How do you price home visits?

RE: How do you price home visits?

Robin Grimmer — Thu, 25 Jan 2018 11:02:40 GMT

Don't confuse need with demand. Owners often want a house visit - more for their convenience or preference rather than any clinical need. Yes we are a service industry and if some vets want to provide that service that is their prerogative. I think there is quite a fundamental difference between rural practices which do visits routinely as they may have a vet allocated on visits, less traffic etc and urban practices which tend to have a lot more consulting so less time for a vet to go out. Traffic and parking can be a nightmare. Doing a GA and procedure in an owner's house isn't something I'd want to do aside from the time it would take up for a nurse and vet plus waiting for the animal to recover. Also, if anything went wrong I think you'd be on fairly thin ice with RCVS, VDS etc.

If you're happy doing home visits in your practice then fine, but I don't think they work for all practices and hark back to the Herriot days which is why I said they were an anachronism.

RE: How do you price home visits?

Michael Woodhouse — Thu, 25 Jan 2018 10:30:57 GMT

[quote user="Robin Grimmer"]There really isn't any need for SA house visits. Everything is better to come in.[/quote]

Better for whom exactly? I suspect the answer is better for the vet, not necessarily for the animal or the owner.

Whilst I have no great intentions of doing general anaesthetics or radiography in people's houses, it's perfectly possible and safe to do so. I've met some of these mobile/visiting vets and they can do a hell of a lot of things you could in a surgery. With a car full of farm equipment and drugs there is usually enough cross over to do good quality work at a person's house. I really don't understand the 'its PTS only' mentality.

At the end of the day we are a service industry. There is clearly some demand from the public for home visits. There are clearly some vets who sit themselves solely in that niche. We are a rural area and I see the practice very much as part of the community. A lot of my friends are clients. We're perfectly happy accommodating all reasonable requests for home visits. I've done all sorts of things outside the surgery and practised good medicine.

If you want be brave and say "I don't like doing home visits" or "I can't make as much money visiting people as I can on my surgery conveyor belt" that's honest, but please don't for a moment suggest that all you can do is kill things. It's actual bunkum. You can be just as good a vet and do just as good a job in someone's house (with a little preparation and forward thinking).

RE: How do you price home visits?

Wren — Thu, 25 Jan 2018 08:45:09 GMT

[quote user="Michael Woodhouse"]Actually I'm struggling to think of anything I couldn't do on a home visit if I really wanted to (develop a radiograph, perhaps).[/quote]

I do this in a stable, so someone's front room shouldn't be a stretch!

(actually, develop' is a bit of an overstatement for the level of complexity involved on my part. I just press a button and the image appears near-instantly on the screen. Technology, eh? ).

RE: How do you price home visits?

Robin Grimmer — Thu, 25 Jan 2018 07:07:34 GMT

[quote user="Michael Woodhouse"]

[quote user="Robin Grimmer"]Home visits bit of an anachronism IMO. Not much you can do other than PTS. Lighting and conditions normally poor for a proper examination. Don't think many other developed countries do house visits these days.[/quote]

Get a decent head torch. We're doing keyhole surgery on cows in sheds. You can do anything you can do in a consulting room on a home visit with some lateral thinking and preparation. To suggest its PTS only is ludicrous. If you could be bothered to take an anaesthetic machine and an O2 cylinder you could do a GA. Actually I'm struggling to think of anything I couldn't do on a home visit if I really wanted to (develop a radiograph, perhaps).

Try farm work to stretch your lateral thinking skills.

The NHS GPs visit. The ambulance service does increasing levels of primary care delivered in the home. Clearly they think its important.

[/quote]

You could do a GA on a house visit. Would I want to? Absolutely not! There really isn't any need for SA house visits. Everything is better to come in. Even euthanasia is purely for the owner's wishes. After all, how many humans have the luxury of dying at home? It's not much of an issue for me any more as the places I locum at now rarely do them. And I have done plenty of farm work thank you.

RE: How do you price home visits?

Michael Woodhouse — Thu, 25 Jan 2018 01:58:45 GMT

Try farm work to stretch your lateral thinking skills.

The NHS GPs visit. The ambulance service does increasing levels of primary care delivered in the home. Clearly they think its important.

RE: How do you price home visits?

vs0u — Wed, 24 Jan 2018 17:14:22 GMT

[quote user="J G Wray"]

[quote user="vs0u "]Are there really areas of the UK where it's dangerous to park an unmarked vehicle on the street in daytime for 20 minutes? [/quote]

See Dr Dyer's post Chikosi survey

[/quote]

If the area was perceived to be that dangerous it would be best to decline to visit . No practice policy would override someone's personal safety anyway.

Do you have a link to the Chikosi survey results?

RE: How do you price home visits?

Robin Grimmer — Mon, 22 Jan 2018 15:27:37 GMT

Home visits bit of an anachronism IMO. Not much you can do other than PTS. Lighting and conditions normally poor for a proper examination. Don't think many other developed countries do house visits these days.

