Educating About “Value” Has Done Nothing to Increase Veterinary Visits

Why Pet Owners Aren't Sold on -Value-

You can educate about the value of veterinary services all day long, but if you are not also offering flexible options for payment, pet owners will continue to stay away from your veterinary hospital because they perceive that the cost burden is too great. Sometimes, it really is about the money.

There is a lot of discussion these days about the importance of effectively communicating to pet owners the value of veterinary services. Helping pet owners understand the value and benefit of veterinary care, it is believed, will motivate them to visit their vet more often.  It is also thought to be a way to increase pet owners’ willingness to pay for veterinary services.

In fact, an oft-quoted statement heard in the veterinary community is, “price is only an issue in the absence of value.”

While this makes absolute sense – no one is going to seek out, or pay for, services that they don’t value – it doesn’t go far enough.  Value is only one piece of the equation when it comes to encouraging pet owners to take their animal to the vet.  Trying to sell pet owners on value, without simultaneously providing them with flexible ways to pay for that value, is like, well…herding cats! You’re just not going to get most pet owners to follow along.

It’s a well-established fact that in recent years, veterinary visits have been continuously declining.  The Veterinary Hospital Managers Association’s (VHMA) most recent data (Sept. 2019) on new client growth was accompanied by this summary statement: “New client numbers in September, 2019 compared to September, 2018 declined by 8%; the year-to-date 2019 decline is 12.3%, compared to a 12.6% decline for the full year of 2018. This continues to be a discouraging trend as these numbers have declined almost every month of the last four years.” (VHMA Insiders’ Insights, Sept. 2019, link in references.)

Some in the veterinary profession place partial blame on “Dr. Google,” who is always ready and willing to dispense free veterinary advice – although the quality of that advice is questionable at best. Others think the reason for fewer visits is because pet owners aren’t sufficiently aware of the importance of routine preventive care for their pets. The solution, say some veterinary thought leaders, is to educate pet owners, so they understand why regular vet care is essential.

Unfortunately, even though survey after survey indicates that pet owners are most concerned about the cost of care (despite fully understanding its value for the health and well-being of their pet), almost no one in the veterinary profession discusses ways to effectively assist pet owners in overcoming the cost barrier to care.

I truly believe that for too long, the role that money plays in declining vet visits has been underestimated. The most recent data (available from the Federal Reserve, The Pew Charitable Trusts, The Brookings Institution, etc – see sources cited below) shows the financial fragility of most U.S. households. Declining savings rates, inability to fund an unexpected emergency of just $400, difficulty obtaining credit (and this isn’t just a problem for low-income households), and the fact that a significant number of Americans live paycheck-to-paycheck (again, not just a low-income problem), are defining elements of the current financial landscape.

The veterinary profession must be more willing to meet pet owners where they are financially. The human healthcare sector is realizing this as well, due to the effects of the Affordable Care Act and resulting high-deductible healthcare plans (HDHPs) that have shifted a significant amount of the out-of-pocket cost burden to the patient, who must now self-pay. Consequently, many hospitals across the nation are putting “patient-centered” payment options in place, in an effort to be proactive with collecting payments. Veterinarians would do well to take a serious look at how human healthcare is helping patients cope with rising out-of-pocket costs.

WHOA, DOC! Hot Rocks no VetBilling logo

Sources: Report on the Economic Well-Being of U.S. Households in 2015; U.S. Federal Reserve 2016, p. 22 Financially Fragile Households: Evidence and Implications. Lusardi, Schneider, et al. The Brookings Institution, 2011 GoBankingRates.com, 2013

When emergency veterinary care saved my dog’s life over a decade ago, I certainly appreciated the value of the services received. I was deeply grateful to the critical care team whose knowledge, expertise and compassion contributed to a successful outcome. But I still didn’t have $4,000 readily available on the spot. Did I want to pay? Absolutely. Was I offered a way to pay that seemed commensurate with the compassion that was offered during my dog’s hospitalization?  No.

(By the way, I had a pet insurance policy at the time – I had been a policyholder for over 12 years by then.  But because pet insurance is predominantly a reimbursement-only model, it did not protect me from the large, out-of-pocket cost burden…which is what human health insurance does.  This isn’t practical for most pet owners, and I learned that the hard way.)

