Hi!
I have been practicing rehab in a very frustrating way for the past 5 years but now my clinic is interested in making it more of a priority...this is very exciting! I was hoping to get some advice on how to make this profitable and efficient. I will basically be building the rehab department from scratch. I very much look up to you and what you have done for the profession!
Do you have any good resources or would you be willing to schedule a phone consult to discuss things? Of course, I would expect to pay a consult fee.
Please let me know!
S.K.
Building a Rehab Department
Re: Building a Rehab Department
Hi S.,
So, I’m not going to offer to do a phone consult. I am beyond my bandwidth right now with my husband’s health and the management I now have to do for the ranch. I just can’t add in anything new. I’m lucky if I remember to shower these days!
But I have answered this question before and I’m going to do a bit of cut and past or maybe I’ll just attach documents. They are one’s I’ve saved to use as blog posts, but just haven’t. The info doesn’t reflect our current prices. We substantially increased them!
I think I’ll turn this into a post on the Forum as well. But you get it first!
Okay, so you likely saw a very similar post on the VetRehab Chat group. I think you are a part of it as well. If you didn’t see it, I’ll cut and paste it here for you!
Watching this thread with interest! I own 3 general practices, all with rehab practices inside.
Across the US, the Net for a “well managed” SA hospital is from 15 -20% and is rarely higher ( I personally only know of three that are higher than that)
In a regular SA practice that is not well managed, I often see a net of less than 10%.
I pay my associate veterinarians 20% of gross and if they are doing acupuncture or chiro I pay them 50% of that individual modality. Caveat. THEY paid for their own training. If I pay for training, they get 20% of gross across the board.
Several of my docs have-over the years- asked for a higher rate of pay on rehab so that they can make it their primary focus in practice. Here is the problem...After the cost of purchasing the equipment, I am unable to pay 50% of production without going into the negative.
As a stand alone cost center Rehab is about break even at a payout of 20% of gross. The rest of the general practice supports the rehab department’s labor costs. In my experience Rehab is a phenomenal tool for giving great patient care, generating loyal clients and differentiating us from other practices. Again this is in my experience- it will not support a normal veterinary salary plus tech labor. Just like general small animal practice, we need to leverage the doctors time by using skilled technicians.
Just for kicks: Here is how the numbers pencil out for me. I charge $200 for a rehab consult (which he really takes 2 hours minimum and includes the first treatments). I limit myself to one consult per day. Packages run between $60 and $100 per day depending on what time they take and which modalities we use. If each patient takes an hour that is 8 patients a day max and does not leave time for charting and planning. Frequently patients take longer than an hour.
If I am completely booked all day with rehab patients for one tech the gross is approximately $800 a day or $200 k per year—- not counting additional diagnostics.
Here is where the money goes
The basic fixed costs of a rehab center inside a general practice are:
1) Rent paid by rehab to the general practice of $25/square foot (fair market) so for a thousand square feet = $25k per year. Mine is slightly smaller than that... plus a I pay a portion utilities.
2) Equipment lease if you cannot Pay cash (for UWTM, laser, Ther-ex equipment, electric stim etc) of conservatively $2000/month lets round up to $25 k per year
3) Tech salary for one of $20/hr or $40k per year,+ add 30% for payroll taxes, workers comp etc. So $12,000 per year.
4) Incidentals of $200-300 per month- let’s say $2000 a year and nothing goes wrong.
That is over $100k
At any rate. Rehab is marvelous and a great addition for
Me to regular practice but I would probably not do a rehab only practice.
Still following the thread of people who know more than I do!
Dr. P.N.
Okay… so her evaluation is good and sound. The practicality of how the business is structured likely needs to change. I said this years ago, and I still think it’s correct:
VOLUME is Key!!!
You need to have more than one dog in and on treatment at any given time. You need to capitalize on using assistants, and that might mean adding in some non-rehab trained vet-assistants to do jobs that can be done in a more automated fashion (i.e. operation of an UWT or Pool and some basic marketing or client follow up tasks). You would train these people ‘in house’.
We’ve done the math at my clinic. One therapist treating dogs and paying her appx 50% commission (on treatment only, not sales) will break even (i.e. pay for reception, overhead, and a portion to office management etc.). One assistant running the UWT or Pool (at a lower price point than ‘therapist-directed sessions’) does not break even. But if we have UWT or Pool operating concurrently with a Therapist in the clinic… then we can make a profit. The more you can offer concurrently, the more you can profit.