RE: How do you price home visits?

J G Wray — Mon, 22 Jan 2018 15:21:17 GMT

[quote user="vs0u "]Are there really areas of the UK where it's dangerous to park an unmarked vehicle on the street in daytime for 20 minutes? [/quote]

See Dr Dyer's post Chikosi survey

RE: How do you price home visits?

vs0u — Mon, 22 Jan 2018 11:12:36 GMT

[quote user="J G Wray"]

What happens to home visit pricing and policy in a practice where the visit address is in an area where there may be a risk to person and/or vehicle?

[/quote]

Are there really areas of the UK where it's dangerous to park an unmarked vehicle on the street in daytime for 20 minutes?

Sensible policy could include only going to registered clients about whom the practice has some knowledge, not going alone, not going in a van marked 'veterinary drugs in here', and not going at night/after dark.

Pricing wise I guess the visits would have to be cheap as people living in these areas are likely to be poor.

RE: How do you price home visits?

Francisco Gomez — Sun, 21 Jan 2018 20:50:13 GMT

[quote user="Michael Woodhouse"]

[quote user="Francisco Gomez"]

As far as I remember, for the last year we hadn't have a single 2hr block appointment empty.

We have struggled with recruitment and space, not with customers.

[/quote]

what about the vets not consulting? My point is everyone's not always doing something.

Maybe I'm wrong.

[/quote]

If they're not consulting, they're on a break or operating.

Maybe we need to book differently to allow this eventualities. But to my mind it would still seems like we accommodate for a lower income.

RE: How do you price home visits?

Michael Woodhouse — Sun, 21 Jan 2018 20:45:54 GMT

[quote user="Francisco Gomez"]

As far as I remember, for the last year we hadn't have a single 2hr block appointment empty.

We have struggled with recruitment and space, not with customers.

[/quote]

what about the vets not consulting? My point is everyone's not always doing something.

Maybe I'm wrong.

RE: How do you price home visits?

Francisco Gomez — Sun, 21 Jan 2018 20:40:37 GMT

[quote user="Michael Woodhouse"]

Is any practice really that busy that every vet is working for every minute and we are cancelling 6X10 min appointments to perform a home visit?

[/quote]

As far as I remember, for the last year we hadn't have a single 2hr block appointment empty.

We have struggled with recruitment and space, not with customers.

RE: How do you price home visits?

Michael Woodhouse — Sun, 21 Jan 2018 20:28:20 GMT

[quote user="Clive Ansell"]Added to which we left a receptionist on her own at the practice who would not have been able to deal with any emergency.[/quote]

I loathe the game of "if". Maybe I should have a spare care in-case mine breaks. Maybe a spare wife if something happens to my current one. The argument that something *might* come in is still less than the animal in need. What if you'd just started a small animal caeser as the emergency walks in, you're still busy for an hour.

RE: How do you price home visits?

Clive Ansell — Sun, 21 Jan 2018 20:14:34 GMT

I think most practices undercharge for home visits.

I did one yesterday, and although only 2 miles from the practice, by the time we had found the place, then got snarled up in traffic it took over an hour. We finished up in a dark poorly lit apartment barely able to see properly to examine a sick cat, and although "collapsed" we struggled to catch and restrain it. Added to which we left a receptionist on her own at the practice who would not have been able to deal with any emergency. It was only about £70 plus treatment, should have been at least treble that if factoring in the time, vehicle and 2 staff members.

RE: How do you price home visits?

Clive Ansell — Sun, 21 Jan 2018 20:06:54 GMT

[quote user="J G Wray"]What happens to home visit pricing and policy in a practice where the visit address is in an area where there may be a risk to person and/or vehicle?[/quote]

I work in many different practices in many parts of the country and have never seen a specific practice policy on this.

Personally, I would decline a home visit if I considered it to be unsafe, as per our RCVS code of conduct.

I know some areas in and around Birmingham where paramedics and ambulances will not venture without a police escort. Would it be reasonable to expect a lone veterinary surgeon to go where they will not? I wouldn't.

RE: How do you price home visits?

Michael Woodhouse — Sun, 21 Jan 2018 19:57:26 GMT

[quote user="Martin Atkinson"]We should charge the amount that we could earn in consultation fees during the same period + travel costs. Given a visit is likely to take an hour, in theory I could see 6 clients with 10 minute appointments @ £30 each so it should be £180 + 30p a mile[/quote]

Is any practice really that busy that every vet is working for every minute and we are cancelling 6X10 min appointments to perform a home visit?

I'm absolutely convinced that these bring a lot of goodwill and help link us to the community. If anything they generate us more work, not less.

RE: How do you price home visits?

J G Wray — Sun, 21 Jan 2018 19:13:29 GMT

What happens to home visit pricing and policy in a practice where the visit address is in an area where there may be a risk to person and/or vehicle?

