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Setting up a home visiting podiatry service

Discussion in 'Practice Management' started by ajs604, Jan 4, 2012.

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  1. ajs604

    ajs604 Well-Known Member


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    Hi all, so I have finally decided to take the plunge and set up a small pod business. I am currently working in a government organisation and feel that I want to slowly branch out on my own so I have decided to set up intially, a small domcillary visiting service. I have so far created the foundations which include registering a business name, applying for private indementy insurance, registering for tax purposes, purchasing a secure filling cabnet and ordering business cards. I just wanted to run a few things by others and would appreciate any advice. I have so far also purchased 7 sets of instruments including clippers, blacks file, nail files and scalpel blade holders. I have also orderd the basics such as size 15 blades, basic dressing packs, saline, emollients, 10g monofilament and betadine for basic wound care. A pod who I know through my organisation (previous staff member) has offered to sterlize each set of my instruments for $5 to decrease my intial costs before slowly building the business. I have invested what money I have and am planning on purchasing new instruments and a portable podiatry drill as the business expands. My plans are to see clients on Saturdays intially and evenings as well as on my monthly schedlued days off. If the business goes well I will then look at renting a room and descreasing my hours at my current organisation. I will also obviously not be operating in the area of my public work for obvious ethical reasons. I realise that a home visiting service will incur additional costs such as fuel and car running costs ect, so I have decided to operate within a realistic area. I am also planning on charging clients for the services I conduct so for basic podiatry (eg toe nail cutting) $35 to more heavy podiatry callus debridement and corn encleation at approx $45. I will also refur clients on who require more invasie procedures such as nail surgery. I will also be issuing custom orthotics on a needs basis. Sorry to baffle on but would appreciate any advice? I have several people already intresting in the service but am still waiting for the equipment to arrive. Would also appreciate any advice on any treatment templates. Thanks in advance and sorry for any typos.
     
  2. Hi,

    Thos may sound terrible but my first piece of advice is that you are not charging enough. If DVA fee is $61.10 and EPC scheduled fee is $51.95 the $35 - $45 is not enough. You will devalue your service and find it very hard to raise your prices later. I have recently given up my domicillary practice (after 6 years starting from scratch) and I was charging $50 - most others in my area (south west sydney) were $60 or above. I did offer bulk billing for EPC clients as these clients cannot get to medicare to receive their rebate and often do not have bank details set up with Medicare.

    Are you only seeing aged care patients?

    Some sort of accounting program is essential. I just used Excel worksheets which worked well.

    Look at financing an autoclave - it may be cheaper paying off your own autoclave than paying $35 once or twice a week. I used Medfin and continue to do so today.

    I found the drill difficult to carry around with me and that it had a heavy handpiece and that a file was much easier and more efficient - not in the case of gryphotic nails of course :) If you are thinking of orthotics it's much easier to cast with foam for home visits.

    Introduce yourself to local GPs and physios.... can't think of anything else as my addled brain has just returned to work after Christmas off but feel free to ask more questions :)
     
  3. Annie H

    Annie H Member

    Hello
    I agree about the prices, its too cheap. You could do a bit of a phone around of other clinics in your area to see what they charge, you dont want to under cut them by too much, plus your ripping yourself off!
    You can purchase a trolley to carry all your equipment, including a drill.
    As for orthotics, briggate now offer these great fibreglass style slipper that you just soak in water and then place on the foot and mould it. No mess
    Good luck, its a great way to start your business, i did it years ago. You can always contact district nurses and other pods to let them know your doing home visits. You will be amazed how busy you will be

    Cheers Annie
     
  4. Squid

    Squid New Member

    I agree, you're charging too little. The time it will take you to see one patient (driving there, unpacking the car, getting the equipment inside and set up, medically interviewing the patient and doing paperwork, treating the patient, cleaning up, packing up and getting it back in the car) will be more than you anticipate. Your time is worth more than you're charging. You might want to carry more items with you, too. The worst feeling in the world will be going to someone's home to help them and then telling them you don't have what you need.
    Also, try to cluster home visits together. If Mrs. Smith and Mrs Jones live one block apart, scheduling them together for the same day will help with traveling time and the costs involved. Good luck.
     
