How do you charge for written prescriptions?

Re: How do you charge for written prescriptions?

Martin Atkinson — Wed, 29 Feb 2012 14:39:37 GMT

[quote user="Bob Russell"]

The cheap practice up the road is clearly an issue but we can only make sure that we are better, more caring, friendly than them and most important there is continuity of care!

People are genuinely worried by 'corporates', they are getting wise to the £70 for two pairs of spectacles that turn out to cost £400 by the time Spec-Savers have added all the little extras!

True budget practices cannot offer the same service standards (I am not commenting on treatment standards here) and owners must make a choice. Many would rather pay more for personal service and avoid the hard sell.

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Sadly the cheap practice up the road is run by a sole charge vet so I can't even blame the corporates but his front-of-house service and bedside manner is impeccable which woos the clients along with the cheap up-front prices, it is the short cuts behind the scenes that unsuspecting clients don't know about that is the problem (an ex-nurse of mine went to work there and walked out in the end in disgust) so we are talking about treatment standards. Another employee has reported him to the RCVS but didn't persevere because she was called up for an interview and couldn't face it. The ex-nurse continued to bring her pets to me even when she worked for him which speaks volumes. Just before anyone accuses me of sour grapes again I have to say the corporates and multi-centre practices around here have been more than fair and I have little beef with them

Re: How do you charge for written prescriptions?

Hannah Wynne Richards — Wed, 29 Feb 2012 13:15:37 GMT

Royal College's biggest mistake in it's entire history-not fighting harder toprevent the OFT foisting lay and corporate ownership of practices onto us The long term consequences for both our profession and ultimately our patients make the current row over overspend seem very trivial in comparison

Wynne

Re: How do you charge for written prescriptions?

Bob Russell — Wed, 29 Feb 2012 12:50:16 GMT

[quote user="Martin Atkinson"]

[quote user="Bob Russell"]

For crying out loud we need to charge properly for what we do so it does not have to be made up elsewhere. Stop giving things away unless you really need or want to and make sure that the profession is financially viable.

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This is of course theoretically so valid. The problem as I see it though is that clients who ask for prescriptions are bargain hunters already one step away from jumping ship to the cheap practice up the road, if you then charge what is in reality a realistic prescription fee that may then make them jump if the cheap practice also charges less for a prescription. The problem is that even though some of us value our time and charge realistically there is always someone, somewhere who is trying to take advantage by undercutting, be it an on-line pharmacy or the cut price practice which is prepared to stack 'em high and sell 'em cheap but cuts corners elsewhere to compensate. Professionalism and the bottom line are not always easy bed partners.

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Someone has to make a stand somewhere! We write one prescription a month (if that) but we do work hard to make sure we get, for example, the cheapest meloxicam we can and pass that saving on to the client.

The cheap practice up the road is clearly an issue but we can only make sure that we are better, more caring, friendly than them and most important there is continuity of care!

People are genuinely worried by 'corporates', they are getting wise to the £70 for two pairs of spectacles that turn out to cost £400 by the time Spec-Savers have added all the little extras!

Re: How do you charge for written prescriptions?

Martin Atkinson — Wed, 29 Feb 2012 12:19:28 GMT

[quote user="Bob Russell"]

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Re: How do you charge for written prescriptions?

Laurence Webb — Mon, 27 Feb 2012 22:45:51 GMT

[quote user="Anthony Todd"]I sort of thought the "dispensing fee" was a "prescription fee" without the paperwork; the thought process and responsibility are the same, but the time taken is more and you should repeat the instructions and admonishments at least twice, IMHO, and then again as they go out the door.[/quote]Yes, but although there are significant costs involved in stocking and dispensing drugs from your own pharmacy, the income from drug sales subsidises the cost of your professional time. With a written prescription there is no cross subsidy, so charging a higher prescription fee than a dispensing fee is appropriate.

[quote user="Anthony Todd"]The same goes for repeats except there's more to check with the owner.[/quote]If there's something to check with the owner why aren't you charging them for your time instead? If you're happy to dispense 3 months worth of Metacam then you're happy to dispense it. It shouldn't matter whether you're writing them a prescription or dispensing the medication yourself. Either get them in for a recheck or charge them for a telephone conversation if you need to monitor them before the 3 months is up.

Re: How do you charge for written prescriptions?

Anthony Todd — Mon, 27 Feb 2012 17:45:50 GMT

[quote user="Martin Atkinson"]The same goes for repeats except there's more to check with the owner.[/quote]

Yes well it's now apparent that, in our case, a "repeat prescription" is something vets write etc. etc. and a "repeat " is just VPOMs we sometimes hand out willy- nilly with a token nod to all the other considerations, as so eloquently summarised by your good self, above.

