Direct (or not) insurance claim (fraud)

Re: Direct (or not) insurance claim (fraud)

Anthony Todd — Thu, 11 Jul 2013 11:45:48 GMT

[quote user="Cat Henstridge"]I think performance related is a good idea but it has to be carefully managed to avoid conflicts like this. He is now at a different practice which rewards for hitting, agreed upon and achievable, targets which include various parameters, not just simple takings figures and it is MUCH better![/quote]

Need more details to assess really, and what the various parameters are. Certainly it can't be on the total invoices or you get into the month of Ceporex situation [which is much easier than a dental but doesn't do the patient as much good].

Re: Direct (or not) insurance claim (fraud)

Wren — Thu, 11 Jul 2013 11:36:23 GMT

The only experience I've had with performance related pay (was going to abbreviate to PRP, but that's something totally different in equine medicine!) was in my first job when I did SA work. We got 20% of any out of hours work done (not including VAT and drugs). It was a good incentive to see those cases which were borderline - eg. a coughing dog on a Sat night which could have waited until Monday at a push, and I was more likely to crack on and operate on a pyo on a Sunday than put it on fluids etc. and leave the op for Monday's ops list. Because the drugs weren't included there was no incentive to send everything away with a month of Ceporex and obviously because it was only OOH work we weren't pushing unecessary dentals etc.

I think on a good month I'd get an extra £200-350 on top of my salary.

Re: Direct (or not) insurance claim (fraud)

Rob Loxley — Wed, 10 Jul 2013 23:57:24 GMT

[quote user="Francisco Gomez"]My feeling about this is: If I get a run of 4 young healthy cats OOH with a simple abscess, and I do unnecessary 'epocs' or 'minimum databases', Am I really doing 'gold standard' stuff?[/quote]

Gold standard gouging maybes?

Re: Direct (or not) insurance claim (fraud)

Rob Loxley — Wed, 10 Jul 2013 23:55:58 GMT

[quote user="Michael Woodhouse"]I need to make a living but there is no way on this earth I'd have put the dog to sleep or sent the owners to a cash machine to get me some money up front.[/quote]

I'd send them off to the cash machine while I did the op.

Re: Direct (or not) insurance claim (fraud)

Cat Henstridge — Wed, 10 Jul 2013 22:20:54 GMT

My husband's last job had performance related pay, not a huge amount, only 5% on earnings above a basic wage and he did fine over the couple of years it was in place. However, the other vet he worked with at the branch really went to town and it did cause quite a few bad feelings amongst the staff. This person would definitely cherry pick the clients, if they weren't insured they would mysteriously come back for check-ups with other people; refuse to do routine (and therefore cheaper) ops but would happily do more major stuff and everything went home with Baytril! When issues were raised with the bosses they didn't really care, because this vet was making them money.

I think performance related is a good idea but it has to be carefully managed to avoid conflicts like this. He is now at a different practice which rewards for hitting, agreed upon and achievable, targets which include various parameters, not just simple takings figures and it is MUCH better!

Re: Direct (or not) insurance claim (fraud)

Claire Fisher — Wed, 10 Jul 2013 21:44:13 GMT

[quote user="Gillian Mostyn"]

As an employer I can absolutely see the benefit of paying a % of turnover - I can imagine it would be very motivating! The problem is I can see too many obstacles:

- vets wanting to cherry-pick their rota/ branch practice or consult list to get the maximum financial benefit to themselves.[/quote]

We are a single centre practice so don't need to worry about branches, there are 5 vets and so we all have the same number of ops days, consult sessions ect.

[quote] -queries as to who has 'earned' the work - the person who booked it or the person who did it. If you try to only book work on your op days then the client is going to lose the freedom to choose when is best for them to bring the animal in.[/quote]

The person who does the work earns the turnover, reception tend to book most of the procedures - we do encourage continuity of care so clients aren't seeing different people all the time. There may be some occasions when I do diagnostics/procedures on a case that someone else saw but over 12 months it tends to even out

[quote]general unease about whether some less than ethical vets book tests/diagnostics simply to bulk out the bill - especially with insured clients. The same could happen with dispensing the most expensive antibiotics/analgesic when a cheaper one would do the job fine.

- developing into a practice where it is more about financial gain than good and appropriate service to the pets and their clients. Spending a lot of money, while sometimes perfectly acceptable to the client, isn't always the best option for the animal. It would be a strong person who would refuse to keep treating a pet, especially if the owner wished you to, and recommend early euthanasia, if your own wallet would take a hit.

Now I do realise that practice partners already work under these circumstances- where their income directly relates to the work they do- but I, probably wrongly, feel this is less likely to impact on the overall ethic of the practice than if all the assistants were earning according to turnover.

How do you work through these issues at your practice? (Genuinely interested.)

