Another insurance problem

RE: Another insurance problem

Bob Russell — Wed, 23 Mar 2016 12:33:53 GMT

£15 for a full booster, £0-20 for a consultation. that is what some parts of the profession think we are worth!

The budget practices are starting to creep up in price though!

RE: Another insurance problem

Hannah Wynne Richards — Wed, 23 Mar 2016 10:24:22 GMT

I think we have created this problem by not valuing ourselves sufficiently highly. I was once given a phenomenal rebuke by a very wise leader of our profession - the late Alasdair Steele-Bodger for saying "vet" as opposed to veterinary surgeon. He said that the term "vet" did not convey to the public the extent of our knowledge - and he was absolutely right.

Another problem is that we are far too willing to give advice free of charge. This is a continuing problem, as far too many veterinary surgeons will give telephone advice, rather than telling owners to bring the animal in. When owners know that they can recieve free advice over the telephone, they won't value our expertise, and will, naturally, be reluctant to pay for exactly the same advice in the surgery. Hence the pressure to do something, and give a totally unnecessary injection.

Wynne

RE: Another insurance problem

Thomas Johnson — Wed, 23 Mar 2016 09:51:39 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]

I have a cynical chuckle about veterinary surgeons who criticise mark-ups but charge dispensing fees, injection fees.........

[/quote]

I don't think anyone has mentioned one very important factor about fees and that is clients perception of fees and value.

eg Dog comes in "not eating". Full history, comprehensive examination, NAD!!

Bit of "observe and comeback" advice and the next question is "Do I owe you anything?" [as there was nothing found, nothing done. nothing given, although a full exam and history would take 15 minutes.....]

I guess clients must think, or did think, that way.

However, if you give it the old placebo bit of Bets and B12 or take a blood with the same "come back if not better spiel" and charge, say a consult and injection fee, client happy, dog will be fine, almost certainly.

So the client "values" the injection but not the very valuable advice, hence the tendency to load the injection cost and not the advice. Very hard to be sure there is nothing wrong!!

I used to consult that way and the client would say "Aren't you going to give it an injection?" or "Why aren't you giving it something?"

Explanations regarding normality, therefore no treatment, were usually met with indignation.....

[/quote]

I think the world has changed a lot, most clients understand that they are paying for our time, and as long as the explanation is good they completely understand why sometimes it is appropriate to make changes to feeding/lifestyle, or do nothing and monitor, as opposed to giving medication.

RE: Another insurance problem

Bob Russell — Mon, 21 Mar 2016 12:35:24 GMT

As I have said before, I do not believe there is a right or wrong mark up. 100% is far from unusual in other fields of trade.

No practice I know has made such extortionate profits that they can be accused of gross profiteering. Even the corporates seem to turn over large amounts but are cagey about how much profit they make!

Metacam is one of the drugs that people search for on-line. The number of suppliers is dropping by the month so even they need a suitable mark up to survive.

There are so many factors in pricing that just stating 100% is unacceptable is far too simplistic. Market pressures probably make it a difficult sell.

RE: Another insurance problem

Clive Ansell — Mon, 21 Mar 2016 11:57:20 GMT

[quote user="Neil Wheadon"]

[quote user="Bob Russell"]

We charge significantly higher mark ups on drugs we are likely to need in an emergency but may never use before the expiry date.

Cheap drugs still need to go in bottles which probably cost far more than the drugs.

100% mark up is not unacceptable and never was. Ask the supermarkets!

Our medicines range from 30% to possibly 300% (not many) depending on the cost to the practice.

[/quote]

i had a farmer on tour last year. He grew s alads for supermarkets and bagged them for which he was paid 10 pence.

[/quote]

The brother to someone I was doing a locum for in Swansea farms on the Gower and used to get 8p for cauliflowers he supplied to Tesco. For that 8p he would have to grow it, pick it, bag it and transport it to a local distribution hub. In addition he was also paying an annual bribe management fee of around £12000 to "maintain the contract" . Tesco would then sell the same cauliflowers for 89p each.

