Access to care: Removing the barriers that keep pets out of clinics
Freelance writer Rachael Zimlich worked as a reporter for dvm360 magazine before returning to school to become a registered nurse. She now works at The Cleveland Clinic.
If the veterinary profession finds new ways to serve clients with limited finances, pets and practices will both be healthier, experts say.
Pet ownership comes at a cost, literally. Food, supplies and, of course, veterinary care all add up financially over the course of a pet's life. But when should the cost of owning a pet prevent someone from actually owning a pet? And what is the veterinary profession's responsibility to pets and owners who face barriers when it comes to obtaining care?
Every veterinarian has struggled at some point to help people afford the care their pets need. It can be difficult to balance the needs of these pets and owners with the needs of the practice. While the answers to these challenges aren't clear, some thought leaders are suggesting that a shift in the way veterinarians provide care may be a start.
The scope of the problem
Nationally, the number of pets whose owners can't afford their care is huge. The University of Tennessee's Access to Veterinary Care Coalition released a national population study in December 2018, with the help of a grant from Maddie's Fund, to understand barriers to veterinary care across the socioeconomic landscape. The report acknowledges the paradox that while families who can't afford pets should perhaps not have them, it's also difficult to deny someone the companionship of a pet.
The report revealed that an estimated 29 million dogs and cats live in households that rely on the federal Supplemental Nutrition Assistance Program (SNAP). Most households in the study reported having 2.2 pets, and only one out of four households owned just a single pet. Households with lower incomes were more likely to have just one pet, the report indicates.
Eighty percent of participants in the study considered their pets to be a part of their family, regardless of income. But roughly a third of households studied experienced barriers to veterinary care, and in 80 percent of those cases, the barriers were financial. This is not just a problem for poor households, either. The report notes that about 75 percent of Americans working full-time live paycheck to paycheck, and even pet owners in higher-income classes say finances are the reason they don't pursue some types of veterinary care.
Veterinarians were polled in the report, too. Most of those who participated believe that all pets deserve some level of veterinary care, and almost 90 percent say pet owners not being able to obtain veterinary care for their pet negatively impacts their (veterinarians') mental and emotional health.
Here are some additional findings in the report:
- 23 percent of pet owners say they've had trouble obtaining preventive care for their pet in the recent past.
- 80 percent of pet owners cite finances as a barrier to preventive care.
- 44 percent of pet owners who can't afford preventive care also share experiences of not being able to afford sick care for their pets.
- 74 percent of pet owners reported not being able to afford sick care, with middle class participants as likely to cite financial barriers as lower-income participants.
- 59 percent of participants in the highest income bracket reported that they did not pursue sick care for their pet due to financial reasons.
- 56 percent of pet owners reported not being able to afford emergency care for their pets.
Other barriers to care cited by pet owners include having trouble getting to a veterinarian, not having a way to transport the pet to a veterinary facility and not knowing where to obtain veterinary services. But financial barriers were by far the most common barrier to veterinary care in every economic population group.
Developing new models
Michael J. Blackwell, DVM, MPH, FNAP, director of the Program for Pet Health Equity at the University of Tennessee and chair of the Access to Veterinary Care Coalition, says pet owners' financial dilemmas are a hard pill to swallow for veterinarians.
“Many practices regularly see clients that have needs the practices can't meet because they can only give away so much of their services,” Dr. Blackwell says. “Most vets can shave fees or change treatment plans to meet needs, but the cost of operating practices has gone up. The cost of healthcare for both humans and animals continues to increase.”
While many veterinarians try to help pet owners where they can, it's a problem that's not going away or getting better.
“When we look at demographics across the country, the working poor as a group are not getting smaller,” Dr. Blackwell says. “More revenue needs to be in the equation, and the revenue is not going to come from families.”
One potential solution is AlignCare, a program spearheaded by the University of Tennessee College of Social Work and supported by Maddie's Fund that aims to use existing resources to achieve better outcomes for pets and help disadvantaged families.
“Veterinary medicine has operated in a silo, not One Health,” Dr. Blackwell says. “When we look at lack of care, it's not that we don't know what to do in veterinary medicine. The problem is human reality, and the ecosystem is low socioeconomics.”
AlignCare is a three-year program that will enroll pet owners through social service agencies and pair them with participating veterinary practices. The program will test Medicare- and Medicaid-type models, paying practices a flat rate for treating a certain number of participating clients each month versus paying a set fee for certain types of conditions.