  5. BeccaHames

    BeccaHames New Member

    I am the operations manager of a medical appointment scheduling service so naturally, I'm thinking about appointments. If you have no appointments, you have no business. How will people call to make appointments? Do you have a number to advertise with? Who will answer it? Do you have a scheduling system? There are some ok online appointment schedulers but be careful because not all of them are HIPAA secure. If you go that route, you'll need to be selective about the demographic information you enter. A word of caution; there are a lot of "answering services" out there that claim to be able to make appointments. Bear in mind that medical appointment scheduling is a specialized niche and answering services aren't trained in medical terminology, triage, and insurance. You might find that they will do more harm than good since that's the first impression of your practice. My company has many podiatrists that have successful home and assisted living health care practices that they operate independently with us doing their scheduling and an outsourced billing company. Best of luck to you!
     
  6. ajs604

    ajs604 Well-Known Member

    Hi BeccaHames, thanks for your points.

    I am currently working in an organisation full time as a Pod so have a guranteed fortnightly income. I have created the foundations of a business creating a name, obtaining an ABN and buying much of the necessary equipment. I have also ordered some business cards so will be putting them in supermarkets, GP surgeries ect. I have also applied for a medicare provider number so I can complete EPC plans for GPs and have created a template to send to GP's - just waiting on the provider number. Whilst I am keen for this business to be a great success I am in no immediate rush as already have an income - but want to build this into something which will hopefully give me a secure future. I am just taking small steps at a time and not rushing it to anything - hence why I have decided to go mobile - once I secure enough clients I will look at a premises. Thanks for all the points.
     
  7. ajs604

    ajs604 Well-Known Member

    Can anyone advise me more on how the provider nuber system works - i have read the info online but can still not grasp the concepts. Do I charge the client or do medicare pay me once I have done any treatment - would appreciate any examples? Thanks so much for all the great help guys!
     
  8. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other threads tagged with home visits
     
  9. ali8un

    ali8un Member

    It is up to you to decide how you want to structure your business. If you have clients on EPC's you can either charge them upfront (which can be more than the medicare rebate amount) and then it is their responsibility to arrange their rebate from medicare or you can get them to sign a treatment voucher which you then send to medicare (bulk bill). Medicare will then pay you directly in a similar way that DVA works. Can be either by cheque or direct deposit into your bank account (this is quickest!)

    I agree with the cost comments. I have not found that clients quibble regarding cost. They are grateful that I come to them - saving them the hassle of taxis or organising family members or even just the physical logistics of getting in and out or a car can be a real challenge for many older folk. Dont forget if they go to your community centre they will be paying a fee and maybe a taxi fare as well.

    It is unlikely that you will be able to easily transfer a lot of Home Visit clients to a clinic at a later stage. Most are likely to be elderly with mobilty/transport issues.
     
  10. OneFoot

    OneFoot Well-Known Member

    I have a small home visit business...

    All I can say is that Home visit Podiatry is not easy...

    Its very very hard to get home visits...
    At times impossible to book people (People change their mind constantly and most want a morning)...
    A home visit takes really one hour.... (driving, cleaning, pack up, notes, etc)...
    People do not regularly book for Podiatry appointments (for home-visits)...:dizzy: They do at the Hosp etc cos its free :D
    You cant transfer people to a clinic if they are treated at home... it doesnt work... they just complain that you have become lazy etc... (I have tried this)...
    You ruin your back etc
    If you are going to be cheap then you need VOLUME and big volume... you cant do it with home-visits.... cos you waste one hour per session.... and the most you could make would be around $350 a day... I would say and thats assuming 10 home visits... not to mention your expenses...

    Most pods I know charge $90 to $100 per home visit... but yeah...

    Which state you in? and which suburbs do you hope to capture??
     
  11. toughspiders

    toughspiders Well-Known Member

    Whole heartedly agree with Onefoot. Home visit are hard, especially in the heat. Organising them is very difficult. You need to increase your prices. Do ten a day at $35 = $350 and you are working a full day on this a real full day. Do 6 at $60 get $360, have an easier day and can spend more time with your clients.
    There are lots of things you can claim back through your tax so home visiting only can mean less overheads.
    Invest in a Dremel Stylus - Bunnings about $100 fabulous as a drill. Think of your back and neck as they WILL hurt after a while. Remember peoples homes are not set up for medical treatments, the light is often not good either. The treatment you give IMO is never as good as you could give in a clinic situation.
    I have two trays in my car, one for dirty instruments and one for clean . I keep aprons and gloves in there too and only carry what i need in for each patient.
     
