Endoscopy prices

Re: Endoscopy prices

Andrew Henfrey — Sun, 05 May 2013 19:41:06 GMT

I have rigid 0 degree 108mm 2.7mm endoscope which I use extensively for otoscopy. I have 4 sterilisable otoscopy sheaths and a rhinoscopy sheath. The telescope and sheaths came for endoscopy4vets.com in Canada. Much cheaper and perfectly good quality. The telescope is non-autoclavable though but can be liquid sterilised.

I got the camera system/light source/monitor from Freelance medical.

It's worth thinking how you would record images or video as some are S-video compatible while some more modern ones work with USB cameras. Mine is s-video so record onto a DVD recorder.

I think the mos timportant thing for your business plan is knowing what additional procedures you will use the kit for, work out how many times a week/month you can confidently expect to use it, and then work out costings to justify the investment.

My kit has paid for itself many times over

Andrew

Re: Endoscopy prices

CatherineThomas — Sun, 05 May 2013 10:54:02 GMT

Thanks for the tip about bulbs Patrick! That's something I wouldn't have thought of.

Re: Endoscopy prices

CatherineThomas — Sun, 05 May 2013 10:53:10 GMT

[quote user="Evelyn Barbour-Hill"]

I can't see that there's much of a "business plan" to write. Are they being deliberately awkward? Is there a certain breakdown of trust here? Or have they read too many management magazines?

[/quote]

Because they are CVS so they want business plans for everything!

I've now written a business plan which has kind of morphed into more than just the use of an endoscope to encompass several aspects of increasing the exotics caseload. I've never written a business plan before though. Is there anyone who knows about these things and has the time to read through it for me?

Re: Endoscopy prices

patrick murphy — Sat, 04 May 2013 16:49:47 GMT

sort of related top tip always have a spare bulb. has happened to me 2 light sources in 6 weeks.cannot do much with an anasethesitised dog without the light , how embarassing

Re: Endoscopy prices

Evelyn Barbour-Hill — Sat, 04 May 2013 16:37:42 GMT

[quote user="CatherineThomas"] I've had a look at VES and they do have the set up I want for only £1600, which is less than half the price of Storz. Are these still good quality endoscopes? [/quote]

Yes!

[quote user="CatherineThomas"]I was thinking that I would charge the practice 80% of the fee charged to the client. If I claim this as expenses do I get taxed on it? They've asked me to write a business plan for how it would work. Anyone got any tips on how to do that?[/quote]

Well, it's income so you have to pay income tax on it. But you might be able to call your endoscopy a private enterprise and set the capital cost against tax. Ask an accountant. I wouldn't work on percentages, I'd charge the practice £x for every time you use it. They can then set the fee as they do for anything else I presume. The only problem would be if they started quibbling on the lines of "but you didn't absolutely have to use it for Miss Bloggs' dragon, and we didn't get paid by Mr. Feckless for his parrot.........."

I can't see that there's much of a "business plan" to write. Are they being deliberately awkward? Is there a certain breakdown of trust here? Or have they read too many management magazines?

I'd try and keep these payments completely separate from your salary. You'd have to declare them on your annual tax return of course.

Re: Endoscopy prices

CatherineThomas — Sat, 04 May 2013 12:34:45 GMT

Thanks for the links. The problem with the gb medical ones is I would need the accessories to go with them such as the operating sheath, biopsy forceps etc and there could be problems with compatability. I've had a look at VES and they do have the set up I want for only £1600, which is less than half the price of Storz. Are these still good quality endoscopes? The catalogue emphasises their after sales care and training which will be helpful. I'll give them a call on Tuesday to get some more information.

With the light source, I'm not really sure what is best to do. For a new light source which isn't handheld they are more than the endoscope itself. Even second hand they aren't cheap when you have to buy a £120 cable to go with it. At the course last week they were telling us that if you want high definition video cameras you need a good xenon light source but if you aren't using a camera it doesn't matter.

Does anyone have any experience of the handheld lightsources?

I was thinking that I would charge the practice 80% of the fee charged to the client. If I claim this as expenses do I get taxed on it? They've asked me to write a business plan for how it would work. Anyone got any tips on how to do that?

Re: Endoscopy prices

Evelyn Barbour-Hill — Fri, 03 May 2013 21:33:30 GMT

[quote user="CatherineThomas"]They say that if they are to buy a piece of equipment they expect the costs should be recouped within 3 months. [/quote]

Then they are very............. errr.............. shortsighted, shall we say.

[quote user="CatherineThomas"]I think the only way I'm going to be able to get an endoscope is if I buy it myself and make an arrangement with the practice so that they pay me for each patient it is used on. Has anyone else done that kind of thing before? I'm in two minds as to whether I should do it or not.[/quote]

It seems like a good idea but I don't know anybody who has actually done it. If you do, make sure the practice pays you plenty for its use.

You're right about the camera and monitor, they are not essential at all. I'm not sure about the handheld light source though –– is it powerful enough? Is it going to let you down at a crucial moment? I don't know, I'm just suggesting things you ought to check.

Re: Endoscopy prices

Michael Woodhouse — Fri, 03 May 2013 20:13:42 GMT

Catherine - seriously have a look here:

http://www.gb-medical.co.uk/proddetail.php?prod=515-2611

http://www.gb-medical.co.uk/proddetail.php?prod=AES-PE205A

The quality will be fine. You can have a full set up for less than £1000. If you use it then upgrade.

Re: Endoscopy prices

CatherineThomas — Fri, 03 May 2013 20:04:16 GMT

I know what I want and I have a quote from Storz. It is the 2.7mm 30 degree one. The people I have spoken to have said that it is worth getting a good quality endoscope such as the Storz but the accessories such as cameras etc can be bought from cheaper places. Although I think at the moment there is no way I can afford the camera and monitor too, I'd have to make do with the handheld light source.

