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Pricing Structure

Discussion in 'General Issues and Discussion Forum' started by Jacky Nowle, Feb 5, 2014.

  1. Jacky Nowle

    Jacky Nowle Member


    Members do not see these Ads. Sign Up.
    What do people think to a pricing structure in which a DOM is only £4 more expensive than a clinic appointment?
     
  2. Leah Claydon

    Leah Claydon Active Member

    I can't see how that could be cost be effective. You have to factor in your normal clinic appointment fee, plus travel time, plus travel cost (eg mileage). My clinic fee is £38 for a standard half hour appointment, generally it's takes longer to do a housecall appointment because you are not in control of the environment plus you have to take the money and schedule the next appointment so have to allow 40 minutes plus getting to and from.

    To be cost effective in real terms a domiciliary appointment should cost at least double your surgery fee because your clinic overheads continue whilst you are out of the clinic. That would make it £76. Most patients would not pay that.

    The only way you can do doms and not be out of pocket is to do them on the way to work or on the way home out of ordinary clinic hours.

    I only do them for existing patients who can no longer attend the clinic for good reason - eg post op I'm generally quite pleased to have this excuse not to do them!
     
  3. tonywatson12

    tonywatson12 Active Member

    hi
    would the home visits offer the same range of treatments

    I have been mulling over the cost I should charge for home visits and as the range of treatments will be limited I may even charge less then clinical visit.

    i think with costing if we were to count all the costs we have and our £25 per hour fee the price will be to high for most.

    I am intending to do one day per location say 10 mile sq and fill appointments as am or pm.
     
  4. Tree Harris

    Tree Harris Active Member

    For my own two cents worth of advice, I have priced my Dom work / home visits based on an hour out of the clinic, and therefore worth two clinical appointment time slots. I personally dislike home visits, and the price is there to encourage me to go, not to entice the client to ask for it.
    But.... I am amazed at how many accept the pricing structure and regularly use this service.
    One client has never been into the clinic yet, despite living less than 5 kms away, and able to attend if so desires. The price is irrelevant to her, it is the service and company that she seems to enjoy.
     
  5. PostMortem

    PostMortem Active Member

    Tony you are making the mistake that I have made and still struggle with and that is deciding how much the client is willing to pay for our service. It is not up to us to decide how much an individual client is willing to pay for our service, that is up to the client. Most will not bat an eyelid as they accept a fair fee for a fair service, there will always be those clients who do not value the skills and knowledge we have and complain about our fees, that is their problem and do you really want those clients? They feel they are being overcharged and you feel you are not being valued.
    I have recently increased my fee for doms and been amazed at some of the responses, eg surprised it wasn't more than you have been charging was one comment and I don't think I have lost any clients yet because of it.
     
  6. tonywatson12

    tonywatson12 Active Member

    what sort of free care system is in aus?

    The NHS depending on area offers home visits on a number of criteria usually house bound.
    It is easier to get patients to hospital as transport is available to hospital settings though the NHS ambulance service.

    Having worked all over the UK it seems to depend on the area as to how strict the criteria is applied.
    also the general price you can charge usually is governed by area.

    The problem I have when I last done private work was about 15 years ago and it was in the south of Ireland.
    My charges reflected the routine cost of a Dr appointment and nail surgery at the price of a hospital appointment
    this was a simple system and people in Ireland are used to paying some amount towards health care.

    In the uk It is not that simple as many people can still get Chiropody form £7.50 and i have seen care home charges at 5 pounds!
    Now say the most type of patient seen at home will be routine care (nails and 1-2 soft tissue lesions) as this is what i see working for the NHS then its going to be a little hard to get more then say £18 - £20
    but again I have seen pods working for home visits for £12!!

    I know (so don't rip my head off) that some of you get higher fees but I do not have the time or money to wait for the people who can pay this to call.

    My fees will be equal to the hourly rate of a band 7 in the NHS but as will also be selling wider fitting footwear hope to make a little more.
     
  7. Podess

    Podess Active Member

    TonyW,
    You said

    I am curious to know where in UK people can get Chiropody for £7.50 ??

    If we return to the OP then I would say that only charging £4.00 more for a home visit cannot be economically viable. The fixed costs for operating a surgery will continue whether the premises are being utilised or not. The domicilary fee should be priced to cover both the operating costs of the clinc (including the practitioner's time) and the actual cost of the visit.

    My vet does visit clients at home and he charges a £45.00 fee for the visit before any consultation or treatment is added on. He also encourages all clients to visit the surgery if at all possible, as most of his equipment isn't portable.

    Poddess
     
    Last edited: Feb 14, 2014
  8. tonywatson12

    tonywatson12 Active Member

    hi
    As you will have noticed your not a vet or a dentist, Dr, psychologist you are a podiatrist.
    as such your charges will be around the same as the other pods in your area or you won't get work

    Ask in any of the nursing homes were you are how much the podiatry charge is and phone some smae pods you may be supprised!