  12. ajs604

    ajs604 Well-Known Member

    Hi, Thanks for the advice BTW - espcially the drill from Bunnings. Do the nails burr attachments fit a Dremel and what would be the issues on infection control? Sorry for all teh questions I am new to this.

    The reason I have gone down the route of HV service is so that I can slowly build it whilst working full time I am so desperate to get out of my current organisations. But, should I rent a room the cost seems so high plus I do not have any clients yet. I have advertised the HV service on business cards and delivered to various aged care facilities on Friday. If I do indvidual HV I will charge approx 55-60 per visit - this will cover all my costs and account for my profit margins. Should i get groups visits such as nursing homes where I can see more than 1 client I will charge the lower price of 30-35 per client. This is my first go and setting up a business and it seems what ever way you do it there are flaws - so thats why I went with the HV service. I know it would be very difficulut or impossible to transfer clients to a clinic. I am just looking to set up a business where I can make a descent living better than what IO earn now say (90-110k a year) and where I can hopefully work only 4 days a week and be my own boss so better work quality all round. Thanks for all the advice everyone - please keep any comments coming.
     
  13. ajs604

    ajs604 Well-Known Member

    Would it make sense to put an add in the local paper. So far no one has called back with business cards. I know its only early days but thought I would have a few people now. i am now starting to realise how nieve I am hahaha - hopefully will build slowly - should get a provider number this week so I can go. i have had a look at the Dremel Stylus this looks good for home visits would their be any implications with infection control and do pod burrs fit on there? Thanks.
     
  14. OneFoot

    OneFoot Well-Known Member

    Ok some more advice.... its based on my experience so take it with a grain of salt...

    1) You really have to wait at least 2 weeks from when the ad was placed into the paper for responses...
    2) Ahhh and having your own business is pretty stressful you will spend lots of time on it.... More then 4 days a week on it and way beyond the 9 to 5 hours....

    Whats your job like now.... in terms of pay and hours.... (dont mention where or who) just broad details...

    Cheers
     
  15. ajs604

    ajs604 Well-Known Member

    Hi thanks for your reply.

    I work full time Mon - fri with a RDO each month. I am a grade 2 Podiatrist - pay approx 61k a year.

    I understand that working for a business requires a lot of commitment and hard work and I am prepared for all of that. I would just rather work for myself as I feel that the public system is not for me. perhaps whem I get clients I could reduce ,y hours and do a bit of both so I get the best of both worlds. Does anyone know if that Dremel drill from bunnings would be ok for Pods as someone else mentioned - its a bagain at 90 bucks. Thanks for the advice!
     
  16. ajs604

    ajs604 Well-Known Member

    My current job is boring - all I do is basic podiatry no nail surgery, biomechanics ect. I think I would relish at my own business as I am creative and work hard.
     
  17. markjohconley

    markjohconley Well-Known Member

    ajs604, what was your mother thinking when she named you!

    You're getting some good advice from some experienced clinicians.
    My tuppence worth, the phone won't stop after your books are full too, Mark
     
  18. radeppeler

    radeppeler New Member

    One thing that might also be worth considering when thinking of doing home visits is your own personal safety. The potential situation of being in someones home if a patient or someone else in the house gets aggressive would be enough to turn me off. Not trying to discourage, but just something else to take into consideration.
     
  19. toughspiders

    toughspiders Well-Known Member

    Hi,
    The Dremel Stylus is excellent. I wouldnt be without mine its my best friend (sad i know) Yes you can interchange drill bits and mandrills. I tend not to use burrs on home visits. I reduce what i can with a moores disc.

    In terms of you existing job being boring don't fool yourself that home visits will be challenging. Generally speaking they are elderly people who just require general nail care.

    Personally i would target all GPs in your area (as long as you're not in mine :dizzy:lol) and advise them that you are a home visiting Podiatrist. My impression is they struggle to find someone to refer to from home visits.

