Practice Healthcare plans

Re: Practice Healthcare plans

anthony chadwick — Wed, 05 May 2010 23:47:37 GMT

Hi Kate

I've run one for over 10 years in the practice. I think it is a classic win-win for practice, pet and client. There is some flexibilty in what drugs we use and the clients get extra benefits. I can't really see an ethical problem with it. Check my website www.parkvetcentre.com

Regards

Anthony

Re: Practice Healthcare plans

Laurence Webb — Wed, 05 May 2010 21:07:12 GMT

I've tried to seperate our healthcare plan from insurance as much as possible as it caused confusion with clients.

When our healthcare plan was run by Scallywags clients used to assume that the optional add-on insurance was 'our' insurance, which lead to red faces on both sides of the reception when they discovered that they'd run out of the limited cover offered by the company. *

Our healthcare plan leaflets have words to the effect 'this is not an insurance policy and we recommend seperate health insurance for your pet' written on them and I am careful to point this out to every client too.

* the premiums were cheap and the excess was only £30 so it wasn't bad value for money, just very limited cover

Re: Practice Healthcare plans

Anita Bates — Tue, 04 May 2010 10:46:52 GMT

On another note - the insurance aspect - if a practice does offer additional insurance it makes a huge difference if they call it something other than insurance - simply because if the owner hears the word insurance they assume it is insured. We do offer a bolt on and it is called "Accidental Injury Cover" if the word Cover is used instead of Insurance then it does make a difference. This type of cover is only offered once a discussion about lifetime insurance has been established and dismissed. The AIC offers very low cost cover and as a result is purely for accidental injury or illness as a result of an accidental injury.

Re: Practice Healthcare plans

Anita Bates — Tue, 04 May 2010 10:41:31 GMT

Hi Kate

What an awful subject to write about if you havent had any first hand experience at it!

I am happy to chat to you about the pro's and con's of Healthcare Plans - I have been in the veterinary profession for many years now in both the private sector and latterly in Industry and Commerce. I currently work for the leading provider of healthcare plans in the UK and so have first hand experiences of the ethical issues that you may be considering writing about!

The first one is the choice of product and flexibility of products that your practice plan allows the client to chose from - we recommend to practices that are starting up a plan to simply follow their current protocol for preventative health care - so if they recommend worming 4 times a year and de fleaing monthly then this is how the plan is priced. However, if a practice believes that pets should only be wormed twice a year or in accordance with their lifestyle then the plan price is build around the products that they currently recommend. Whilst the practice is encouraged to keep it simple for the clients and staff to understand it can still work with different plan categories ie Indoor cat and Outdoor cat with different products in them. If an animal within a particular plan needs additional parasite control then the owner pays for it but gets a discount on it. This also applies for practices that recommend a KC vaccine but do not include it in the plan as it is a NON CORE vaccine. In theory Direct Debits can be collected for any type of plan - assuming it is priced correctly and fairly. Our Horse plans are a classic example here when it comes to the ethical issues of worming - most plans include the heathcare and preventative aspects - like vaccinations, healthchecks, worm egg counts and dental rasping and only worm when the lab results indicate worming is necessary. (Again at a discount to secure the purchase at the practice rather than another outlet).

As for flexibility of product - most practices have a preferred product for parasite control and price the plan for that product. However, if the owner wants another product and it is cheaper the practice has to have a protocol in place as to how they handle this. If the plan price is based on the worst case scenario price wise then the practice doesnt lose out - at the same time most plans are worked out on the net net price of the inclusive items plus the actual cost of the professional fees - so the client is generally not being overcharged for the items that they are taking. Let's face it - these plans are not designed to make money for practices per se they are designed to secure clients to a practice and as a result they attend more frequently (so increased footfall) and naturally the average client transaction value increases.

The only other ethical issues could be around a pet that dies perhaps. As most are collected by direct debit, a refund is easily worked out - however, some practices work out the difference between received monies and inclusive items taken before working out if the owner is due a refund.

I'm new to this site (as you can probably tell!) but if I can help you out with any queries just yell. I will find it a very useful exercise as I will be able to support our current and potential sites better if any issues come up that I havent met yet.

Thanks

Re: Practice Healthcare plans

Kate Dawes — Sun, 02 May 2010 18:03:08 GMT

OOh dear - not sure what I've started here......