RE: Another insurance problem

Gerry Henry — Mon, 21 Mar 2016 11:47:13 GMT

I might be wrong but I don't think insurers can recover VAT, this might be the nub of the problem.

RE: Another insurance problem

Neil Wheadon — Sun, 20 Mar 2016 14:26:22 GMT

[quote user="Bob Russell"]

We charge significantly higher mark ups on drugs we are likely to need in an emergency but may never use before the expiry date.

Cheap drugs still need to go in bottles which probably cost far more than the drugs.

100% mark up is not unacceptable and never was. Ask the supermarkets!

Our medicines range from 30% to possibly 300% (not many) depending on the cost to the practice.

[/quote]

i had a farmer on tour last year. He grew salads for supermarkets and bagged them for which he was paid 10 pence.

Neil

RE: Another insurance problem

Evelyn Barbour-Hill — Sat, 19 Mar 2016 13:34:48 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]

I have a cynical chuckle about veterinary surgeons who criticise mark-ups but charge dispensing fees, injection fees.........

[/quote]

I don't think anyone has mentioned one very important factor about fees and that is clients perception of fees and value.

eg Dog comes in "not eating". Full history, comprehensive examination, NAD!!

I guess clients must think, or did think, that way.

So the client "values" the injection but not the very valuable advice, hence the tendency to load the injection cost and not the advice. Very hard to be sure there is nothing wrong!!

I used to consult that way and the client would say "Aren't you going to give it an injection?" or "Why aren't you giving it something?"

Explanations regarding normality, therefore no treatment, were usually met with indignation.....

[/quote]

Yes, it probably was that way, mostly, 40 years ago. Things have changed, gradually. My clients seem very happy to pay (well as much as anyone is ever happy about paying anything) my consultation fee, having been told that no treatment is necessary.

Not sure what this has to do with say, examining a dog, dispensing some Metacam, charging 50% markup on the Metacam wholesale price and charging a dispensing fee as well. Or injecting some Rimadyl, charging for the Rimadyl at 50% markup, plus a little bit for a syringe and two needles and charging an "injection fee" as well.

RE: Another insurance problem

Anthony Todd — Sat, 19 Mar 2016 10:39:34 GMT

[quote user="Evelyn Barbour-Hill"]

I have a cynical chuckle about veterinary surgeons who criticise mark-ups but charge dispensing fees, injection fees.........

[/quote]

I don't think anyone has mentioned one very important factor about fees and that is clients perception of fees and value.

eg Dog comes in "not eating". Full history, comprehensive examination, NAD!!

I guess clients must think, or did think, that way.

So the client "values" the injection but not the very valuable advice, hence the tendency to load the injection cost and not the advice. Very hard to be sure there is nothing wrong!!

I used to consult that way and the client would say "Aren't you going to give it an injection?" or "Why aren't you giving it something?"

Explanations regarding normality, therefore no treatment, were usually met with indignation.....

RE: Another insurance problem

Stuart Jackson — Sat, 19 Mar 2016 10:17:07 GMT

[quote user="Evelyn Barbour-Hill"]

I have a cynical chuckle about veterinary surgeons who criticise mark-ups but charge dispensing fees, injection fees.........

[/quote]

Just to help you out on this one, to prevent too much flack - I think you mean the level of the fees and not the charging per se :)

RE: Another insurance problem

Hannah Wynne Richards — Sat, 19 Mar 2016 08:24:24 GMT

Gillian, like me is the owner of a small practice.

I recently had a client move to me from a huge corporate. The dog was already on Optimune - expensive drug. I warned the client that my price would probably be higher - as I didn't have the same buying clout. We discovered that my selling price was 8% higher. I bet the purchase price differential was much greater, and that both their % and actual mark up were greater.