[/quote]

I'm not sure assistants are more prone to thinking about these than partners - I certainly dispense my fair share of ampicillin, TMPS and other cheaper drugs if appropriate. As far as I know deliberate overcharging hasn't been a problem - but certainly it does need to be monitored

Re: Direct (or not) insurance claim (fraud)

Braden Collins — Wed, 10 Jul 2013 12:51:59 GMT

The inconsistency will cost more clients. If one vet does a lot and charges a lot, then the next one does things differently and the bill is much lower, the client will not know what to expect when they come in, and that can lead to a lack of satisfaction. If everyone works the same and charges the same, you will have clients with the same expectation every time and you can match those expectations every time. That is why we have our systems in place about how to approach things and try to get everyone doing dentally at the same stage, consistent advice with fluids, etc. the clients know we work to a certain standard and cost, so they can decide if what we do is right for them.[quote user="Francisco Gomez"]

I've never worked as an employee of a practice that uses these measures so I am not sure if my comment counts or not. I was in an interview once and I just didn't like it.

But I have one thought:

- I guess if a vet 'under-performs' regarding turn-over, he or she may get a bit of a talk from the partners when, really, he or she just feels that they don't want to over-charge for services that they perceive as too expensive for the work done. This client that feels that had been charged fairly will come back to the practice, but the feeling that the partners will have is that the vet under-performs.

- On the other hand, an 'over-performing' vet may lose clients because, maybe on some occasions over-charges?

I don't know, I may be all wrong about this. I just feel so much happier to know that what happens in the consultation room has no direct benefit to my bank account... Isn't it a lot easier if that doesn't play a part? I mean, for your conscience...

[/quote]

Re: Direct (or not) insurance claim (fraud)

Anthony Todd — Wed, 10 Jul 2013 12:32:54 GMT

Welcome to gold standard, state-of-the-art, cutting edge, then refer to a specialist, veterinary practice my friend, anything less and you'll be cast into outer darkness like me.....

Re: Direct (or not) insurance claim (fraud)

Francisco Gomez — Wed, 10 Jul 2013 11:02:15 GMT

[quote user="Anthony Todd"]

[quote user="Francisco Gomez"] I guess if a vet 'under-performs' regarding turn-over[/quote]

But it's not straight turnover; it's based on good practice. Some of my people hardly ever wormed anything, some did hardly any dentals, for example.

[quote user="Francisco Gomez"]'over-performing' vet[/quote]

Or this could be said to be "the gold standard" of modern practice ie bloods X-rays scans fluids referral etc, etc. then the specialist removes the palpable corn cob 3 days later.....

[/quote]

This touched a fibre ;)

I was told once by a senior figure in a OOH provider that doing 'minimum database bloods, 'epoc's' and charge the patient as 'unstable' was regarded as 'good practice'. I didn't agree but, of course, I try, as best as I can, follow their policies... Point is, the practices of this OOH provider get recognition (not sure if they would get some sort of financial allowance or not, this would be something internal of what I don't know anything about) depending of what percentage of the patients presented would get these charges.

So, if you have 10 patients and perform the 'unstable' charge in 8 of them, you would be regarded as doing better practice than someone else who only charged 'stable', being 'unstable' more expensive...

My feeling about this is: If I get a run of 4 young healthy cats OOH with a simple abscess, and I do unnecessary 'epocs' or 'minimum databases', Am I really doing 'gold standard' stuff?

Re: Direct (or not) insurance claim (fraud)

Anthony Todd — Wed, 10 Jul 2013 10:40:48 GMT

[quote user="Francisco Gomez"] I guess if a vet 'under-performs' regarding turn-over[/quote]

But it's not straight turnover; it's based on good practice. Some of my people hardly ever wormed anything, some did hardly any dentals, for example.

[quote user="Francisco Gomez"]'over-performing' vet[/quote]

Or this could be said to be "the gold standard" of modern practice ie bloods X-rays scans fluids referral etc, etc. then the specialist removes the palpable corn cob 3 days later.....

Re: Direct (or not) insurance claim (fraud)

Francisco Gomez — Wed, 10 Jul 2013 10:27:53 GMT

I've never worked as an employee of a practice that uses these measures so I am not sure if my comment counts or not. I was in an interview once and I just didn't like it.

But I have one thought:

- On the other hand, an 'over-performing' vet may lose clients because, maybe on some occasions over-charges?

Re: Direct (or not) insurance claim (fraud)

Anthony Todd — Wed, 10 Jul 2013 09:46:27 GMT

[quote user="Gillian Mostyn"]

Hmmm.... very interesting points raised. Worth some thought.

[/quote]

A few more, or one at least.

We based the parameters on services that were good practices eg dentals, worming, special diets, and less on reception sales, ordinary pet food etc.

We paid a sort of part of the turnover share as a monthly "salary" if you like and topped it up quarterly coinciding with quarterly VAT returns which you've got to do anyway.

