The kiss of death: DVMs 'bungled' the bundle

The kiss of death: DVMs 'bungled' the bundle

Mar 01, 2002

George silently pads to the kitchen searching for a cup of coffee. Gladys is already sitting at the kitchen table making a list of "to do" items for the day.

George's eyes narrow, "You never make lists. What's up?"

"I need to talk to you about Ginger. She started limping last week and this morning I noticed that she wasn't eating as much as usual. And last night the kids noticed an awful rash on the top of her hips. She is getting older and I am worried about her."

George listens somewhat absent-mindedly. He wonders to himself if she may be overreacting. Thinking out loud he offers to Gladys, "But 'Ginger' has always gotten her shots."

Gladys gets up and moves to the refrigerator where she last saw Ginger's vaccination reminder. She found it buried among the potpourri hanging from numerous magnets.

"Good grief, this was sent eight months ago."

She immediately calls Acme Animal Clinic. Judy Nelson, a longtime employee at Acme, quickly answers.

"Judy," she blurts, "I need to make an appointment to get Ginger's shots. She is overdue. How much will that cost?"

Judy kindly gives her the answers and books a slot for Ginger.

As she hangs up the phone, she tells George that while she is there, she will point out these other issues to Dr. Cavaness.

Zero hour

An hour later Dr. Phil Cavaness looks over the chart before entering the exam room. Cheryl, the new animal assistant, has written down that Ginger needs her 'shots'. All the vaccinations are drawn and ready to go just as she was recently trained.

Dr. Cavaness, bone-tired from a late night emergency, greets Gladys with a smile, asks some cursory questions and quickly vaccinates Ginger.

It is at this time that Gladys springs the surprise.

"Doctor, I also have noticed some other problems," she says.

Only now does Gladys describe, in some detail, what she had previously relayed to George just a few hours ago.


What are Dr. Cavaness' options?

A. Make a note to scold someone before sitting on a stool to get some shut-eye. Respond to Gladys when awakened.

B. State that there will now be a consultation charge added before any queries will be answered.

C. Apologize to Gladys for not asking more leading questions and for not thoroughly examining Ginger.

D. Listen and go about answering her questions. Then proceed with further treatment as if everything is hunky-dory.

E. Ask her to come back tomorrow so that Dr. Cavaness can separate the vaccinations from the examination and thus charge her for a full consultation and subsequent treatment.

The answer is C.

Many of you might say that the real answer is missing: i.e. Listen, answer and charge a reduced office call.

Note that an office visit had not been included in the price quoted by Judy. If you charge a reduced office call, the client base will be split between understanding the added charge and not understanding the added charge. Your goal is no misunderstandings. Sorry folks, but Dr. Cavanass is going to have to swallow some pride. You would be surprised at the overall good a little humility will do for you when dealing with clients. Most clients are pleased that you would have liked to have done a better job and will gladly dismiss the oversight completely. Therefore, the answer is still (c) with the proviso that a lot of changes are in order after Ginger leaves.

Rule not exception

Most veterinarians are faced with this situation daily but refuse to make the changes that will make this type of client visit economically viable.

First, we as veterinarians must come to the realization that the previous drama is more often the rule and not the exception. Busy people like Gladys are drowning in the minutia of life and will tend to make appointments based on the obvious oversight on their part (vaccinations) and are oblivious (and rightly so) to the financial structure in a professional office. What changes need to be made?

First and foremost we must unbundle the product/service bundle. (See related article on page 18.)

Product/service bundling

Veterinarians must never forget that their time is always valuable.

Vaccinations need to be priced according to real worth and your time also should be charged according to its true value.

One of the first benefits to unbundling the vaccination from the exam is that it results in a better examination of the pet. If you are charging a fee, you will feel much more inclined (and obligated) to be thorough. This is part of Dr. Cavanass' problem. He derives no economic benefit for doing a better job when a number of problems are revealed after Ginger is vaccinated.

More culprits

Vaccination visits are not the only culprits here.

Clients often call in for nail trims, anal gland evacuations and grooming and flea control issues that will often result in the giveaway of a free examination and consultation.

Primarily, it is the 'bait and switch' tactic that the client in most cases innocently imposes on the hospital as last minute questions. In no way is the client to blame. Our procedures and bundling have fed into our own economic problem.

Our goal is to eliminate misunderstandings and to make pet vaccination visits (and all product-oriented visits) to the veterinarian economically viable. The tradeoff for the client is that, in fact, your service side will improve through more thorough examinations and staff communication. If you think that your practice has too many product/service bundles and want to start to unbundle your product service mix, here is where to start.

Fee schedule

Life is too complicated to just add fees to your fee schedule, but this is something that makes sense and thousands of veterinarians are finally accepting this line of thinking.

If you are currently not charging some form of vaccination exam fee during your annual visit, then add one and use it.

Next, reduce your annual vaccination package by a similar or lesser amount. While you are at it, add professional fees for ectoparasite, pre-surgical, boarding, and late night special services. At first, make these fees as low as you want. It is a fact that if one makes these fees too high in the beginning you will refuse to charge these fees. You can then claim that this doesn't work 'in your hospital'. For some, charging real, actual professional services other than an 'office call' is a hard thing to do. It needs to be done.

Proper staff training

The receptionist must dig a little deeper.

On the phone, clients are often disorganized in their approach to pet problems and needs. The receptionist must ask the kind of leading questions that determine all the needs a pet may have and write them down for the veterinarians. Quoting prices should always include some form of professional service fee-whether this is called an office call, exam fee or consultation is not that important. On the other hand, I personally dislike the words 'office call.' It is non-descriptive and suggests to the client that this is some sort of an 'overhead' fee. Also, describing every service fee as an examination dictates that some form of exam must be given even when a client merely wants to discuss a problem. Exam/consultation is a more appropriate name for what we really do for our client.

Once the client is informed fully the only thing your receptionist needs is full cooperation of the owner/veterinarian. This can sometimes be difficult.

Your receptionist needs from the veterinarian:

* Uniformity in your approach to charging service fees.

* Reliability that you will charge what she quotes to the owner.

* Certainty when the client is discharged that you, in fact, did a thorough exam and consultation-otherwise they will hear about it.

Exam room technician

The tech should start by telling the client that the doctor will be in to examine the pet and to answer questions that they have. This sets the client up for the exam/consultation and more importantly prepares them ahead of time for the fact that this is not just a product or vaccine-related visit but a real professional service visit.

Next, the technician must translate what the client has told the receptionist into language that will have more meaning to the veterinary staff. For instance, a client will state, "She hasn't eaten a thing in three weeks." The tech must try to separate the client's emotion and hyperbole from reality and determine with some degree of accuracy what is really happening to the pet's appetite. This will take some further digging. Asking questions in a way that reveals underlying truth is a learned behavior. The accuracy of your technician's written summary will add value to your client's experience.


As a veterinarian the only thing that you can bring to your patient is knowledge and experience.

Products are only tools to help create positive outcomes from your knowledge base. This base has come at great expense to you in time and financial outlay. Clients realize this and appreciate it.

Don't hide your ability all bundled up in some product or other service. Charge for knowledge and experience every time you see your patient. You then have an obligation to give your patient and client the very best that you can muster. It is only fair to both.

Dr. Lane is a 1975 veterinary graduate of the University of Illinois. After graduation he practiced as an associate in California before moving to Carbondale, Illinois and establishing Lakeside Veterinary Hospital in 1978. Dr. Lane completed a master's degree in agricultural economics in 1996. He is the author of numerous practice management and economics articles.