What to Make of the Affordable Sliding Scale
The sliding scale is still an unusual concept and some people struggle with it and what to actually pay. Following is a blended version of recent conversations I had with several new patients.
me: For this 1st visit, the sliding scale is from $25-50. You can pay anywhere in that range. You decide.
For follow-up visits, the sliding scale is $15-40. Anywhere in that range is fine.
client: I don’t get it. You don’t have a set fee ?
me: No, I don’t. This is one of about 70 community acup. practices in the U.S. and we charge affordable rates on a sliding scale so that patients can have the number of treatments they need, and not have to stop being treated before the recommended number of treatments is reached, because of the high cost.
client: I see that. I was being charged $70 by another acupuncturist and going more than 3-4 times was too much money. So, for this visit, what do I pay?
me: Anywhere in the $25-50 range. You decide.
client: I still don’t get it.
me: Here’s a sliding scale guideline based on one’s income. I don’t go by it , but you can take a look at it and use it as a starting point to decide. I don’t need or ask for income verification. It’s totally up to you to decide what you pay so that you can have the treatments you need. Some people pay $25, others $30 or $40.
$25 is fine.
client: How about $35 ?
Okay, I just added that last line for effect. And I don’t usually say those many words on the topic.
People like it that the service is affordable and times are hard, so that especially makes the s. scale attractive. But I think they also want to be fair to the acupuncturist. Even though I can honestly say that paying $25 for a 1st visit and $15 for a follow-up is totally fine, some people still hesitate to do so. It probably seems too good to be true, and that there must be a catch somewhere. (When it comes to this extended a conversation on the topic, it’s a good time to mention that the only way I can charge affordable rates is by having enough clients, who are mostly referred by other clients.)
Author: David Villanueva, L.Ac.
Have been practicing community acup. since early 2008. Solo acupuncturist. No employee. Previous employments in Home Audio retail sales and Insurance claims.
the sliding scale, a beautiful, unusual creature, rarely seen…
it’s different than having a set fee and offering discounts if “market rates” seem to be out of living wage and sub living wage people’s price range.
we’ve also had quite a few peeps ask , what’s the catch? are you licensed? are you students? are you a school?
no catch. just reality.
a tip of the hat to Lisa for reviving this lost art form, you can find her articles here before she was, er, CAN’ned by AT.
Keith Zabik
Tucson Community Acupuncture
http://www.tucsoncommunityacupuncture.org
Tucson, AZ
Ilse’s favorite question about the sliding scale
is when people ask her, “how many needles do you get for fifteen dollars, and how many do you get for thirty-five?” She says she hardly ever gets that question anymore. (What she tells them is that it’s the same, but if you miss an appointment without calling her, no matter what you pay, next time you don’t get to see your acupuncturist, you get her in the parking lot with her staple gun.)
Thanks, David, and Keith, for reminding me how amazing it is that all of us are doing this wildly improbable thing, and that patients are getting used to it by the thousands. How cool is that?
first visit flat fee
I recently started charging a flat fee of $35 for the first visit because I was finding it too cumbersome to explain two different sliding scales. This has been working out very well. I still have the same $15 to $40 for follow ups.
Tom Riordan
too cool!
After I make my Che-style tshirts of Miriam Lee, I’m going to make a tshirt with a picture of Ilse brandishing a staple gun.
Sometimes I’ve thought of explaining the sliding scale as one that slides UP – i.e., $15 is the base – not the “discount” or “charity” fee – and if you can pay more that’s great. But mostly folks get it pretty well – they know a $20 bill goes a lot farther some weeks/years/lifetimes than others.
no chocolate, no roses…
I have an unbridled love for the sliding scale.
It crouches in the corner of my clinic.
I’ve seen it many times… threatening to jump, stop time and overcome me with humility and gratitude.
Out of the Mouth of Babes
So the kids and I were driving in the car tonight, and my first grader decides to delve into the economics of my acupuncture practice. From the backseat: “Mom, who did cheap acupuncture in Frederick before you?”
“Well, Fred (my husband) was giving acupuncture for $38, but everyone else charged $75-$100 a visit.”
Shocked stuttering from the first-grader: “But who…who could pay?!…How could anyone pay that much?!? They wouldn’t be able to get acupuncture for very long then, would they? But that wouldn’t really help them then, would it?” … Stares out car window in disbelief… “Why would they want to charge *that* much if nobody can pay for it, Mom?”
“I don’t know, Honey. I just don’t know.”
Even a seven-year-old can appreciate the disparity between disposable income and cost of care in boutique practices…
Thanks, Jessica
Your first grader could teach the AAAAAAAAAAAAOM something about health care (emphasis on “requires you to CARE”. This made me tear up. Thank you for rasing kids who get it.