required at the discretion of the tax authorities.
Organization and conduct of briefings
All dental, clinic or medical center personnel must undergo occupational safety training. The following types of instruction are distinguished:
- Induction training is conducted for all employees without exception upon employment. During this briefing, the employee is told the general safety requirements that must be observed on the territory of the medical facility.
- Initial briefing at the workplace - is carried out to the employee upon employment immediately after completing the introductory briefing. During this training, the employee is informed about the safety requirements that must be observed in a particular workplace.
- Repeated instruction – carried out at least once every six months. This briefing is intended to remind and reinforce the requirements of initial training in the workplace.
- Unscheduled briefing – carried out in special cases specified in clause 2.1.6. Resolutions of the Ministry of Labor of the Russian Federation and the Ministry of Education of the Russian Federation of January 13, 2003 N 1/29 “On approval of the Procedure for training in labor protection and testing knowledge of labor protection requirements for employees of organizations”
- Targeted briefing – carried out before performing one-time work; emergency response; holding mass events.
The fact of conducting labor safety briefings must be reflected in the relevant journals, indicating the date and signatures of the person being instructed and the person instructing.
Workplace equipment
Equipment, furniture, consumables
The list of equipment will depend on what you plan to do. For example, if you are opening a fertility clinic, you are unlikely to need an MRI, X-ray, or dental unit. But an ultrasound machine and cryo-devices will be needed.
In addition to equipment, you will need auxiliary items to carry out the procedures. Their number depends on the size of the clinic, the list of services, the number of rooms and the flow of patients:
- stands for droppers;
- medical instruments and consumables (tweezers, syringes, bandages, etc.);
- medicines;
- bactericidal air recirculator, etc.
Don't forget about furniture for offices and for medical purposes. If you are drawing up a plan for how to open a dental clinic, then provide special chairs for patients, and if you want to open a children's clinic, then purchase furniture for a play waiting area, etc. Here is a minimum list of furniture that may be useful to you:
- couches;
- gurneys;
- chairs;
- cabinets for medicines and consumables;
- operating tables/dental/gynecological chairs;
- furniture and office equipment for doctors' offices and administrative personnel.
Software
If previously all records at the registry were kept in handwritten journals, today special programs are used to work with patients - CRM systems. You can use them to make appointments for clients, maintain cards, record treatment history, and manage all transactions and payments. Let's look at the main capabilities of these programs using the S2 CRM system as an example:
1. You can maintain an electronic patient record.
All the information necessary for the doctor is stored in separate tabs in the system:
- general data: full name, age, diagnosis and any other information;
- logbook: information about all patient visits to the clinic;
- examinations: protocols of each visit with details of prescriptions and treatment;
- invoices: information about all client payments;
- history of work with the client: on the right, the card contains all the doctor’s and administrator’s notes, letters from the client, call recordings.
Electronic patient card in S2 CRM.
2. Course of treatment
(list of medications and dosage)
can be printed in one click
and given to the client: you enter into the client’s card what medications you need to take, and the CRM will automatically format the data into a beautiful recipe. You can create a branded recipe template and it will populate itself.
3. Conveniently register clients with specialists
in the interactive calendar, both for an individual appointment and for a group appointment (for example, for exercise therapy).
In it, you can set the work schedule of all doctors, and the CRM will show free windows for appointments. This eliminates the risk of mistakenly scheduling several patients at the same time: the system simply will not allow you to do this. In addition, you can add an unlimited number of specialists to one calendar. You can also create several calendars to manage different branches of the clinic.
So in S2 CRM you can make an appointment for a patient in 2 clicks.
4. CRM can be
integrated with the website
and set up an appointment widget on it, so that patients can, by visiting your website, make an appointment with a doctor online, choosing a specialist and a convenient time. And you will see this entry in CRM as a new request.
5. If
you integrate the system with an SMS mailing service
, you can send reminders to clients about an upcoming appointment: this way they will not forget to come and will become more loyal.
Conducting medical examinations
Labor laws also oblige the employer to ensure that all employees undergo medical examinations.
Employees must undergo an initial medical examination upon employment, as well as periodic medical examinations during their work activities. The timing of medical examinations is established by order of the Ministry of Health of the Russian Federation dated January 28, 2021 No. 29n.
Let's consider a brief algorithm for conducting a medical examination:
- Compile and approve a list of employees subject to medical examination.
- Within 10 days, send the approved list to the territorial body of Rospotrebnadzor at the location of the organization.
- Conclude a civil contract with a medical organization that will conduct a medical examination.
- Send workers to undergo a medical examination.
It is prohibited to allow employees to perform their job duties without undergoing a medical examination.
Conducting a special assessment of working conditions
The next important element of occupational safety in a medical organization is conducting a special assessment.
A special assessment of working conditions must be carried out for all workplaces. To do this, you need to contact a specialized certification organization. Employees of this organization will take all the necessary measurements and draw up documents that will reflect the state of working conditions in the organization. The validity period of the SOUT results is 5 years.
After carrying out the SOUT, all employees must be familiar with its results against signature.
Responsibilities of the head of the medical center in the field of occupational safety
In their daily work activities, dental, clinic and medical center employees may be exposed to a variety of workplace hazards:
- cuts from sharp parts of operated tools and equipment;
- burns from heated parts and surfaces of operated equipment;
- electric shocks;
- falling from the stairs;
- infection from contact with patients;
- tripping over electrical wires or any other uneven floor.
All of these potential hazards can sooner or later lead to an accident and, as a result, inspections, lawsuits and fines. Therefore, the employer should be attentive to the issue of organizing labor protection.
Creating safe working conditions for personnel is one of the most important responsibilities of the employer, which is regulated by the labor legislation of the Russian Federation.
What does labor protection consist of in a medical institution? The following main elements can be distinguished:
- development and maintenance of occupational safety documents;
- organizing and conducting briefings;
- organizing and conducting occupational safety training;
- conducting a special assessment of working conditions;
- conducting medical examinations;
- providing workers with personal protective equipment, as well as flushing and disinfecting agents.
Let's take a closer look at each item on the list.
Recruitment
The next stage of opening a private clinic is forming a team.
Vladimir Donkin, managing partner of the agency for increasing the profit of medical clinics Donkin and Partners, suggests using the following search channels:
1. Websites for posting vacancies:
- HeadHunter
- Avito
- Zarplata.ru
- SuperJob
- Rabota.ru
2. Profile platforms:
- stomjob.ru
- stomatologclub.ru
- stomdoska.ru
3. Profile medical social networks:
- Doctors of the Russian Federation
- Doctor at work
- Doctors together
4. Social networks. You can post a vacancy on your page and ask your friends to repost it. There are also urban communities and groups of different medical universities on social networks.
5. Universities and colleges. You can invite graduates or students of medical universities to work. As a rule, there are a limited number of such establishments in each city. Call the educational institution and find out the contacts of the person who is responsible for students’ internships. You can also post a vacancy through the student council or trade union committee.
Each clinic determines the number of employees independently. However, there is a main principle: the responsibilities of managers, doctors and administration should be divided.