    In terms of personal safety, yes it is an issue. I do have at least one client who is quite suggestive. I have a Receptionist who knows exactly where i am at what time. There are obviously other measures you can take for this. In the UK we were issued with personal attack alarms. I believe you can get them here.
     
  20. OneFoot

    OneFoot Well-Known Member

    dremel stylus has no vacuum beware...

    How is it going this week btw???
     
  21. JRB123

    JRB123 Active Member

    The dremel drill seemed to be quite popular with home visiting Pods when I lived in Western Australia. Also it is a cheap investment for a start up business. However if your business takes off and you decide to do this long term I think a vacuum drill would be the better option for health and safety. Good luck with the business.
     
  22. OneFoot

    OneFoot Well-Known Member

    how is business mate??
     
  23. ajs604

    ajs604 Well-Known Member

    Hi,

    If I am honest......I have not seen one person. I have distributed business cards to retirement villages and aged care facilities. I have had a couple of phone calls and when they ask what I charge $60 for a HV they say 'oh I can get that cheaper at the health centre'. I have also have a provider number but no referrals yet I need to put an add in the local paper i think. Thanks for asking anyway.
     
  24. OneFoot

    OneFoot Well-Known Member

    ok just some quick tips...

    You wont get any patients from retirement villages & aged care places as they all have their own Podiatrist... (they are gold mines and most always have a Pod)

    'oh I can get that cheaper at the health centre' - These are the people you will never get and you dont want... They already see a Podiatrist at a health / community centre where they pay $20 / $25 for a consult... MOST important they can drive so they dont need a home visit....

    The market for home visits is very very small.... If a person needs a home visit then they have to pay extra... The health / community centres dont offer your service of home visits...

    Finally DO NOT GIVE YOUR CARDS to retirement villages and aged care facilities they will throw them in the bin....

    If you want to have a simple & effective Pod Business then maybe you should seek out a room in a GP clinic... In the end you will pay 50% commission to the practice... but its a start... or you should save up and buy a practice....

    Its really hard mate.... dont worry your not doing anything wrong.... it just that the market for home visits is really really small....

    Also you need private pts as they can claim money back from their home visit....

    Thanks
     
  25. lizziet83

    lizziet83 Well-Known Member

    My 2 cents:

    I've been building mine for 2 years and am finally at the stage of getting busy enough.
    Trust me when I say after you get a few clients word of mouth from your patients will get you busy. They'll ask for cards for their friends ("my friend at church has a diabetes and can't drive and didn't know you could get a HV podiatrist")

    Stick with it. Apart from the summer heat, I quite enjoy it.
    Ignore nursing homes and villages. They won't take your price because some company probably charging them $20 and over working their pods (been there done that).

    Where abouts are you?
     
  26. ajs604

    ajs604 Well-Known Member

    Hey guys thanks so much for all the advice....its really helped me a lot and would be lost without this site. Just an update I have my first HV tonight and they are happy to pay what I have been asking. My partner is a nurse so she has also told several of her colleagues who have recommended me so hopefully it will continue to build. Will keep you updated. Many thanks.
     
  27. PowerPodiatry

    PowerPodiatry Well-Known Member

    Setting up a business is a form of insanity that we feel that we have to go through...because we never really thought about the business side.

    I sold mine after 25 yrs and only had a lapse into sanity for a few short months.

    Now if you don't have a marketing plan...or think an ad in the paper is a marketing plan you haven't done enough research into what being a business person is.

    Most people will describe themselves as a Podiatrist...wrong mindset when you go into business.

    Think outside Podiatry and think business and remember the definition of a business.
    "something that creates the income AND lifestyle that I want"

    If it doesn't meet these criteria then you are swopping one job for another and your boss is now INSANE.
     
  28. lizziet83

    lizziet83 Well-Known Member

    I have a question regarding appointment scheduling.

    Do people make their next appt (for HV) whilst with their patient? I'm eager to hear how you do this? At present I'm ringing approx 2 weeks prior to their next to give them a date and time. This way I can organize my day with regards to logistics and driving.

    Just wondering if there was an easier way?
     