The program seeks to develop a better understanding of decision points in veterinary practice and also to test a managed care environment, where veterinarians agree to provide services at a below-market level while a third party pays a subsidy and pet owners pay a copay.
The program will be implemented in 10 communities by July 2019. After three years, Dr. Blackwell says, AlignCare will assess whether to expand the model throughout the country.
But what's in it for veterinarians?
Veterinarians have one of the highest suicide rates in the country, and Dr. Blackwell says there's no mystery as to why.
“The kind of people attracted to the profession are not the kind of people who ought to be euthanizing animals they can't help,” Dr. Blackwell says. “We are not built to do that.”
The solution is not to give away services, he says, but to find creative ways to help pet owners. By helping more low-income pet owners, veterinarians can help reduce euthanasia rates or, at the very least, reduce suffering while also helping their practices obtain revenue through new models of care.
“They're able to serve clients they would not have been able to service before because now there's a subsidy that will help,” Dr. Blackwell says.
In the end, Dr. Blackwell says the goal is to make veterinary care more available to low-income pet owners, and to allow veterinarians to receive reimbursement for cases that in the past may not have generated any revenue at all.
“We believe that the biggest resource of people, knowledge, equipment, skills and facilities is the private for-profit veterinary medicine industry. So AlignCare is based on trying to leverage that resource,” says Dr. Blackwell. “We're not trying to promote nonprofits. Let's look at the biggest resource in this nation and figure out how to leverage it.”
Creating a new standard of care
AlignCare will also examine providing incremental care versus. the gold standard. In gold-standard care, bills are much higher, driven by top-of-the-line tests and treatment options, Dr. Blackwell says. Many times, he adds, the cost of working up a case leaves pet owners unable to afford the actual treatment. Incremental care-or starting with less-expensive treatment options for possible diagnoses before performing expensive diagnostics-is one strategy to control overall costs and one that Dr. Blackwell hopes to standardize.
“In doing that, we don't take care away from middle class citizens who can pay for advanced care, but we also don't let the gold standard be the barrier for other families,” Dr. Blackwell says.
David Haworth, DVM, PhD, former president of PetSmart Charities, agrees that finding a way to provide care for low-income pet owners is key to the future of veterinary medicine. In a presentation at the Fetch dvm360 conference in December 2018, Dr. Haworth outlined the plight of low-income pet owners and the opportunity veterinarians have in serving this market.
Low-income families (those who make $20,000 a year or less) who do spend money on veterinary care spend about $200 yearly on average, Dr. Haworth says. With an estimated 59 million pets in that demographic, “the math gets really big really fast in unrealized revenue.”
“I really believe the ultimate solution is a free market–based solution. How do we in philanthropy get the free market to realize it's there and de-risk the market for those who want to get into that space?” Dr. Haworth says.
While $200 per year may not go far when it comes to chronic conditions or trauma, Dr. Haworth says it can provide a lot of benefit in offering pet owners counseling and options. Some practices have found success in offering simple options based on what pet owners can afford-again, incremental care versus the gold standard.
“These pet owners are great owners because they're doing what they can-whatever that is,” Dr. Haworth says. “If we said that to ourselves more often, then we would all feel better about the jobs we're doing. A bad veterinarian is the one who watches them suffer. A good veterinarian is the one who looks at options and does what they can. Gold standards really hurt us as a profession. When we get trapped into the gold standard, clients on the lower end of the spectrum suffer.”
By doing something instead of nothing, pets and pet owners benefit along with practices, he says.
“If we can do those things, the animals will be better off and there will be revenue,” Dr. Haworth says. “Something is better than nothing.”
The key, Dr. Haworth says, is in creating a new mindset and finding a new model that benefits pets, owners and veterinarians.
“A lot of people think they can't afford veterinary care for their animals, but they can afford more than they think they can, and veterinarians could be getting that revenue if they could open their minds and eyes to take advantage of it in the right way,” Dr. Haworth says. “Ultimately it's up to the veterinarians to say, ‘I want to do this because it's the right thing, and this is an area where I can make a living and build a business.' We've got to break out of the traditional veterinary practice. There's always going to be room for that. But that's not the only model.”
Rachael Zimlich, RN, BSN, is a former reporter for dvm360. In addition to freelance writing, she works as a registered nurse at the Cleveland Clinic in Cleveland, Ohio.