Podiatry Arena members do not see these ads

Good evening everybody.

Calculation of charges has always been an interesting subject for me. It seems many practitioners charge a similar fee to their competition on the assumption the competition is making stacks of cash. This is rarely the case as I haven't seen many pods driving Golf GTI's, Audi's, BMW's, Porshe's, Bentley's etc. Even established practitioners are very cautious of increasing charges. Why is this, are they afraid of offending the patients? There has to be a happy balance: if every new patient enquiry results in an appointment then your charge is too low, conversely, if it results in the patient going elsewhere you are charging too much. The problem is most pods err on the side of caution because they do not like rejection or confrontation. As far as I am concerned salesmanship is part of the job and rejection comes with the territory. Rejection should be welcomed because without it you do not know if you are charging enough.
So what percentage of rejection should we be aiming for, or are we all playing boringly safe?

Best regards,
Graeme
:) :) :)

There are 4 ways:

1) What the market will stand
2) What the person down the road is charging
3) What the 3rd party funders pay/reimburse
4) Zero-based budgeting (Add up the costs of runing the business and how much you want to make and divide that by the number of patients to be seen)

The problem is when you do (4), it is usually very different to (1), (2) and (3) .... don't figure

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Hi all

I used to play 'boringly safe', until a couple of years ago when I grasped the bull by the horns and totally 'went for it'.

I see on average 5-8 pts by way of home visit per day Mon - Thurs, Friday I take off, Saturday is my busiest day and can see up to 18 - 20 pts both in a surgery and afterwards via h/v's. (surgery fee's are slightly less)

I give myself 6-8 weeks holiday a year, buy a new car every 2-3 years (no, not a BMW usually a (reliable) Honda), if the car don't work, I don't work!

On average I get 2-4 new enquieries a week out of them maybe 1, or at a push 2 will ask for treatment. New patients I try to see almost immediately, they seem to be impressed on relaibility I have also found that the phone rings when:

a). After the school run.
b). After 'Trisha'
c). Christmas week all the way up to xmas eve
d). When the inetrest rate comes down
e). Late on a Friday evening when there is an important soccer game the next day (OC)
f) Prior to summer holidays
g). When the new yellow pages comes out

Fee's I charge start at £28 for first visit and £20 for subsequent visists, this is regardless of the treatment. Orthotic treatments command a substantially higher fee of course, and I get 1 - 2 a month. Fee's go up annualy by £1.

Fees are applied/charged for all pts no exceptions, negotiating is like the kiss of death, if people can't afford my fees they go else where with no hard feelings, or they say "I'll get back to you on that"

When I arrived to the area I phoned around to all the local chiropodists and introduced myself and asked what they charged and their scope of practice (here we go again the 'S' word) the majority were helpful a coulple dismisssive. I then took slightly above the average fee and worked from there.

Regards

David D

ps, I also got a good accountant (worth their weight in gold!)

Hello David D,

Thanks for your extensive reply; it seems my posting hasn't aroused much interest. Obviously pods like earning low salaries!
Very approximately my conversion rate is 90% although I haven't done an exact analysis. I charge £24 for clinic appointments, pay rise pending in the New Year.
The point I was trying to make, perhaps somewhat poorly after having a few beers, was that there are many practitioners who are afraid of charging too much for any patient. This may account for the general low charges in the UK. I don't understand why many people charge less for their domicilliary visits than Scholl charge for their clinic appointments.

Cheers,
Graeme.

Hi Graeme

I did post on another site (the one beginning with S) that all chiropodists in any given area should get together, have a beer, become friends and agree on a minimum charge, this should to some extent rule out the £5 a shot, (or less), guys and give those who are serious to this profession a chance at making a decent living out of it.........I was then , in not so many words, accused of proposing to try and form a cartel!

I think at times we are our own worst enemies, its no wonder there isn't much communication (except on here that is) :)

Now if you will excuse me I must go and tend my poppy fields

Cheers

David D

Hello all,

recently starting out in private practice has been a steep learning curve. One of the points that became apparent very quickly, was that patients/customers will tend to pay what you ask of them. WITHIN REASON, however it tends to be harder getting conversion rates from phone enq.. with a higher fee.