    I live in the north east and just over a year ago took over a nursing home from a BSc pod who was charging 5 quid I managed to raise it to £7.50.
     
  9. Leah Claydon

    Leah Claydon Active Member

    [QUOTE
    I live in the north east and just over a year ago took over a nursing home from a BSc pod who was charging 5 quid I managed to raise it to £7.50.[/QUOTE]

    I'm still in shock at reading this. No wonder our profession is in trouble and undervalued.
     
  10. tonywatson12

    tonywatson12 Active Member

    yeah
    I agree Leah we do get little recondition for our skills but what can we do?
    patients will only pay what the (Going rate is!!)
    I know many pods I trained with 20 years ago left the profession to do other things as were unable to make enough to fund living in the south.

    Some radical changes in the private sector is needed and (i know its a problem blah blah) but a price guide should be made and all HPC pods need to work to it.
    (no price fixing)

    Also universities should include this price guide in the training.

    We could have a user group help us come up with prices as its them who pay

    sorry your shocked but its dog eat dog and nursing homes usually have 30-40 nail cuts and its good money even at 7.50!!
    tony
     
  11. Kaleidoscope

    Kaleidoscope Active Member

    Back to what the OP said:-


    "What do people think to a pricing structure in which a DOM is only £4 more expensive than a clinic appointment?"

    In answer:
    Since (it must be said) I am one of the people to whom Ms Jackie Knowle is referring to (either directly or indirectly) I obviously needed to comment.


    Firstly, I suppose it depends on what your ethos is for your clinic?

    Obviously it is a business and needs to make enough money to cover everything and give a fair return. BUT I fear sometimes, if the sole reason IS to just make money, a little of the joy of our job is lost in chasing only the evil lucre !

    I, for one, believe I am indebted to the NHS for funding that helped pay for my education and have tried to repay that debt by humanitarian and direct ways such as working on an honorary contract and also working (very) cheaply on NHS Bank staff and working with the home-less - which has enriched my continued educational development in so many unexpected and enlightening ways....

    Secondly, I do NOT disagree with the calculations cited as often double the rate in the clinic as, of course, time spent outside is time LOST in the clinic that cannot be regained.

    Having said that, I do NOT undertake home visits lightly. I do not, for instance, take on just any home visit request as many are NOT necessary and the person could easily attend the clinic and/or are often quoted ridiculously low prices in my area by the unregulated, so expectation is dashed when I quote even my clinic charge!

    Despite the above, I am confident that what I offer is a fair rate (given my area) . The reason for the £4 on top is solely a little extra for diesel and paperwork. It is not dear enough to dissuade someone from requesting a HV (which is why some charge very high fees) but equally it is not too much more to prevent that request should it be really NECESSARY.

    And here I come to the crux of my argument:
    I do not want my patients to feel that all the time they are able-bodied enough to attend that I’m there for them, but when they are ill, disabled either temporarily or permanently, that now, that same person who has cared for their feet NO LONGER CARES!!!! That is NOT the ethos of my clinic.

    Like Mark Russell said in another post, on a similar topic – I AM that Podiatrist who worries about them after they’ve gone. I am that person they have voiced those fears and sad stories to, and I am also often the only person they have told how they really feel. I cannot, in all conscience, demand that they now pay me an extortionate fee just to see me. Although I do NOT condemn any that DO charge such fees – that is their choice and I would not deem to judge them – although it appears the OP appears to judge my/others stance? As long as someone can substantiate their reasons I do not see it is anyone’s business but theirs.

    So how do I manage financially to do this? Well what I do to offset this potential loss is to either see them on my way to work – during a break – or after my session ends. I make that concession in celebration of all the times they have turned up to see me – and made my clinic the success it is!

    So no I don’t take on HVs lightly and will and have turned down requests or placed a premium on top should I get a call from a Care Home for instance whom I know has often an unregulated person servicing the home and they have an emergency or problem – since I believe if they had paid the correct fee in the first place – this emergency would not in all probability have occurred and also, it is ALWAYS a longer visit so I need to charge more.


