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A bientot...

Julian
Podiatrist-at-large

Dear Julian,

How much does it cost you to run your practice?

Do you rent premises own premises and all associated costs.

Do you own and run a car and all associated running costs.

What do you charge your practice for the services you provide on behalf of the practice.

What Revenue does your practice need in a year in order to provide you and yours with a standard of living commensurate with your eduaction training skills and social standing.

Also how much does it cost you to go to a Nursing Home and provide the high standard of care that the patients in the home expect of a health care professional. Remember you still have your practice costs and no revenues being generated by the practice while you are at the nusing home.

Or does the home just want a $10.00 nail trim?

We as a profession are embarrased to charge fees commensurate with our training and skills, ceratinly compared with our other AHP colleagues.

Use the Medicare fee reimbursement of $47.85 for a clinic fee as a guide . This corresponds to a 85% reimbursement of a $57.00 fee.

So you have to include your time and costs of taking all your equipment etc to the home time to set up and pack up etc etc.

You are neither a charity nor a charlatan so charge a professional fee for a professional service.

So what do i consider a fair fee.

Does the home provide assistance from their own staff in helping to provide the care to the resident. Or do you trip from bed to bed buggering up your poor old spine in the pursuit of a painful retirement.

So i would say that if you are provided with a suitable well equipped room with assistance from the staff then a fee of a at least $57.00 per patient based on a minimum of a 4 hour session plus call out time at $110.00 per hour travel and set up. So a awhole day of 7 hours duration tt time would give $800.00 plus travel and set up time of 1.5 hours at 110 ph is $165.00.

So for a days work tt 14 patients you would create revenues of $965.00.

Hopefully this would lead to a profitable days work after all costs are deducted.

The above is just a rough outline on one brief way to cost out a days endeavour.

regards David

Hi Julian & David,

I am in total agreement with David.

I charge the same for a nursing home contact as I do for a clinic appt. (local area only)

The patient receives the same level of professional care as my clinic patients would expect.

The only difference I find is the restriction in surroundings. Bed fast patients etc. + carting everything with me.

I feel it fair to expect a professional fee for a professional service.

Patients, regardless of location are paying not just for routine nail clipping but for your skills as a professional podiatrist.

Regards,

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:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

Thanks for that David and Twirly. I am in a similar position to Julian in that I feel I should increase my pitifully low fees for the local aged care facility. Yes I do feel a bit mean in this regard when I know I shouldn't. So thanks for the boost and for your advice.

Rebecca

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My location

Hello guys,

Yes I feel the same way too. As far as I'm concerned, we are a valid profession just like any other, offering people professional service.

I don’t understand what the stigma is with our profession? In my opinion, we help a lot of people, just as much as any other health profession. Why should we charge any less?

Do we, or our pts, grumble when the accountant or lawyer dishes out the invoice? No.

Why don’t we just send our pts back to their GP's to get their get there nails trimmed, I'm sure they wont complain when they get the bill.

Dan

Asher,

Another way to soften the blow is to give plenty of notice to patients.

I always advise in advance of fee increases (usually with a minimun of 3 months notice)

At least that way they can go elsewhere if your fee doesn't suit.

There will always be someone willing to do the same for less but you may find your patients know, trust and on the whole will remain loyal to you.


Regards,

__________________
:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

Thanks for the replies guys.

Certainly food for thought!
I can assure everyone I do not charge $10 for a "nail cut" as one put it (I'm sure that was not serious though). Nor do I quite charge $57 pp.

Now I will bump up the fees......

Thanks for your encouragement dear colleagues.

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A bientot...

Julian
Podiatrist-at-large

I recently went for an interview at a nursing home where they wanted another chiropodist to cope with the large amount of residents. All seemed to go well until we discussed fees. I said that my charge was £22.00. I was astonished to find the other guy was only charging£11.00 a patient. I was considered to be very expensive. Not the case I said, the other bloke is undercharging and in my opinion lowering the status of the profession. Needless to say I didn't get any work in that home. Probably a good thing!

Hi Alvin,

This has also been similar to the scenario in the area I work in.

Fees are (in my case as in yours) non-negotiable.

I would rather not work than sell myself/or profession short to appease anyone.

I find it amazing that many individuals believe what you charge is ALL for profit.

No tax, no overheads etc etc........

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:)
twirly

Mandy Brooks
Brooks Podiatry
S64 0DE

Suffering a fondness for odd things.

This sounds all too familiar. I was just looking through the various threads to get some advice on this very subject. I have recently had a meeting with a nursing home manager about providing a podiatry service for the residents. The manager was new so didn't have all the details, but seemed to think the previous chiropodist treated either 60 or all 120 residents over 2 days every 6 weeks. She is going to confirm this for me when I phone her back. This was for £6.50 per patient, which is pretty standard in the Glasgow area according to other homes she has spoken to?

