Guest post by Rebecca Parker: The difference $5 makes…

The sliding scale as it was started in Portland, and how we practice it here at Philadelphia Community Acupuncture is $15-35. There is some wiggle room in the CAN guidelines for those who need to alter it slightly to fit their needs and still be in the network. This is a good thing, as not all of us will have rents like Portland or Philly.

However, I want to make it clear that $5 really does make a difference to the character of your practice and whom you will attract. I wouldn’t have thought it to be so, but my experience tells me otherwise. It makes a big difference.

Over the summer I had the great opportunity to cover for another community acupuncturist in my city. The sliding scale there is $20-35. The space is much smaller, and he sees less people per hour. I loved working there, his patients were wonderful and obviously appreciated him a lot. But it was different than PCA. It made me appreciate the PCA patients, their diversity and sheer number. There are many things that affect what type of patient is attracted to a certain clinic, including personality of the practitioner, location, etc. But the price is just as significant, if not moreso. When you are thinking of how to structure your sliding scale, make sure you take this into account. Are you willing to cut out all those people who can spend $15 at a time but not $20? Maybe you need to because the overheads in your area are too high, or because of how you choose to practice. But don’t pretend it won’t make a difference. It will change the face of your practice, which means it will change whom you are spending your time with. It will affect your numbers. Take that into account.

Here’s another allegory: I belong to two food coops, both in very diverse areas. One has amazingly low prices, as they have figured out how to use member labor to lower their overhead. The other doesn’t have such good prices, doesn’t require quite as much work from its members and doesn’t enforce those requirements as well. Guess which one has the constant discussions about “How can we make our coop more diverse?”

ellengrover
Author: ellengrover

is a punk at Philadelphia Community Acupuncture and POCA's current membership coordinator. Email her at membership@pocacoop.com.

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Responses

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  1. I need some help in deciding

    I need some help in deciding the range of my sliding scale.

    If $5 really does make a big difference, then should I offer a $10–$30 sliding scale. I don’t want to cut out all those people who can spend $10 at a time but not $15.

  2. whatever you do

    don’t decide the range of your sliding scale based on this blog post.  Do your numbers and figure out what you need to earn in order to afford to keep doing acupuncture.  Lots of help and information about this stuff in the CAN forums, if you were to join.  That said, we have plenty of patients too who pay $15 a week and come three times in that week – so we don’t cut out people who need more treatment than they can afford in the beginning, or until they get a lot better. 

  3. Likewise, as stated above,

    If you need to start your sliding scale at $20 to make the numbers work and your business sustainable, do it!  Just don’t be deluded in thinking it won’t make a difference in whom you are treating.  Just think how different our practices would be if we could start the sliding scale at $10 for everyone.  But that’s not a sustainable business model for most of us, given the realities of overhead, etc.  The bottom line is, the decision on where to put the sliding scale involves more factors than just how much we can get away with charging and still be listed on the CAN locate-a-clinic.  It goes both ways.

  4. It’s good to know that

    It’s good to know that you’re really flexible with your sliding scale, Ellen. I wonder how many others are too.

    I wonder because it seems to me that a sliding scale ranging within $15–$40 per treatment cuts out the lower working class and, maybe even, the middle working class. I understand that one needs to earn enough to afford to keep doing acupuncture, but I thought that the CAN business model was supposed to give EVERYONE affordable access to acupuncture. Many people in my rural community can’t afford to pay $15 per treatment.

    Well, I’m at a loss….

  5. Tim

    The CAN business model is not at all about giving EVERYONE access to acupuncture – there are millions of underclass people who can’t afford a $15 treatment or even a $5 treatment for that matter.  As Lisa has written about before, all that existed in this country before community acupuncture came along were the equivalent of soup kitchens and five star restaurants. The CA business model is a successful attempt to fill the void in the middle of those two extremes with – and I forget how she described the kind of restaurant in the middle, but you get the picture.  Something with lots and lots of noodles, for sure.  It’s definitely not about charity.  That said, I am pretty sure that most clinics out there are just as flexible with their sliding scale as we are when they need to be.  

