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Not Just Vision Therapy
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By Thomas and Amee Lecoq
First of all, it is our preference that parents pay in full, in advance, at the beginning of therapy, because it increases completion of therapy, and compliance with your attendance policies. Many doctors fear asking that will cause most prospective patients to decline therapy, and if the patient is not properly prepared for this during the first phone call and subsequent interactions, they are correct.
But not for parents who are aware from the beginning that therapy will cost in the general range of orthodontia or a Reading Tutoring Program. That information must be presented at every contact in order to give the parent time to arrange for payment. A parent who has come through a step-by-step-by-step process leading up to the presentation of treatment plan and fee will have shaken themselves out, or worked out how they will handle their financial and time considerations.
In calculating a global fee, several factors come into play: 1) nature of the problem (Dx), 2) a generous estimate of the duration of therapy to resolve the problem(s), 3) determination of an appropriate hourly rate for therapy, 4) determination of an appropriate fee for initial evaluation, perceptual testing and the parent conference.
How much should a typical course of therapy cost? That depends on the nature of the diagnosis, or the complexity of the case. A relatively uncomplicated reading related problem may be resolved in 36-40 sessions, while a more complicated case may take 48-60 sessions.
We believe that the cost of a straightforward reading-related case should cost about as much as a year long reading program at a major tutoring provider or reading specialist. At this time, that is about $8,000.
We generally suggest that fees for the initial evaluation be set between $225-$325. This gives a low hurdle for parents to make the initial determination that vision is probably the problem and that you probably have the solution.
The perceptual battery fee can be anywhere from $325 to $400. (These are the fees we see most often in successful practices. The perceptual battery determines the exact nature of the problem and points to any complications that may affect the duration of therapy. Combined, these add up to about $700.
Some rehabilitation cases may take much longer to resolve so duration of therapy may be open ended, but that is another discussion.
For the uncomplicated - 40 session -- case, $8,000 is the intended fee. Subtract the combined evaluation fee and you have a balance of $7,300. Divide 7,300 by 40 and you get an hourly therapy yield of $182.50 per hour per patient. Given the high cost of operating a practice, overhead, salaries, training, marketing, etc., this is a fair rate, particularly in urban and suburban areas. We don't think it is a good idea in any location to charge fees of less than $150 per hour.
Note: If the reading tutor is getting $8,000 for a 1 year gain in reading (not guaranteed), and you are only going to charge $6,000, the sales person at the reading center has only to say, "you get what you pay for" to discount the value and impact of your proposed therapy.
The next calculation is the duration of therapy. We suggest that doctors use the COVD guidelines for duration of therapy per diagnosis as a starting point. (Download a copy here) For example, you have 3 diagnoses, the first is most complex and according to the chart, will require 36 sessions. The secondary diagnosis requires 16 sessions, and the tertiary diagnosis requires 8. To calculate, add 36, then half of the subsequent durations (half of 16 is 8, half of 8 is 4) That is, 36+8+4=48 sessions. 48x182.50=$8,760 for the course of therapy, plus the $700 for testing comes to $9,460.
If those numbers seem uncomfortably high, you have undervalued your costs and your work. If you don't charge enough, your costs will be high and your profit margins will be small. Remember that that margin is what you take home, what you use to train and develop staff and attend meetings and conferences to stay on top of the emerging neuroscience that underpins vision therapy. And having sufficient profit margins is one of the things that attracts new doctors to vision therapy.
Another factor in duration: Paid in full in advance presumes a predictable duration of therapy. We recommend for less experienced and beginning doctors that they add another 10 percent of sessions to the COVD estimates. If the case goes longer, you are covered, if the child finishes early, consider adding what Dr. Steve Ingersoll has called a cognitive finish. These sessions are about enhancing visual and cognitive abilities. For example, Lynn Hellerstein, O.D., FCOVD has an excellent book on visualization with techniques simple to complex. Other doctors have teacher therapists who teach reading and study methods that a child may have never learned because they were visually unable to execute the methods.
A few doctors simply say that the therapy will go on until the child's problem is gone and report that parents are thrilled that they don't have to bring their child in every week. We like this approach too, but know that few doctors or staff are going to be effective with this kind of presentation.
Many other factors come into play in having adequate fees, paid in full, up front.
First, you must have consistent marketing, both internal and external to generate patients who can both afford therapy and are so committed to their childrens' futures that cost is not the determining factor. This is a big part of what participants get from the Community Outreach aspect of our More Patients Breakthrough Course.
Second, you must have a system of communications in place that consistently get to the emotional factors that move parents to place the wellbeing of their child before their financial considerations. As every VT OD has found, once a committed parent knows that vision is the problem and VT is the solution, cost, time and other considerations disappear. The More Patients' Breakthrough Course provides a structured but very personal way of bringing parents to this emotional state where positive choices occur.
Third, we know that parents need from 1.5 to 3 hours exposure to the VT message in order to choose to enroll in a course of therapy. That is the purpose of the step-by-step-by-step process we have our clients implement. This process is quite gentle, yet very powerful in enabling the parent to become certain that the problem is vision and that you have the solution. Some of this is discussed in the More Patients' course, but it is detailed, with guides and staff training as a significant part of our consultation.
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CONTACT Amee direct at: 760-686-4648 (cell)
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