The other thing which I never fathomed is the differences in prescribing between vets.

I've always thought, and clients sometimes demanded it, that unless you gave the animal "an injection" the client would suspect that you'd done nothing and the animal wouldn't get better [even when obviously dead owners would ask "can't you give it an injection or something?".

The best performing vet was the poorest for giving injections and never changed. Go figure!!

Re: Direct (or not) insurance claim (fraud)

Gillian Mostyn — Wed, 10 Jul 2013 08:26:47 GMT

Hmmm.... very interesting points raised. Worth some thought.

Re: Direct (or not) insurance claim (fraud)

Braden Collins — Wed, 10 Jul 2013 03:19:32 GMT

We tend to base our pay on turnover, but pay a salary so we expect consistent billing and turnover spread through the year. We aim to pay around 25% of turnover as a salary.

I wonder how many associates not paid on a turnover basis don't recommend work because they feel uncomfortable discussing the money side of things? How many dentals don't get done when their is mild dental disease and are put off until the dog has a mouth full of rotten teeth because money is a difficult subject? I feel at least if they get a bit extra for going outside their comfort zone, they should be rewarded for it.

This is very different to overservicing. As an example, I still won't recommend pre-anaesthetic bloods before routine desexing or stitching up a healthy, happy 2 year old dog as it so rarely changes my approach to the case or finds anything a thorough history and physical exam doesn't show up. An I would never encourage my staff to overservice. In fact, if I felt they were overservicing I would quite happily pull them up about it and ask for a clinical justification for what has been done.

Since becoming a practice owner, I do recommend dentals earlier than before, IV fluids more frequently, and generally advise the best level of care we can provide. I don't feel I am overservicing, but rather feel I am being compensated a bit better for the difficult discussions about money that come from offering a high level of service. I feel as a result of this, the level of care I am offering my patients has improved and I'm certainly not seeing the stinking mouth full of rotten teeth anywhere near as often now.

Re: Direct (or not) insurance claim (fraud)

Anthony Todd — Wed, 10 Jul 2013 01:32:23 GMT

Gillian "that practice partners already work under these circumstances- where their income directly relates to the work they do"

Mmmm, I think my people would have said my income directly relates to the work they do.....

Re: Direct (or not) insurance claim (fraud)

Anthony Todd — Wed, 10 Jul 2013 01:28:31 GMT

[quote user="Toby Birch"]Those of you who are on % turnover renumeration or employ people who are - do you make clients aware of this?

[/quote]

No, but I'm not sure clients would be unhappy; never had it raised by a client as far as I remember.

Re: Direct (or not) insurance claim (fraud)

Anthony Todd — Wed, 10 Jul 2013 01:23:50 GMT

[quote user="Gillian Mostyn"]The problem is I can see too many obstacles:[/quote]

There can be but I'll try and comment on them.

-cherry picking. Rotas are pretty fixed but, sure, some vets did try and book "their" cases and manipulate the credited payments but not too many. Some try to avoid some work too [dentals...]

Locums, with some excellent exceptions, did 50% of the work of the regular vets. Perhaps supporting the argument for incentives?

-general unease. ... Again possible but we monitor the Rx per consult and can break the bill down by item. In my experience the main problem has been the reverse; getting vets to do at least the minimum workup which is now expected by the client [back in the day I was accused of not knowing what was wrong when I wanted to take a blood.....] not so now thank goodness.

-developing into... .. again possible but isn't this the way practice in general is trending? Back in the day [again] we had a vet who seemed to have good turnover, in the days before we measured performance. We discovered that virtually everything got a month of Ceporex....

We had 2 separate categories one practice determined; spays, vaccinations, consult fee etc. which was influenced by price set alone ie if we increased the fee for spays the vet got more automatically ,but it wasn't via his or her efforts, and Vet determined where the fee was fixed but it depended on the vet actually doing it eg bloods, dentals, xrays etc.

Practice determined was shared at a lower percentage than Vet Determined.

Re: Direct (or not) insurance claim (fraud)

Michael Woodhouse — Wed, 10 Jul 2013 00:36:09 GMT

[quote user="Hanna Bennett"]GDV OOH sat evening, owner barely had £100 to scrape together but did bring an insurance certificate. what would you do? [/quote]

Try and save the dog.

I did a bitch caeser last week - 7 live pups. I know for certain they haven't got the full fee sat there, but they will pay - even if it is when they sell a puppy. I need to make a living but there is no way on this earth I'd have put the dog to sleep or sent the owners to a cash machine to get me some money up front.

Re: Direct (or not) insurance claim (fraud)

Gillian Mostyn — Tue, 09 Jul 2013 23:23:53 GMT

[quote user="Bob Partridge"]So partners are more ethical than assistants?[/quote]

Not at all. Simply that all the staff and clients are already aware that the partner owns the business and therefore earns according to how profitable the practice is. Same as any other similar business. This is not usually the case with assistants or any other staff.