The prevailing payment model for veterinary care – in full and up front – which is the final act capping off a client’s veterinary experience, can quickly destroy all the goodwill that was earned by compassionate, expert medical care when there is a perception that the hospital is inflexible about payment – especially when the pet owner is facing a large bill. That loss of goodwill then becomes the defining element of the whole experience for the pet owner, and can overshadow any feelings of gratitude and appreciation they have for a job well done by the veterinary team.

Which the team deserves, and then doesn’t get.

We recently had to take a family member’s Labrador puppy to the emergency clinic after she ingested parts of a tennis ball and required emergency surgery. I had some time alone with one of the veterinary nurses who said to me, “the only thing you see about us [the hospital] when you read reviews is, ‘they’re all about the money. They don’t care about pets.’  And it really hurts — I work 16 hours a day, 6 days a week because I love this. I don’t do it for the money – none of us do.  We go above and beyond for our patients.  But all the clients see is how much it costs, and how unfair it seems that we don’t offer payment options that most clients qualify for. So in the end, it’s almost like what we do for their pets doesn’t matter.”

There is a huge emotional toll exacted on both sides when flexible payment options aren’t available. CareCredit and Scratchpay, which are based on traditional credit models, unfortunately don’t help enough pet owners today.  With an overall approval rate that hovers around 40%, too many pet owners are denied access to care when they don’t qualify for these options.

You can educate about value all day long, but if you are not offering clients creative options for paying, they will continue to stay away because they perceive the cost burden to be too great.

Educating about value is extremely important. It is absolutely necessary that pet owners understand what they are paying for. But helping them find realistic ways to pay for that value – by offering pay-over-time methods that are reasonable and attainable for “average” people – is equally, if not more, important – even urgent.  And not just for pet owners, but for the well-being of vet teams too.

Sources:

VHMA Insiders’ Insights: The Insiders’ Insights Benchmark Report is published by the Veterinary Hospital Managers Association (VHMA) on a monthly basis. The report tracks several key economic indicators to determine how VHMA member practices are performing, as well as results from VHMA surveys on issues impacting the profession. There are over 700 VHMA member practices who regularly contribute key economic indicator data. Data is representative of companion animal practices only.
Link to access reports (must be a VHMA member to access: https://www.vhma.org/resources/benchmark-reports)
Report on the Economic Well-Being of U.S. Households in 2015: U.S. Federal Reserve, 2016.  p. 22
Financially Fragile Households: Evidence and Implications.  Lusardi, Schneider, et al.  The Brookings Institution, 2011.
Survey of American Family Finances: The Pew Charitable Trusts.  March, 2015.
How Do Families Cope with Financial Shocks: The Role of Emergency Savings in Family Financial Security:  The Pew Charitable Trusts. October, 2015.
Reversing the Decline in Veterinary Care Utilization: Progress Made, Challenges Remain: White paper.  American Animal Hospital Association (AAHA), American Veterinary Medical Association (AVMA) & Partners for Healthy Pets.  March, 2014.
JAVMA News: Vital Statistics. Katie Burns, January 2013.
Partners for Healthy Pets Reports Elicit Concern, Optimism Over Preventive Care Statistics.  Hardesty, Constance.  AAHA.org: July 2014.
Revenue Cycle Management as return on investment. DiChiara, Jacqueline. RevCycleIntelligence: April, 2015

 

9 Comments

  1. Kay

    I got a CareCredit account when I had to purchase hearing aids that ran over $4500. I was surprised to learn this account could be used for Vet expenses. We’ve paid off the card but keep it handy. Our pup is getting cardiac assessment soon and this may be our payment choice. I’m thankful we have the option.

    Reply
    • Suzanne Cannon

      Hi Kay,

      I’m thankful that you have that option too! Some pet owners don’t qualify for medical credit cards like Care Credit, so they need an alternative option – which is what we at VetBilling provide.

      Regardless of the financial tool that is used, it is essential that options exist so pet owners can pay for costly care. Good luck to you and your pup, I hope everything turns out well!

      Reply
  2. Alan Abrams

    This is the EXACT reason that we exist.

    The Dr. Steve Abrams Memorial Foundation – PetSavers, Inc., is dedicated to providing funds to pet parents who cannot afford treatment in order to eliminate Economic Euthanasia.

    Hi… Thanks for connecting! Please view this short video, https://youtu.be/3ANGGDwvqj8, visit our site at http://www.DoctorSteve.org and see how we help make the world a better place.

    Reply
  3. Hb

    This is exactly why if done correctly wellness plans work for both the clinic and the client. It offers an additional payment option to get the best care for their pet at an Affortable price. This also leads to an increase in visits for additional services and revenue for the clinic. But again, it only works when it benefits both the client and clinic.

