Nursing Home Fees...?

In reply to the breakdown of price I am in the advantageous position of
a) running my business from home, sterilising from there, repacking and travelling to my Aged Care facilities. Of which only two of my ten facilities are further away than 30 kms.
So there are no rental amounts to consider
b) As per another thread currently running, I purchased all of my equipment off of the liquidator of the previously failed Aged Care Company, which reduces sterilisation costs
c) I don't pay the boss, she does it for love apparently
The majority of my facilities are High Care (Non-Ambulant) and are seen six weekly. About 30 per day.
I don't work fridays ( I have the kids) and it adds up to not porsche material but comfortable till the munchkins are at school

 

Paul & Pommy,
It's all well and good to say that, "It doesn't pay enough, so I won't do it"....but where does that leave us as a profession and our attempts to control what our market worth is? In the end, our whole professional reputation is at stake because we abdicate responsibility of care. We need to fight for it somehow.

It leaves the door open for the disreputable companies, to swoop in and say, "Hey, we'll do it! and we'll do it cheap!" We all know however, that they don't last long (see the other thread)...they can't get pods to work for the peanuts once the percentages are divvied out and the ACF's return visit times get stretched further and further out, until it all collapses again...you know what happens then? They ring up private pods begging for service.

I was recently contacted by an ACF who was signed onto a 3yr contract with a company. They had been waiting for a visit for 3mths. They rang the company and were told that they didn't have anyone to send and wouldn't be continuing with the service. If they hadn't of rung, they'd still be waiting...
I told them I didn't really have the time to fit them in. I am however a sucker for a sob story and I agreed to go...but on my terms. They had EPC's for quite a few, and I told them I would bulk bill them and any others had to match the EPC fee of $50. They were more than happy to pay it.

I find it sad that patients have to be neglected to the point where facilities finally cave in and pay up.

Having said all that, in regards to fees and what is an approp amount...if you see one patient in the clinic for a 20-30min appt and charge $50, or if you see one patient in an ACF for 10-15mins and charge $25 - aside from an extra set of instruments...it works out the same money/time ratio.

I know there is some statistic that a set of instruments apparently costs $12 to sterilize...I don't quite see how that figure comes about though...how does that cost break down?

As far as I'm concerned, if you are a private pod with the contract, and not working for a company you have to share the fee with, you can earn a good day's wage...

 

This is a very interesting discussion and it seems we are all on the same sort of track.
We all want to be paid a "fair and resonable" fee for our services.
I don't see the problem with have a scale of fees depending on patient's needs and how the Pod care is delivered i.e in room or patients brought to you, nails only or corns etc.
In the end we do this for a living, if it's not profitable it is un-sustainable and that serves no one.

 

Where does it leave us as a profession if we provide cheap, poor quality service? The argument goes both ways. In some cases it is better to just not get involved at all rather than get involved and do the job poorly!

Fight all you like - but you cannot fight costs. If it costs $x to do something it must cost you $X + Y to have it done. Simple economics.

It already happens. How will "controlling" it anymore make any difference?

This is a facility problem - not a Podiatry one. If a facility wishes to abuse its patients, that should not be shunned onto the Podiatrist providing a service.

Sure - if your fee is $200 per hour and you see a patient in 20 mins then charge accordingly.

Time, autoclave costs, electricity, staff costs, instruments decontamination, time costs for batch numbering etc... It adds up, I would be willing to bet its more than $12 or so.

 

I work in a rural area with a number of aged care facility contracts. When the previous podiatrist didn't renew their contract with these facilities they approached me for a quote. I knew I was going to be significantly more expensive but I explained to them a number of points:
1) I have no shortage of work available privately
2) I do not drop aged care facility contracts - in order to do this I charge the same hourly rate to the facility as what I expect privately - this way I'm never tempted to "drop" a facility because I'm overworked and not receiving as much money from them as the private patients - they're all equal. Psychologically and financially it therefore makes no difference to me whether I'm at a facility or in the private clinic
3) Patients in aged care facilities will receive the same high level of care as if they saw me privately, however it costs the individual patients less as I am seeing slightly more patients in the same time frame.
4) I insist on staff assistance to maximise my efficiency and it means they are only paying me for my qualified expertise, not my time running around locating patients and files - it means I can see more people.
5) They have an advance schedule of appointments for 12 months (including extra visits for dedicated diabetic assessments etc) and these will not be cancelled unless I'm ill. This helps them organise their staff and patients effectively - everybody knows in advance of their "roster" or "appointment".
6) I insist on things being set up properly right from the start - Aged Care Facilities generally have things set up properly for GPs and hairdressers - why not podiatrists? They need our skills like the hairdressers and we're helping them out by going to them so we need to be able to set up properly.
7)They can contact me about patients even when I'm working privately
8) I bill the facility and they can divide the fees and collect the money from individuals themselves - it saves me time and I don't have to take money from, or explain my fees, to patients. Just one invoice with an accompanying list of patients seen sent to the facility. Less hassle and if you have bad day with patients refusing treatment you still get paid for your time - it motivates the facility to make sure things operate smoothly.