Hi Stuart

I can completely see your point, and don't take anything you've said as a personal criticism at all. My main point against what you say would be that the professional key skills module is only the first of five - I would think that planning and implementing a program based on each essay would take considerably longer and more work than the notional 100 hrs of study. I am already anticipating that it will probably take me around 12mths to complete all 10 essays to a good standard. I can see that for C modules of the cert AVP (GP) it is obviously necessary to demonstrate practical experience eg for the clinical audit module, but had understood that the prof key skills module was aimed at demonstrating an understanding of the issues (not necessary to a detailed level), rather than necessarily having practical experience of everything. As a practice principal it may be easier to implement a lot of changes to a practice than it is as an assistant - e.g clinical audit and health care plans. I have recently submitted an essay on the benefits of clinical audit (yet to find out if I passed or not!), and although I have as yet no experience of carrying out an audit I have done quite extensive reading around the subject and am now much more aware of the benefits of audit and the need for audit in practice. As an assistant however it isn't up to me to decide on practice policy, although I may make suggestions based on the study I'm doing. I would also have severely struggled to find the time e.g to set up a programme of clinical audit as well as my normal clinical work.

I think this healthcare plan essay is the one where I don't have much experience to reflect on, (and there must be plenty of other candidates in my situation), although I'm sure by doing sufficient research I can still come away learning a lot about the pros and con's of healthcare plans and ethics in general in small animal practice.

Whilst I welcome the modular certificate (I was put off doing an old style small animal medicine certificate for years because of the poor success rate), I think that there is already possibly more work involved than the old certificates - if I want to go on to do a Cert AVP small animal or feline medicine which is what I'm considering , I still have to do almost as many case studies etc for the clinical modules as the old cert. What I'm trying to say is that if you make the prof key skills module more involved than it is I think even more people would be put off.

Re: Practice Healthcare plans

Stuart Jackson — Sun, 02 May 2010 11:11:17 GMT

Hi Kate,

It seems to be that this part of the Cert has been dummed down by the RVC. The whole point of this part of the Cert, in partcular, is to show that the candidates have gained valuable experiences by planning and implementing programmes within their own practice, thereby proving that they have professional skills. If the premise of these skills is based on "if", then the Cert has failed in its mission.

I am going to email the "SPVS Masters Group" to see what they think. I will also contact the "leader" of the RVC - I shared a flat with him at Uni, so he should be able to explain himself fairly honestly!

Re: Practice Healthcare plans

Kate Dawes — Fri, 30 Apr 2010 11:07:18 GMT

No, I didn't choose the topic - I'm enrolled with RVC and have to write 10 essays on titles given to me with no choice. I do think this is a bit flawed when the essays are supposed to be reflective! Was planning on writing it in a hypothetical way - ie we don't currently use a healthcare plan, but if we did these are the ethical issues we would need to consider and we would resolve these by x y z................. RVC offer feedback on essay plans but very little else (apart from Library access) by way of support.

Re: Practice Healthcare plans

Stuart Jackson — Thu, 29 Apr 2010 16:35:45 GMT

Hi Kate,

Did you choose the subject?

I am not sure you can demonstrate your personal key skills in a subject in which you have no experience and therefore no (proven) skills. The Professional Key Skills part of the Cert is designed to show how you have implemented a project using your skills and how you, the practice, staff, clients etc have benefited professionally from the experience. Perhaps the module has changed, but I think you need to "reflect" on the choice of skill. If you had been involved in designing or implementing a plan with the staff and the personal training involved, then you would have an ideal subject for this part of the Cert. I think you should seek advice from your facilitator - it would be a shame to be marked down because of bad advice and poor subject choice at the outset.

I hope you take this a constructive criticism - it is meant to be !

Stuart (CertAVP(VetGP))

Re: Practice Healthcare plans

Arlo Guthrie — Thu, 29 Apr 2010 14:38:13 GMT

Topical news story, which may be of interest ...

http://www.vetsurgeon.org/blogs/veterinary_news/archive/2010/04/29/16767.aspx

Re: Practice Healthcare plans

babybassist — Wed, 28 Apr 2010 12:15:10 GMT

I've only worked in this practice for 4 months so I'm not really in a position to debate the way things have been done for years. I didn't design this plan and had no input into it whatsoever, but I accept your point.