What I can tell you is that our Initial Assessments are currently $295 (80-min appt), our 40-minute physio appointments are $101, UWT sessions are $49, Pool sessions are $39 (they’re 30minutes total time, maybe only 10 - 15 minutes swimming). Multi-dog families are charged by time beyond the 40 minutes, and I think we go up by $2 a minute or maybe it’s $1.50 (or somewhere in between). We do have a different charge for sporting dog assessments (i.e. nothing wrong with the dog that the owner knows about, but it’s a canine athlete and they just want him/her checked out and put onto a monthly rotation for check-up/tune-up).
Okay, when you go through these two documents (they are basically e-mail questions to me from back in 2012!!!) you’ll see that my prices have significantly increased from back then. I’ll also add that I now have 8 part time therapists on staff. We also offer Pool in addition to UWT… and I wish we had never put it in! Stick with one or the other! The two compete with each other and the overhead is simply that much higher.
Okay… this should get your started.
And by posting on the forum, I hope we get others involved as well!
Cheers,
Laurie
So, I’m not going to offer to do a phone consult. I am beyond my bandwidth right now with my husband’s health and the management I now have to do for the ranch. I just can’t add in anything new. I’m lucky if I remember to shower these days!
But I have answered this question before and I’m going to do a bit of cut and past or maybe I’ll just attach documents. They are one’s I’ve saved to use as blog posts, but just haven’t. The info doesn’t reflect our current prices. We substantially increased them!
I think I’ll turn this into a post on the Forum as well. But you get it first!
Okay, so you likely saw a very similar post on the VetRehab Chat group. I think you are a part of it as well. If you didn’t see it, I’ll cut and paste it here for you!
Watching this thread with interest! I own 3 general practices, all with rehab practices inside.
Across the US, the Net for a “well managed” SA hospital is from 15 -20% and is rarely higher ( I personally only know of three that are higher than that)
In a regular SA practice that is not well managed, I often see a net of less than 10%.
I pay my associate veterinarians 20% of gross and if they are doing acupuncture or chiro I pay them 50% of that individual modality. Caveat. THEY paid for their own training. If I pay for training, they get 20% of gross across the board.
Several of my docs have-over the years- asked for a higher rate of pay on rehab so that they can make it their primary focus in practice. Here is the problem...After the cost of purchasing the equipment, I am unable to pay 50% of production without going into the negative.
As a stand alone cost center Rehab is about break even at a payout of 20% of gross. The rest of the general practice supports the rehab department’s labor costs. In my experience Rehab is a phenomenal tool for giving great patient care, generating loyal clients and differentiating us from other practices. Again this is in my experience- it will not support a normal veterinary salary plus tech labor. Just like general small animal practice, we need to leverage the doctors time by using skilled technicians.
Just for kicks: Here is how the numbers pencil out for me. I charge $200 for a rehab consult (which he really takes 2 hours minimum and includes the first treatments). I limit myself to one consult per day. Packages run between $60 and $100 per day depending on what time they take and which modalities we use. If each patient takes an hour that is 8 patients a day max and does not leave time for charting and planning. Frequently patients take longer than an hour.
If I am completely booked all day with rehab patients for one tech the gross is approximately $800 a day or $200 k per year—- not counting additional diagnostics.
Here is where the money goes
The basic fixed costs of a rehab center inside a general practice are:
1) Rent paid by rehab to the general practice of $25/square foot (fair market) so for a thousand square feet = $25k per year. Mine is slightly smaller than that... plus a I pay a portion utilities.
2) Equipment lease if you cannot Pay cash (for UWTM, laser, Ther-ex equipment, electric stim etc) of conservatively $2000/month lets round up to $25 k per year
3) Tech salary for one of $20/hr or $40k per year,+ add 30% for payroll taxes, workers comp etc. So $12,000 per year.
4) Incidentals of $200-300 per month- let’s say $2000 a year and nothing goes wrong.
That is over $100k
At any rate. Rehab is marvelous and a great addition for
Me to regular practice but I would probably not do a rehab only practice.
Still following the thread of people who know more than I do!
Dr. P.N.
Okay… so her evaluation is good and sound. The practicality of how the business is structured likely needs to change. I said this years ago, and I still think it’s correct:
VOLUME is Key!!!
You need to have more than one dog in and on treatment at any given time. You need to capitalize on using assistants, and that might mean adding in some non-rehab trained vet-assistants to do jobs that can be done in a more automated fashion (i.e. operation of an UWT or Pool and some basic marketing or client follow up tasks). You would train these people ‘in house’.
