Loyalty schemes/cash back for referring vets

Re: Loyalty schemes/cash back for referring vets

Gareth C. — Sat, 10 Jul 2010 09:39:53 GMT

You make a good point: we treat our best clients well, why whouldn't they. Maybe the line should be drawn at actually offering money, or transferable vouchers for CPD. Anyway for many of us the choice of referral centre is dictated by whether the client wants to drive two hours or five hours each way!

Re: Loyalty schemes/cash back for referring vets

Michael Woodhouse — Thu, 08 Jul 2010 13:14:12 GMT

There's a part of me that thinks if referral centres want to offer CPD to referring practices FOC then the more work the practice sends the referral centre the more they deserve in return. Even if you just allocated a basic points system or something.

We have some big dairy farms that we would do things for that we wouldn't for the odd chap who buys an odd bottle of Spectan at lambing time. (By 'doing things' I mean dropping off drugs, maybe pop in on way past to check a cow FOC etc). They spend more money with us so get a better service.

It's how it works in life. Different if they are giving cash in the pocket but not if they are providing CPD pro rata to the work you send them IMO!

Re: Loyalty schemes/cash back for referring vets

Gareth C. — Wed, 07 Jul 2010 15:29:40 GMT

Whatever the rights and wrongs of offering incentives, cpd, kickbakcs etc, my worry would be what the clients would make of it. We have to be seen to be doing the right thing, I would be worried if cash is being offered (albeit to fund cpd) that despite referring to the afore mentioned-centre-run-by-an-ex-RCV- president being in many circumstances the right thing to do, if a client found out I got financial reward from doing so and not from somewhere else, it would not be seen to be the right thing to do. Why complicate matters? I am sure it is normal practices in other industries, but why does that make it desirable in ours? Why put ourselves in that questionable position? In most other industries you can't have your carreer taken away from you for making the wrong decsision...

Re: Loyalty schemes/cash back for referring vets

anthony chadwick — Mon, 05 Jul 2010 15:21:28 GMT

It definitely wasn't me either. Although, I am offering some free CPD on atopy on Thursday 9pm via my webinars. Go to www.thewebinarvet.com/products and put vetsurgeon in discount box. Hope to see you there

Anthony

Re: Loyalty schemes/cash back for referring vets

Kate Richardson — Mon, 05 Jul 2010 14:30:51 GMT

[quote user="Andy Moores"]It's interesting that it is an ex-RCVS president who is now running Langford Clinical Services![/quote]

Yes I became aware of this recently following a discussion about this thread with my boss. Good to see the RCVS have the veterinary industrys best interests at heart...not. Sorry she is EX rcvs.

I don't suppose there are any Langford clinicians on this forum willing to make a comment? Probably not. And that is not a dig at the clinicians, they are not making the rules, I know the ones that I speak to regularly are conscientious hard working caring people who do a fab job.

Re: Loyalty schemes/cash back for referring vets

Hannah Wynne Richards — Mon, 05 Jul 2010 10:34:21 GMT

I agree with you Andy. I'm also a Bristol graduate, and am very sad it's gone downhill so much that I've been forced to look further afield for a quality service

At least the incoming RCVS JVP is content to market his referral centre on results

Wynne

Re: Loyalty schemes/cash back for referring vets

Andy Moores — Mon, 05 Jul 2010 09:40:14 GMT

It's also not us Hannah!

Langford are clearly trying to build up their caseload through all means possible, which I think reflects (I regret to say as an ex-Bristol undegrad and resident) the poor reputation they have had over the last few years.

I have also heard of a similar 'cashback' scheme being enforced on a referral practice further north. The story as I heard it (second-hand news I'm afraid) was that the referral practice was effectively being held to ransom by one of the larger corporate practices with a lot of branches near by. Effectively -give us 10% (or whatever) cashback on the cases we send you way or we will stop sending them.

This sort of behaviour is potentially very damaging to the profession -I strongly believe that clients should be given free choice in deciding how their pet is treated and where. An RCVS position on this sort of behaviour would be very useful, before another anti-vet media campaign is initiated! It's interesting that it is an ex-RCVS president who is now running Langford Clinical Services!