    Reply
    • Suzanne Cannon

      Hb,
      That is an excellent point. Wellness plans are very helpful, especially if they can be paid in monthly installments for those pet owners who find it challenging to pay in full for a year’s worth of services.

      What wellness plans don’t cover, though, is the cost of a sick pet visit, emergencies or surgeries. These are the situations that the average pet owner finds most challenging in terms of cost, even more so than routine preventive care.

      So having wellness plans in place is a definite plus for pet owners, but I think it is essential that vet practices also find ways to offer flexible payment arrangements for “big ticket” services.

      With only 2% of pet owners in the U.S. carrying pet insurance, I believe it is necessary – and makes good business sense – to work WITH pet owners to help lessen the financial blow when an emergency or surgery arises. The availability of third-party financing is one way to do that. Unfortunately, approval rates for these programs aren’t high enough to help many pet owners who, despite being denied by traditional lenders, are often still creditworthy.

      It is these owners, who fall into this sort of “black hole,” that VetBilling wishes to help. Our goal is to minimize the financial risk of offering in-house credit to pet owners, by fully managing contractual, auto-draft installment payments for veterinary practices. Our services make it possible for vet clinics to help more pet owners, so fewer fall into that “black hole,” and therefore are not forced to choose economic euthanasia or surrender.

      Thank you for contributing to an important discussion!

      Reply
  4. Christine Scarborough, RVT, CVPM

    Suzanne,

    Thank you for writing this! You make some excellent points, and this is definitely something that should be addressed more.

    When I was in management, the topic of adding value was discussed all of the time. The truth is, we can talk about adding value until we’re blue in the face, but that still won’t change a client’s ability to pay for services.

    Don’t get me wrong, I’m not saying vets need to give away services; I’ve never been a proponent of that. What I am saying is that our industry still has a lot of room to grow when it comes to payment options for clients. The economy hasn’t improved enough for pet owners to have more disposable income for pet care, yet for the most part, prices for care continue to rise and clients still aren’t that aware of available options.

    I recently surveyed pet owners, and a couple of the responses really frustrated me. 24% said that their hospital didn’t discuss estimates with them. 34% said their hospital had not discussed pet insurance or third party payment options with them. I’m really dumbfounded as to why more hospitals aren’t communicating with clients on these issues. Maybe if we had more of these discussions, we’d see more pets getting the care they need.

    Reply
  5. Suzanne Cannon

    Hi Christine,

    Thank you so much for your comment!

    I totally agree with you about vets not giving away services – in fact, we at VetBilling believe that more vets can get paid for services when they accept more payment options from clients.

    While that seems counterintuitive to the commonly held belief in the profession that receivables should be kept to an absolute minimum, I don’t think that is realistic in the current economic climate.

    There is a difference between aging receivables that just “sit on the books,” and a healthy roster of receivables that actually provides a year-round stream of recurring revenue. Healthy receivables can be defined as those that consist of client accounts that are actively being paid on, after an upfront, candid discussion about how much clients can reasonably, and comfortably, afford to pay. And by this I don’t mean that the total price of care should be negotiable – not at all – but I do mean that WAYS to pay for it should be negotiable and attainable for most pet owners.

    These days, expecting the average pet owner to be able to come up with hundreds or thousands of dollars immediately is generally not a workable, or practical, expectation.

    And that is where the importance of estimates and open discussions come in. I’m shocked by the fact that your recent survey indicated that so few owners are receiving estimates! In my opinion, this is where the discussion MUST begin. Owners who are “sticker shocked” are going to be unhappy, unprepared, and no more able to pay if the cost of care is kept “under wraps” than if they are consulted and collaborated with on the front end.

    I think this is where human healthcare payment initiatives can be instructive, as I mentioned in the blog post. Human healthcare providers have shifted their focus from a “collections” mindset to a proactive, “patient-centered” strategy, that seeks to ameliorate the problem of “uncompensated care” (as they refer to non-payment) by meeting patients where they are financially, instead of NOT discussing how patients can be HELPED to meet their financial commitment.