RE: How do you price home visits?

Edward Jones — Sun, 21 Jan 2018 09:57:39 GMT

I do the occasional low cost visit as a form of community service. It's discretional and not advertised. Normal visit fee is £60, which is probably a bit low, although my visits tend to be within 1-2 miles so there's minimal travelling time.

RE: How do you price home visits?

Francisco Gomez — Sun, 21 Jan 2018 09:54:02 GMT

I tend to agree with Martin here. Why should the business lose out to accommodate a single client? It is, by definition, that you shouldn't lose useful and competent staff at the practice for a lower price that you'd earn with them there.

It is not just that you accommodate the needs of this client, but the practice pays a price by losing staff. Staff that, in our sector, often complaint about their working conditions ie. pay. Isn't a lower price for a visit that you'd earn without (the visit) a management failure?

Then, one of my colleagues pointed out that we also offer the 'taxi service' whereas a housebound client would receive a visit from the nurses to collect their dog, bring the patient for consults and then bring it back. This is charged of about £5 each way, which is similar to what a taxi would charge. To my personal belief, this seems ridiculously low, but then he pointed out that by doing this, a service is being provided to the local community.

Thoughts?

RE: How do you price home visits?

Martin Atkinson — Sun, 07 Jan 2018 18:48:43 GMT

We should charge the amount that we could earn in consultation fees during the same period + travel costs. Given a visit is likely to take an hour, in theory I could see 6 clients with 10 minute appointments @ £30 each so it should be £180 + 30p a mile but I don't as it is likely I would be visiting in a quiet time so I charge enough to put them off but not enough to be punitive which works out at an arbitary £80 + treatment if it less than 3 miles and £100 if its 3-5. I won't visit if its over 5 miles except in exceptional circumstances. We don't do any OOH.

RE: How do you price home visits?

Charlotte Marshall — Sun, 07 Jan 2018 18:35:54 GMT

We have 3 prices for visits dependant on distance and then standard consultation and treatment goes on top of that. When we used to do our own on call there was an additional charge on top for that for out of hours visits (which were extremely rare).

RE: How do you price home visits?

Wren — Sun, 07 Jan 2018 07:30:08 GMT

That only works if there is a practice vehicle that the nurse can use, or the nurse has their car insured for business use, otherwise they may invalidate their insurance. We found cheaper to send a vet (whose cars were already insured for business ), than to mess about with the nurses' insurance policies.

We tried to send a nurse out for a nail clip home visit

RE: How do you price home visits?

mariette asselbergs — Fri, 05 Jan 2018 23:32:15 GMT

I have worked in several different set ups. In my first mixed practice, most work was large animals, but we also did of course the farm dogs and cats, and as Michael says, when you already have a route for farm visits, the small animal home visits can fit right in and don't need to cost much extra.

In a second situation, the practice I worked for had taken over a small animal practice whose building was a wreck, and they took the bold decision to offer the client base a vets2you service without visit cost as alternative for keeping the [practice open. Of course this was only possible with the main practice as backup for further work ups, hospitalisation and surgery. But they managed to work it in that way: no extra cost for a home visit at all;. This of course worked because they had a whole list of home visits every day and could plan the most sufficient routs in a densely populated urban and suburban area.

In the OOH practice I work now, we don't do home visits, and have good alternatives on offer like pet friendly taxi service, but if there is one really really necessary or wished for like a PTS, then we have a vet who used to work in the day practice, and who we can call to see if he wants to go. Sometimes he is not available, on holiday, or just had a drink. But most of the time he will be able to do a euthanasia or so. He comes to the practice, picks up a nurse and a box of equipment and drugs, returns with the dead pet, and earns £250 which we charge the client (who pays over the phone). Treatment comes on top of that. This is usually at night or in the weekend and usually takes a total of at least 2 hours.

So those are the three different scenarios with different costs for the practice and the owner.

I suppose there are many more

Mariette

RE: How do you price home visits?

Michael Woodhouse — Fri, 05 Jan 2018 20:17:22 GMT

[quote user="Francisco Gomez"]How do you calculate your home visit price?[/quote]

It's priced a little higher than our farm visit charge given they have a choice. No difference if a vet or vet+1. Then charge normal fees on top. Currently ~£45 (i think inc VAT, but not sure).

Sometimes (in cases of genuine need when they will fit in with us) I don't always charge for the visit and do it when passing. Having vets out on the road helps with that.

RE: How do you price home visits?

Rob Loxley — Fri, 05 Jan 2018 18:54:44 GMT

[quote user="Francisco Gomez"]Vs repeated injection (i.e cartrophen)?[/quote]

It would be efficient to send a VN to do this?
We have VN visit prices as well as solo vet and vet+vn prices, and sliding scale on distance. We don't differentiate based on reason, but general checks for a housebound owner might just be a vet, and euthanasia (our main reason for home visits) always vet+1.