But i would say that if they are going to visit you, then they are going to visit you. And unless there is a problem, in the patients eyes, they will continue to visit you.

The comments on fees are almost a means of boasting to family and friends, as long as the product/service quality exists.

In general i have adopted the view that those people whome seek regular podiatric treatment will not/do not notice the difference between a low or high price in real world terms. In that they will still be able to eat and pay the bills, visit favorite holiday destinations etc.

I also accept that not every customer is my customer

Being a realist i am also aware of the smaller number of patients that are in pain, cannot see an nhs pod in a timely fashion and are suffering as a result of inadequate expendable income.

Given the fact that i only really see musculo-skeletal complaints and biomex at the moment this can be a problem, and i am 'too soft'. In that the package will be altered to suit the individual concerned.

As ever we learn from our patients, i was recently advised to charge more and accept that it is not affordable to everybody. Hmmmm...

Anyhow did i hear mention of a cartel!

I would be on the street charging £5-£10 as i know some do, linking to the tittle of 'work or hobby'?

Kind regards

steven.

Hi Steven

I wasn't boasting, just stating a fact......or have I got the wrong end of the stick???

Cheers

David D

Hi david,

sorry, that was as clear as mud :). Trying to post between jobs as usual.

I an with you on this one.

regards steven

Hello David,
How right you are, I believe you should charge what the market will stand but mainly what you are worth, if the £5 and £8 pods out there want to work for that then let them. They cannot be making a living unless cutting corners.

PS I liked your idea first time round of a cartel, dentist do it

Ronnie

Hi Graeme et al. One of my favourite subjects! I've noticed in recent months a number of domiciliary chiropodists in my area retiring or 'quitting'. I would not be at all surprised if many of them are the cheapskates who have realised they cannot survive under the new regs. Interestingly, patients who have come to me from some of these el cheapo chiros, (I have had fees of betwen 5 and 10 pounds quoted to me!) are now paying more than double at my rates, and seem to have no qualms about doing so, once the initial shock has worn off. At the end of the day, if you are providing a good service then I believe you can charge a reasonably high rate, possibly higher than the competition, as I do in some cases. It is all a matter of confidence at the end of the day, which sadly many chiropody practicioners seem to lack.


T

Not necessarily.......
Bear in mind that this is a world-wide forum. In other countries (or in specialist fields even in the UK - ie surgery or biomech) podiatry fees are directly influenced by what the medical insurance companies will allow.

A specialist podiatrist working in those fields can charge anything from £50.00 upwards for a consultation. Gait analysis, orthoses, and surgical procedures raise additional charges. The total for consultation, gait analysis, casts, prescription orthoses and follow-up in my clinics is over the £500 mark.
The pod surgeon I work with charges similar amounts for a surgical procedure + follow-ups.

Cheers,
David

Hi all

Going slightly wide of the mark, earlier this year I had to see an ENT consultant (no, I'm fine thanks for asking ), it cost my insurance company £250 initial consultaion....in at 2pm, in my car on the way home at 2.10pm...two follow up consultations at £150 a go, both under 10 mins, and in fact I think the last one was about 5 mins.

Now thats what I call a fee :)

Cheers

David D

B##**y 'ell!!

Knew I should have paid more attention in Biology lessons at school :)



Tim

Medical pedicure, £85 for 45 mins would be very nice on a full list. I just have to develop a french accent and at least, some culture?.....Damn counts me out

David, are the fees you mention typical, and accepted with the mainstream providers of health insurance?

regards steven

Hi to all.

I looked at fees in the local private hospitals about five years ago to find out what was being charged for a simple ingrowing toe nail op. The hospital in Hove quoted about £120 for a consultation, £600 for the op and more for any follow up and redressing. In Eastbourn the rate was £100 for the consultation and £450 for the op again with extras. That would be a nail bed resection or partial resection.

