"Per patient" contract work

[physiof]

Hi all,
I am about to start some contract work in a private physio clinic and we are looking to do this on a per patient payment basis.

Can anyone give an indication of what is generally considered a fair rate (% of consult fee). This will obviously need to take into consideration that there will be no leave or superannuation entitlements under this system.

Thanks heaps

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[MrPhysio+]

Hi
% payment rates depend upon the skill level of the therapist, including experience, your ability to afford the rate, duties required eg if reception, money taking, report writing is included. Rates can vary from 60% down to 30%.
Hope this helps.

[Physiobase]

In my experience rates vary from 30% up to 50%. It would be rather unusual for anyone to actually pay over 50% as to do so would be business suicide!

Senior staff over 10 years experience would be on as much as 45%. It is my suggestion when employing a new physio to give a base rate %. Then to encourage them to maintain a good patient load by adding in a bonus structure that could give them what they want, but only if they achieve their target of monthly treatment sessions.

The danger is that if you pay to much as a base rate the person could earn enough to meet their real needs by only working half as much and therefore not maintaining a list. This affects your business and also makes you feel rather negatively to the staff member for cracking such a great deal in the beginning and then not delivering.

Hope this somewhat different apporach is some assistance from both ends, e.g. if someone wants to pay you less than you want, ask for a bonus based on performance to make up the difference

[alophysio]

Hi

Depends on your fee structure.

e.g. in the city where expenses may be higher, a lower % may apply.

I don't pay more than 45% usually. Any more than that i don't make any money as the owner.

I work in Australia so it is 45% + 9% for superannuation + Workers Compensation so it comes to about 50% of the income they bring in.

A downfall of this system is that the therapist may overservice compensable patients to keep their income up.

Hope it helps!

[Physiobase]

I would say that with all the additional conpensation stuff the physio employer has to pay in Australia, then the base rate for the employee should be not much more than 35%. To pay 50% makes it not really worth emplying anyone, unless as you say the practices are servicing to the max! I suppose we can blame the government and the insurance companies for that!

[DMITSCH]

Physio's should focus more on the fee than the percentage. 35% of $35 = $12.25 per consult. 35% of $60 = $21 per consult. If a someone believes they are worth more money, get out there and prove it by attracting better revenue rather than just more patients.

On the flip side, employers should consider rewarding physio's that cover thier proportion of the overheads faster by looking at bonuses for bringing in more revenue as a percentage of costs.

www.physiotherapy.asn.au/pba

[alophysio]

Hi Damien,

Can you expand your point.

I am using figures of $50 for a standard consult - something i know you guys at PBA would like to see higher:b

I agree (i think) that we shouldn't be focusing on the % but the fee but how do you compete with a practice where the owner is happy to run at a near loss at $35 for a standard and $20 for pensioners because the doctors own the clinic and refer everything over to the clinic?

Or the dedicated physio who is in it for the love of physio (seriously - i am not trying to be funny) and so charges $45 but is not the major breadwinner so doesn't worry (like i do)...

So how would you structure a package to reward the physios as you have hinted at?

[MrPhysio+]

Hi
Interesting subject. We all need to be provided with up to date Australian fee averages, before calculating percentages. Also, the way the average State Australian fee is calculated should be explained. Damien once intimated to me that as I charge more than the average fee in Victoria ($50), and the average is ($45), I should not complain! I explained that the figure of $45 was an average, meaning some charge more, and some less. Damiens comment to me does not add up when compared to the statement in this forum. Calculation of the average involves all the discounts people use, and may also include the enforced less- than -market- rate compensable body payments, plus reduced payments via preferred provider schemes such as Health funds.

We need to pay what we can afford, and hold our staff tenure in a mutually happy relationship, without providing incentive to over service. The previous statement is an impossible balance to achieve, especially in these difficult ecnomic times. Physiotherapists, I believe, are one of the worst paid professional groups, especially considering University entrance score levels, and level of education.