Andy

Re: Loyalty schemes/cash back for referring vets

Malcolm Holland — Tue, 29 Jun 2010 15:05:08 GMT

We contacted the RCVS earlier this year regarding similar incentives being offered by North Kent Referrals. This was the reply: "the referring veterinary surgeon should ensure that any referral is to 'a colleague who they are satified is competent to carry out the investigations or treatment involved.' All referrals should be made on this basis and NOT on the basis of any financial incentive."

VRCC has always considered such schemes unethical.

Malcolm Holland, Practice Director VRCC

Re: Loyalty schemes/cash back for referring vets

Evelyn Barbour-Hill — Mon, 21 Jun 2010 21:49:51 GMT

[quote user="Rob Smith"]

You get what you pay for eh.

[/quote]

As in "pay bribe, get contract?"

Re: Loyalty schemes/cash back for referring vets

Rob Smith — Mon, 21 Jun 2010 20:53:11 GMT

You get what you pay for eh.

Re: Loyalty schemes/cash back for referring vets

Evelyn Barbour-Hill — Mon, 21 Jun 2010 19:19:38 GMT

[quote user="Peter Ding"]

"Not really, or only a very little bit. It needn't cost a University or big "referral centre" anything to give some CPD, unless you count the coffee or the sandwiches."

How refreshing, a referral centre that doesn't seem to need to charge for its clinicians time!

I'm tempted to send my referrals to you if consultations are free of charge!

[/quote]

The clinicians are there on salaries anyway. They won't be taking time out of fee-earning.Their "Powerpoints" are probably prepared already, or if not the university has loads of resources to get 'em done. Practical sessions might cost a little to organise if materials are needed.

And yes, you are welcome to send me your referrals, and the consultation is free of charge if an operation results.

Re: Loyalty schemes/cash back for referring vets

Peter Ding — Mon, 21 Jun 2010 16:55:21 GMT

"Not really, or only a very little bit. It needn't cost a University or big "referral centre" anything to give some CPD, unless you count the coffee or the sandwiches."

How refreshing, a referral centre that doesn't seem to need to charge for its clinicians time!

I'm tempted to send my referrals to you if consultations are free of charge!

Re: Loyalty schemes/cash back for referring vets

Hannah Wynne Richards — Mon, 21 Jun 2010 16:43:04 GMT

Oops Just realised Langford do have a cardiology Cert holder

My apologies

Wynne

Re: Loyalty schemes/cash back for referring vets

Kate Richardson — Sun, 20 Jun 2010 12:25:15 GMT

I had a thought regarding this situation and how it could be extrapolated to the wider world. Whenever I see something that is usually expensive eg electronic equipment, cars, furtniture, etc, on a special offer for a period of time, I always ask my self- how can they afford to do this, and rightly or wrongly, I always come to the conclusion that they obviously make huge/excessive amounts of profit on 'normal' prices, and hence can afford to drop the prices and still make a reasonable profit. In which case, why can't they keep the prices lower all the time?

I think there is possibly a danger here if this gets out into the wider public arena of this further damaging our reputation in the veterinary profession as being money orientated and only after a profit. If 'bonuses', or 'free offers' or 'cut price' treatments are offered this may lead to support of the public theory that 'vets charge too much' as they can afford to offer freebies or whatever you want to call them and one would assume they are still making a profit.

Referral centres should be chosen on the quality of the job that they do primarily, as described above by Eveleyn or Wynne, and other factors such as cost/location will come into this, but I feel most comfortable referring to someone that I know will do the best job possible and that is my motivating factor when choosing where to refer to. The point that free cpd to everyone may garner more work is so true- you are more likely to go ( we all like something for free at the end of the day!), you get to know the clinicians, and wider knowledge will promote more referrals if you know what the options for treatment are.

Re: Loyalty schemes/cash back for referring vets

Evelyn Barbour-Hill — Sat, 19 Jun 2010 13:33:39 GMT

[quote user="Peter Ding"]f some referral centres don't charge for CPD, aren't the referred clients paying for it anyway through referral centre charges?[/quote]

Not really, or only a very little bit. It needn't cost a University or big "referral centre" anything to give some CPD, unless you count the coffee or the sandwiches.