  29. twirly

    twirly Well-Known Member

    Hi,

    I have a clinic & also provide visits for housebound patients. Most patients usually rebook during their appt. They select their return appt. & I can see in my diary which day Iwill be in their area. This generally helps to reduce mileage & is less stressful for me as I can see my work load for the coming weeks/months. Gives me a useful guide for income.

    Good luck. :drinks
     
  30. lizziet83

    lizziet83 Well-Known Member

    Thank you.

    I am solely home visits so I book up very quickly and cover a huge area.

    I am thinking I may just upgrade to sync my ipad with a mac book pro, take the ipad with me, which is connected via iCloud, and shuffle appointments while I am there.
    Because I do all home visits, I dont really need a appointment program that will cost me heaps.

    Am I missing something obvious that is easier?!
     
  31. OneFoot

    OneFoot Well-Known Member

    Hey how is business now mate?

    Ill be honest most places I know are finding it hard...
     
  32. ajs604

    ajs604 Well-Known Member

    Hi, its is going well thank you. I now have approx 25 clients, which equates to about a day and a half work per month and the clientel is building. I have sent letters to most of the doctors in the area and district nurses so have a constant stream of new people coming in. It was slow intially but it has already exceeded my expectations. I had hoped that the business would be in positive equity by the end of the year but I have already reached that point so hopefully continue to build gradually. I work full time as well so its just a welcome extra income. Thanks btw for asking. Where are you based?
     
  33. ajs604

    ajs604 Well-Known Member

    BTW everyone I agree about the prices and after several mths i realise that it is necessary to charge enough. Intially I started charging $55, I then increased it to $65 for newly referred clients and now with the end of the tax year looming I have increased it to $70. I have kept the price the same for the exisiting clients but most of them pay $65 with all the new ones now paying $70 and I was quite surprised no one argues with the price, so I freel I am being paid what I deserve more.
     
  34. ali8un

    ali8un Member

    Sounds like all is going well! Good to hear. So glad you took the advice of everyone regarding charges. Now that you are linked in with the GP's and District Nurses you will have no trouble with client numbers. I have had to close my books as I am at maximum numbers - and I have gone back to full time study. After several years I am still enjoying my home visiting practice, have no back issues and have worked out how to arrange my run to maximise my ability to see as many people as possible in a day (easier because it is a rural area and I have restricted my region). Financially it is very good with few outgoing expenses. And I LOVE the little break in my car as I drive to the next visit.
     
  35. ajs604

    ajs604 Well-Known Member

    Good for you. where are you based? I am hoping to study in the future so the home visiting service will work well with that?
     
  36. ali8un

    ali8un Member

    Absolutely! I am back in melbourne now though my Home Visiting work is in West Gippsland area (was living in Warragul). I go up every other saturday and any other day when I have time. I've also set up a practice at my house and am just letting that slowly build. No advertising other than a sign out the front. This is my first semester back being a full time student so I have been content to see how it would all fit together and didnt want to stress myself out with work. My hope is that by the end of 3rd year that there will be enough work that I can put on an associate during the day while I am at uni. Help pay for 4th and 5th year! Lol. (am studying chiro). You have given me a welcome break from studying micro and physics ...but better get back to it. Exam for both this arvo!
     
  37. jay82

    jay82 New Member

    Hello everyone. i happened to be going through this thread, and it made me wonder, if a podiatrist employed at a hospital and already provided all required insurance coverage, in addition, also does private practice at home, would he require professional indemnity for his private practice and public liability insurance coverage as he catering to clients at home?
     
  38. klyons

    klyons New Member

    Some notes on home visit safety -

    Make sure someone knows where you're going - never just pop in to do a quick HV without someone knowing you're there

    Park on the street - not in the driveway

    Make sure they don't lock the door behind you when you enter the house

    Keep your mobile with you (some of my colleagues hae 000 on speed-dial so they just have to hit 1 button while its in their pocket)
     
  39. jay82

    jay82 New Member

    Thank you Klyons . Your post has my mind reeling. If you have more information regarding home podiatry services, i'd appreciate if you would enlighten me. i wasnt quite so aware it would be a risky option...And what of the insurance that i would require to cover this risk?
     
  40. sid1ani

    sid1ani Member

    Hi Ajs,
    Would like to know how you going with your home visit business?

    thanks in advance.
     
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