The problem needs to be addressed by a VERY strong representative Association. Unfortunately, I have yet to see this occur, as excuses such as the ACCC price fixing legislation are used to reduce potential actions against under payers.

MrPhysio

[alophysio]

Hi!

I agree with you MrPhysio.

Accountants,as smart as they are, can get into uni on lower TER scores and eventually earn $200k per year. Even the average accountant earns above Gr2 physios in hospitals.

We need stronger, more militant representation but we are a bunch of lovely people who help people (LOL).

I would like to see stronger representation from both the APA and ASPP.

[MrPhysio+]

Hi AloPhysio,
Thanks for the support. I have made my opinions known to the APA quite strongly over a number of years. This has resulted in the APA (via David Malone) insisting that all my mail be directed to him for comment, and that other staff are not to comment to me (re compensable body issues). I believe that I am the only member in Australia treated in this manner. A worrying trend has emerged, as reported in the latest article in the APA magazine InFocus, written by David Malone. He has stated that from next year the APA intends to undertake ' a strict compliance and a firm approach to rescinding APA membership when necessary'.
As a member that has experienced the weight of censorship intrusion via restricted commentary access to representatives, I am concerned that the APA will begin to cull members providing criticism. Very worrying.
Watch this space, as I could be the first person to have the new policy implemented, should I continue to be an active member and state my views in an open and constructive manner.
Comments are invited.
MrPhysio

[Physiobase]

Well MrPhysio, Physiobase does have to agree with you, although we do try to remain a bit unbiased.

The APA is full of issues surrounding the private practitioner. On the one hand they are making deals to increase the general throughput for the private practitioner (which is good) but from what I read in the mail this seems to be tied to special "deals" or referral contracts at reduced rates.

This is not good for anyone. We stand alone in our importance and we should not need to make "deals" in order to make an impact on the market. Our abilities and professionalism are all that is needed there. After all Physio is one of the most sort after courses following the HSC.

I am an Aussie PT who has been living in London since 1996. The APA has died during my absence and although it has made some financial recovery, this has not been at the benefit of the private sector, more at the grass roots union type behaviour of a national health system. If we are not careful we will fall the way of the nursing profession. And who wants that? I only commented to several other Aussie Physios here last week that if I returned to Australia I would cease to practice. It just doesn't seem worth it...far to much red tape across all borders.

That's the reason I also started a competitive PI Product. The APA had a long standing monopoly on that market. Now there are three making it a much more beneficial and competitive market for all Aussie Physios.

All your comments are welcome on this forum, as are any and all from the APA directly, cheers PhysioBob

[alophysio]

Since we are on the APA...

I have been trying to get the jourals Manual Therapy and Spine added to the list of online-journal subscriptions. They report they are considering it.

It would seem to me that the most represented group in physiotherapy has some form of outpatient contact be it in the public hospital system or privately. If that is the case, shouldn't resources be directed at quality journals such as the above to allow for better access to evidence based practice?

Physiobob, it ain't that hard to practice here - just not as financially rewarding!

[Physiobase]

I see your point and agree. Also I never said it was hard to practise in Aus, just a pain in the arse with insurance companies, veterans affairs, medicare etc etc. It has to wear down the practice owner overtime, much more than the people who work there. But then I do admit it is nearly 10 years since I practiced there and I have many friends with very busy practices working there. Seems a shame so much money is spent chasing up billing though.

It actually reminds me of Canada where we were paid once the billing was received from the government (prior to electronic billing). There were times we in March of one year we were still waiting on billing from the previous June! Maybe some canadians can suggest if this is still the case?

[DMITSCH]

In coming back to this forum, I must start by firmly rejecting some of the assertions made by MrPhysio. For a start, my well known and publicly stated view in relation to fees is more accurately reflected by alophysio. If physio fees were close to that of Dentistry, I'd be very pleased.