[quote user="Peter Ding"]the Petplan reward sheme?[/quote]

What is that? I remember some of the insurance companies used to offer rather pathetic little bribes to nurses, but I thought all that came to an end when the FSA stepped in.

Re: Loyalty schemes/cash back for referring vets

Hannah Wynne Richards — Sat, 19 Jun 2010 10:06:23 GMT

With referance to Paddy's comment on" over-provision "of referral clinicians, and Evelyn's on referral centres competing on quality, the way I see things having developed over the last 25/30 years is this

Senior University clinicians didn't want to do much OOH, or indeed much clinical work at all, so employed a succession of young, poorly-paid 3/4 year qualified residents to do most of the referral work. These posts are called training posts, and are certainly paid as training posts, so should be limited in number, so as to be CLOSELY supervised by senior clinicians, who should personally do the bulk of referral work

Some of the residents, on achieving their Diplomas, went into private referral centres, where they would be better paid than junior lecturers-anyway, the Universities couldn't keep them all on-as there were far too many of them

We now have a situation when we in 1st opinion practice have 3 choices with a problem patient

a) referral to a private referral centre, where we can be certain our patients will be seen by RCVS Specialists

b) referral to a Certificate holder

c) referral to a University, where the chances are the patient will be seen by a 3/4 year qualified resident, who in the 1st year will merely be studying for a certificate-it's no contest

I know that when Bristol were granted temporary approval by Royal College (autumn 07 ) one of the reasonsthe VR stated for dissatisfaction was a lack of referral patients. They have now been granted further temporary approval, although this time the reasons for not giving full approval have not been stated. I suspect (but don't know ) that the lack of case load is still a problem, and this initiative is a desperate attempt to improve matters

It's unlikely to work unless they regain the confidence of good, experienced practitioners by employing more staff who already hold specialist status, and having them actually doing the work

I've arranged with an owner, only this morning to refer a dog with a stifle problem, which I think will need surgery. I'm in Bristol's catchment area, but , after discussing options with the owners,I will be referring to a certificate holder in Newport

Alex. I don't think you need worry too much about this initiative, as I notice one of your certificates is in cardiology. I may be wrong (if one has been employed recently ) but last time I checked, there wasn't even a Cert holder in cardiology at Langford. If they empoyed someone with a Cardiology Diploma, who would actually see cases, you would have reason to be worried !!!!!!!!!!. When I was a student, Jimmy Holmes was there !!!!!!!!!!

We need some residents, or there won't be Specialists in the future, but to rely on them for providing a referral service is unfair on residents, referring practitioners, and most important of all-patients

Wynne

Re: Loyalty schemes/cash back for referring vets

Peter Ding — Sat, 19 Jun 2010 09:31:32 GMT

I still don't see how this is inherently different from a bonus scheme within a practice.

Both should be insignificant in determining what are the best treatment options for the patient.. both have to be paid for by the owner.

CPD either has to be paid out of a practice's income or that of the referral centre.

IF Incentives schemes/practice ownership doesn't alter our decision making in treating patients at our own practices why would it in deciding which referral centre?

If one is uncomfortable with owners becoming aware of it, doesn't the same apply to employee remuneration incentive schemes, Drug company discounts, cashbacks, rebates, and even the Petplan reward sheme?

If some referral centres don't charge for CPD, aren't the referred clients paying for it anyway through referral centre charges?

Re: Loyalty schemes/cash back for referring vets

Laurence Webb — Fri, 18 Jun 2010 23:28:08 GMT

When we were visited my a representative of LVS I was given the impression that their intention was for any CPD vouchers to be redeemed on CPD at Langford, so it was a sort of free CPD offered to referring practices.

It's probably cheeky people like me asking 'If you've got nothing of interest can I use the vouchers elsewhere?' that lead to them offering to pay for CPD at other providers. I suspect they'd prefer them to be used in-house as the cost to Langford of subsidising £100 of their own CPD must be less than paying another provider £100 cash.

Re: Loyalty schemes/cash back for referring vets

Evelyn Barbour-Hill — Fri, 18 Jun 2010 21:39:23 GMT

Some of my clients are capable of arithmetic, and can work out quite easily that if you are going to give 10% of the final invoice as a backhander then you need to inflate your charge by approximately 11% to break even.