Initially there were some dropped jaws and some hesitation but the promise of not having to find a replacement podiatrist every 6 -12 months and a consistent, high level and comprehensive treatment which translates into fewer foot and leg problems/ulcers, higher mobility, reduced wound treatment/amputation costs has them all happy with the arrangement. Podiatry is no longer a problem for the facility.

I believe if you act like a specialist and provide quality specialist advice and care they'll see you as a necessary medical professional.

Mind you, you have to make sure you provide that high level of treatment at all times so you're constantly earning your money - same as with a private patient.

 

Thanks everyone for your input within this topic. I too used to work for some facilities for a pittance (within a compnay) and found the deadlines/pt targets a joke.

I am looking to do this now on my own and believe I can offer a higher level of care but demand a corresponding payment.
You could also argue that the bigger compnaies may offer a cheap rate, but they have ridiculous targets to meet, which means compromised care.


Random question, but may I ask how others are obtaining these contracts? is it a matter of mailing everyone and letting them know of your expertise?

Do you put a time frame on these contracts? eg. i am the sole podiatrist at the ACF?

im loving the input to this thread and have kept up to date with it!

 

Hi

I was fortunate in that one of the Aged Care Facilities in my area rang me because their existing podiatrist resigned their contract fairly suddenly and they were left in the lurch. I took the contract on and the other Aged Care Facilities all gradually rang me when they lost their podiatrists.

I did ring the Directors of the Aged Care Facilities that I knew did not have an existing podiatry service to let them know I was available - most got back to me when my services became fairly urgently required.

One facility didn't agree with my proposal or fees and couldn't come to an agreement on days or invoicing etc - I didn't compromise or drop my fees (I have a standard rate across ALL my Aged Care Facilities because they're in the same area and surprise, surprise staff and relatives talk) and they decided they didn't require my services and would make alternative arrangements. I let them know I was happy with that and wished them well.

They rang me back 18 months later desperate to have a podiatrist - they'd had no consistent podiatrist for 18 months and no service for 6 months and had a lot of upset residents. They were now more than willing to agree to my terms including the fees - they simply told their residents that it was still cheaper than seeing a podiatrist privately and that was their (the resident's) only other option.

Unfortunately they had to wait another 2 months before I could schedule in an "emergency" visit and the rest of their 12 month schedule as I had to work around all the schedules for the other ACFs and was booked out 6 weeks in advance privately. I won't reschedule existing "clients" just because an ACF is now desperate when they've had opportunities before. I don't think many podiatrists would be that desperate for work that we need to compromise our standard of care and conditions under which we work.

As for contacting ACFs I personally never contact an ACF that already has an existing podiatry contract in place - there is plenty of work out there in most places and I'm happy assuming that the existing professional podiatrist is doing a good job and keeping their clients satisfied. If they're not then, in my experience, the ACF will "hear" about a good podiatrist in another ACF and approach them when contracts come up for renewal.

I personally don't like to "compete" for a contract or try and say I'm better than another podiatrist - just my personal preference and opinion. I offer my service if asked and the ACF can take it or leave it - I'm in the happy position of being busy enough regardless.

I do personally believe that, if set up properly, ACFs are a good way to practise with low overheads and reasonable income with added flexibility - you know in advance when you're seeing them and don't have to have a "shopfront" as well. Income/expenses are pretty easy to estimate - great for part time or flexibility around children. Good way to keep your hand in without too much stress although you're still working hard to provide a high standard of care.

What are other people's opinions or approach?

Cheers
RStone