I am aware of MrPhysio's views and acknowledge his right to air them (although I don't acknowledge his privately expressed opinion that the APA has an obligation to provide public forum for him to do so). As is often the case, I must correct a few factual inaccuracies.

1. ACCC legislation tends to be not negotiable as the AMA found out in a very very expensive exercise (for both the organisation and individuals) a couple of years ago. In the last 12 months, I've had one health fund threaten to drag us into the courts before they backed down and one that threatened to drag us before the ACCC because of our position on fees. I always find it strange that some physio's want the APA to break the law on their behalf. If you're committed to breaking the law - do it yourself.

For a laugh - look up how many solicitors work for insurers first. Then consider that health insurers spends over $160Mil a year on physio alone - the profession (worth over half a $Billion a year in Aust) provides the APA around $10Mil.

2. PBA has always publicly stated that preferred provider schemes are not in the interest of physiotherapists. We recommend that people don’t join however funds have a legal right to have such schemes (yes - the ACCC solicitors checked it for us) and physio's have the legal right to ignore our recommendation.

3. I completely disagree with MrPhysio's reporting of recent communications from the APA - It's inaccurate. The new APA strategic plan called for strong protection of the APA member brand, particularly in relation to continuing professional development, code of conduct and compliance with APA professional standards - The article is clear on this so I'd suggest people read it and form their own view on its contents.

4. We can argue about competitive strategy till the cows come home however the APA has had more success in the last 3 years in Victoria (a jurisdiction MrPhysio has an interest in) than it had in the previous 10 years and the APA alone (and I repeat for ASPP fans - the APA alone) has managed to get the last 2 increases in NSW workcover fees - market rates plus 12.5% (and we're working on NRMA / MAA insurers - Hot Tip - charge MAA patients full private fees and let them argue with insurers). The APA's stated position is market rates plus the additional cost of servicing compensable patients. Competitive strategy takes more that a baseball bat.

As for APA "deals" physiobob - No APA service comes with a requirement that any product is purchased through a third party (there's those pesky ACCC laws again) - and remember, the APA does return all revenue to members by way of service and advocacy - we're not for profit and owned by the members so lets not go there.

Alophysio - On a more positive note, we're looking at those journals but they're bloody expensive. The ones you refer to will only allow access on a per member fee basis (rather than the capped fee we have with the existing journals) which means the APA doesn’t add significant value through group purchasing (which means all we're doing is forcing all physio's to effectively buy MT or spine online). If we can’t add value through a service, we'd prefer to keep the fees lower and let people make their own decision on whether they should purchase products. We are looking at whether the relevant clinical groups may be able to offer them on subscription.

Finally, I'm not here to debate APA policy or to fend off misrepresentations about the APA - I'm here to offer some comment that physio's may find helpful (to the extent that I'm able without diminishing the value of PBA membership).

The guys offering cheapy services rarely survive in the long run. I'd say differentiate your services so that you're not competing directly with cheap services on price (and before you say it - they differentiate salt so don’t tell me you can’t differentiate physio). Focus on key target markets that don’t require referrals from network type GP's (yes, I'm as concerned about GP Networks in Western Sydney as you are) and try to get directly to the client. Work out what your break even point is for each employee (yes PBA has a tool to help), add the desired return on investment and pay employees a fair percentage up to that point. After the employee has covered their costs and a fair return on investment, increase the percentage as an incentive (but calculated on a moving average model over several weeks to prevent abuse). I strongly suspect that if every practice owner in Australia went through this exercise, consultation rates would jump because they'd realise how little they are making from their efforts.

Finally, if you want to do compensable work - focus on it and build a high volume, systemised, low cost of delivery practice (lots of graduates, lots of process and IT driven results, ruthless focus on return to work and endpoints). If you don’t have a high volume low cost practice - it will always be difficult to make money from compensable patients (an unfortunate but increasingly true fact that means that in future, compensable patients just wont get access to the best physio's as they will only do private work).