I quite agree it should be about dental hygiene and I will suggest your points as I think they are very good ideas, thanks for your reply. I would like to re-emphasise that it is a once in a blue moon thing, and as a junior vet, when your boss has booked in a scale and polish and he has been the one to admit it, I'm sure you can appreciate it is very hard to argue with them that you don't think the scale and polish is necessary.

Salvage is not included in the plan only extractions. That is made very clear in the wording They would be added on as an extra and no-one here does root canals etc that I know of. I am fully aware that you can't tell whether it will need extractions until it is under, but the plan is designed to cover the costs, or so I am told.

Re: Practice Healthcare plans

Evelyn Barbour-Hill — Wed, 28 Apr 2010 00:03:57 GMT

[quote user="babybassist"]My ethical issue with this is that we do get some dogs through for dentals that, well, don't REALLY need them. And I feel uncomfortable GA'ing them for the sake of scaling a bit of tartar off that the owner doesn't really like the look of. This is a VERY "once in a blue moon" occurrence, but still.[/quote]

Then - with due respect - why do it?

Why not emphasise that your health plan includes frequent checks of the dental state and oral health with advice whenever required about cleaning, diet and so on....... and maybe make your plan benefits include two or three toothbrushes and tubes of paste a year, and/or some rawhide chews?

Anybody with pretensions to dentistry should be constantly advising about oral hygiene: that's what a dental health plan should be about, not a periodic "free scale and polish".

Then how can a health plan include "extractions if needed"? Those extractions could be a ten-minute job or a two-hour job. And suppose a tooth could be extracted as the easy way to deal with it, or would be better (but more expensively) treated and salvaged? You won't know until you are actually doing the "dental", so you can't quote in advance.

Sorry, I don't mean to single you out, but you happened to raise the point.

Re: Practice Healthcare plans

katie mountford — Tue, 27 Apr 2010 23:10:02 GMT

we have a healthy pet club which includes vacc,flea,worm and varying percentages off drugs/food/fees within the practice. one of the most useful aspects is we have a 'free' 6m health check between boosters so the animal gets a clin exam every 6m. This is great for nervy youngsters that have had vacc/chip/spay in a short space of time as they generally just get a check over and fuss as there are no probs, hopefully getting them slightly more used to coming in to the practice. the main advantage obviously tho is the geriatrics. we have picked up a number of early thyroid/renal cats by subtle changes in clin exam (weights/HRs etc) or by owners mentioning mild pupd etc. The 6m checks also double as prescriptions checks for animals on long term meds. ethically speaking-flea/worm treatments are fixed so can cause some probs but i think the benefits outweigh the problems overall

Re: Practice Healthcare plans

babybassist — Tue, 27 Apr 2010 15:30:48 GMT

We have a VIP and VIP extra scheme, and the costs are banded according to the animals weights. They spread the cost of worming and defleaing thoughout the year and includes a free 6 monthly health check and vaccination annually. VIP Extra also includes the cost of neutering with fluids in the first year, and for the years after, covers the costs of GA, scale and polish, fluids and extractions if needed. The worming and flea stuff is whatever suits the animal/owner. It also includes a 10% discount on any other treatment needed.

My ethical issue with this is that we do get some dogs through for dentals that, well, don't REALLY need them. And I feel uncomfortable GA'ing them for the sake of scaling a bit of tartar off that the owner doesn't really like the look of. This is a VERY "once in a blue moon" occurrence, but still.

On the plus side it does make owners much more bonded to the practice, they love being called "VIP" clients, and the VIP's are much more likely to get their dogs/cats/rabbits checked out if they are worried than to leave it a few days until it gets worse. (But then you could argue that the type of client that would take up a VIP scheme is much more pro-active about their animals welfare anyway). You also know that they are getting the best quality flea and worm treatments.

We are super-careful NOT to market it as insurance.

Re: Practice Healthcare plans

Kate Dawes — Tue, 27 Apr 2010 14:16:46 GMT

Thanks for everyone's thoughts, would be particularly interested to know if anyones had any particular problems with schemes like this (apart from clients getting it confused with insurance)

Kate

Re: Practice Healthcare plans

Laurence Webb — Fri, 23 Apr 2010 22:28:06 GMT

We used to run a healthcare plan through Scallywags but abandoned it and set up our own one in August 2009.

