Addressing the affordability gap: Proactive financial client conversations

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Your patient is a 3-year-old dog with inappetence, vomiting, and diarrhea. Nothing on the signalment, history, or physical exam is obvious for a direction, so you recommend imaging, bloodwork, and a fecal exam to begin the hunt for a diagnosis. A plan is created for review with the owner, and you head to your next patient. Ten minutes later, your technician tells you the owner doesn’t have the finances for the diagnostic plan and asks if you could decide what test is the most important. You have another discussion with the owner about the vague symptoms and the list of possible diagnoses, but ultimately the owner elects for only the fecal exam in house, bloodwork out to the lab, and treatment of symptoms. You make note in the record of the declined recommendations and caution them to go to the emergency hospital if things don’t resolve in the next 24 hours. Cerenia and subcutaneous (SQ) fluids are given, and a gastrointestinal specific diet is sent home. The outcome of this case has become so commonplace, we don’t even realize how much we compromised on this dog’s care. Although most of these cases are acute, uncomplicated gastroenteritis that will resolve with that symptomatic care, what if it isn’t? What if that dog had acute liver insult and died overnight?

I had just such a case years ago when I worked in day practice, and it rocked me to my core. I began to question myself: Did I stress the importance of the tests? Did I accurately convey how sick this dog could be? Would reducing or eliminating financial constraints have changed the outcome?

Financial frustrations

In addition to my work as a consultant, I pick up shifts at my local emergency hospital to practice veterinary medicine and maintain my skills.I see these types of cases every shift. Some owners say yes to the diagnostics, we get answers, and we tailor treatment appropriately. These take less time and everyone is satisfied with the outcome of the visit. Then there are the owners that take the better of an hour to decide what level of care they will do for their pet and everyone leaves that case frustrated:

• I am frustrated the pet didn’t get the care it deserves and worry they won’t improve and therefore suffer more.
• The owner is frustrated that they financially cannot do what is needed and may take that out on everyone else, or take to social media to bully and demean the hospital and staff.
• My technicians are frustrated because they have been reduced to explaining the money rather than the value of the medicine, and they also worry the pet won’t improve.
• My front desk staff is frustrated because they were belittled and made to feel like they shouldn’t collect money for the services provided.

What is the common denominator in everyone’s frustrations? Money. Too often, pets do not get the level of care they deserve because their pet parent was not financially prepared—whether that is for preventative/routine care or for unexpected illnesses or injuries. Veterinarians know this to be true, yet we shy away from having upfront, proactive conversations with owners about financially planning for the care of their pets. We wrongly assume pet owners realize the cost of veterinary care and put money in savings for their pet. The reality is, the average American is not putting money into savings for themselves or their pets:

• According to the Federal Reserve Board's Economic Well-Being of US Households Report 2022: 37% of Americans are not equipped to handle a hypothetical $400 emergency expense.¹
• Bankrate's 2023 Annual Emergency Savings Report reveals that a majority of Americans: 57%, lack the funds to cover a hypothetical $1000 emergency expense and 22% of adults have no emergency savings.²

How quickly will your diagnostic/treatment plan approach $1000 when you have a blocked cat, or a diabetic dog, or a pancreatitis cat? How quickly would a suspect an atopic dog go through $1000 in ruling out all other causes while treating for the infections and starting anti-pruritus treatment? These are common patients in veterinary hospitals across the country, yet many owners will struggle to pay for the care their pet needs.

Lack of financial planning is a root cause for veterinary burnout as well. A 2017 JAVMA article surveyed veterinarians about owner economic limitations. Of those that responded, 84% of veterinarians said economic limitations of their clients limited or altered their treatment recommendations daily. About 77% cited it was a significant or substantial factor in their burnout.³ These factors are not limited to burnout of veterinarians; it also leads to burnout and turnover of great technicians, client service representatives, and other support staff.

Proactive vs. reactive

Veterinarians know the problem exists, yet are unwilling to embrace a solution: proactive conversations with pet parents about financially planning for the care of a pet at their very first visit to the hospital and anytime cost of care is discussed.