*Yes MrPhysio, I know - that doesn't work with semi rural practices because the doctors wont refer......... Rural practices are an entirely different challenge and not one that I have time for at 8:20pm on a Friday night. I'm going home because like most of my association colleagues, I've done enough for the physiotherapy profession this week.

[Physiobase]

Many thanks DMITSCH for your update and clarity on a few points. I think it would be nice to take the following comment from your text

The APA's stated position is market rates plus the additional cost of servicing compensable patients.

and now discuss that by means of a new topic.

I think I will however post it in the general physio section 8o

[alophysio]

Dear Damien,

Thanks for your replies. You sound frustrated but I think it is because you have to deal with the same issues over and over again. To illustrate, i will use the journals as an example.

I have emailed / sent feedback via the website about the journals. I have gotten responses which basically said they are looking into it for next year and they will let me know.

To me, that's a fob off. I understand that there are budget concerns and that you have to maximise the value of every dollar you guys have at your disposal. I think I am fairly reasonable.

However, your explanation in your post about the fact that they will charge you per member is information that may change my mind. I don't want a cardiothoracic physio subscribing to MT. I take it from the post that you may be able to get the musculoskeletal group to have their members subscribe, it might be worthwhile. I think so too.

My point is that useful information sometimes doesn't get passed on. Until I read your post, I thought they were tossing up whether or not to spend a couple of grand on an institutional subscription - which to me is not that much given how many people there are in MS physio.

I know that you try to get info out in various forms - email, magazine, etc. but it sometimes doesn't get through.

I am naive about what goes on at the APA a lot of the time and so the $1100 per year i put in sometimes makes me question if it is worth it. How do I measure the value of that money? I have yet to rejoin the ASPP since they haven't shown me the value of joining them. I went to a seminar, paid my $80. Told I would get information and notes on private practice in a few weeks following the seminar and now it has been months. Not good.

I know that the APA has put out brochures why we should keep joining (and i have rejoined for next year) but how do i get the most out of my membership???

Thank you also for the info about the contracts and competing. I do try to differentiate myself. I also find getting the patient to rave to their doctor about you is the best since the GP is more likely to remember that than a physio off the street touting their services.

[DMITSCH]

Thanks for that alophysio.

I wouldn't say I'm frustrated from getting similar queries (particularly those like yours) on a regular basis after all, we're here for the members.

I do get disapointed when I see people posting misrepresentations.

[MrPhysio+]

Damiens comments are, as always, an interesting slant on comments made. As readers can no doubt interpret, he and the APA have a problem accepting critical comment, and are not veiled in attacking members who do so. As Damien states, readers can determine the tone of the postings for themselves. I know that I am far from alone in my beliefs, and strangely I echo the APA in its written intent. It is more the substance of action that is found wanting.
I notice that Damien did not rerspond to a previous members posting asking him to clarify his previous comments, but did respond when the convener of this forum made some statements agreeing with my view.
A pattern is developing where Damien and others within the APA single out my observations. ?raw nerve being hit.
Obviously I do not believe that my comments are misrepresentations of the facts, and resent the implication. As previously stated, members can judge for themselves.
These comments have been written after my post to the new forum topic concerning these issues, as I had not read Damiens response at that time. It is of further interest that the Shadow Minister for WorkCover expressed a view to me that he thought that the APA interpretation of the ACCC issues was spurious.
MrPhysio

[DMITSCH]

:rolleyes

I think I've said all I needed to Mark - "Finally, I'm not here to debate APA policy or to fend off misrepresentations about the APA - I'm here to offer some comment that physio's may find helpful (to the extent that I'm able without diminishing the value of PBA membership)".

[MrPhysio+]

Hello again
Thanks for the debate anyway Damien. I think forum users should have gained a valuable insight from our to'ing and fro'ing. As an APA representative, I had thought that it was part of your responsibilities to explain and defend the policy if and when it was questioned. Sorry if my interpretation of a representatives duties was incorrect. I am sure others will continue the debate and exchange information concerning this issue.
MrPhysio