We’ve done the math at my clinic. One therapist treating dogs and paying her appx 50% commission (on treatment only, not sales) will break even (i.e. pay for reception, overhead, and a portion to office management etc.). One assistant running the UWT or Pool (at a lower price point than ‘therapist-directed sessions’) does not break even. But if we have UWT or Pool operating concurrently with a Therapist in the clinic… then we can make a profit. The more you can offer concurrently, the more you can profit.
- Right off the bat. Charge more than you think.
- Right off the bat. You are too skilled to be pushing buttons on an UWT - hire someone else to do this.
- Right off the bat. Separate out your UWT appts from your Therapy appointments. Think of them as different entities. Not all dogs need Water Therapy. If a dog needs both, then have the owner book the appointments back to back, and charge accordingly. Thus you can set a time limit on appointments. Our Therapy appointments are 40 minutes. Our UWT appointments are 40 minutes (scheduled total time - but water time might only be 10 - 20, maximum 30). And don’t provide UWT on the Initial Assessment. There’s too much else to cover and a home program to create.
- Right off the bat. Plan for growth. If you get to design a treatment space, have more than one treatment room, or a big open area where you and your tech or vet-assistant(s) can monitor & treat multiple patients at once.
What I can tell you is that our Initial Assessments are currently $295 (80-min appt), our 40-minute physio appointments are $101, UWT sessions are $49, Pool sessions are $39 (they’re 30minutes total time, maybe only 10 - 15 minutes swimming). Multi-dog families are charged by time beyond the 40 minutes, and I think we go up by $2 a minute or maybe it’s $1.50 (or somewhere in between). We do have a different charge for sporting dog assessments (i.e. nothing wrong with the dog that the owner knows about, but it’s a canine athlete and they just want him/her checked out and put onto a monthly rotation for check-up/tune-up).
Okay, when you go through these two documents (they are basically e-mail questions to me from back in 2012!!!) you’ll see that my prices have significantly increased from back then. I’ll also add that I now have 8 part time therapists on staff. We also offer Pool in addition to UWT… and I wish we had never put it in! Stick with one or the other! The two compete with each other and the overhead is simply that much higher.
Okay… this should get your started.
And by posting on the forum, I hope we get others involved as well!
Cheers,
Laurie
LAURIE EDGE-HUGHES
Re: Building a Rehab Department
Addendum: Staring a Rehab Practice Q & A # 1:
Hey Laurie,
I have been monitoring your videos and I am very impressed. I haven’t signed up quite yet due to cost of getting my own place up and running but I have a few questions and was hoping to get some feedback.
I am trying to figure out pricing – now, I know we are not supposed to compare but you are in Canada and I am in SC so I don’t think we will dominate the field with the pricing. My questions are pretty generic so I was hoping to get your ideas.
I am thinking about doing packages instead by the hour because I don’t want people to pick and choose which treatment they would want.
So I am wondering about how long an “average” post-surgery patient stays with you – is a just a daily thing for a few weeks, do they stay in the facility, or do they just come SIW/BIW for a few weeks?
What would be the “average” total cost of their rehabilitation at release point? I understand it depends on the surgery type but just a guesstimate.
Do you have prices for:
¥
What would their “average” cost?
Do you have different levels of conditioning for athletes?
Do you have “packages” for OA and obese pets?
I have a ton of questions and I respect the knowledge you have of the whole process so I am picking your brain – trying not to lead you to distraction. I would appreciate any insight you could give me because eventually the contractors will get everything done and I will have to walk through those doors.
Thanks,
D
______
My Reply:
Hi D.
At my clinic, we bill by time - vs 'buffet cart' style - paying per modality. For two reasons; 1) as a PT, that's how we deliver services to humans & 2) I only once had a client try to 'tell me' what she would pay for, despite me saying that I thought a different direction / selection of therapies would be more beneficial. And it was such a terrible situation to have the client being the one to pick and choose & dictate therapy - it was maddening!!
So, I am very upfront about prices. I charge $215 for the initial assessment/treatment - which we book 1hr 15 mins for. It is a whole body assessment - and more thorough than any other assessment they would have received before, includes some treatment, a written home program, and communication with their vet (referral acquisition and assessment report sent back). We do offer Fitness/Performance Assessments for sporting dogs who are NOT lame, injured, post-operative, but rather having performance issues or the owners just want their dog assessed in order to avoid potential problems in the future. For those, we charge $120 and book off an hour of time - no vet communication occurs with these.
Follow-up 'physio' visits (with the therapist) are $78/30 minutes, $93/45min, $103/1hour...
