Running two branches as one hospital

Opening a second branch usually feels like the reward for getting the first one right. The OPD is full, patients are travelling from the next town, and a smaller centre closer to them makes obvious sense.

Then the small things start. A patient who was seen at the main hospital walks into the new branch and gets registered all over again. The doctor there cannot see last year's notes. Cash at one branch does not match the software. A box of lenses moved across town never shows up in either stock register. Each one is small. Together they eat a lot of the week.

This is how some larger Indian eye care groups organise branches, what the rules ask of each new site, and how to keep two branches feeling like one hospital.

How Indian chains think about branches

Several large Indian eye care groups describe a hub-and-spoke pattern. Dr. Agarwal's Health Care describes three tiers: primary centres that do not operate, secondary centres that handle cataract surgery, and tertiary hospitals with the super-specialities, which act as hubs for the rest. Maxivision's leadership has described its tertiary hospitals in Tamil Nadu as "hub centres supported by spoke secondary care eye hospitals."

The idea works at any size. A small OPD-only centre close to patients sends surgical cases to the main hospital. The patient gets convenience, and the hub's operating theatre stays busy.

Aravind's founder, Dr. G. Venkataswamy, famously asked, "If McDonald's can do it for hamburgers, why can't we do it for eye care?" His point was not fast food. It was that a hospital can run the same way, to the same standard, in every place it opens.

What each new site needs on paper

Registration is tied to the establishment and its address, so plan the paperwork for the new site early. A few things to check, with your state's own rules:

• Clinical establishment registration. The Clinical Establishments Act, in the states that have adopted it, says no one may run an establishment that is not registered, and a change of location needs a fresh application. Check your state's own act and rules for the new address.
• Biomedical waste authorisation. Every occupier handling biomedical waste needs authorisation from the State Pollution Control Board, whatever the quantity.
• Drug licence. A pharmacy licence is tied to the premises. If the new branch dispenses medicines, plan for its licence.
• GST. If your hospital is registered, for pharmacy or optical sales for example, registration is state by state. A branch in the same state is usually added to your existing registration as an additional place of business. A branch in another state needs its own registration, and the two are treated as separate businesses for tax, so moving stock between them is generally billed like a sale.

What "one hospital" looks like in practice

Centre for Sight, which had 49 centres in 2014, chose not to franchise so that administrative control stayed with it, Business Today reported. You do not need fifty centres to feel the same pull. With two or three branches, these are the things that keep control simple:

One patient, one ID. A patient registered at any branch should be found at every branch by phone number or patient ID, with one record. Two registrations for one person means two half-histories, and nobody notices until something important is missing.

Shared records, with sensible access. The doctor at the branch should see the patient's history from the main hospital. Who can see what is a setting, not a wall between buildings.

One price list, with room for local differences. Keep one standard list of services and packages, and allow a branch-level change where rent or local practice genuinely differs. Otherwise prices drift and patients notice.

Cash closed every day, at every branch. Each counter closes its cash against what the software says it collected, every evening, and the difference is explained the same day. Small gaps found a month later are rarely explained at all.

Stock that moves on paper when it moves in the van. A transfer from the main store to a branch should leave one store and arrive in the other in the records too, with someone at the branch confirming receipt.

Reports by branch, and for the whole hospital. Patients seen, surgeries advised and done, collections, by branch and combined. Branches compared fairly show you where to put the next doctor, and where the next branch should go.

Doctors who work in more than one place

Many hospitals share doctors between branches on fixed days. It works well when the branch knows in advance which doctor is in on which day, appointments are booked to that schedule, and the doctor's notes go into the same record wherever they see the patient. It goes badly when patients arrive for a doctor who is at the other branch that day.

A branch runs on its schedule, so the roster and the record should be shared across branches.

Please note: this article is general information, not legal or tax advice. Registration rules differ between states, and GST treatment depends on your setup. Check with your adviser before opening a new site.

Sources

• Business Today, Centre for Sight, September 2014. Article
• Clinical Establishments (Registration and Regulation) Act, 2010, Section 11. Text
• Central Pollution Control Board, biomedical waste authorisation. CPCB
• CGST Act, 2017, Section 25 (registration in each state) and Schedule I paragraph 2 (supplies between branches in different states), CBIC. Section 25, Schedule I