How does your practice charge for dentals?

Re: How does your practice charge for dentals?

Hannah Wynne Richards — Fri, 02 Nov 2012 15:27:08 GMT

Iain It's not you taking it on the chin-it's the practice owner

Wynne

Re: How does your practice charge for dentals?

Iain McAllister — Fri, 02 Nov 2012 15:17:12 GMT

I locum and see different practice use different techniques which usually means there is no ideal way to do it - the difficulty lies in making an accurate assessment of work required - this can really only be done after removing the calculus and using the pocket probe on every tooth - but the more experienced you get then the easier it becomes to estimate with a fair degree of accuracy in the consult room

Most pets are good enough to let you make a thorough exam in the consult room - its quite easy to have a quick scan and rush to make an estimate but I would advise really taking your time and assessing the merits of each tooth - it will take longer but you will end up with a more accurate result and less time consuming hassles with clients down the line

People don't like really wide estimates so that will definitely put them off - try to make the estimate range as narrow as feasible and try to stick in the range - some cases you will lose out on if you get a difficult extraction but you have to take it on the chin!

Re: How does your practice charge for dentals?

Rob Loxley — Sat, 27 Oct 2012 15:22:49 GMT

We charge separately for GA, 'descale & polish' (one fee for cats, bit higher fee for dogs), extractions (per time taken), xrays, suture material and intra/postop drugs.

Re: How does your practice charge for dentals?

Hannah Wynne Richards — Wed, 24 Oct 2012 14:58:37 GMT

Anthony All I can say is my sympathy Owners can really be the pits on occasions

Wynne

Re: How does your practice charge for dentals?

Anthony Dennison — Wed, 24 Oct 2012 14:50:40 GMT

[quote user="Evelyn Barbour-Hill"]

I never ever say to a client that Binky "needs a dental". The nearest I would come to it would be "Binky needs a general dental overhaul, as you might say......." followed by an explanation, as lengthy as it needed to be.

[/quote]

I tried this twice this morning, "dental examination under GA plus necessary treatment", went at length about not knowing if the dog is in pain with teeth but probably is, and being able to see the difference. Both owners said no... obviously need to be more persuasive.

Worst thing was one of them came in solely because the owner was complaining the dog had bad breath! 'Oooh I can't afford that, what else can I do?'

Re: How does your practice charge for dentals?

Charlotte Marshall — Tue, 23 Oct 2012 19:49:11 GMT

we charge on time taken with a dental time per minute charge. However it does mean we often have to give quite wide ranges for estimates! it is not always obvious what is going to be hidden under all that tartar. Anaesthetic and drugs on top of that of course.

Re: How does your practice charge for dentals?

Rajat — Tue, 23 Oct 2012 17:34:22 GMT

[quote user="Evelyn Barbour-Hill"]Yes, but you could charge for a nominal time of 30 minutes. Otherwise the supervet by being brilliant is actually losing the practice money. And relative lack of competence is gaining the practice money.[/quote]

do you mean a standard of 30 minutes as per an average vet, so in 30 minutes one expects the average vet to probe chart xray and S+P a small dog's mouth. So if I understand you right, regardless of time taken, this is the fee everyone charges in the practice?

[quote user="Evelyn Barbour-Hill"]I'm so glad I'm singlehanded and don't have to torture my brain with this stuff. [/quote]

I have to say it is impressive you can do all that oral surgery using just one hand

[quote user="Evelyn Barbour-Hill"]Yes, but one tooth might be very difficult and time consuming in one patient, while in the next patient nine teeth might plop out in your hand. And, er, suppose you extract none but spend half an hour on treating pockets, say..................[/quote]

I totally agree. Our system is flawed. I just put it up here to illustrate how we charge certainly not as a model for others :)

As for treating pockets- I usually charge a surgical fee with a discount i.e. surgical time minus 30% or so..We don't have a separate fee for this but definitely worth considering.