We bill for the UWT separately and have it divided into Rehab UWT (dog is concurrently under the care of a therapist / on a rehab treatment program &/or needs a modality treatment in addition to 'water')... These start at $35 for 10 minutes and go up a $1/minute. For Fitness/Conditioning cases (no rehab concurrently, no modalities utilized) it is $10 cheaper.
We have also created just some modality session prices that our assistants can conduct - so the animal is not seen by a therapist that does a re-eval or any manual therapies - the dog just comes in and gets modalities as prescribed by the therapist and administered by the assistant. I honestly, can't remember the price... but it's cheaper than a 1/2 hour PT session.
As for a package system. I've not gone there and whenever we have got to thinking about it, we've backed away. Here are MY reasons for not going with a package system - Every dog / rehab event is different, and cannot account for set backs, complications etc. - We didn't want to have to deal with 'refunding' of unused portions. - Others in the rehab community have mentioned that they have had cases where clients stop therapy at the end of their 'package' (i.e. set # of treatments) b/c they didn't want to buy another package and didn't want to pay full price for a handful of additional sessions. We have developed an approach that seems to resonate with our clients. I tell them upfront that we can do as much or as little as the would like or can feasibly fit into their lives, schedules, finances. Generally, we find that a really good client can come twice a week (more than that is RARE). So I tell folks that twice a week would be ideal, but that there is lots we can do with once a week, and if that's not feasible, then I can create an extensive home program for them and monitor progress every second week. I have found that giving the owners control in this nature, builds trust, rapport, and dedicated clients that tend to see their dog through to completion of therapy. We now even have referring vets promote our services in such a way by telling their clients to discuss with us what they can manage financially and that we will work with them. It's great because some vets are referring any and all cases b/c they know that we will do our best to work with them regardless of their finances.
So... to your real question.
Rehab tends to last for 8 - 16 weeks (some dogs get better faster than others). so if you are wanting a generic time frame - I'd shoot for the middle - 12 weeks. 99% of our patients are brought in by their owner. We don't do any overnight boarding...but we have had a handful of patients that are dropped off in the morning. I have found that the majority of our clients want to be there with and for their dog. However, a colleague of mine in Florida finds that her clients want to drop their dogs off. (I'm not sure if that is a geographical ideology thing - or what - but I don't think I could actually sell a drop off service to my customers!!!)
I am smiling because your questions are very 'vet'. By that I mean that a PT would answer that no two cases are the same, and that each case needs an individually created therapy program. For example with an OA case - you can go two ways: 1) Get the animal exercising in the UWT and go with building muscle and exercising in a buoyant environment, or 2) modalities & one-on-on hands on approach using modalities, manual therapies, acupuncture etc. Or 3) start with modalities for pain relief and progress to exercise. Therapists tend to approach different cases differently. So, until you see the patient for the first time, you might not know what you will choose, or how the animal will respond. There is a rule of 3 that many PTs use - if within 3 treatments the patient is not improving to the degree that you would like or expect, then you need to 1) change your approach or 2) revisit your diagnosis. (Thus another reason why I dislike packages - they tend to remove 'individuality' from the program design).
We are actually working on an Obesity program at the moment... but I have to put in more work into it to flesh it out completely and deal with the 'what if's' / 'individual differences' that might arise!
Educational consultations are just paying for my time... no different than if I use modalities or manual therapy. I think of it as the client buys my time: Me, my brain, my hands, my knowledge and what I choose to do with them.
As a big picture strategy. We have come to recognize that because rehab takes time... the price cannot be exorbitant (as with surgery) for each session... if you want them to come and see results. Therefore, the ticket to success and survival is volume. Plenty of satisfied, regular, returning clients... coming not only through their active rehab but afterwards for tune ups and check ups on a semi-regular basis. ('Build your herd' mentality.)
Hopefully this gets you thinking & I'm open to more questions... which I'm sure this line of discussion with produce!
Cheers,
Laurie
Hey Laurie,
I have been monitoring your videos and I am very impressed. I haven’t signed up quite yet due to cost of getting my own place up and running but I have a few questions and was hoping to get some feedback.
I am trying to figure out pricing – now, I know we are not supposed to compare but you are in Canada and I am in SC so I don’t think we will dominate the field with the pricing. My questions are pretty generic so I was hoping to get your ideas.
I am thinking about doing packages instead by the hour because I don’t want people to pick and choose which treatment they would want.
So I am wondering about how long an “average” post-surgery patient stays with you – is a just a daily thing for a few weeks, do they stay in the facility, or do they just come SIW/BIW for a few weeks?