    Apologies for the rant – just felt the other side of the coin needed airing also!
    Regards
    Linda Russell
     
  12. tonywatson12

    tonywatson12 Active Member

    have an idea
    i will ask all the patients i am seeing on the current nhs contract i am doing as is a general practice role

    any suggestions on the wording of the questions (keep it short as limited time)

    I will post them in say 2 weeks should be about 100-200 patients
    what do you think?
    tony
     
  13. Jacky Nowle

    Jacky Nowle Member

    It was not a rant.
    I do not undertake home visits lightly. I find them very clinically compromising . The individual that has this pricing structure does not do them before/after work, but as part of the working day, I know that for a fact.
    You quite correctly said about doing before/after work. It tickles me when people say, "you can't come then, I am doing this and that. I'm not out of bed then, oh, I'm having my tea then, I'm going shopping then." and they say their housebound.
    I charge a professional fee, but I do have a heart.
    A diabetic pensioner patient of mine had a foot problem had a problem which needed regular treatment. I knew that she would have to travel to the NHS pod clinic and the taxi fare would cost her a lot over time. Either that, or she would have to wait for the transport clinic bus to get there and back.
    I treated her for free for a period of time, until the problem resolved. She could get out easily, but to get to my surgery, the taxi fares would soon have added up. She suffered from depression badly, and my going to her/treating her for free, at least I knew that was one huge burden off her chest.
    Leah said she was aghast at how someone can charge £7.50 per patient for a care home. How on earth can this profession gain respect when people are charging these fees.
    When you get a patient who has multi health problems, has a problem with their feet that needs a professional to do, they want a home visit, and grumble about the fee that you have quoted, you say to them, "how much would a plumber cost to come before they have even started to do something". All that happens is that the phone is put down on you!
     
  14. blinda

    blinda MVP

    Indeed. In fact, that's why I only charge an extra £3 to existing patients who cannot attend my clinic post surgery/illness. By private arrangement, I visit these after work hours and they are incredibly grateful and usually attend clinic if and when they are able.

    Any new enquirers of dom visits are advised that I do not undertake home visits as my premises accommodate people with reduced mobility, including wheelchair users. I also provide the numbers of a local pod and fhp who do home visits.
     
  15. tonywatson12

    tonywatson12 Active Member

    how can the profession gain respect well not though fees!
    To me its about how we educate and gain the respect of patients.

    please stop comparing us to plumbers taxi drivers dentists vets as we are not.

    people will usually cut their own nails,buy wart treatment and insoles or get ref to the NHS for minor surgery and msk problems.
    the majority of podiatry patients are still made up be the elderly and diabetics(who usually are seen in the NHS)

    We in private practice see all the rest the people that can usually afford to pay or want to pay for one reason or another.

    now as the NHS stream line the services by medical need ( or as is the case discharges vast amounts of patients due to funding) we in the private sector and in reality is any one who has the title HPC pick up them if and only if they can afford our fees.

    you are in competition with all these HPC reg pods/chiropodists BSc,smae,or what ever else as the only working part after Podiatrist (not protected) is HPC (protected) and they all have this.

    We need a structure of pricing as to give all of us a fair working pay and then patients will know that podiatry fees are between x - y for x treatment

    its time for change and patient help in pricing
     
  16. Jacky Nowle

    Jacky Nowle Member

    Tony,

    Yes. Bel and Linda quite correctly have said that they do these patients before/after work for this fee.

    Respect is gained by offering a good thorough service, with advice given, letters possibly being written to GPs as part of the service. But taking time out of your 9-5 schedule to travel to a patient for only an extra £4 is surely very poor business sense!
     
  17. tonywatson12

    tonywatson12 Active Member

    yep
    we have to have a living
    I would not do any free podiatry as it is the responsibility of the GP and NHS to do this.

    we have to and must earn enough to at least pay us the same as an nhs pod or whats the point!

    as much as I love the job and want to develop private work I am convinced that the numbers of pods in my area doing private work will limit and development.

    Last year I spent over 200 pounds on a number of forms of adverts including gp surgery leaflet packs and 100 nursing homes and yes at £7.50 at the end of the advert campaign I had zero calls or online hits.
    going to try again but just a Dom practice to start
     
  18. Fliss

    Fliss Active Member

    Keep it short and sweet:
    "what do you think is reasonable to pay for a home visit?"
     
  19. tonywatson12

    tonywatson12 Active Member

    £18 for routine nail care and 1 soft tissue lesion.
    About 15-20 min

    oh here come the arrows!!!!!!
     
  20. Podess

    Podess Active Member

    http://bizfinance.about.com/od/pricingyourproduct/a/Pricing-Your-Product-Using-Markup.htm

    Hi Tony,
    The above is something I found about pricing structures in busines. It's quite interesting.

    When I worked for the NHS (many years ago) I could treat 8 dom patients in a morning without breaking into a sweat. I could achieve this because I was working in an urban area (Salford - Greater Manchester) where many properties were terraced or patients lived in high-rise blocks of flats. I could park the car and walk to treat several patients in one street/on one landing with minimal travelling time.

    If a practitioner is working in a rural area then travelling time needs to be factored into the equation which can't help but elevate the cost of treatments.
     
  21. tonywatson12

    tonywatson12 Active Member

    yes I agree its all about route and planning
    tony
     
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