Also a patient went to the local private hospital with a VP. The appointment lasted about five minutes. The patient showed his foot, the consultant froze the leision and the patient left. No debriding or padding or anything else. The fee £120, and if he wanted it done again, that was another £120! He went elswhere.

Boots wanted from £170 for a PNA, which I think was quite fair, though I don't know what was included. An SRCh in Eastbourne was charging £75 last I knew, I think it's worth double that.

Fees in general are lamentably low. I think that there is a lack of understanding of what business costs really are. There is your rent, materials, transport, your wages, administration, depreciation, your training and CPD etc. which everyone knows. Your wage cost is what you think you are worth. If you take some equivalent NHS rate, and why should you be paid any less, you have to add on all the extras, sick pay insurance, NI, pension etc., and consider the extra hours you do, it will surprise you just at how much you have to take in fees.

As a rule the fee also defines your service just as price defines a product. Take perfume, the content cost pence, the packaging pounds, the marketing and branding even more, and on the shelf a small fortune, £40 for 50cl thats £2000 per litre, and it sells. At £14 you will attract a £14 customer, many will not trouble you if you charge £24. But £24 customer might feel it's not worth the risk going to a £14 chopper. The £24 service must be better, after all if you can get it others must think so too and anyway you are worth it. There is no point in charging a low fee just because you have low overheads, you should enjoy the benefit.

Access to NHS patients may not be a good idea. I have heard of independent providers being paid £14 - £16 per treatment (Bexhill). To make that pay you have to give an NHS 20 min appointment service. Have you wondered why NHS dentists pack the patients in. They are not happy bunnies at the moment. Public sector finance is different as there is always another wad of money down the line. For example their pensions are not funded, which may yet cost us 10p in the pound in income tax. I don't trust them to come up with a fair reward, neither do I wish to sell my soul. I suspect that insurance based payment would be much better.

What you sell is a service which has benefits for the customer. It is the perceived benefits that the customer pays for. It is those benefits which you should market

As for pedicures, I believe our French friend is charging £100 in Claridges.

By for now
Luke Hawkins

£50 for a consultation is probably the lowest a specialist podiatrist doing medical insurance work would charge............ but yes, mainstream providers accept this level of billing :) .

To make it quite clear though, this is for specialist work. A podiatric surgeon may or may not have a degree in podiatry (usually they will), but they have done extensive post-grad training, and been examined at theory-level and practical-level. A podiatrist carrying out biomech work (gait analysis, orthoses etc) will have some post-grad quals (the "gold standard" in the UK is probably an MSc in biomech or bioeng).

Most medical insurance companies will require the podiatrist to have been qualified (read SRCh, or HPC-reg as it is now) for five years.
They will also require the patient to have been referred by an NHS Consultant.
Many podiatric surgeons hold this title and can legitimately see their private patients with only a GP referral. They can also refer on to a pod who specialises in biomech, which is how I see many of my patients :) .
Regards,
David

I recognise that it may not be wise to take in NHS patients via a local contract . NHS contracting-out would have to be properly set up at national level, with up-front monies available to set up a practice, with guaranteed income levels, and with contracts which ensure continuity.

20-minute appointments for routine care are fine. I worked like that in private practice for years - no problems.
Cheers,
David

Thanks david,
far better than the small print on schedules!

Looks as though CPD pays in the end :)

regards steven

I have to say that it's a real treat to see colleagues actually wanting to talk about the business of private practice. I think the HPC is going to be a wake up call to the profession in the UK. Serious money is going to be extracted from registrants for the privalage of allowing them to continue treating their patients. It could well be that the practices that are going to survive the next few years will only be the ones that can AFFORD to keep up with the legislation. (We've all had our premises surveyed for asbestos as required haven't we? See the fee your surveyor charges you!)