What would be the “average” total cost of their rehabilitation at release point? I understand it depends on the surgery type but just a guesstimate.
Do you have prices for:
¥
- educational consultations
¥ general consultations
What would their “average” cost?
Do you have different levels of conditioning for athletes?
Do you have “packages” for OA and obese pets?
I have a ton of questions and I respect the knowledge you have of the whole process so I am picking your brain – trying not to lead you to distraction. I would appreciate any insight you could give me because eventually the contractors will get everything done and I will have to walk through those doors.
Thanks,
D
______
My Reply:
Hi D.
At my clinic, we bill by time - vs 'buffet cart' style - paying per modality. For two reasons; 1) as a PT, that's how we deliver services to humans & 2) I only once had a client try to 'tell me' what she would pay for, despite me saying that I thought a different direction / selection of therapies would be more beneficial. And it was such a terrible situation to have the client being the one to pick and choose & dictate therapy - it was maddening!!
So, I am very upfront about prices. I charge $215 for the initial assessment/treatment - which we book 1hr 15 mins for. It is a whole body assessment - and more thorough than any other assessment they would have received before, includes some treatment, a written home program, and communication with their vet (referral acquisition and assessment report sent back). We do offer Fitness/Performance Assessments for sporting dogs who are NOT lame, injured, post-operative, but rather having performance issues or the owners just want their dog assessed in order to avoid potential problems in the future. For those, we charge $120 and book off an hour of time - no vet communication occurs with these.
Follow-up 'physio' visits (with the therapist) are $78/30 minutes, $93/45min, $103/1hour...
We bill for the UWT separately and have it divided into Rehab UWT (dog is concurrently under the care of a therapist / on a rehab treatment program &/or needs a modality treatment in addition to 'water')... These start at $35 for 10 minutes and go up a $1/minute. For Fitness/Conditioning cases (no rehab concurrently, no modalities utilized) it is $10 cheaper.
We have also created just some modality session prices that our assistants can conduct - so the animal is not seen by a therapist that does a re-eval or any manual therapies - the dog just comes in and gets modalities as prescribed by the therapist and administered by the assistant. I honestly, can't remember the price... but it's cheaper than a 1/2 hour PT session.
As for a package system. I've not gone there and whenever we have got to thinking about it, we've backed away. Here are MY reasons for not going with a package system - Every dog / rehab event is different, and cannot account for set backs, complications etc. - We didn't want to have to deal with 'refunding' of unused portions. - Others in the rehab community have mentioned that they have had cases where clients stop therapy at the end of their 'package' (i.e. set # of treatments) b/c they didn't want to buy another package and didn't want to pay full price for a handful of additional sessions. We have developed an approach that seems to resonate with our clients. I tell them upfront that we can do as much or as little as the would like or can feasibly fit into their lives, schedules, finances. Generally, we find that a really good client can come twice a week (more than that is RARE). So I tell folks that twice a week would be ideal, but that there is lots we can do with once a week, and if that's not feasible, then I can create an extensive home program for them and monitor progress every second week. I have found that giving the owners control in this nature, builds trust, rapport, and dedicated clients that tend to see their dog through to completion of therapy. We now even have referring vets promote our services in such a way by telling their clients to discuss with us what they can manage financially and that we will work with them. It's great because some vets are referring any and all cases b/c they know that we will do our best to work with them regardless of their finances.
So... to your real question.
Rehab tends to last for 8 - 16 weeks (some dogs get better faster than others). so if you are wanting a generic time frame - I'd shoot for the middle - 12 weeks. 99% of our patients are brought in by their owner. We don't do any overnight boarding...but we have had a handful of patients that are dropped off in the morning. I have found that the majority of our clients want to be there with and for their dog. However, a colleague of mine in Florida finds that her clients want to drop their dogs off. (I'm not sure if that is a geographical ideology thing - or what - but I don't think I could actually sell a drop off service to my customers!!!)
I am smiling because your questions are very 'vet'. By that I mean that a PT would answer that no two cases are the same, and that each case needs an individually created therapy program. For example with an OA case - you can go two ways: 1) Get the animal exercising in the UWT and go with building muscle and exercising in a buoyant environment, or 2) modalities & one-on-on hands on approach using modalities, manual therapies, acupuncture etc. Or 3) start with modalities for pain relief and progress to exercise. Therapists tend to approach different cases differently. So, until you see the patient for the first time, you might not know what you will choose, or how the animal will respond. There is a rule of 3 that many PTs use - if within 3 treatments the patient is not improving to the degree that you would like or expect, then you need to 1) change your approach or 2) revisit your diagnosis. (Thus another reason why I dislike packages - they tend to remove 'individuality' from the program design).