[quote user="Evelyn Barbour-Hill"]I never ever say to a client that Binky "needs a dental". The nearest I would come to it would be "Binky needs a general dental overhaul, as you might say......." followed by an explanation, as lengthy as it needed to be.[/quote]

I'm certianly prone to this error, and I think we demean what we do by calling it a dental - I do try and call it a different term as prev explained, but the whole practice is used to the term dental as all encompassing, as are most vets out there, I think a paradigm shift is needed..!

Re: How does your practice charge for dentals?

Jo Cobbett — Tue, 23 Oct 2012 13:24:53 GMT

We have different categories for S&P only, "easy extractions" (ie the ones that fall out once you've removed the tartar, or simple single roots), 1-2 difficult extractions, and 2 or or more difficult extractions. all other bands include scale and polish. different bands for cats and dogs. Costs include GA, but analgesia and antiobiosis charged on top.

Re: How does your practice charge for dentals?

Mark Holmes — Tue, 23 Oct 2012 10:44:05 GMT

Interesting thread on charges in general. I have struggles for a long time witht the idea that we charge per proceedure and why practices don't charge soley on time. I hear the argument about differing level of experience but differential pricing according to experience exists already. How many new grads through a lack of confidence run bloods that a more experienced vet might not feel they required. How many new grads would take xrays when a more experienced vet would be happy to wait 24 hours. In fact the reasoning that new grads don't generate as much as more experienced vets would bear a fuller examination on this basis alone. Further pricing by item leaves alot to be "forgotten" and doesn't allow for the fact that say one xray could be a 2 minute proceedure or take 20 minutes depending on positioning of the patient, size shape and body weight. I have just taken bullae rads on a boxer, it was a pig of a picture to get due to its short neck and big tongue. A greyhound would have been a piece of cake.

I even question the logic of a GA fee. My first job never charged one, the costs being worked into the proceedure on the basis that the length of the proceedure better refected the GA fee than a simple figure. "Extra minutes GA" is in my experience frequently omitted from bills.

It seems to me that overheads and fees would be better charges according to a vet's time and soley on a vet's time thus better reflecting the cost of the proccedure being performed. There is less to "omit" from a bill and vet's performance could be monitored and if necessary a bonus paid on charged hours rather than turnover. Further any phone calls or associated admin could be included in the charged hours and therefore paid for.

How does one track the way a practice is running relative to a business plan when differential hourly rates are being charged according to whether the revenue generator happens by chance to be taking an easy xray, performing "a dental" - sorry Evelyn or repairing a leg. All of which take skill, one could argue as to the differing levels of skill.

Am I naive to suggest the a practice should be able to estimate its costs for twelve months ( including contingency) determine the required turnover to cover these costs and desired profit and then apply a target of say "65% of a Vet's time must be billed at £X per hour" to achieve this. Inexperienced vets could be charged at 0.75X per hour or similar.

A further benefit is that the Vets who are "slower" not due to inexperience but due to inefficiency would be able to see clearly how that inefficiency is costing the client where as in most practices it costs the practice and hence the client but is not readily seen by those responsible.

Re: How does your practice charge for dentals?

Hannah Wynne Richards — Tue, 23 Oct 2012 09:38:46 GMT

Like all other surgery GA fee and surgery fee depending on time Drugs on top

Wynne

Re: How does your practice charge for dentals?

nikki — Mon, 22 Oct 2012 23:15:07 GMT

we charge for the GA, there is a cat S&P and a dog S&P and a miniature dog S&P. If we extract a lot of teeth we might charge half a S&P.

Xrays are priced separately.

Extractions are priced by dog or cat and then by the tooth and how many roots it has or if it's a cat with a resorbed root on xrays then there is a slightly reduced fee for a crown amputation.

Suture materials, abs and analgesia charged separately.

Post-op checks included.

Re: How does your practice charge for dentals?

