Buying a diagnostic ultrasound in private practice - a wise investment?

We often get emails and questions on our courses asking how do you justify spending several thousands of pounds on an ultrasound machine in private practice? How do you get your money back? What is the return on investment (ROI)?

In fact, it is not just the machine that has to be considered. There is no point purchasing a machine without budgeting for some training courses.  To develop the motor skills required and the knowledge to implement ultrasound into your clinical practice takes several years andit is a huge time and financial commitment.

Many clinicians start with buying a machine and don’t spend the time developing their skills, leaving a very expensive machine to get dusty in the corner of the clinic! It takes approximately one year to get to a basic level of competency if you are scanning regularly on patients, this is approximately a minimum two full sessions a week (20 scans). Weekend courses cost £500-700 and post graduate certificates over £2500. You must also consider the time off clinic to attend the courses and attend a supervision session, plus the train and hotel costs. This all adds up! So how do you get your money back!!

To purchase a decent ultrasound machine is not cheap. If you do buy a low-cost machine, without adequate knowledge, you may quickly learn to regret it. The new Butterfly IQ handheld machine has left many clinicians with regret! Buy cheap buy twice! The quality of the machines is improving, as I have discussed in many of my blogs, however, it is likely that if you do purchase a machine of approximately £5000-£7000, that in two to three years you maybe looking to upgrade. There is no problem with this, as long as you are aware and factor it in.

To reiterate, to purchase a machine that is going to be ‘future proof’ i.e. last you for 5 years plus, will cost you approximately £10,000 to15,000 (this is with one high frequency linear probe, for example a 3-12MHz, which is all you need to get started). By ‘future proof’ I mean the image quality will be good enough as your scanning improves. Image quality is particularly important when you want to see deeper anatomical structures such as the hip or proximal hamstring and/or when you are after the finer anatomical detail of a region.

So, what about ROI on ultrasound machines? Well, it is not that straight forward.

Justifying this spend on a spreadsheet is actually quite difficult. As an example of a piece of machinery for the clinic that has a clear ROI, I recently bought a focussed shockwave machine. It cost a significant amount of money but has a very simple ROI. For every shockwave treatment we carry out at the clinic we charge £100. So, I simply multiply this by how many sessions I think we will carry out and my ROI was calculated at two years. This is pretty good and hopefully money well spent!

If you are a clinician who carries out ultrasound guided injections or get reimbursed by health insurance companies for a formal ultrasound scan, such as sports doctors, the ROI is quite straight forward (please note, health insurance companies will not reimburse a physiotherapist  or an osteopath to carry out a scan or guided injection in their practice, irrespective of your experience). As a physiotherapist, MSK Sonographer and an independent prescriber I carry out many ultrasound guided injections in private practice each week , so it is easy to justify the spend and is a simple ROI calculation. But this rules out a significant percentage of clinicians working in private practice, particularly physiotherapists and osteopaths. Therefore, the ROI can be quite difficult to justify.

There are many reasons for adding ultrasound to your clinical practice (other than a direct ROI), for both you and your patient’s that help to justify the spend:

1. New career/skill opportunities e.g. progression to ultrasound guided interventions
2. Improved skill set
3. Improved diagnostic ability
4. More awareness of the limitations of objective assessment
5. Improved anatomical and surface palpation skills

As a result of adding diagnostic ultrasound to your practice you will find you get more referrals specifically because you can carry out a scan. I would suggest 50% of my client’s book into see me because they know I will carry put a scan as part of their clinical assessment. These clients come from a variety of sources, a majority are referrals from other clinicians and word of mouth. Getting the correct diagnosis is essential to maximising your chance of getting the patient better.

In terms of ROI, here are a few points to consider:

1/ Once you have developed your ultrasound skills and knowledge (which will take a least one year to get to a basic level) many clinicians will then increase their initial assessment fee to include an ultrasound fee. I would discourage you from charging an extra fee for the ultrasound scan. It should be built into your initial assessment fee.

Why?

An ultrasound scan is an extension of your clinical assessment. The ultrasound adds another layer of information to your diagnostic ability and you are often able to make a more confident, accurate and specific diagnosis. Ultrasound should not be a stand-alone assessment or a separate examination in the hands of a clinician. They complement each other and being able to carry out a scan there and then is one of the reasons patients will attend your clinic.

For example, when in clinic I do not want to be in a position where I have a patient with shoulder pain or Achilles pain that I do not scan as they do not want to pay the extra fee for the ultrasound scan. This will potentially limit the information I can gain during the assessment, compromise my diagnostic ability and implementation of the most effective management program for that patient. Once you start scanning, the ultrasound is just part of your assessment, it is ‘what you do’ and I wouldn’t want to compromise that. Therefore, your fee structure needs to incorporate the scan.

For example, in my practice, because I use diagnostic ultrasound, I charge a higher rate for an initial assessment, which will include an ultrasound scan. This is greater than my colleagues as I carry out a scan. If they do not require a scan, they will often be booked into a colleague’s diary. This does require a well versed reception team.

2/ As a clinician who scans, you should not advertise an ‘ultrasound clinic service’. To reiterate an ultrasound scan being carried out as an extension to your normal clinical assessment, is a very different offering to providing an ‘ultrasound clinic service’.

The other reasons you should not advertise or charge separately as an ‘ultrasound clinic service’ are:

• On a musculoskeletal ultrasound list, you are likely to get ‘lumps and bumps’ e.g. a lump on someone’s neck or leg and some non-musculoskeletal conditions. Unless you have specific training in these areas, you are not going to be competent enough to give that patient the information they require. Therefore, you do not want ‘lumps and bumps’ on your list and so you should not advertise an ‘ultrasound clinic service’.

• If you are going to charge and carry out an ultrasound clinic scan as part of an ultrasound clinic service, then this needs to be carried out on a premises with CQC (Care Quality Commission). You also need to have all the necessary policies and procedures in place and a PACS system or equivalent for the storage and recall of the scans. There are many GDPR implications surrounding the storage of scans. All of these need to be considered and are unlikely to be in place in most physiotherapy clinics.

Finally….

Integrating diagnostic ultrasound into my clinical practice has been a game changer for me in terms of diagnostic capabilities, patient satisfaction, clinical reasoning and earning potential. But, before you embark on integrating diagnostic ultrasound into your private practice, it is very important to be fully aware of both the financial and time commitment.

Hopefully you found this blog useful and if you would like to discuss aspect of this article or discuss your specific situation feel free to contact me directly on chris@ultrasoundtraining.co.uk