I can't really explain why I think it would affect how the practice would 'feel' if the assistants were only paid according to their individual turnover - it just feels a bit wrong for all the reasons I listed. However, this is only because I have no personal experience of it. I do have friends who have worked in practice where they have been expected to reach targets, and haven't enjoyed the experience.

I am genuinely interested how people have made this business model work without impacting on their ethics or working relationships with colleagues.

Re: Direct (or not) insurance claim (fraud)

Bob Partridge — Tue, 09 Jul 2013 22:58:28 GMT

[quote user="Gillian Mostyn"]that practice partners already work under these circumstances- where their income directly relates to the work they do- but I, probably wrongly, feel this is less likely to impact on the overall ethic of the practice than if all the assistants were earning according to turnover[/quote]

So partners are more ethical than assistants?

Is this the tenet ?

Bob

Re: Direct (or not) insurance claim (fraud)

Toby Birch — Tue, 09 Jul 2013 22:51:13 GMT

Those of you who are on % turnover renumeration or employ people who are - do you make clients aware of this?

Re: Direct (or not) insurance claim (fraud)

Gillian Mostyn — Tue, 09 Jul 2013 22:09:25 GMT

[quote user="Claire Fisher"]We get paid on a similar system - morale is fine most of the time - have a quiet few weeks and it can get a bit fraught.[/quote]

As an employer I can absolutely see the benefit of paying a % of turnover - I can imagine it would be very motivating! The problem is I can see too many obstacles:

- vets wanting to cherry-pick their rota/ branch practice or consult list to get the maximum financial benefit to themselves.

-queries as to who has 'earned' the work - the person who booked it or the person who did it. If you try to only book work on your op days then the client is going to lose the freedom to choose when is best for them to bring the animal in.

-general unease about whether some less than ethical vets book tests/diagnostics simply to bulk out the bill - especially with insured clients. The same could happen with dispensing the most expensive antibiotics/analgesic when a cheaper one would do the job fine.

How do you work through these issues at your practice? (Genuinely interested.)

Re: Direct (or not) insurance claim (fraud)

Gillian Mostyn — Tue, 09 Jul 2013 21:56:25 GMT

[quote user="Francisco Gomez"] But In one of the practices I work for, we have one receptionist shift that involves solely completing insurance forms, thus it is a cost for the practice. The ins form fee (don't remember how much it is now) barely pays this cost in some cases (some cases are difficult to figure, whether conditions are related to each other or not, phone calls to the insurer in some cases, letters from the us the vets quering a decission, etc...)[/quote]

Or practice manager spends approximately half of her time doing insurance forms so I agree the 'cost' of completing them can be significant. I still think, though, that this cost has to be added to the general wage bill rather than expecting the insured clients to pay for it directly. If I were a client, I don't think I would be impressed if I were given an invoice from the vets simply for filling in the forms - I would simply see it as 'part of the service'. There are quite a few staff, such as auxillary care staff, cleaners etc, who don't directly interact with most clients or bring income to the practice and yet provide a vital service to the client base as a whole. I sort of see the time spent on insurance forms in the same way - albeit they are bringing in money too!

Re: Direct (or not) insurance claim (fraud)

Claire Fisher — Tue, 09 Jul 2013 20:43:20 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Todd"]It was surprising the difference in performance, some vets having 7 times the rate of dentals per 100 contacts and some doing almost no xrays or lab tests in a million years....[/quote]

Not really. I think all of us could generate more (or less) income if we wanted to. If some vets are doing 7x the work of others I would be worried about whether the system is fair to the owners, let alone the vets. Did you find staff morale to be a problem?

Hanna- we accept direct claims as long as they aren't with well-known difficult companies. I think the benefits, mainly to the client but also to ourselves outweighs the occasional hassles. We also don't charge for insurance claims, which most of the vets round here do now. I do think there is a risk of biting the hand that feeds us....

[/quote]

We get paid on a similar system - morale is fine most of the time - have a quiet few weeks and it can get a bit fraught.

Re: Direct (or not) insurance claim (fraud)

Francisco Gomez — Tue, 09 Jul 2013 19:54:30 GMT

[quote user="Gillian Mostyn"]We also don't charge for insurance claims, which most of the vets round here do now. I do think there is a risk of biting the hand that feeds us....

[/quote] I agree with most of what you have said. But In one of the practices I work for, we have one receptionist shift that involves solely completing insurance forms, thus it is a cost for the practice. The ins form fee (don't remember how much it is now) barely pays this cost in some cases (some cases are difficult to figure, whether conditions are related to each other or not, phone calls to the insurer in some cases, letters from the us the vets quering a decission, etc...)