Why are we so averse to having these conversations? For me personally, I don’t like having conversations about money for fear the owner is going to think that is all I care about. I remind myself that just like any conversation, it is in the words chosen and the honesty in which they are given that can make all the difference in how the conversation is perceived. If the pet owner recognizes I’m not just committed to their pet’s well-being but to their own, then proactively educating them on the cost of care and their financial options helps demonstrate that commitment. It also sends the message that the hospital’s commitment to finding solutions that make quality care accessible. Owners feel heard and supported and are more likely to have a long-lasting bond with your hospital and recommend you to others.

Could a 30-second proactive conversation about cost at that first visit mean never having a money conversation again?

What are the benefits of financially prepared clients?

• Better care for the pet. Financially prepared clients are more willing to accept and follow treatment recommendations for their pet’s care, whether it be wellness, preventative, disease, or trauma. High upfront costs are less of a shock when the client is paying monthly for a financial buffer, like insurance, a wellness plan, or has an existing line of credit for veterinary care.
• Positive staff morale. When veterinarians, technicians, and support staff get to provide 100% of the care a pet deserves, they get to live out their childhood dreams. If veterinary professionals could have more days where they go home from the hospital feeling fulfilled instead of bullied and drained, hospitals would experience less turnover and a more positive work environment.
• Hospital sustainability. Financially prepared clients visit the hospital more often and say yes to “Plan A,” meaning they have a higher annual spend at your hospital without you having to change anything. More revenue means staff can be paid what they are worth, equipment can be upgraded, and the hospital can grow in a positive, sustainable way. Owners that have wellness plans, established lines of credit for veterinary care, or pet insurance often return to the hospital to make their purchases. The elimination of cost barriers also allows these clients to make decisions quickly saving valuable time.

Solutions

Veterinarians often have clients ask if they offer “payment plans.” Although we never want to decline to care for a pet when an owner doesn’t have the money, the alternative can be worse when that owner inevitably doesn’t live up to their side of the agreement. Here are alternative solutions to that age-old question:

• Veterinary Credit Cards, such as All Pet Card and CareCredit. Providing information about and accepting these cards gives the owner the option to spread the cost over several months. Offering a 6-month deferred interest payment plan incurs an additional expense of about 1-3% over regular processing fees, but this far outweighs the alternative of non-payment or suboptimal care and can lead to client loyalty as the cards are valid at the veterinary hospital, not at online or retail sellers.
• Pet Insurance. Insurance plans help defray the costs of veterinary care. Companies and policies vary in what they cover, how they cover it, and what they will pay. It is unnecessary to get into detail here. Simply educate the owner that pet insurance is available, and it is a way to be financially prepared. Provide owners with information they can use in learning about pet insurance, as well as a couple companies that have been positive experiences for you and your staff. An example of a non-biased company for general insurance information is Pet Insurance Review.
• Wellness Plans. The ins and outs on how to provide this as a hospital are beyond the scope of this article, but wellness plans spread the cost of preventative and wellness care over the year. This approach often creates more compliant owners as they want to reap the full benefits of what they are paying for monthly. Pets on wellness plans are more likely to have timely wellness exams, get regular dental cleanings, and receive heartworm and flea/tick preventatives on time.

Now what?

If you have been nodding your head in agreement while reading this information, then I have one question: why not? Why not make this change tomorrow? Why not have a serious conversation with your hospital team and prioritize having a short conversation at each and every initial puppy and kitten appointment? Why not start proactively providing financial options when cost of care is discussed? What if anything is holding you back?

Give yourself some time of honest introspection, then articulate your concerns, and decide if they are valid in the face of the information presented here. Have conversations with colleagues that struggled with the same concerns, but are on the other side and proactively educating their clients. Talk with practice management consultants about the lasting benefits for you, your hospital, and your team. It won’t be easy to start, but once you see the positive changes, you will wonder why you waited so long.

References

1. Report on the Economic Well-Being of U.S. Households in 2022 - May 2023. Board of Governors of the Federal Reserve System. Accessed October 24, 2023. https://www.federalreserve.gov/publications/2023-economic-well-being-of-us-households-in-2022-executive-summary.htm
2. Bankrate's 2023 annual emergency savings report. Bankrate, LLC. Accessed October 24, 2023. https://www.bankrate.com/banking/savings/emergency-savings-report/
3. Kipperman BS, Kass PH, and Rishniw M.Factors that influence small animal veterinarians’ opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout.JAVMA 2017; 250:7.