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Trouble with Ethics

Discussion in 'Practice Management' started by badfoot, Oct 30, 2006.

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  1. badfoot

    badfoot Welcome New Poster


    Members do not see these Ads. Sign Up.
    I have been having trouble with competitors waving fees for certain organizations when their insurance companies do not cover 100%, or charging extra for orthotics to cover the difference when a shoe is being purchased. Is this not unethical?? Any suggestions?
    Thanks.
     
  2. Cameron

    Cameron Well-Known Member

    badfoot

    >Is this not unethical??


    Podiatrists confuse ethics with morals. As a professsion, podiatry per se does not work under an ethical code as other professional bodies do i.e medicine and nursing.

    Professional bodies outline a professional code of podiatric practice (for the mutual benefit of members and clients) and this will invariably include guidlines on fair trade. So you would need to read the fine print of your competitor's professional association. If you are a member of the same group then you are bound by the same conditons, and may have a case.

    Otherwise it is an open and highly competitive market with few rules.

    Cameron
     
  3. Podiatry777

    Podiatry777 Active Member

    Imagine that your the customer, and some friend told you the rudiment cost of something (manufacture to sellable product). Now your friend gave you an overview of practice running costs that may impact on the product and you quickly summise whether this impact is of any relevance.

    Average out this information and you'll end up with a gut feeling of what is reasonable and how much you'll pay for it. I mark up items like orthotic packages as long as my patient can see each part is significant. Hence with patient education of what biomechanics show, they know they pay for product and professional judgement based on facts. Ie I break down each orthotic package component and they pay as they go. ALL are happy and complete the Initial, biomech/gait,cast,fitting visits! No lie.
     
  4. Renea

    Renea Welcome New Poster

    Hi Badfoot,

    It certainly has been some time since you originally posted your question. Do you feel you are “missing out” on sales? In all business practice, whether it is Podiatry or whatever the “secret” is to sell the benefits. If you describe to and educate your patients the benefits of orthotics and decent footwear at the same time (or whatever the Rx or product is), you will find that price is practically irrelevant. I’m new to Podiatry but do have a strong sales background. I use this same technique in anything I am selling. Product knowledge is everything in your business.

    As far as your competitors are concerned, try not to think about their pricing techniques to gain a quick sale. I have had a profitable business previously and have never undersold myself, my ability or my product.

    If you feel like you can’t compete with this aggressive style of marketing, then maybe you need to consider re-inventing your business and your demographics. This is the beauty of business; you can evolve and change with the market.

    Kind Regards,
    Renea
     
  5. Stuart Blyth

    Stuart Blyth Active Member

    Thought I might wade in on this one.

    If its Australian podiatrists that we are talking about then yes there is a problem with waiving fees. The insurance company's base the rebate amount on the amount billed to the patient. It's is against health fund rules to bill the patient a fee for service then write off any gaps. There have been at least 4 pods that i know of that have been audited and sanctioned by various health finds for doing this. This can have serious results, I know of one Pod that can no longer bill a particular health fund at all after having his name "blacklisted".

    Regards
    Stuart Blyth
     
  6. Stuart Blyth

    Stuart Blyth Active Member

    Sorry Cameron that not the case at all, both the HIC and health funds have lots of rules, problem is not that many pods know about them.

    Regards

    Stuart Blyth
     
  7. cpcpod

    cpcpod Member

    Stuart,
    If health funds state it is not allowed to waive the gap, how is it that they encourage "preferred providers" to charge "rebate only"??? It also seems that many optometrists, dentists etc accept rebate as full payment for certain services. This seems to be a common practice.
    I don't condone the practice but see that many professions seem to do this. I think costs should dictate your fees and patients are always happy to pay professional fees if they see value for expertise. Education is the key!!
     
  8. Stuart Blyth

    Stuart Blyth Active Member

    Common practice this may be but i have personally been involved in these health fund investigations involving podiatrists.

    No gap consults are achievable by billing a agreed amount under an arrangement with the fund but the pod cannot bill the fund a fee then write off the gap. It is a clear violation of fund rules.

    Stuart Blyth
     
    Last edited by a moderator: Jun 21, 2007
  9. cpcpod

    cpcpod Member

    Stuart,
    I can understand if you are increasing your fees to obtain a higher rebate and then accepting rebate as your fee that this could be seen as fraud by the funds but what about the situation where you charge your standard fee to the fund but accept the rebate as full payment for some patients. eg a patient that is in financial hardship, a professional colleague etc. This means you are giving the patient the discount. You are still charging the fund your usual fee - I do not see that this could be construed as fraud as you are not deceiving the fund or out to "gain" more. Many specialists will accept a rebate when treating a professional colleague or perhaps a pensioner?? Is this different???
     
  10. Stuart Blyth

    Stuart Blyth Active Member

    Hi cc pod

    Firstly let’s make sure we are talking about the same thing, I am talking about Private health funds, not the H.I.C (Medicare D.V.A etc).

    Private health funds insist on the gap payment for several reasons

    In general the health funds base their rebate amount on what the fee from the practitioner is; some do this as a percentage of the individual fee charged, some as an average of all the fees charged across Australia. The reasoning behind this in broad term is the funds know that, say out of 10 patients, 5 need devices but only 3 will get them because the other 2 can’t afford the gap payment.

    Therefore when a pod starts writing off the gap amount more patients get devices and the rate of claim to the fund increases. Funds don’t pick a figure out of thin air when setting rebate amounts and membership fees, it’s a carefully calculated formula of that ensures the funds know how much they need to pay out on each policy they issue thus ensuring a profit.

    It’s possible to do a no gap transaction with a fund that pays a set amount for an item number not a percentage of the fee. For example a fund that has a set rebate amount for devices like Defense health paying $220.00.You can simply charge the patient the amount of the set rebate thus no gap. But when you are dealing with a percentage based fund (the majority of device rebates paid in Australia are) you can’t do this because the amount rebate amount is dependent on the fee charged.

    This will still raise the fund eyebrows because they believe that you should be charging the same amount to all patients regardless of which fund the patient is a member off, thus ensuring them of a level playing field.

    I know that this all sounds complicated but that what health funds are, Complicated! A simple way of thinking about it is that if you say to a fund " I am charging Mrs Jones $500 for her new devices how much will you rebate? They say o.k based on that fee of $500 we will pay $250" then if you write off the gap, your not really charging $500 are you? thus you have given the fund untrue information. If you had have said "I am charging Mrs Jones $250" the fund could say o.k will will rebate you $100.

    Regards

    Stuart Blyth

    P.S

    In an earlier post you mentioned the optometrists doing a similar thing. I am aware of that but can’t really comment as I have only been involved in discussions with the funds about Podiatry.
     
  11. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Stuart

    This is quite important information, that I think very few private practitioners are aware of.

    I think it would be great if you could write a short article about this that could be published in the national newsletter to make everyone aware of it.

    I think the practice of charging a "rebate-only" fee is quite widespread in podiatry, and other health professions.

    LL
     
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