There was nothing wrong with Scallywags (and Petplan had tried to poach our business off them but we didn't see any huge difference in the plans although Petplan was slicker in presentation) but paying then £1.00 per animal per month meant that the client was paying around 10% of their monthly fees for adminstration alone.

When we used Scallywags we set it up so the client was paying roughly the same amount annually that it would cost them to buy vaccinations/flea/worming products up front, we were just pocketing 90% of the amount.

Now we run it ourselves we still take 90% of the amount it would cost for clients to pay up front, but they pay 90% of the cost too. That has lead to a massive increase in uptake. Clients can see it's good value for money and we are happier 'selling' it to clients for exactly the same reason. The only practical difference is that it's a standing order rather than a direct debit as it's incredibly expensive to set up a direct debit system.

One of the receptionists does the administration during quiet periods at work so our administration costs are almost zero. In a busier practice someone would have to be paid to work extra hours to administer the scheme which would bite into profits.

Our plan covers routine vaccinations, flea and worm treatment. 'Member's can also get 10% off food, over the counter products, neutering and routine dentistry. So far we are getting higher food sales so the discount is being offset by greater takings.

It has no insurance aspect and that is something I wanted to get away from entirely. Both Petplan and Scallywags (amongst others) also sell insurance and clients were confused about the two. In addition Scallywags insurance cover was very limited (can't remember exact figures but around £100-£1500 per condition). Clients saw the insurance as 'our' insurance no matter how much we told them it wasn't and that let to problems when they ran out of cover or claims were refused.

Telling clients that our healthcare plan is purely for routine preventative healthcare, not for illness and that they must look to an insurance company for that makes things simpler.

The monthly cost is based on the cost of booster vaccination plus Advocate monthly plus Droncit 1-2 times per year. If client or clinical preference indicates using FrontlineCombo + Milbemax/Drontal or Program + Milbemax/Drontal then that's all covered for the same cost (generally they cost a bit less). If ticks are a significant problem then it wouldn't cover Frontline monthly for dogs but we'd chuck in a Scalibor collar for free. The cost of other products would have to be calculated on an individual basis. We're therefore able to prescribe parasite treatment tailored to an individual so there's clinical freedom.

I looked at our rates of booster vaccinations and flea and worming treatment last year. For each primary vaccination course we did around 4 boosters which suggests that most clients give up vaccinating at some point (we're not bleeding clients to a 'nicer' practice!) For each animal given a booster they only received 3 months flea treatment per year (ie most people don't buy flea/worming treatments from us or, if they do, they they woefully fail to treat at the recommended frequency).

If we can increase the rate of revaccination and routine parasite control via a healthcare scheme then animals will be better off and the 10% discount will be more than offset by the regular income. If they pay us monthly but don't pick up the flea/worming treatment then we're richer but their animal is no worse off than it would have been!

Re: Practice Healthcare plans

Colin Cameron — Fri, 23 Apr 2010 16:54:59 GMT

One thing is that you have to explain to clients that it is NOT an insurance policy but a cost spreader to cover normal care costs.

Re: Practice Healthcare plans

Colin Cameron — Fri, 23 Apr 2010 16:47:45 GMT

We use a company called ISOPLAN. Very easy to deal with. Simple set up for monthly payment plan. They charge a fixed fee per client per month (Some others charge a percentage) and are quick to let us know of any payment defaults. Clients on the plan do pick up all their stuff. The plan does not require much in the way of management. We find that once people are on the scheme they do not stop it.

Re: Practice Healthcare plans

James Allsop — Fri, 23 Apr 2010 16:28:47 GMT

I looked at these 2 years ago and put then back on the to do tray as a quick canvass of our regular clients was very mixed and generally not interested. Some we looked at were Practice Plan for Vets, VetPlan - off shoot from denplan and run by AXA (which offers insurance also) and 1 run by Alan Robinson's company - Practice Business i think.

The plans can include what ever you want, some restrict to vaccine, worm and flea, others include separate pland for puppy/kitten and cover neuter and IDchip also, others run it as a "Gold Club" type arrangement and offer discounts to members for consults, treatments, food etc. Bath Vet Group run one that you can look at online http://www.bathvetgroup.co.uk/HPCleaflet.pdf

In the end we left it as something we thought was generally a good idea but required a lot of management and ultimately if the client defaults on the direct debit then you dont get paid, yet the company are quite happy to charge you to "manage" the direct debit payments otherwise if everything goes OK. They recommend you only given out 3 months flea/worm at a time so it encourages more regular visits & you are not too much out of pocket if the client cancels.