    It sounds like you have a big challenge, thinking about setting up a clinic in a rural community.  There have been so many clinic additions to the network that I am not sure offhand who has done that before.   There is https://www.idyllwildcommunityacupuncture.com/ that is described as being in a little mountain town, and I think this one might be as well:  https://www.communityacupuncture.ca/,  I’ll say it again, though, the best help you can get will be in these CAN forums. 

    ellen

  6. $5 makes a difference in everyone’s life…

    I have patients on disability who cannot even begin to pay $15 per treatment and I practice in Fitchburg, MA which has lots of poverty and violence. A couple of patients only pay me $15 per week and I see them 3 times per week. I have others who pay higher than $15 and so they balance. Ellen is right and so are you Tim. However, you could really do a $10-$35 sliding scale if you can afford to do it. My guess is that your business will take off in a short period of time providing you market your services well or are already well connected in the area you plan to practice.
    You could even do something like treat a flat fee of $10 per treatment and then work your clinical skills to the point where you can see 15-16 pts. per hour and then you could be making as much as a higher fee community practice. If you have the focus, determination and the people skills, no reason that couldn’t work for you. On friday I treated 5 regular patients in less than 1/2 hour, so believe me, so could you in no time at all. Most people fit predictable treatment patterns anyway so you would be spending about 90% of deep thinking time on 10% of your patients.
    Philosophically/politically is besides the point. Your skills and your determination to provide your skills to more people is what will make your practice work in a way that you can make a liveable wage.

  7. Thanks Tess! Your response

    Thanks Tess! Your response was very helpful.

    I believe that people in rural communities are just as deserving of affordable acupuncture as people in urban/suburban communities. So, as far as earning enough to keep doing acupuncture, I look at it this way: six patients per hour at $10 per patient comes out to $60 per hour. Earning $60 per hour ($30 after expenses) is fine with me — it’s certainly more than what most people earn per hour.

  8. When I started out doing CA treatments

    I used a $20 to $40 sliding scale. After 2 years of doing that we expanded the sliding scale, first as an experiment to include $15 at the low end.  Right off the bat many people commented that they were happier having the $15 option and that at $20 per tx multiple treatments per week were much less doable.  We ended up bringing the high end of the scale down to $35 as well.   As a result of lowering our sliding scale that $5 we got a lot busier, and had a lot more people committing to coming for 2 or 3 visits a week, which is great because we so often make much better progress that way. Neither our patient numbers nor our weekly take have dipped down due to bringing the sliding scale to $15.  I highly recommend starting at  $15 if you can afford to.  

  9. Lowering the sliding scale

    Here is a thread on lowering sliding scales as appropriate for location and times, in this case Detroit.

    https://www.communityacupuncturenetwork.org/node/4151

    If your overhead is cheap in your area, and you can make the numbers work for you in a sustainable way, go for it.  Do the math first, so you know what to expect.   Then open your doors and watch your neighbors pour in for treatment and have a blast!  

  10. just remember though…

    $60 per hour has to pay for all of your overhead.  If you doing this on your own, you will have to work many hours.  many people do but treating as many per hour as you plan can be exhausting work.  Personally, I think many acupuncturists make too much of this as I know some of the more successful practices have practitioners who work their asses off…just like any small business owner.  Working hard takes the “precious” out of what we do…our profession could use more of that.  

    Use seem to have a good attitude about what you want to offer your rural patients.  Central Mass is largely rural and I have patients who come from many places and MANY media outlets so you may have to figure that out if you need to get busy fast.

    I complain alot (one of my favorite pastimes) but I am currently at between 60-75 pts per week (with some peaks and valleys as expected) after under 1 1/2 years.  Lots of things outside of my practice made building go more slowly but I’m lucky that I have better outside help now so I expect my numbers will continue to rise (like foothills which fall too) until May or June with a mid summer lull and back in the saddle in September.  Lots of marketing helps.  

    Desire and determination are your best allies…let us know how you make out. 

  11. the sliding scale

    One other thing to keep in mind is to remember the model; high volume, low cost. I’ve come to realize that there are layers of community acupuncture for both the patient and practitioner that takes some time to really understand….especially starting out. For instance, telling a patient who has an acute condition that they need to come in for 10 treatments. If we uncover any resistence that’s a financial one – we can tell them that for those 10 treatments that they can pay whatever they can afford. It could be $50 or it could be $100…they decide. They start coming everyday and most likely, they will get better. (Or they decide very quickly that this is not for them) Not only have you helped a patient, you have a patient advocate who will tell their friends that this acupuncture stuff really works..This is how the numbers game really starts to work. Having a room full of people is one of the best marketing tools we have. It generates more energy, builds patient population as well as gets punks in the zone to treat lots of people. With a room of people in recliners your patients will notice and you can tell them, yes this is how it’s supposed to look like in our clinic….. so tell your friends…
    -Joseph

  12. Might it be smart to make the low end of the scale 20 or 25, and then offer discounts or free treatments if people pre-pay for monthly plans? For example, a person who would normally pay at the low end of 20, will only have to pay 15 if she pre-pays for a month’s worth (8 to 10) of treatments. What do you think?