Las Vegas-A syndicated pet columnist says more and more pet owners are complaining about veterinary fees, whereas veterinarians and management experts dismiss the argument but say it signals the importance of improved communications in practice.
Steve Dale, a syndicated pet columnist with the Chicago Tribune and WGN Radio in Chicago, says that more and more people are writing him about escalating costs of veterinary care.
He tells DVM Newsmagazine that while he is great supporter of the profession, he also understands the client's perspective. For Dale, this entire subject started with one letter from a pet owner who just spent thousands of dollars on a surgery. When the pet owner took a look at the itemized bill, she saw a charge for a nail clipping. After spending that kind of money with the veterinarian she was spurred to write because she had felt "nickel and dimed."
The result has been much more than he bargained for.
Dale said he used the letter in his column, got a well-known veterinarian to respond to the inquiry about fees, yet it still opened up the floodgates for pet owner comments.
"What is important is there seems to be this division between client and veterinarian, and it seems to be growing," he adds.
Dale moderated a panel discussion on veterinary fees at the Western Veterinary Conference. He shared the panel discussion with Drs. Robin Downing, John Ciribassi, Tom Catanzaro, Marsha L. Heinke, David Knight and Sheldon Rubin.
"At the meeting, I asked how many people dealt with veterinary fees monthly. Everyone raised their hands. I asked how many dealt with fees weekly; everyone raised their hands. I asked daily, and still everyone raised their hands. I think this is a huge issue. The trick will be how the veterinarian as a professional will be able to maintain the unique trust that clients have in them and at the same time pass along more and more expenses to people who are in some cases less and less able to afford that care."
So, how can fees be too high, when veterinarians and veterinary staff members are not paid commensurate with their education and training? Dale readily admits that veterinarians are the lowest paid when compared to other health care professionals, but his column should only be viewed as one conduit to client sentiment, he says.
"This is being talked about by veterinary clients," he adds. And that is exactly what the panel discussion attempted to address; think about fees from a client's perspective and address costs right up front.
On the radar?
For Dr. John Ciribassi a practitioner in Carol Stream, Ill., he says the fight about fees hasn't been on the rise for his practice. "In the context of a day, we do have people who have comments about fees, but I don't think there are necessarily more."
Ciribassi says, "We need to understand that everyone has a different emotional attachment to their pet, and everyone has a different financial attachment to their pet. For us as veterinarians to try to think we can tell who is who is a mistake."
"So as a result, most veterinarians aspire to offer the best possible treatment for a pet's condition, but in addition offer options and allow the client to make a choice based on what their own knowledge is based on their own relationship with their animal and financial situation," he adds.
Dr. Thomas E. Catanzaro, a nationally recognized management consultant, says that veterinary costs are rising. He adds that people complain about the cost of milk if given the opportunity; so you have to keep complaints about fees in perspective.
Dr. Marsha L. Heinke, a practice management expert and accountant with OEM Inc. in North Olmsted, Ohio, says, "What we have noted in many cases is that costs of running a veterinary hospital continue to rise at a rate greater than income increases."
Heinke says that many veterinarians have real fears about increasing fees and passing them onto clients to subsidize these costs.
"It seems that the fear is based as much in losing the favor of the client, as it is about losing the client to another veterinarian. And certainly, many doctors are concerned that patients may not receive all the medical care they could if veterinarians don't keep fees lower for clients that don't value their animals as much as the care costs," she adds.
"Unfortunately, the quality of care that a hospital can provide is directly affected by its willingness to charge appropriately for that care," she says. When veterinarians do increase fees in response to these pressures, they often find little negative feedback results, she says.
Serving up an $8 nail trim is one thing, slapping down a behavior consultation fee after asking a technician about simple and typical animal behavior is another. Overcharging on prescriptions is yet another. Veterinarians say there has been too much of a reliance to charge for products rather than services. On a bill, it may show as an inflated price for a product, when in reality the practice fee for service was too low.
From the client's perspective it can look like a practitioner was gouging for the price of a product, but from the veterinarian's side it was trying to recoup some of the costs that go into staffing and facility costs while containing the service fee.
Ciribassi contends that communication is the root to all the misunderstandings. "The big issue is how well you communicate. If veterinarians take the time to communicate what options for treatment are, and also about the costs involved, it would eliminate 90 percent of the misunderstandings that occur between veterinarians and clients."