I just have a funny feeling that some staffers in some practices [certainly ours] may not realise that a "repeat" bottle of a VPOM is actually a repeat prescription without the paper but a "repeat prescription" is some piece of paper signed by a vet to enable clients to buy POMs cheaper than we can buy, not sell, them....

And I think Sting went on to sing "every breath you take, every move you make, I'll be watching you" and I imagine it's being hummed by certain regulatory bodies as I type.... and there may not be a happy ending......

Re: How do you charge for written prescriptions?

Holly Norman — Mon, 27 Feb 2012 15:16:10 GMT

Here at my current practice we charge a £6 dispensing fee onto any medication dispensed in house. For a written prescription we charge £8.95 per prescription (one medication per form). This are both set fees that don't change even if the pet is on long term meds

Re: How do you charge for written prescriptions?

Bob Russell — Mon, 27 Feb 2012 15:06:02 GMT

A prescription is a legal document with a lot of implications. The grumbles about how much we should charge is typical of the 'charity' mentality that 'dogs' the profession (sorry for the pun).

Doctors charge over £30 for a prescription, solicitors charge £30 for every breath you take when you are talking to them and we make a fuss about charging a tenner or so for something so important!

We charge £10+VAT for the first item and a smaller amount for the additional items. I don't apologise for it and on the few occasions where it happens I will explain why I am not apologetic!

Re: How do you charge for written prescriptions?

Martin Atkinson — Mon, 27 Feb 2012 10:06:06 GMT

[quote user="Anthony Todd"]

I sort of thought the "dispensing fee" was a "prescription fee" without the paperwork; the thought process and responsibility are the same, but the time taken is more and you should repeat the instructions and admonishments at least twice, IMHO, and then again as they go out the door.

The same goes for repeats except there's more to check with the owner.

[/quote]

In my mind a dispensing fee is to cover the time it takes to fill the pot, the cost of the said pot, an allowance for spillage/wastage, the cost of printing a label which includes the computer which does it, the nurses time for sticking the label on the pot and the responsibility for checking that it is all correct - in theory the vet should check off all dispensed drugs to make sure it is correct before handing to the client so more vet's time, not to mention a contribution towards the VDS subscription if it all goes wrong! A prescription fee includes the time taken to fill out the script, the cost of priting/preparation and again a charge for expertise in getting it right plus the VDS contribution. I would argue that no-one should be handing out repeat prescriptions without re-examining the animal but if not, at the very least it should include a frank discussion with the client which again involves extra time. It is true that we shouldn't be deliberately charging a prescription fee as a deterrent as it discriminates against the client who requests one but if we are not making as much profit because someone is getting their medication somewhere else we have to charge more somewhere to maintain our profit, either on a consultation fee or on the mark-up on the medication we sell to clients who don't want a script. This is equally discrimination against those who don't want a prescription. So which is right and which is wrong? I think the idea of a medicines decision fee was good: it goes on everyone's bill and the person who wants a script to take away pays it, if they choose to redeem their prescription in house the MDF is refunded as way of a loyally discount, that way there is no discrimination and just a nominal prescription fee to cover the costs of producing it if it is actually printed out can be added.

Re: How do you charge for written prescriptions?

Anthony Todd — Sun, 26 Feb 2012 15:54:16 GMT

[quote user="Gillian Mostyn"]But only the last 2 points are different for a written prescription as opposed to an in-house one, so, officially, you shouldn't be charging for that if you aren't doing so for your in-house prescriptions. No? Or do the vets not check all prescription requests?[/quote]

We've just been discussing this at the vet's meeting, particularly the last sentence above.....

The same goes for repeats except there's more to check with the owner.

Re: How do you charge for written prescriptions?

Gillian Mostyn — Sun, 26 Feb 2012 00:42:28 GMT

[quote user="James Laidlaw"]I don't see it as just an in house dispensing cost comparison. For a written prescription you need to review the case, ensure the dose and medications are correct and don't need altering, fill in or write out a prescription, and most importantly - put your signature to it.[/quote]

But only the last 2 points are different for a written prescription as opposed to an in-house one, so, officially, you shouldn't be charging for that if you aren't doing so for your in-house prescriptions. No? Or do the vets not check all prescription requests?

Re: How do you charge for written prescriptions?

Clive Ansell — Sat, 25 Feb 2012 18:15:18 GMT

[quote user="Gillian Mostyn"]

But a consult fee is more than just time....

The problem is that the written prescription fee is NOT meant to stop competition in the drug sales market, much though some people are trying to make it such. It is simply supposed to cover any costs IN EXCESS of what it would be to get the drugs in-house. You should, ethically, be charging similar to your dispensing fee on your own drugs. Any more and you are risking looking like you are either profiteering or preventing a fair market.