Re: Endoscopy prices

CatherineThomas — Fri, 03 May 2013 19:57:57 GMT

Thanks for the advice.

The reason I want an endoscope is because I want to do more exotics and I'm trying to do my certAVP ZooMed. I've been told by a reliable source that if I have casees which need endoscopy and I haven't done it I would fail the case study, because it shows that I don't have the equipment to be able to treat exotics. Plus endoscopy is one of the points in the assessment which has to be covered. Unfortunately my boss doesn't seem to understand this. They say that if they are to buy a piece of equipment they expect the costs should be recouped within 3 months. I'm never going to do £4000 worth of endoscopy within 3 months!

I did a day course on exotics endoscopy last week and I think I can manage to do basic stuff and I can practice on all the dead pigeons to improve my skills.

I think the only way I'm going to be able to get an endoscope is if I buy it myself and make an arrangement with the practice so that they pay me for each patient it is used on. Has anyone else done that kind of thing before? I'm in two minds as to whether I should do it or not.

Re: Endoscopy prices

Evelyn Barbour-Hill — Fri, 03 May 2013 19:25:43 GMT

[quote user="CatherineThomas"]Those of you who have endoscopes, what do you charge for endoscopy? Do you charge per minute or have a set charge for a short, medium or long proceedure?[/quote]

Oh, fixed procedure charges, no question. Others here have already hinted why.

And I don't mean a fixed endoscopy fee, to be added to a fixed radigraphy fee, to be added to.... I mean, to take a common example from what I do, a fixed fee for "investigation of nasal discharge", comprising GA, radiography, endoscopy, taking biopsy, taking swabs.

[quote user="CatherineThomas"]'m trying to convince my boss that we really need a rigid endoscope, mainly for exotics but I hope that it would be pretty useful for dogs and cats too.[/quote]

It will be useful for cats and dogs, but it won't in itself be as useful as all that. How will you examine the internal nares (the choanae) without a flexible endoscope? Your rigid one will probably go down a cat's trachea, but how far down a dog's trachea will it get? Are you thinking of a straight forward looking one or a 30 degree angle one? For some purposes either would do, but for some purposes you would want one or the other.

Talk to a supplier such as VES where they do actually know what they are talking about and will not try to sell you something you don't want.

[quote user="CatherineThomas"]Also for the practice owners, if you were to buy a piece of equipment such as an endoscope how long would you expect it to take to recoup the costs.[/quote]

Well, five years I guess. But as a singlehanded practitioner I'm in the fortunate position of not having to let that heavily influence my decisions.

[quote user="Michael Woodhouse"]Other aspects to 'sell' the idea include offering something your neighbours don't have, and bonding you to the practice and hoping you less likely to leave and they get the hassle of finding a replacement for you (I'm not saying leave if they won't buy you one!). As a recent owner there is a less sound financial sense that some things are 'nice to have' and make the job more satisfying and pleasurable. Sometimes every single bit of kit doesn't have to pay for itself directly - especially if by being able to offer this service for exotics you get more exotic business.[/quote]

I agree very much with that.

I'm intrigued by the idea of an additional setting-up fee or washing-up fee. Was that a joke?

Re: Endoscopy prices

bob lehner — Fri, 03 May 2013 18:50:21 GMT

The problem with endoscopy n my opinion is that it is not as easy as you might think (beyond the very simple/basic stuff). Like ultrasound, it's one of these things you can't learn from a book - and unless you do a lot of it you never really progress beyond the basics..

My experience was that 'scopes were an expensive investment which spent most of their time hanging on the wall earning nothing. I always belived they were the poorest fee-earners of all our kit - and that was in a busy SA hospital. Charging by time is difficult in the early stages as you might take forever to try and look round a stomach for example - which an expert would do in a rather short time.

Of course on rare occasions it's a winner, as you can make a spectacular diagnosis.

Re: Endoscopy prices

Andrew Kent — Fri, 03 May 2013 16:38:48 GMT

Most places I have worked have had levels of endoscopy pricing plus usually a set up or washing fee. So for a quick procedure (eg quick look at something or quick remove grass blade in cat) would be a level 1 up to a level 4 which would be upper and lower GI endoscopy with biopsies.

Re: Endoscopy prices

Michael Woodhouse — Fri, 03 May 2013 13:50:04 GMT

Catherine - I try to price things like this at fixed prices as it is much easier charging someone for a procedure if you can tell them the cost in advance. If you were going down laproscopic surgery then time might be the only fair way.

If I am buying something outright I want to break even in a year. If I was buying on finance I want to make profit on the equipment every month. We have just bought a 2nd hand ECG and I am pricing it over an anticipated usage over a year. I'd 'expect' a life of 3 years minimum. Sometimes having something available does allow you to find cases where it would be useful and in almost all cases I have used new things more than I had planned so making money sooner.

Try to put some figures down on paper. Cost of equipment (remembering that there is a lot of 2nd hand medical stuff around at good prices and quality compared to some of the far East crap some people try to push onto the vet market), anticipated use, lifespan etc. Do remember that most things that do not wear out (like a rigid endoscope) still have a value at the end of their life. If bought 2nd hand you can sometimes lose very little money.

Other aspects to 'sell' the idea include offering something your neighbours don't have, and bonding you to the practice and hoping you less likely to leave and they get the hassle of finding a replacement for you (I'm not saying leave if they won't buy you one!). As a recent owner there is a less sound financial sense that some things are 'nice to have' and make the job more satisfying and pleasurable. Sometimes every single bit of kit doesn't have to pay for itself directly - especially if by being able to offer this service for exotics you get more exotic business.