My practice survives on high quality "core value" chiropody. I hate the term "cut an come again" The PNA's Biomex etc. I regard as jam on the bread. As has been said, patients pay for benefits, and we make their visit to us a very pleasant experience. I don't understand why certain sections of our profession denigrate "routine" treatments. If an OAP is willing to pay my "routine fee " of £35 rather than go half a mile up the road to the free NHS clinic, this must make some kind of a point.
As regards fee structuring...I'm with the school of " work out all your expenses, then work out what you want your practice to deliver in the way of t/o having factored in time off, and divide the figure by the number of patients you have to see to obtain that figure." It's not rocket science. Private practice is all about perception. How your patients percieve you and your practice. Look and feel successful and that's what you'll become. Our American colleagues have known this for years and it's about time we caught up!

And IT WORKS. For what it's worth, I worked 32 4day weeks (no Sats.) last year, drive an Merc SLK and thoroughly enjoy my life. If I can do it, believe me anyone can.

Get together in the pub regularly as we do in my area. Talk to each other and you'll find you all have the same business problems. Try visiting each others practices...there's a novelty! But you'll learn from each other. Keep up the dialogue!!

Hi Alex,
Thanks for your posting.
I also enjoyed your recent, very informative article on PP in Podiatry Now.

As a successful private practitioner, may I ask canvass your opinion on a matter being debated elsewhere on this site?

How would you feel about taking on a quota of NHS patients - either into your existing practice, or into a (new) branch practice? You probably would not want to work this yourself, given your quoted clinic hours, which I think are pretty realistic.

Many of us who have been around a bit remember the last time this was done, and the fiasco which resulted from these patients being withdrawn from private practice at very short notice (a month if I remember correctly).

The new proposal would circumvent this by nationally-agreed contracts, which I guess would include;
having monies available up-front (either in the form of a low-interest loan or as part of 1st-year income) for practice establishment, realistic notice of withdrawal of patients (or withdrawal of labour by the pod), payment up-front for work being carried out, etc.

Good for you on driving a merc. I do like to see pods in decent cars :) !
Cheers,
David

Dear David.......I'm glad you enjoyed the article! I too was around when The Halsbury Report was implemented, and many practices lost their NHS patients.This, as you will also recall, was after the same practices had been continually asked by the local health authorities to take on more NHS patients.(remember that?) It should also be remembered that The Society continually warned practitioners NOT to take on too large a case load of NHS pts. Just in case.....they were proved right.

However, in retrospect, it showed just how few "private" practices there were at that time, with many losing up to 60% or more of their case loads.When the dust settled, the practices that survived agreed that they were actually better off financially, for this created waiting lists where none had existed before and the same pts. had now to pay for treatment if they couldn't wait. (In my area of Richmond Surrey.......pre Halsbury, all NHS chiropody was carried out in Private surgeries)

Anyway, after that trip down memory lane....yes I would take on a NHS case load BUT only because I have a "spare " surgery that could be utilised. You're right.......I wouldn't treat them. I'd employ an associate, pay him/her more than the NHS and still be profitable. This would only be viable on a fee per treatment basis at around the current NHS "contact fee" or whatever they call it of £20. See 3 pts an hour........and watch the waiting lists shrink!!

BUT BUT BUT...........If we're talking a dental model of payment with an annual one off fee per patient, and having to get permission for extra/specialized treatments.......then I don't think I'd be interested. The figures would have to stack up, and I can just imagine the admin involved.

Any NHS work would be run as a separate part of the business. Just in case!!!! I certainly would NEVER rely on it for ANY part of my main income, and wouldn't consider taking on a new surgery for NHS unless you had a cast iron contract with your Trust. Which I don't think you'll get!

Hope my ramblings add something to the debate.

Alex

Hello Alex

I can see we're going to have an interesting chat when we meet up! You make comment about a system of payments for practitioners who take on a component of NHS work. Can I offer some observations?

The problem government will have with a per item or per capita fee is the same one that blighted the dental service before it pulled out from NHS work - namely it does not provide value for money and is ripe for exploitation. With podiatric care (more so than dental care) if a per item fee is set against each patient visit, there would be little incentive for the practitioner to adopt a more curative regime into their clinical practice. For example, when a patient presents with footwear-related dorsal 4th PIPJ corn, best practice would be to remove the lesion and either modify the footwear with a balloon stretch or have the patient purchase new shoes. But if the practitioner were to receive a fee each time the patient presented to his or her surgery with the same problem the natural tendency would be to forgo the footwear element of the care. In essence it would promote (and I know you dislike the term) ‘cut & come again’ practice. From the NHS and government point of view this would not represent value for money and from a professional perspective it would anchor the profession firmly in the palliative care regime of the 1970’s.