We are actually working on an Obesity program at the moment... but I have to put in more work into it to flesh it out completely and deal with the 'what if's' / 'individual differences' that might arise!
Educational consultations are just paying for my time... no different than if I use modalities or manual therapy. I think of it as the client buys my time: Me, my brain, my hands, my knowledge and what I choose to do with them.
As a big picture strategy. We have come to recognize that because rehab takes time... the price cannot be exorbitant (as with surgery) for each session... if you want them to come and see results. Therefore, the ticket to success and survival is volume. Plenty of satisfied, regular, returning clients... coming not only through their active rehab but afterwards for tune ups and check ups on a semi-regular basis. ('Build your herd' mentality.)
Hopefully this gets you thinking & I'm open to more questions... which I'm sure this line of discussion with produce!
Cheers,
Laurie
LAURIE EDGE-HUGHES
Re: Building a Rehab Department
Addendum 2 - Starting a Rehab Practice
This was from another e-mail sent to me back in 2012. My thoughts are similar now as they were then!
On to business... these are tougher questions - especially giving financials. And to be quite honest, I think most of us out there practicing are sort of making it up a we go along, and trying to find the winning formula - I know I am - since nothing out there exists to say "THIS will work, I guarantee it".
So I wrote down your questions on a sheet of paper, and I'll just start going through them:
Leveraging your techs and assistants to see more patients:
1) Have your tech do all of the UWT (you may both need to be involved for the first little while to see how things do, what you like, trouble shooting etc.)
2) Enable / allow scheduling for Modalities Only treatments that your tech can do - there are some dogs where this is all that is needed (i.e. some of the pain cases, geriatric cases, and early post op cases)... of course, you can always throw in ROM & stretching to this, as she will be trained to do those as well. You may also be able to get away with YOU coming in to do acupuncture (can't recall if you do this) - throwing in the needles and then leaving the tech to do the rest.
3) Have your tech 'following up' after you see each patient - You reassess the patient, do any manual therapies, set the plan for the session & your tech carries it out. You could potentially run two techs this way... but it's maybe not the way to START as your case load is not likely to warrant this approach just yet.
4) Now, the next suggestion is based on my own findings within my clinic, that the clients become very attached to the therapist... and you gain so much in regards to 'relationships', compliance and buy in from letting them have a FULL appointment access with you. So perhaps you alternate sessions between the ideas 1 & 2 and a full session with you.
Predicting patients is hard as a start up.
My clinic - we have 4 part time therapists. We see about 73 - 85 patients a week (physio only... this doesn't count the UWT... I'll get there). The therapists are providing approximately 59 hours of coverage. The UWT is seeing up to 52 patients a week within 39 hours. Our UWT is currently serviced by tech assistants / animal care attendants / learn on the job / previous vet clinic experience...
Scheduling... and this is specific to ME and the fact that I LIKE to have talking time built in, cleaning time between patients, buffer time for charting etc.
So all appointments are booked for 45 minutes - with the intention that the appointments are 30 minutes long roughly.
I tried to get the UWT to snug up their time slots - but it was too hard for them to get tidying up and cleaning done between patients - so we left it at 45 minutes.
I'm sure a true business analyst would kick me in the shins for allotting so much down time...but that is what I call the 'intangible' that we have built into our clinic and has created a very loyal group of followers / groupies / returning customers - even when their dogs are done active rehab!
We see anywhere from 24 initial assessment last month (September is a slower month) to 38 the previous month (our highest ever)! We have been a 'physical business' (i.e from when we opened The Canine Fitness Centre and after I had been treating from my home office & mobile) for nearly 9 years now... we didn't start with those numbers. In fact, we started with being open only 3 days a week back then too! We were that way for 1.5 - 2 years, and then brought on a second therapist.
Charges - oh this is a hard one. Rehab is time intensive (for everyone involved) and not a 'one shot deal' (i.e. the dog needs to come back a few / several times often)... so you can't blow them out of the water... that being said - there's an phrase I heard today on a marketing audio I was listening to: "You can price it high and watch them buy, or price it low and hope it grows." Likely a valuable lesson in that. So, when we started, we modelled the prices I was charging from my home office and grew them from there... we couldn't jump too much higher b/c people were used to paying for those prices...but I didn't have nearly the overhead... and as a 'stupid, naive, bleeding heart health care worker', I was already undoubtedly priced much too low already!!! But I admit to having that damn bleeding heart health care worker mindset as my background (and Canadian at that...i.e. universal health care is a 'right')... which I am STILL very much trying to shake!!!