    Human healthcare providers have gone so far as to say that they believe that, given the chance, most patients want to do the right thing and pay their bill. I believe the same is true of most pet owners. Of course, there are and always will be people who are irresponsible and unethical and problematic – they are commonly referred to as “deadbeats” and statistically, those people are here to stay. BUT – honestly, out of 10 clients how many of those are TRUE “deadbeats,” and how many of those are responsible pet parents who are willing to pay, but simply need a reasonable way to pay that doesn’t cause them extreme financial distress? These are the pet owners that VetBilling WANTS to help, and these are the pet owners that the veterinary profession should also want to help.

    This is NOT about kissing money goodbye and providing services for free – it is about finding a workable solution that meets the needs of BOTH veterinarians AND pet owners. The current, most commonly offered solutions do NOT do that well enough. Traditional third-party lending options don’t have high enough approval rates to help most pet owners; therefore, they don’t help enough veterinarians because how does a practice deal with all the pet owners who fall into the black hole of being declined for third-party credit?

    The only options are to either turn away the pet owner, which helps no one; or to accept that the client won’t pay “because they never do.” I submit that clients WILL pay, but they must be provided with a financial tool that makes it easy to comply with their payment obligations.

    Expecting a veterinary practice to have the financial tools in place to manage recurring payments and to follow-up on payment-related issues is an enormous burden. Without a dedicated billing department, it is next to impossible to achieve satisfactory payment compliance. We would like to take that burden OFF of veterinary providers and handle this for them, since we have over 30 years of experience in managing payments for clients across a number of industries.

    We truly want veterinarians to be fully compensated for the care they provide. But it does mean that the emphasis must shift away from the now-outdated requirement to “pay in full at the time services are rendered.” The cost of care has gone beyond most pet owners’ ability to do this, especially for anything other than routine, preventive care.

    Providing estimates up front, discussing ALL payment options up front, and encouraging pet owners to buy pet insurance are all ways that veterinary practices can help owners pay for care, and help themselves to GET paid for the valuable services they provide.

    Thanks again, Christine, for contributing to what I think is a very, very important discussion!

    Reply
  6. Mike

    Great article!
    Unfortunately we are going thru this situation at this time with our Bulldog pup. We have had English Bulldogs for over 12 years and know what it takes to keep up on everything on them and we do have a care credit card.
    Our new baby boy has suffered a fall and now needs Right Tibial Crest Avulusion surgery withing the next 24 hours or he will not be able to use his right leg for the rest of his life. Our vet specializes in Bulldogs but does not do this kind of surgery,so they referred us to 2 surgeons who would be able to do this surgery.
    Well neither one will take a down payment and weekly payments to cover the 2000-3000 surgery. We would use our credit care card but his exam put our available credit close to the top,and we have only had this card for a short time and cannot up our limit at this time.
    I have spoken to both surgeons and even offered collateral until surgery bill is paid and the answer is still “we just cant help unless paid in full at time of services”
    We can no problem pay but do not have 2-3k sitting around so our baby has to suffer? We are outraged by this and cannot believe that if we dont come up with this money our baby has to be crippled! Absolutely disgusting these surgeons/vets dont seem to care about animals its all about the money

    Reply
    • Suzanne Cannon

      I am so sorry to hear about what you are going through, Mike! Thanks for sharing your experience. While I know it *feels* like your veterinarian/surgeon only cares about money, I can assure you that this isn’t likely to be the case.

      The problem is the way the business is set up to accept payments – or in your case, to NOT accept payments. Most vet hospitals have neither the staffing nor the financial tools in place to enable them to accept installment payments. That is one of the common problems we see here at VetBilling, and that is why we are trying to solve that problem, both for the veterinary practice and the pet owner.

      When a vet works with VetBilling, we provide them with the tools and support to accept payments – on a weekly, bi-weekly or monthly basis. This takes a considerable burden off of the pet owner, obviously, and allows them to budget the high cost of surgery – especially when it’s unexpected.

      It also takes a big burden off the vet, because VetBilling handles the pet owner payments, and works to keep owners on track with their payments by offering the support of our customer service team.

      We are working really hard to spread the word about our services to pet owners and vets, so they can meet each other halfway when it comes to eliminating the cost barrier to care.

      As far as your puppy is concerned, I REALLY hope you were able to work something out, or get a second opinion with a less expensive estimate for the cost.

      I know the whole situation seems unfair, and I have been where you are before. Maybe you can suggest to your vet/surgeon that they look into working with VetBilling so we can help you, and other pet owners who are in similar situations. We know there are a lot of you out there!

      We’d love to get an update from you on how your pup is doing. Best wishes from all of us here at VetBilling 🙂

      Reply

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