That said I can fully understand why from a business standpoint, you would be happier with a per item scheme! Dentists milked the NHS system for all it was worth before the government pulled the plug and lowered the fees. If we are to go down the line of having an established general podiatry practice network in the UK which encompasses both fee paying and state supported patients then we need to devise a system of remuneration that is sustainable and favourable to all parties. Remuneration can take other forms than just a managed care fee (supported by caveats for complex conditions – as you noted). There can be practice development grants; funding for staff and equipment; incentivisation payments for screening programmes.... ad infinitum. That way if you have a national footcare scheme for cutting toenails in the elderly you might have a 'fee' of (say) £5.00 levied to the patient but receive additional payments from the State to support the practice, thus increasing your income to a respectable and desirable level. To achieve that platform we must first, as a profession, convince government that podiatric practice is an important facet of modern society and has an undeniable value which is worth supporting. Oh and using a volunteer army and denegrating general podiatric practice to 'social care' - and yes, allowing the regulator to make an ass of standards within the body of the profession - does little to convince anyone that the practice of podiatry has any real 'value'. That is why we must quickly rethink our professional strategy if we are to make real progress in practice establishment.

I’m not at all against podiatrists earning six-figure incomes and neither are politicians, providing there is a measurable improvement in the nations foot health. Payment by results rather than by numbers; quality rather than quantity. That is the only way to go.

Kind regards

Mark

Hello Mark,
All your observations are valid, and I admit my last posting was based on a purely business footing rooted in the here and now.

You've summarised the dilema beautifully!! When NHS work was done in PP surgeries I seem to recall the pt paid 15p (!) towards his treatment. You are quite right .......the Govt are not going to be exploited again as they were by the dentists. I don't think we'll get a fee per treatment deal much (as you say) I'd like it!!

However, I've to be convinced we'll get a decent deal for preventative podiatry as well. What happens to the pts. who won't/can't afford to e.g. get shoes that an orthotic will fit? If we
discharge them why not do the same to un co operative smokers in the hospital system? Someone's got to treat them, and they need treatment. How's about a speciality post in palliative care? That's novel!! Make a change from diabetes!

As you say.......lots to discuss!! But at least Private practitioners ARE starting to talk!

....if we can prove our case re: improving the nations foothealth then we might get a decent deal. But I can't help thinking it's a long way off.......and would you trust a government with the statistics!!

I'm all for the profession going forward, but as far as the NHS is concerned, I'd want a decent deal and decent assurances. (not have my NHS pts taken away at 6weeks notice like last time)

And we haven't talked about the surgery inspections that would have to be carried out..........or the admin . Never mind about your receptionist.....who's for practice managers??!! Still, as I said, if the deal stacked up, It MIGHT just be worth it. Who knows

Best wishes, Alex

Alex

I think it’s going to be a long dinner.

All your points are valid and I can tell are borne out of years of experience. There are a lot of issues that we need to look at. Say for example a patient qualifies for state care but refuses to comply with your advice [No Mr Catto, I’m not wearing those shoes, there’s nothing wrong with my Van-Dals!] and she wants treatment to her troublesome corns every four weeks. To a certain extent that situation already exists in NHS practice and sometimes the problem – like the corns – is intractable. Especially when the patient complains about your persistent reminders and the management bow to her pressure!

My own view in these cases is that the patient should bear the cost of the treatment and if we are to have a general practice scheme there has to be effective mechanisms in place to address all these circumstances. It’s much more complex than just contracting services out!