Our initial assessment charge is $215 for 1.5 hours (we tell the clients 1hr 15... and that way if we go over, they think we're great.) It includes assessment, treatment, written home program (and all of the paperwork necessities that go along with it - referral acquisition, charting, note back to the rDVM...). Now, we have just had some discussion at the clinic in regards to appointments that are notably shorter than this (i.e under 1 hour) - in which case, we only do a charge of $160... but we never tell the clients that they might be charged less if it takes less time! If it's a straight forward, simple case, that's what their charged. Alternately, if its a straight forward simple case (perhaps post op) where their best treatment would have been UWT -but it's unavailable (or maybe it it...) then they are charged the full $215 and their first UWT treatment (that day or the next appt day is 'free'). Just for your future reference, in this scenario, when we are paying commission to the therapists - the therapist is only paid on her commission % of $160, and the remaining $55 goes entirely to the clinic to pay for the UWT.
For UWT. There is never a need to use it for less than 10 minutes. To do so is criminal and entirely a waste of everyone time. I am being so blunt, because perhaps you heard from someone somewhere along the way of your studies who may recommend only 2 or 3 minutes of UWT use. Complete and absolute rubbish!
So, all of our sessions start at 10 minutes (yes, there may be rest periods within this time).
We have broken our down into UWT Fitness & Conditioning - for the agility, conformation, obedience dogs that are using it for that:
These dogs start at $25 for 10 minutes and go up by a dollar a minute there after. Mind you a fitness & conditioning case will start at 15 - 20 minutes usually.
For Rehab Cases - i.e. they are actively on treatment, they may also get laser as part of their UWT session, and the UWT person communicates with the therapists about progress etc and tracks when the dog should go back for a therapist re-evaluation:
These dogs start at $35 for 10 minutes and also go up by a dollar a minutes.
Note: It kills me, but we did just lower our prices back in April because we had noted that the UWT prices were too high and I think we had priced ourselves out of the market.... and we didn't have a differentiation between Fitness & Rehab. It has made a difference to the overall # of UWT cases that come in during a day.
Note Note: We also have a 'modalities only' charge for appx 20 minutes of time for one of our assistants to use just modalities... which is $40 or 45 I think... I'm not at the clinic, and I don't have that one memorized.
Our current prices - just just increased everything by $3.00 (and we're still a bit low I think...but the explanation lies above...)
So for a 1/2 hour it's $78 and essentially it all goes up by a dollar a minute thereafter.
Okay - so I think I got to all of your questions as best I could. I'm sure you'll have more.
I'm going to cut and paste my own responses somewhere so that I can start to write 'that business book'!!!
Cheers!
Laurie
This was from another e-mail sent to me back in 2012. My thoughts are similar now as they were then!
On to business... these are tougher questions - especially giving financials. And to be quite honest, I think most of us out there practicing are sort of making it up a we go along, and trying to find the winning formula - I know I am - since nothing out there exists to say "THIS will work, I guarantee it".
So I wrote down your questions on a sheet of paper, and I'll just start going through them:
Leveraging your techs and assistants to see more patients:
1) Have your tech do all of the UWT (you may both need to be involved for the first little while to see how things do, what you like, trouble shooting etc.)
2) Enable / allow scheduling for Modalities Only treatments that your tech can do - there are some dogs where this is all that is needed (i.e. some of the pain cases, geriatric cases, and early post op cases)... of course, you can always throw in ROM & stretching to this, as she will be trained to do those as well. You may also be able to get away with YOU coming in to do acupuncture (can't recall if you do this) - throwing in the needles and then leaving the tech to do the rest.
3) Have your tech 'following up' after you see each patient - You reassess the patient, do any manual therapies, set the plan for the session & your tech carries it out. You could potentially run two techs this way... but it's maybe not the way to START as your case load is not likely to warrant this approach just yet.
4) Now, the next suggestion is based on my own findings within my clinic, that the clients become very attached to the therapist... and you gain so much in regards to 'relationships', compliance and buy in from letting them have a FULL appointment access with you. So perhaps you alternate sessions between the ideas 1 & 2 and a full session with you.
Predicting patients is hard as a start up.
My clinic - we have 4 part time therapists. We see about 73 - 85 patients a week (physio only... this doesn't count the UWT... I'll get there). The therapists are providing approximately 59 hours of coverage. The UWT is seeing up to 52 patients a week within 39 hours. Our UWT is currently serviced by tech assistants / animal care attendants / learn on the job / previous vet clinic experience...