Wynne

RE: Another insurance problem

Rob Loxley — Fri, 18 Mar 2016 23:44:36 GMT

[quote user="Gillian Mostyn"]

[quote user="sajackson"]

[quote user="Bob Russell"]100% mark up is not unacceptable[/quote]

It is on a bottle of Metacam

[/quote]

I agree. (Ours is 50%)

[/quote]

I'd guess you are paying less than half the manufacturer's list price for that bottle; is your 50% markup on list wholesale price or your net net price?

RE: Another insurance problem

Francisco Gomez — Fri, 18 Mar 2016 22:37:29 GMT

[quote user="Gillian Mostyn"]

If you think that vets should be able to charge whatever they like, and insurance companies should simply pay up, then you are being very short sighted!

[/quote]

my practice gives a 10% discount to those (clients) who sign for a 'practice plan' (a direct debit paid by the client, not the insurance). But if the client is insured, they (the insurance) get the discount because we can't price the drug differently based on the client being insured or not. Shouldn't we be able to recall that money back? It is a two way street right? Apparently not.

What if I buy 10,000 bottles of metacam very cheap for my 50 practice corporation? Would the insurance not pay my >100% mark up if I got them cheap enough? Would they then be complaining about a higher price in a 3 branch practice that doesn't have the same buying power and where the price sale doesnt reach 100% mark up?

The insurance isn't the right entity (in theory) to decide if the work is worth being paid, that should be the practice owner decision, and it should be the client's decision which practice they choose (for their pet) and which insurance (for their finances). You decide how much your coke is sold at your shop, its not up to you who pays the wage of those who enter the shop and buy the can, but it is up to you not overpricing it so a) it gets sold leaving you a profit and b) you're competitive with the shops nearby.

RE: Another insurance problem

Gillian Mostyn — Fri, 18 Mar 2016 22:28:56 GMT

[quote user="Francisco Gomez"]The insurance has no business whatsoever on the price a vet practice purchase an item[/quote]

There are plenty of examples of insurance:companies dictating what is a reasonable amount to pay out. It is their money!

You often have to go to specific companies to get your car fixed, or get 3 independent quotes for work in the house. Unless we want to end up with a similar situation across the board (it is already happening in referral) then don't abuse the current system!

If you think that vets should be able to charge whatever they like, and insurance companies should simply pay up, then you are being very short sighted!

RE: Another insurance problem

Francisco Gomez — Fri, 18 Mar 2016 22:13:42 GMT

Want capitalism? Enjoy its consequences!

RE: Another insurance problem

Francisco Gomez — Fri, 18 Mar 2016 22:12:11 GMT

The insurance has no business whatsoever on the price a vet practice purchase an item. They dont know (and has no right to know) what sort of deal (if any) you have with the wholesaler or manufacturer. Their business is to pay or not to pay to the client, further than this their shareholders should either reconsider if they chose the right corporation to invest on or face trading standards on advertising something that they aren't properly equipped to sell. On the same page, if a practice charges too much, they might be on the pickle of not being able to sort a patient medical requirement when they really need it, but again this would be the client's legal choice of practice: not the insurance's fault and not the practice's either.

RE: Another insurance problem

grumpyoldman — Fri, 18 Mar 2016 21:06:28 GMT

probably is time we had an RRP on these things from the manufacturers , if people choose to discount that is their business.

RE: Another insurance problem

Evelyn Barbour-Hill — Fri, 18 Mar 2016 19:55:41 GMT

I have a cynical chuckle about veterinary surgeons who criticise mark-ups but charge dispensing fees, injection fees.........

RE: Another insurance problem

Clive Ansell — Fri, 18 Mar 2016 18:27:20 GMT

[quote user="sajackson"]Cheap fees are equally "unethical" as high markups. There is no excuse in any practice business model, or pricing structural policy, to have a mark up of 100% (on Metacam) unless one's business plan includes profiteering.[/quote]

I agree, and one of the problems of a profession being hell bent on being as cheap as possible to attract clients with lost leaders, then loading up the price once they are through the door. Same applies to dragging them in for 50 quid dental's, then peddling bloods and fluids for 3 to 4 as much

I remember a cat spey about 2 years ago, that had bad ears too - the bottle of 15 ml Canaural at £33 was more than the spey!