I explained to her that 30 patients is a lot to treat in one day in order to provide the required standard of podiatric care. She also seemed to think that £15 per patient I quoted was excessive and doubted whether residents and their families would be willing to pay more than double the previous cost.

I am keen to take the work on, but closer to my terms.

John

Hi Guys

I vary my charge according to the number of people I have on the list at the homes. Under 6 and I charge $30-$33 ( Charity I know.) and over that $25 / Person. If they need Padding etc the cost usually goes up. The trouble is these people will pay $15 a week for a "Hair Set" and grizzle about $25 for a Nails and corns Ulcers and full Foot health assessment every 2 months. Its hard to charge full fees, because we Pods are competing against Beauticians and Laypersons who do "Nails". for peanuts.

I have often pondered the Amount of $ budgeted for " Foot Care" in the Rest Home Rents tenants pay and how much is actually utilised for feet. But I have never had the gumption to ask the managers?

Charging full fees and travel etc is just not feasible in the town.

Cheers

Joe

Hi John,

I now charge $35 AUD per resident/patient and have a minimum of 10 patients rule (extra for padding, insoles etc and use the facilities dressings etc), my Australian Fee equates to 16 GBP or 18 Euro, so your charge of 15 GBP appears very reasonable.

Of course charges vary from one location to another, but 12000 miles away and another continent and our fees seem relative !

Unless you are desperate for work, I'd wish Madam Nursing Home Manager a pleasant day and advise her to make alternate arrangements. Her job is to negotiate a 'cheap' rate, yours is to cover your costs, cover your insurance (Car, Life, Professional) , and receive a fair remuneration for your expertise, if the residents are not fully utilizing your expertise, so be it!

Just remember, if heaven forbid, you got ran over while traveling to the facility, Managers like this first thought is "...Oh dear, now we'll have to get a new Podiatrist !"

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A bientot...

Julian
Podiatrist-at-large

its true that there seems to be a big discrepency between what people charge for podiatry within a care environment. I have been charging £15.00 for about 2 years in the residential homes near me. this is considered a lot and i tend to get the "How much!!!!!!!" quite often. it sometimes gets me down until i remember that it costs more to get the dogs nails cut at the vets by the assistant. Charge what you are happy to work for and you wont feel resentful about working hard and professionally.

Hi just a couple of sense worth
I no longer do N/H as many of them have contracrts with big companies that supply the work.
Unfortunately the common theme we hear is that you only get your nails cut!
The fee charged does not cover any thing else.
We see clients who are not happy as they have corns or other oproblems and these are not addressed.
It is an interesting area, ;the companies or pods charge a low fee BUT they do not all do a podiatry service
for those who do I am only stating what I have continually had to deal with.
As I refuse to put a colleague "down" it is hard to appease the clients with why private treatment is different to what they have experienced.
I strongly believe those who do not do a full service and are paid by the number they do, so the more they do in the shortest time the greater the pay...Do a great diservice to their 3-4 years of study and to the profession in general!
MUST BE LATE, I don't often get on the
Again I know there are many pods who do not fit this category and I congratulate YOU:

Cheers

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Heather J Bassett
137 Wheatsheaf Road
Glenroy 3046
Victoria
Australia

Lack of adequate treatment is a category of misconduct according to the HPC's rules. Any podiatrist that has not treated the hard skin without giving a REASONABLE explanation to the patient, carers, is guilty of misconduct and that is therefore a matter for the HPC.

A colleague of mine had a patient come to him about 6 weeks ago. This patient had had chiropody in a care home, but still had VERY thick callous. My colleague said that in his opinion, he was looking at months of callous build up and they had not been done properly whilst in the home. The patient was going to make a complaint.

I heard of a case that was reported to the HPC, it was inadequate treatment. The chiropodist said, "well I only charge £13". The HPC's response to that was, "you do a complete job whatever fee."

When some of these chiropodists start having to fork out for the cost of treating a patient (out of their own pocket) because they have quoted a care home a ridiculously low fee AND have to do a complete job, they may want to think twice before quoting a ridiculously low fee.

Good post Brummy...

I would have paid good money to see the look on that 'professionals' face !

__________________
A bientot...

Julian
Podiatrist-at-large

Weren't there some stats from the Australasian Podiatry Council some years ago stating that the cost to Sterilize (inclusive of time, energy, machine costs and disposable costs) a set of general Podiatric instruments was around $12AUD? So if my memory serves me correctly with those figures, those of you charging $25AUD for a consult are making $13 profit for your time?

How do you run a business like that?

Each of our patients is aware of where their money is spent. Via handouts, clinical information they are given costs as to why a consult is $X or why their orthoses cost $X or why their wound dressings cost $X (and why that is apparently expensive!)

Education is all that is needed. Patients are happy to pay fee's when they know they get quality care.

I agree with you on your point of patient education.

I was talking to a friend of my sister-in -law a few months ago, saying that most elderly should be able to afford chiropody, it's a matter of priorities. I said that at a SOCAP AGM, someone said that elderly ladies can soon afford to have their hair nicely done, but they think that chiropody is too expensive.