Evelyn Barbour-Hill — Mon, 22 Oct 2012 22:23:27 GMT

[quote user="Rajat"]So charging surgical time isn't really justifiable as it may take me 30 mins to do what it takes a more experienced vet 15 minutes and a less experienced vet 45 minutes...[/quote]

Yes, but you could charge for a nominal time of 30 minutes. Otherwise the supervet by being brilliant is actually losing the practice money. And relative lack of competence is gaining the practice money.

I'm so glad I'm singlehanded and don't have to torture my brain with this stuff.

[quote user="Rajat"]and then extractions based on # of teeth --> 1-3, 4-5, 5-9 and >9.[/quote]

Yes, but one tooth might be very difficult and time consuming in one patient, while in the next patient nine teeth might plop out in your hand. And, er, suppose you extract none but spend half an hour on treating pockets, say..................

P.S. I don't quote, I estimate. And no client has ever asked me for "an estimate for a dental". If one ever did, I'd ask them what they meant by "a dental". And what they answered would be the starting point for a discussion of dental and periodontal diseases and their treatments.

Re: How does your practice charge for dentals?

Rajat — Mon, 22 Oct 2012 20:50:23 GMT

Hi Louise

I feel a problem exists in our terminology- often our clients will compare prices (like we all do in daily life) and if we quote them for a 'dental' and they get another quote for a 'dental' from another practice, for what its worth its an MOT or a tax disc to them. They don't 'get' the difference between practices, all they are hearing is 'dental' so one assumes that the procedure is identical when it so often isn't!

I try to explain what is included - including the fact their pet will have a GA monitoring machine along with the nurse monitoring, pain relief including local anaesthesia, dental rads to check for silent probs (explaining that it is saving them money in the long run in case fluffy's hiding FORLs decide to crop up coronally in her other canine tooth in 6 weeks...)and so on..

When I book it in, I book it in as ..."Dental assessment + treatment under GA, including radiographs and extractions as required"

So clients already know that I am not just 'doing a dental' - otherwise it comes across as a relatively unskilled job.

In terms of charging- I have known places to charge by root extracted. Scale and polish was separate.

In my current place we charge for S+P (one fee for all!) and then extractions based on # of teeth --> 1-3, 4-5, 5-9 and >9. A somewhat crude system but effective as we have recent grads and experienced vets and people in between. So charging surgical time isn't really justifiable as it may take me 30 mins to do what it takes a more experienced vet 15 minutes and a less experienced vet 45 minutes...

If we extract, we do not charge S+P on top, rightly or wrongly.

Local nerve blocks+ agents are on top as are dental rads, suture material etc.

Not all pets require each component of these things, so it allows us to charge exactly whats been used which helps with stock taking system too which automatically re-orders stuff when needed...

Re: How does your practice charge for dentals?

Stephen Courtney — Mon, 22 Oct 2012 20:34:09 GMT

As has been alluded to in other posts, you must allow enough time to do a proper job, especially if you are new to the art of better dentistry. There is no such thing as a quick dental, and if you are in a big hurry to finish because your consults start ion 10 minutes, you have messed up.

Re: How does your practice charge for dentals?

Evelyn Barbour-Hill — Mon, 22 Oct 2012 18:15:17 GMT

[quote user="Louise Alexander"] (I know there are some very cheap dentals out there at the low cost clinics )[/quote]

Ignore them. Even at £35 I bet they are lousy value. "There is scarce an article in this world which some man cannot make a little worse and sell a little cheaper, and those who consider price alone are that man's lawful prey" . I think it was Ruskin who said that, but I'm not sure.

It all depends on your practice's general method of calculating charges, so no-one can really tell you what to do. However I'd respectfully suggest that

[quote user="Louise Alexander"]we have price bands, S&P, up to 4 extractions and 4+ extractions.[/quote]

is not a good way. You might have eight really easy extractions, or maybe one really tough one. Anyway, it seems to suggest that extraction is the only thing you can do to a tooth?!

