Direct your fee conversations


The way you talk to clients about what you charge and why can help your practice provide good care- or block your progress. Do you need to rethink your role?

You have a big role in directing your practice's financial health. So the more you know about fees, the greater the chances your practice will thrive and grow. When you help build a healthy practice, you contribute to healthy pets, healthy benefits for your team, and high-quality medicine.

You may not realize it, but clients look to you to decide whether your practice's fees are fair. And you're also probably responsible for ensuring clients are billed for all of the services provided. These are huge responsibilities, and here's why.

MORE MONEY THAN YOU THINK MAY MOVE THROUGH THE PRACTICE WITHOUT STOPPING. In fact, it's not unusual to see 5 percent of a practice's charges fall through the cracks. For example, if your practice generates $1 million a year in gross revenue, you may not be invoicing clients for $50,000. This money reduces the practice's profitability so the doctor can't invest it in equipment, drugs, salaries, benefits, continuing education, and so on. One little missed charge may not seem like much, but they can add up to a huge cost.

The solution: Help plug the leak. For example, you might mark services off on a travel sheet or you may enter the fees in the computer as your team offers the care. You also can prevent missed fees by double-checking the services noted in the medical record against the invoice.

The practice down the street charges less. How can I explain our fees to clients?

PETS WON'T GET THE CARE THEY NEED IF YOU'RE NOT 100 PERCENT BEHIND THE FEES YOU CHARGE. So when clients complain about the cost of care, you need to deal with those comments professionally. For example, if a client comments on the cost of a dental prophy, you might say, "I can see how it seems like a lot of money, but we need to anesthetize Fluffy to get all the plaque off her teeth. And this will make her breath smell better and help prevent a variety of health problems."

Or if someone complains that their pet's care costs more than their own, you could say, "I know it seems that way. But that's because your insurance helps cover the true cost of your healthcare. It's easy to overlook the total cost when you're just paying a co-pay at the doctor's office. Let me show you this brochure about pet insurance. And I promise, in human medicine, this procedure costs 50 times more." In any case, acknowledge the client's comment and show the value your practice offers.

YOUR OFF-THE-CUFF REMARKS AFFECT CLIENTS' PERCEPTIONS ABOUT THE VALUE OF YOUR TEAM'S SERVICES. For example, a client may leave the exam room and say, "Dr. Felsted just recommended a dental cleaning for my dog. Do your dogs have their teeth cleaned?"

My owner gives away services to people who can afford to pay. Should I say anything?

The wrong answer would be to laugh and say, "No, I can't afford to have it done here. They're just going to have to live with dirty teeth!" While this receptionist probably isn't intentionally trying to harm the clinic, the message the client hears is, "Dental cleaning costs too much here."

The right answer: "Yes, my dogs do have their teeth cleaned. Not only does their breath smell much better, but it helps prevent disease. Just imagine what our mouths would be like if we never had our teeth cleaned."

IF YOU DON'T PROVIDE CONSTRUCTIVE FEEDBACK, YOUR MANAGERS MAY NEVER FOCUS ON PROBLEMS IN THE FEE SCHEDULE. There's always some low-level complaining about the cost of care, but pay careful attention to any real trends. For example, do you field regular complaints about your prescription fee? You probably hear more complaints from clients, team members, and associates than the owners or managers will, and sharing this feedback can help your team fine-tune the fee schedule.

Some clients can't afford fees-shouldn't the veterinarian still offer care?

It's impossible to create a fee schedule that pleases all of your clients, unless you just give everything away. However, with even the fairest fee schedule, you may need to adjust a few fees here and there. If lowering the ultrasound fee $15 makes this procedure more palatable to clients and makes doctors more likely to recommend the care when it's necessary, then it's worth making a change. The increase in volume will offset the decrease in the fee. If the prescription fee really makes clients feel ripped off, talk to your boss. Maybe you can get rid of it and increase each of your lab tests by $1 instead.

Tackle your fears

Now I know some of you don't agree with your practice's fee schedule. You may feel the fees are too high and worry that clients don't make the best choices for their pets because of financial pressures. While focusing on the money sometimes seems to be at odds with the goal of providing outstanding medical care, ultimately your practice can't provide high-quality medical care if it's not financially successful. Remember, your practice's fees have to generate enough money to keep the practice—and its employees—in business. (See "Where the Money Goes")

Where the money goes

If you're concerned about clients' ability to pay, work on developing programs to help them out. You may create a fund that provides care for indigent pet owners. Or you can become an advocate for pet insurance, which could help more pet owners provide all the care their pets need.

Finally, remember that you need strong fees if you want your practice owner and manager to reinvest in the practice and take care of your network of caregivers. When you support your fee schedule, you're contributing to higher quality medicine for pets in a practice where your team is fairly compensated for your care and compassion.

Karen Felsted, CPA, MS, DVM, CVPM, is a consultant with Brakke Consulting in Dallas. Send questions or comments to

Karen Felsted, CPA, MS, DVM, CVPM

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