Re: Practice Healthcare plans

Clive Ansell — Wed, 21 Apr 2010 17:00:45 GMT

I came across one problem whilst working in an OOH clinic.

one of the user practices had their own payment scheme, in house insurance, call it what you will. However, when their clients presented at the OOH clinic for treatment they were aghast to discover the "all inclusive" scheme did not cover ooh care. caused a lot of problems.

Re: Practice Healthcare plans

Kate Dawes — Wed, 21 Apr 2010 16:22:40 GMT

Do you find that the majority of clients take up all the flea and worming treatments they are entitled to under the scheme, or do they forget? Do you send out reminders whenever they are due flea or worming?

Also agree re the need to emphasise that most of these schemes are not the same as insurance - I think I would be concerned that it might put clients off getting insurance as they've already got one direct debit going out each month for the dog/cat.

Re: Practice Healthcare plans

Colin Cameron — Wed, 21 Apr 2010 15:36:51 GMT

We worked out costs on weight ranges, eg. up to 10kg, 10-20kg etc. This seems to work for worming and flea treatments and clients seem to accept it. Once we explain the concept the client become quite enthusiastic in wanting more information. Good luck

Re: Practice Healthcare plans

Evelyn Barbour-Hill — Wed, 21 Apr 2010 15:25:18 GMT

[quote user="Kate Dawes"]Most of the examples I've looked at are done on monthly payments. My concern re worming/flea tx would be that there would be a tendency to use what's most economical for the practice rather than what's best for the animal.[/quote]

I'm looking into one at the moment. My understanding is that one of the selling points to the client is that each animal has its parasite treatments individually tailored. Of course you have to average out what's likely in order to decide what monthly payment to quote. I am finding this a little difficult, but not impossible.

The other advantage, to both the practice and the patient, is that the owner gets all the treatments from you, so you know the animal is getting good stuff and not Bob Martin's rubbish.

I am worried that owners will confuse the scheme with insurance. The health scheme is for the predictable; they still ought to have insurance for the unpredictable, and I think this point will need to be emphasised.

I'm not convinced many people will want the scheme, but I think I'll give it a try. I am hoping to put a strong emphasis on dental health in the way it is set up.

Re: Practice Healthcare plans

Colin Cameron — Wed, 21 Apr 2010 15:15:57 GMT

We have run a health plan for about 6 months now and it is building up steadily, albeit a bit slowly in these cash strapped times. We base our costs on what we consider to be the best treatments for parasites and not the cheapest. Surely it depends on the integrity of the vets what they use? I would expect all vets to act in the animals interests first and their own pockets second, although I realise that this is not always the case. You can still make a decent living by being honourable or is this outdated?

Re: Practice Healthcare plans

Kate Dawes — Wed, 21 Apr 2010 14:22:10 GMT

Most of the examples I've looked at are done on monthly payments. My concern re worming/flea tx would be that there would be a tendency to use what's most economical for the practice rather than what's best for the animal.

Anyone else any thoughts - would be interested to here experiences of people that use these schemes and what you think the good and bad points are.

Thanks

Kate

Re: Practice Healthcare plans

Hanna Bennett — Tue, 20 Apr 2010 19:54:03 GMT

[quote user="Rob Reid"]

Another issue I had was that the healthcare plans effectively priced the people who needed them out the system. The annual lump sum was good for middle class types, but the poorer folk couldn't afford that lump in one go, so ended up paying more for the same treatment. Bit like the situation with energy providers and pre-pay meters etc.

[/quote]

Not run healthcare plans yet, though we are looking into it - I thought the point was to spread the cost to the client rather than have them pay it in one lump sum ie. to make it monthly payments by direct debit and thus cover the cost of vaccines and preventative healthcare at around £10 a month. I work in a private practice, and was under the impression that we can set up our plans to include whatever we want - and if this means that client A gets Profender and client B gets milbemax surely that has to be the way it works (no chance of getting a tablet within six feet of one of my cats so I thoroughly sympathise with my clients in a similar position!)