I'd suggest you charge like anything else surgical. For instance, consultation (if any), plus "induction fee" (or "standing charge', or whatever you call it), plus cost of propofol, plus Time (at a lesser "non-sterile procedures" rate if you have one); plus suture material; plus oral post-op home drugs (if any). Add a bit extra if you've been clever. Cost of predictable consumables (gloves, masks, throat packs, polishing paste etc) and predictable analgesic injections I would not charge separately for but build in. I don't charge extra for Xrays, the cost is built in. Post-treatment reviews and checks (usually just one after a week, then again in two months, but sometimes there are more) are all free (or rather, included).

For me, that's far better than itemising everything, so much for each root extracted, so much for each surface rootplaned, and so on and so on (bit like the old NHS scale, so much for a filling, bit more if it went on to another surface..........) But that's me, I'm not saying it's the only way to do it.

But: don't be greedy. Don't pile on the charges. Don't necessarily even charge fully for time at first. Thus you will get your clients to have stuff done and spread the word about its benefits and quality and value (not about its incredible cheapness) . This is not the same as trying to "compete on price" with the cheapo vets.

Anyone who looks upon dentistry solely as a "new revenue stream" or "new profit generator" is likely to be doing bad work, or sadly disappointed. I have little to say to such.

Re: How does your practice charge for dentals?

Laurence Webb — Mon, 22 Oct 2012 17:42:55 GMT

[quote user="Louise Alexander"]I'm trying to work out the best way to charge for surgical extractions etc. And how to incorporate the difference between a cat mouth scale and polish and a greyhound mouth scale and polish for example, in terms of time![/quote]Why not just charge for time? Assuming a standard skill level between vets in your practice it would be fair to assume you'd all take an equal amount of time to perform the same procedure. Of course this doesn't work if you have a wide range of skills/experience between vets where a new graduate may take twice the amount of time to perform a procedure that someone more experienced does.

Re: How does your practice charge for dentals?

James Laidlaw — Mon, 22 Oct 2012 17:41:52 GMT

Pretty much same as Clive, but we have extraction costs for non-surgical, surgical (small vs large tooth) and canine/carnassial ranging in cost. I tend to use my judgement here about charging depending on the length of time taken for an extraction or if there has been a surgical flap etc...

Additional drugs/materials charged on top (local, suture material, post op meds etc).

We also charge x-rays depending on one area/2 areas/full mouth etc. They are reasonably priced so as to not crate a barrier to doing them, seems to be I will x-ray pretty much every dental now - which is very easy with digital but a pain in the proverbial with a fixed atomscope/standard x-ray unit.

Re: How does your practice charge for dentals?

Clive Ansell — Mon, 22 Oct 2012 17:27:20 GMT

Where I am at the moment we have a GA fee for cat and 4 weight ranges of dog which includes opioid analgesia as needed. Then a "peridontal treatment" fee which includes S&P, oral exam and charting the teeth; dog and cat. Then 4 different extraction fees based on time. drugs, any sutire materials and consumables are charged as used. Up to 2 post op checks are included as//if needed.

Re: How does your practice charge for dentals?

Anthony Dennison — Mon, 22 Oct 2012 16:47:29 GMT

We have GA fee, then canine/feline scale and polish, or canine/feline scale and extraction grades 1-3. Plus a post-op check if any teeth have been extracted, and pain relief to go home with

Re: How does your practice charge for dentals?

Michael Woodhouse — Mon, 22 Oct 2012 16:39:46 GMT

[quote user="Louise Alexander"]How do people charge for dentals?[/quote]

Better than we used to. Old boss used to have 'dog dental' and 'cat dental' on the computer. Pretty much irrespective of whether scraping off tartar or removing all the teeth.

We now have 'scale teeth', and 3 grades 'simple', 'moderate' and 'extensive' each getting about 50% more extensive each time. I have also added 'dental time' at a slightly lower rate than surgical time but haven't really used it.

I intend to get more dental equipment and have a stab at doing a better job (have already improved things markedly). Our entire dental kit was less than 10 items, including hacksaw blades