Veterinarians are in the people business too, Ciribassi adds. "As veterinarians we are in this business to treat pets. But we can't lose sight of the fact that we are also treating the people who bring those pets into see us. Every situation we encounter in practice involves an owner. If we lose sight of the fact there is a person attached to that pet, I think as a profession, we lose a lot."
She says, "The negative commentary that does arise can often be traced back to poor communication of what the care will cost prior to beginning treatment," she says. "And since consumers seem especially sensitive to pharmacy pricing on the human side of medicine, traditional markups on dispensed veterinary items may lead to client perception of high fees in other areas. One box of flea medicine looks like another, regardless of vendor source."
Clients also may not be astute enough to understand that convenience and product supervision by their veterinarian adds value, or that pharmacy pricing help subsidize the entire veterinary practice operation. Low prices on vended heartworm, flea, and chronic care medications will mean higher prices for office calls, surgery, hospitalization and diagnostics, she explains.
What it takes?
The reality is only about 10 percent of most of a practice's clientele have financial trouble in meeting a bill, Catanzaro says.
But if you are getting complaints about fees, take on the issue from several fronts. Start talking about prevention and get clients in more than once a year.
"Prevention is what is going to make pet care affordable. Now, you can do pet care in small bites with multiple visits each year rather than one big mega visit, and it is a lot smarter from the management side."
Catanzaro also suggests that practices work to extend credit when needed. Companies like CareCredit can help, and he counsels you work with a local bank to do short-term loans for clients. He also suggests practice owners budget in good Samaritan work each year, and consider establishing a not-for-profit trust fund to help pay veterinary bills for clients who cannot afford the fees.
He adds that local veterinary associations could perform a huge service to the profession by administering this type of fund. Drives and bake sales could be coordinated to bring in revenue for the cause, and it would promote the benefits of pet care to the public. "Association medicine needs to step forward and establish community programs for people that are economically disadvantaged and the individual practitioners don't have to eat it," he says.
"We have set ourselves up as this James Herriott profession, which is good. But we need an alternative funding system," Catanzaro adds.
Dale says, "I think it is great that the veterinary profession is starting to gather scientific evidence that say pets are good for us, especially for senior citizens or people who are lonely. My question is still, how are those people supposed to pay for it? I don't know the answers, but I do know that pets are good for folks, and the problem is that not all folks can afford all care."
Dale adds that he also believes alternative funding is going to be necessary.
But not everyone agrees.
Not everyone for insurance
Ciribassi is not shy when he says he is against widespread use of a third-party payment system. He says that a system should be an option for people, but veterinarians should not be promoting any services. Ciribassi looks at the insurance debacle in human health care as a telling lesson. He says that widespread use of insurance will ultimately allow veterinarians to raise their fees, and that will force pet owners into buying policies. That is exactly the point in which veterinarians lose control.
Ciribassi contends, "Once insurance becomes pervasive and we can increase our fees, what happens to the people who don't have pet insurance?"
Catanzaro believes that a third-party system is essential.
"We can't get to the prices we need to as a profession without offering the client some method of subsidizing care."
"Pet health insurance is an indemnity insurance," he says. "The slippery slope stuff with human health care isn't there. The human health care model is not based around indemnity insurance."
What they are saying...
Excerpts from pet owner letters on veterinary fees, courtesy of Steve Dale, syndicated pet columnist.
"I don't mind paying for real care. But I recently paid $3.50 fee for a tech to put eight pills into a bottle. That's outrageous! When my dog was boarded, I was charged an extra $7 fee for exercise time. I later learned, all they did was let the dog into a dog run. I now go over each bill and ask about every penny. I once trusted veterinarians. I don't now!"
" I think veterinarians who charge more than drug stores for the same exact medications are unethical. Also, you can get some medications on the Internet for even less money."
All vets do not charge the same. It pays to shop around and look for specials. For instance, February is national Pet Dental Health Month, and some vets give discounts for teeth cleaning. Other vets offer a discount if you have more than one pet. The least expensive might be a new practitioner trying to build a client base. The reality is that economics does matter for most of us."
"I wish I had a doctor as good and caring as my veterinarian. If you adopt a pet at a local no-kill shelter, this man does not charge for the first visit. He's a kind man - and I believe the animals sense that."