I wonder if Langford will show the kickback as an item on that itemised invoice? I suspect not.

Obviously they are doing it because they are not getting enough - or what they consider enough - referral business. Well, it's OK for specialists to compete for referrals if they must, but the competition ought to be on:

1. Quality of work.

2. (A very close second) Quality of service to the client, in all its manifestations.

3. (A distant third) Cost to the client.

I feel the clinicians at Bristol might be a little upset at the realisation that the head of Langford Veterinary Services (who is that again?) has so little faith in their performance in 1 and 2, that the offer of "inducements" to the general practitioner has to be resorted to. As for 3, the head of Langford Veterinary Services has probably worked out that the clients fall into three categories:

a) Those with insurance, who probably won't think too closely about it, as long as the kickback is well hidden on the invoice supplied to the insurance company.

b) Those with pots of money, who might be a little more thoughtful, but probably won't worry.

c) Those who are neither of the above but are prepared to make sacrifices for their pet. Still, if they are that dedicated, you can screw them for a bit more.

CPD? Any referral veterinary surgeon with any wit offers CPD free or cheap, since greater understanding of the subject among their GPs will bring them more referrals.

Re: Loyalty schemes/cash back for referring vets

Evelyn Barbour-Hill — Fri, 18 Jun 2010 20:37:55 GMT

[quote user="Rob Smith"]I think it's a great idea, and not at all unethical. It happens in every other industry except ours, including in private medicine. It would be unheard of not to get kickback in something like the building industry. [/quote]

I presume that's what John Poulson used to say.

[quote user="Rob Smith"] I think clients presume it happens, and would be shocked that it doesn't.[/quote]

I think not. Your clients must be very different from mine.

Re: Loyalty schemes/cash back for referring vets

Louise6732 — Fri, 18 Jun 2010 20:18:09 GMT

Wynne, I agree! It makes it more than tricky for me as a potential referring vet. I happen to be very local to Langford, and refer there on occasion anyway. Now this new bonus scheme has come in, I will continue to refer there based on the criteria I always use to decide which centre to refer to. Now, how do I explain to clients that Langford is great, and I'd have chosen to refer to them regardless of bonus schemes? Puts me in a bit of a tricky spot! Word is bound to spread within the general public locally of this scheme.

I graduated from Bristol in 2009, and I too am saddened at how the reputation has changed since then. A great shame really.

Re: Loyalty schemes/cash back for referring vets

Hannah Wynne Richards — Fri, 18 Jun 2010 17:02:46 GMT

Louise If the centre is the one which gives the bonus-will the client believe you when you say you think it's the best ?????????

That's the real objection-this scheme will destroy the client's trust-and that is miuch easier to lose than it is to regain

Wynne

Re: Loyalty schemes/cash back for referring vets

Hannah Wynne Richards — Fri, 18 Jun 2010 16:45:53 GMT

I'm a Bristol graduate, and it makes me cringe that a veterinary school which I remember having no trouble attracting referrals, due to the quality of their referral clinicians, has now sunk so low

Wynne

Re: Loyalty schemes/cash back for referring vets

Malcolm Ness — Fri, 18 Jun 2010 16:22:31 GMT

I am not doctrinally opposed to this, though I think it a very poor idea for a number of reasons. Not least is the concern about how much the client is told. I think it unlikely that all clients will be told everything all of the time. ("Ms X is an excellent cardiologist and it is for that reason alone that I am advising this referral. However, for completeness I should tell you that I personally, will receive a quite considerable bung as a direct consequence of you going there and nowhere else.")

Imagine the fun a lawyer might have in the event of things going wrong and a complaint being made. Similarly, it doesn't take much imagination to start wondering whether the referral clinicians are also being "incentivised". "I know that an MRI isn't strictly necessary but your 10% of the fee is not to be sneezed at".

Re: Loyalty schemes/cash back for referring vets

Alex Gough — Fri, 18 Jun 2010 15:55:11 GMT

One obvious difference is that in that situation the employee gets remunerated on the amount of work they do, just as they would if they were a one man practice.