RE: Another insurance problem

Stuart Jackson — Fri, 18 Mar 2016 17:56:53 GMT

[quote user="Bob Russell"] I would not automatically criticise a practice for their choice of mark up.[/quote]

I would, and do.

Cheap fees are equally "unethical" as high markups. There is no excuse in any practice business model, or pricing structural policy, to have a mark up of 100% (on Metacam) unless one's business plan includes profiteering.

RE: Another insurance problem

Hannah Wynne Richards — Fri, 18 Mar 2016 17:53:04 GMT

As Clive and Gillian have said. A mark up of > 100% can certainly be justified on something like preds, or frusemide, where the cost price is low, but not only does a bottle need to be supplied, there is a significant time spent in counting the tablets. It could also be justified on rarely used drugs that have a significant wastage, but, when needed are needed in a hurry.

Wynne

RE: Another insurance problem

Gillian Mostyn — Fri, 18 Mar 2016 17:40:51 GMT

[quote user="sajackson"]

[quote user="Bob Russell"]100% mark up is not unacceptable[/quote]

It is on a bottle of Metacam

[/quote]

I agree. (Ours is 50%)

I have some sympathy with the insurance companies on this one. Although we should be adding a mark-up to drugs to cover our costs of holding stock/wastage etc etc, I think doubling the cost on all drugs is difficult to justify. As has been said already, we also have higher mark-ups than that on some drugs where wastage can be higher, but doubling the cost of fairly expensive drugs that have a quick stock turnover, minimal handling costs and very little wastage seems excessive to me.

RE: Another insurance problem

Bob Russell — Fri, 18 Mar 2016 17:36:45 GMT

[quote user="sajackson"]

[quote user="Bob Russell"]100% mark up is not unacceptable[/quote]

It is on a bottle of Metacam

[/quote]

But we don't have a 100% mark up on meloxicam. I would not automatically criticise a practice for their choice of mark up. It is the overall cost of treatment that indicates fairness.

I don't think hiding fees is fair. No consultation fee but massive mark ups may bring the punters to the door but they very quickly get wise!

Seems to be a week for whipping eyes out here. A budget practice has apparently quoted a couple of hundred pounds more than me but they charge half my consulting fee!

Mark ups are misleading and do not indicate value for money or otherwise. Therefore in principle 100% mark up on Metacam is not unacceptable IMO.

RE: Another insurance problem

Clive Ansell — Fri, 18 Mar 2016 17:35:54 GMT

[quote user="Bob Russell"]100% mark up is not unacceptable and never was. Ask the supermarkets![/quote]

Surely that depends on the cost of the goods? 100% mark on 50p worth of preds is fine, but loading 100+% on to Vetoryl, Atopica etc is blatant profiteering. Maybe a flat across the board dispensing and labeling fee would be fairer.

Most practice seem now to add a flat fee on to external lab fees rather than a percentage, but still charge % on drugs sales - go figure.

[quote user="Bob Russell"]Ask the supermarkets![/quote]

Maybe one of the reasons behind the problems facing farmers'? last time I looked the price difference between lamb in Waitrose and farm gate price was 2000%!. I Know there is a cost to transport, slaughter and packaging, but it's one hell of a difference.

RE: Another insurance problem

Stuart Jackson — Fri, 18 Mar 2016 17:30:47 GMT

[quote user="Bob Russell"]100% mark up is not unacceptable and never was. Ask the supermarkets![/quote]

But Marsh wasn't investigating supermarkets. Marsh correctly chucked out that argument anyway, as we are a profession which charges fees as well as making "sales".