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How does one decide what is a reasonable prescription fee - I don't know? surely you have to factor in your professional and practice time to review the notes and complete the paperwork, say 5 minutes, as well as the fact that one is legally responsible and accountable for it too.

How is the time for a consultation more or less valuable or professional than time to complete a legal document?

I don't know what the fee should be, but the only indicators I can think of are professional and practice time as % of a consultation, and the fact a private GP prescription is around £36. Charging a reasonable and realistic professional fee is not profiteering, and we all should do so without apology. Get a lawyer to review and sign a legal document and I would wager it is more than a fiver.

A dispensing fee alone is not a like for like comparison, as some of the revenue will be made from % mark up on the drug sale. Maybe we should sell drugs at cost with a much larger dispensing fee and/or prescription fee.

Re: How do you charge for written prescriptions?

James Laidlaw — Sat, 25 Feb 2012 18:08:16 GMT

I don't see it as just an in house dispensing cost comparison. For a written prescription you need to review the case, ensure the dose and medications are correct and don't need altering, fill in or write out a prescription, and most importantly - put your signature to it. How much do we value our signature? It ensures any problems can be traced back to us by our friends at the DMV. For £1.50 some people don't value their professional opinion or status very much it would appear... I find it rarely takes me less than 5-10 minutes to fill in the BVA prescription form (we also have the little stickers that go on them - which aren't free!) - so I have no qualms about charging for filling a script. I should note too that I am a mere locum, and not a practice owner or have any financial investment in the business I work for. I think charging for prescriptions is fair and less than a tenner is pretty ridiculous.

Re: How do you charge for written prescriptions?

plantagenet — Sat, 25 Feb 2012 18:05:07 GMT

[quote user="Laurence Webb"]Smug answers along the lines of 'we don't need to charge because no-one asks for a prescription' will be given a red star! [/quote]

£10 + VAT but they all get a lecture - effects on consultation charges, provenance etc etc. It actually works quite well and at the moment the only prescriptions I am writing are for the local pharmacist and for a couple of products where it really is a ridiculous amount cheaper from Boots.

I am not sure this would work in a big practice where there is a different relationship with the clients, then I would be tempted to charge more since it is us doing all the hard work.

I do tend to offer a discount for clients on long term, very expensive meds, but it is more of a token and the clients seem to appreciate it.

Re: How do you charge for written prescriptions?

Michael Woodhouse — Sat, 25 Feb 2012 17:31:11 GMT

We don't have a small animal prescription fee on our PMS. We charge ~£20 for a VWD and then ~£12 for subsequent ones. If someone insisted on a prescription that's the fee I guess I'd use.

I have (so far) always managed to negotiate with the client, and kept the business.

Re: How do you charge for written prescriptions?

Gillian Mostyn — Sat, 25 Feb 2012 16:55:22 GMT

But a consult fee is more than just time....

Now, it isn't a fair market as the online pharmacies can get drugs at such a dramatically lower rate than we can, and they don't abide by the same rules as us. But fighting this with massive prescription fees makes us look the villains and risks us having yet more rules imposed..!! Presumably the VMD will eventually realise that they cannot possibly regulate the market and we'll have to see what happens then.

Re: How do you charge for written prescriptions?

Clive Ansell — Sat, 25 Feb 2012 16:12:24 GMT

You may well be right Gillian, but cannot understand why many practices charge so little for prescription fees. The way forward surely has to be reduced drug prices and a higher prescription fee.

How long does it take to review the clinical notes and complete the paper work?? 5 minutes?? maybe 1/2 a consult fee then ??

Re: How do you charge for written prescriptions?

Gillian Mostyn — Sat, 25 Feb 2012 16:07:34 GMT

I think comparing ourselves with GPs is pointless - they are 2 completely different business models. We need them, full stop. They can do what they want. Our clients can go elsewhere.

Re: How do you charge for written prescriptions?

Clive Ansell — Sat, 25 Feb 2012 15:55:05 GMT

The highest I have seen is £15 per item, no discounts.

The lowest is £1.50 for as many items the client wants.

Why don't we make it the same as a private GP prescription, £36 I think the last time I asked for one? is our time and professionalism worth so much less than theirs?

Re: How do you charge for written prescriptions?

Lorna McHardy — Sat, 25 Feb 2012 15:37:40 GMT

I'm pretty sure most practices I've worked in charge per prescription. I don't think I've ever written one with more than one medication on it, though.

Re: How do you charge for written prescriptions?

Gillian Mostyn — Sat, 25 Feb 2012 14:30:07 GMT

...but we only charge £5 for first 2 meds and then £2 for every med after that. I couldn't justify any more than that because it really doesn't take that much time or effort.