Jean's reply was, "well having your hair permed is more important, no one looks at your feet, they see your hair though." She did not realise what can go wrong if your feet are not done. Also Jean was amased that we have to sterilise our instruments in between patients and keep records. "You're joking" she said. "No I'm not, it is a legal requirment, and you can get struck off if you're caught not doing it!" She never knew.

How many other customers do not know what is involved in carrying out our duties properly/legally, and what can happen if things go wrong! It is patient education!

I would think that at least basing fees on what is recommended by the government ($48 medicare $ $57 DVA) would make sense. Have confidence in the fact that your providing a professional and valuable service.

But surely this is the wrong way to view this? Do you think other specialists base their fee on what Medicare rebate or suggest - absolutely not, that why my GP charges $77 for a consultation when the medicare rebate is sub $50.

Gush_Horn - why do you use the Medicare schedule? Why don't you use the MBF private health schedule who think you are worth $22 for a subsequent consultation?

I am sure a good deal of my well educated and experienced colleagues will attest that their valuable time is worth much more than a $48 medicare schedule per consult! The beautician across the road charges $82 for a pedicure - and they paint your nails as well!!!!!!

The DVA argument is completely different - DVA actually pay quite well for services rendered. Rarely does a thorough consultation require only 1 item billed.

In this day and age you get what you pay for - if you don't want to pay my fee, don't come back and complain that the "cheaper" person did a poor job!

Completely agree Paul. I was saying that as a minimum (read posts above of people charging around $30). Podiatry is a really needed and valuable service and this should really be reflected in the pricing structures. Having people charge peanuts really goes a long way to undermining the profession

Hi
With regard to the fee, I was contacted by the owner of 4 homes, to carry out treatment to the patients, we agreed £15 per person( a verble agreement), each paitent is invoiced to pay the fee within two weeks of the treatment carried out in June 09.

I am still waiting for some of the fee to be paid to me, I have sent several emails to the owners and the managers that run these homes with regard to non payments I have left several telephone massages for the managers to call me- to date I have not had any response from the owners and one of the homes has asked for me to come back and treat the patients.

I have told this manager that as there are problems with fees , I will need to be paid on the day the treatments are carried out and I need this agreed in writting. So far he has not responded if anything he has asked for me to come and treat the patients. It seem he is ignoring my request to be paid on the day

I don't think that I should be going back until I have received all my fees, and if I were to go I should want my fees to be paid on the day. Any advise is greatly apperciated.

Shilpa.

When asked about doing nursing homes as, "it must be a good source of income." My reply to the patient is, "you must be joking, very few chiropodists doing chiropody to make a living, and worth their salt, will touch a nursing home with a barge poll." Why, you are a dogsbody, the working conditions are atrocious, staff are not helpful, and the pay is atrocious. Two patients of mine got an almighty shock when I showed them posting from TFS re: nursing homes and fees!

Hi

My mum is in a nursing home for which £1000 per week is charged. The visiting chiropodist charges £13.00.

I have seen this lass at work and have not been very impressed. She sits on the floor to do her treatments. How can we expect respect as a profession? I do not visit nursing homes in a professional capacity and make a living none the less

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Zaffie
My location

I think it depends very much on what treatment you are giving.
It is a distinct possibility that over half the people in the home only need non-pathological nails cut/filed.
Can we really justify charging people £25 for that? Even with all our lovely education I'm not sure it is a "fair" price. But then again, they're getting in a medical professional in - they should pay the fees for the medical professional. They always have the option of getting in a Foot Health Practitioner to do the social nail care and calling in the Podiatrist for any additional, medical care their patients need.
NB: Medical care is supposed to be provided within the home fees (not so Social Care) so any charges you make will not be passed on to the patient/their families. Or should not at any rate.
It's something you could discuss with the home at any rate?

I am a Podiatrist in Australia and have been working for myself for 3 months. I base my rates on what others charge in the area that have their own clinics and also go by Medicare or clinic rates.

I don't do many low care nursing home patients and am lucky enough to have landed 4 day contracts with nursing homes where the homes pay me direct...and I earn a good day rate, in the region of $700 for 15-20 patients.

After 3 years of study, I think $40-50 dollars per patient is reasonable, including transport fees, carting stuff around and putting your back at risk....

+1

Totally agree...unless you are desperate...tell them payment on the day, I've been doing it for years and once they are in the habit it gets easier. As for when you will be returning to provide treatment - tell them you'll be in a few days after you get paid for the last visit, or, write a firm but polite letter asking for payment again and have it 'registered' with the Mail provider so they have to sign for it. This is evidence of receipt by them that you could use if you took the matter further.

BTW AUD$40-50 is equal to about 20-27GBP, so you are NOT overcharging at all, and its a cheaper cost of living (generally speaking) in Aus than the UK!

Hope this helps...

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A bientot...

Julian
Podiatrist-at-large