You touched on a very important point when you mentioned inspecting practices. Not only do I believe that the profession needs a dedicated regulator, I also think it essential that we have a Podiatry Practice Board which will advise, inspect and uphold standards – from premises and equipment through to patient management and fraud prevention. Such a body would also be responsible for payments and agreeing fee structures and as such will have to operate at a local level but within a nationally agreed framework. Good jobs for podiatry managers when the existing service is cut to a small core salaried workforce – Stephen Moore take note!

I’ll try and finish the objectives and strategy proposal that I started on the SCP forum recently by the middle of next week but I have an email box that has become quite ridiculous in recent days – yesterday I had nearly 130 to give a reply to! You are right – people are starting to talk, and that’s no bad thing; it’s about time this profession woke up!

Kind regards

Mark

as an american practitioner i found this discussion about fees among our british colleagues not to different from what we are going through.in the states podiatry is covered is by both public and private insurance plans.however,many practitioners are being squeezed by shrinking fees and ever rising costs of operation.
many of more successful practitioners are resorting to the dental model of time efficiency and to office dispensing.we are desperate to find new sources of income.the point for us is that when the government sets your fees. it is very hard to get the public to pay higher cash fees.
in the states american podiatrists do drive beamers and benzes.we just can't afford them.

See?
I KNEW other pods couldn't afford their cars !
Cheers,
David

I recently looked into getting an entertainer for my daughter's 6th birthday. If I have a 'fairy' come to the house and play games and do craft activities for 2 hours with 6 little girls, it will be £120. She's also very booked up! By the sounds of it most pods don't charge as much as £60 an hour. The mind boggles- are fairies worth more than Pods? Could we put our fees up if we wear a fairy outfit in clinic I wonder?

I think you have hit the nail on the head, Pod-on-Sea,

Alex Catto made a prediction on this thread in 2004 which seems to becoming a reality :-


Here are some prices I have been quoted/have paid for work :-

The plumber charged me £2000 labour for fitting a new bathroom - assuming that he worked a 40 hour week then that equates to £50.00 per hour.

The chap who mended the washing machine charged me £70 (which included a small part) and was in the house 15 minutes.

My vet charges me £35 for my cat's yearly boosters, and I am in the surgery about 10 mins.

The tree surgeon charged £300 for cutting down and removing a diseased tree from my property. It took him about 3 hours (and then I presume he would have to dispose of the wood.)

These are not complaints but just a few examples for comparison.

Does anyone know where I can buy a fairy outfit?

Dido

Dear All,

In my humble experience Pods usually think of a number and HALVE IT

Then their competitor undercuts them a bit more

So Pod goes for market share in the $10.00 market.

What do you Pay your Dentist, Optician etc etc or even your Placebo Therapist.

Seriously the fees here in Sydney are not great but Govt Schedule fee tends to set fees here.

As a Profession we really undervalue our selves, skills and the relief from pain our skills provide.

Look at your local HAIR EMPORIUM and think to yourself many of my clients go there once a week. Cogitate this and then reflect upon your fees.

Do you want to see thirty $10.00 pts per day or 10 $30.00 pts per day or 3 $100.00 per day.

All the above result in earnings of $300.00 per day but your costs vary wildly.

Remeber the expression that my FEE represents excellent value

As i am by nature a lazy illigitimate child, doing less for more has a pleasant ring to it.

regards David

I like the thread of this posting as it has pods talking about charges.

I run a two practice set up with also a residential home side to the practice.

I average my hourly charges for when I work at a minimum of £80 per hour.
That is for a chiropody treatment.
when I do nail surgery that rises to £200 per hour
when I do orthotics the hourly rate rises to £500 per hour
the treatment charges in the residential homes are lower but is designed on a through put basis and is done b y an associate.
I learnt a lot from a chiropractor i worked closely with for four years before setting up my own dedicated clinic.

One comment is patients are funny folk. I had a lady who would see me once every 8wks and asked why I charge £25 do "do her Corn" she then proceded to tell me how she went to a Chiropodist in a market once a week at a £5 every week and why didn't I charge the same. I said why doesn't your other chiropodist do your corn for you. Her response was she isn't very good at that.!!

Don't figure

Dave