Scheduling... and this is specific to ME and the fact that I LIKE to have talking time built in, cleaning time between patients, buffer time for charting etc.
So all appointments are booked for 45 minutes - with the intention that the appointments are 30 minutes long roughly.
I tried to get the UWT to snug up their time slots - but it was too hard for them to get tidying up and cleaning done between patients - so we left it at 45 minutes.
I'm sure a true business analyst would kick me in the shins for allotting so much down time...but that is what I call the 'intangible' that we have built into our clinic and has created a very loyal group of followers / groupies / returning customers - even when their dogs are done active rehab!
We see anywhere from 24 initial assessment last month (September is a slower month) to 38 the previous month (our highest ever)! We have been a 'physical business' (i.e from when we opened The Canine Fitness Centre and after I had been treating from my home office & mobile) for nearly 9 years now... we didn't start with those numbers. In fact, we started with being open only 3 days a week back then too! We were that way for 1.5 - 2 years, and then brought on a second therapist.
Charges - oh this is a hard one. Rehab is time intensive (for everyone involved) and not a 'one shot deal' (i.e. the dog needs to come back a few / several times often)... so you can't blow them out of the water... that being said - there's an phrase I heard today on a marketing audio I was listening to: "You can price it high and watch them buy, or price it low and hope it grows." Likely a valuable lesson in that. So, when we started, we modelled the prices I was charging from my home office and grew them from there... we couldn't jump too much higher b/c people were used to paying for those prices...but I didn't have nearly the overhead... and as a 'stupid, naive, bleeding heart health care worker', I was already undoubtedly priced much too low already!!! But I admit to having that damn bleeding heart health care worker mindset as my background (and Canadian at that...i.e. universal health care is a 'right')... which I am STILL very much trying to shake!!!
Our initial assessment charge is $215 for 1.5 hours (we tell the clients 1hr 15... and that way if we go over, they think we're great.) It includes assessment, treatment, written home program (and all of the paperwork necessities that go along with it - referral acquisition, charting, note back to the rDVM...). Now, we have just had some discussion at the clinic in regards to appointments that are notably shorter than this (i.e under 1 hour) - in which case, we only do a charge of $160... but we never tell the clients that they might be charged less if it takes less time! If it's a straight forward, simple case, that's what their charged. Alternately, if its a straight forward simple case (perhaps post op) where their best treatment would have been UWT -but it's unavailable (or maybe it it...) then they are charged the full $215 and their first UWT treatment (that day or the next appt day is 'free'). Just for your future reference, in this scenario, when we are paying commission to the therapists - the therapist is only paid on her commission % of $160, and the remaining $55 goes entirely to the clinic to pay for the UWT.
For UWT. There is never a need to use it for less than 10 minutes. To do so is criminal and entirely a waste of everyone time. I am being so blunt, because perhaps you heard from someone somewhere along the way of your studies who may recommend only 2 or 3 minutes of UWT use. Complete and absolute rubbish!
So, all of our sessions start at 10 minutes (yes, there may be rest periods within this time).
We have broken our down into UWT Fitness & Conditioning - for the agility, conformation, obedience dogs that are using it for that:
These dogs start at $25 for 10 minutes and go up by a dollar a minute there after. Mind you a fitness & conditioning case will start at 15 - 20 minutes usually.
For Rehab Cases - i.e. they are actively on treatment, they may also get laser as part of their UWT session, and the UWT person communicates with the therapists about progress etc and tracks when the dog should go back for a therapist re-evaluation:
These dogs start at $35 for 10 minutes and also go up by a dollar a minutes.
Note: It kills me, but we did just lower our prices back in April because we had noted that the UWT prices were too high and I think we had priced ourselves out of the market.... and we didn't have a differentiation between Fitness & Rehab. It has made a difference to the overall # of UWT cases that come in during a day.
Note Note: We also have a 'modalities only' charge for appx 20 minutes of time for one of our assistants to use just modalities... which is $40 or 45 I think... I'm not at the clinic, and I don't have that one memorized.
Our current prices - just just increased everything by $3.00 (and we're still a bit low I think...but the explanation lies above...)
So for a 1/2 hour it's $78 and essentially it all goes up by a dollar a minute thereafter.
Okay - so I think I got to all of your questions as best I could. I'm sure you'll have more.
I'm going to cut and paste my own responses somewhere so that I can start to write 'that business book'!!!
Cheers!
Laurie
LAURIE EDGE-HUGHES