As the co-founder of VetBilling®, I am writing this as a sort of “open letter” to express my frustration and sadness with the current veterinary business model of pay-upfront-in-full for all services – especially given the financial devastation wrought by the coronavirus pandemic.
My frustration led me to re-post our “Vicious Circle” graphic on our social media channels for the first time since it was originally shared in August of 2019. At that time, it was our only post that ever went “viral” – resulting in over 23K post clicks, 6K shares, and nearly 2000 comments. While a lot of the comments displayed the deep chasm of mistrust and misunderstanding between pet owners and veterinarians, I think they highlighted what a searing pain point this is, and how the problem of financial access to care negatively – and continuously – impacts both sides.
I believe it is long past time to challenge the status quo of “pay upfront and in full” for every service. It is also long past time to start thinking about proactive ways to help clients pay. It’s time to get to work and start figuring out how to bundle chronic disease packages and create pay-over-time options to help clients manage those costs; it’s time to let clients make installment payments in advance for non-emergency care like dentals and spay/neuter; it’s time to give clients access to tools like VetBilling’s Pet Savings Accounts, so they can make protected financial contributions for future veterinary care.
No one seems to be talking about any of this right now. On the contrary, I’m seeing lots of excited discussion about revenues rebounding and how the pandemic didn’t negatively impact practices as much as was initially feared. Don’t get me wrong, this is very good news – we don’t want veterinary practices to struggle and go out of business. We need them to remain as financially healthy as possible.
But focusing on this without thinking about how to help clients afford services in the wake of COVID is baffling. I don’t get it.
This makes me think of the bizarre phenomenon of the stock market being up when the current real unemployment rate is nearly 24% and US jobless numbers are at 37.4 million as of this writing. (Reference: https://fortune.com/…/us-unemployment-rate-numbers-cla…/amp/)
Maybe I am crazy, but I can’t see how “rebounding revenues” are sustainable in vet med as the year unfolds, especially with many of the jobs lost likely never coming back.
I think this initial bump of rebounding revenues is due to clients coming back for non-essential services that were temporarily restricted during March, April and May. They postponed appointments (I know I did), and now many of them are trying to catch up (yep, me again.)
But this in no way indicates what is probably coming down the pike, especially in the 3rd and 4th quarter of this year. And next year, and the year after that. The financial damage from this unprecedented global event is going to be with us for a long time.
Add this to the fact that a record number of pets have been adopted during the pandemic – which is great, until they get sick or injured and need emergency care, and all these people without jobs and income have to figure out how to pay for it. That phenomenon itself creates a whole other type of vicious circle – many of these pets may end up in shelters and rescues yet again.
Or they may become victims of economic euthanasia.
I often wonder what it is going to take to get vet practices thinking about the reality of most clients’ financial situations. I thought COVID would, but so far it seems it really hasn’t.
Instead, most of the energy and excitement has been around introducing telemedicine. While I understand that this was a necessity, this only addresses a very narrow part of the huge problem of access to veterinary care. I don’t feel like anyone is really interested in looking at longer term solutions to help clients afford care. Why? Because talking about payment and financial solutions isn’t really that exciting or “sexy.” The profession wants this to be the clients’ problem. But it’s also their problem.
At VetBilling®, we believe the existing model of pay-in-full-upfront for every service, especially costly ones like sick and emergency care, is outdated and fails to acknowledge the financial reality of most pet owners – particularly in the wake of the financial impact of COVID.
We strongly encourage that all available pay-over-time options be clearly and transparently communicated to clients. Signage and brochures about payment options should be prominently displayed all over the clinic, and widely shared on all social media channels and practice websites. Our data shows when practices advertise payment options they attract new paying clients and have a higher client retention rate. Don’t assume that just because you and your team know all about CareCredit® or Scratchpay or VetBilling®, your clients do too. Many of them don’t.
Because of this, they may avoid or delay making an appointment at your practice because they don’t even know you have payment options. Potential clients who never show up is a number that may be impossible to quantify, but publications like the VHMA’s Insider’s Insights Report deliver macro-data on this right to your inbox. Since 2014, their monthly reports have shown that new client growth has been down on average 8.8% every month, existing client visits have been flat and revenue growth has been trending downward.
Could these numbers reflect pet owners’ assumption that they can’t afford veterinary care? Do these stats indicate that they don’t know payment options are available at veterinary practices? Are they afraid they’ll be one of the 60% of pet owners who won’t be eligible for the payment options that they do know about?
Helping clients navigate payment solutions should no longer be an afterthought that is dealt with only at the point of checkout. A proactive approach demonstrates compassion and empathy, and honors most clients’ financial reality. We would love to see clinics appoint 1 or 2 team members as “financial counselors,” who can talk to clients about proactive options like pet savings accounts, pre-payment plans and pet insurance.
We know that most pet owners would welcome this and breathe a sigh of relief.
Veterinary practices need to communicate loudly and clearly that they are ready and willing to meet pet owners where they are financially. This isn’t just caring and compassionate – it is good business.
This Isn’t a New Problem
Pet owners’ concerns about the cost of veterinary care long pre-dated COVID-19. They have been giving voice to their concerns for decades.The veterinary profession itself has collected and published its own data about this. Just look to the Bayer Veterinary Care Usage Study published 9 years ago in 2011. Some key points from the Executive Summary:
- “Cost of veterinary care. Many pet owners expressed shock at the size and frequency of price increases at their veterinary clinics.”
- “Pet owners responded favorably to a proposal that their veterinarian clearly define what their pet would require over a year’s time and how much these services would cost. Many indicated they would also welcome an opportunity to pay for veterinary services in monthly installments throughout the year, rather than in a single large invoice.”
Let me repeat: This was in 2011.
And while pet insurance has expanded in response to such findings, market penetration still doesn’t exceed about 2%. Why is this? Because it’s an inadequate solution for pet owners who live paycheck-to-paycheck, through no fault of their own. Almost all pet insurance companies operate on a reimbursement-only model (pay in full upfront, submit claim, then wait for reimbursement.)
But what if your bill is $4,000 — like mine was when this whole problem first really hit home for me, over 10 years ago? I had pet insurance. I was still on the hook for that $4000 upfront. I was panicked and scrambling, trying to figure out how to come up with that kind of huge outlay of cash or credit. That was what I thought the whole point of pet insurance was – to prevent me from ending up in a desperate panic over how to pay for my dog’s emergency care.
[As a caveat I feel compelled to mention that since then, some pet insurance companies like Trupanion have tried to address this problem by offering direct-to-vet reimbursement. But it’s not available through all vets and in all cases. I am not saying that pet insurance can’t be a useful tool, especially when combined with point-of-service payment options. But it just isn’t suitable for all pet owners.]
I really want to put an end to the “Vicious Circle” and throw this whole graphic away. I wish it wasn’t descriptive of what still happens too often at veterinary practices around the country.
But it is. That is our reality.
The good news is we can change this reality. It doesn’t have to be this way. Let’s think creatively. Let’s cooperate and collaborate to address this problem.
Please make sure you are letting clients know how your practice can help them pay for care. Publicize your payment options as much as you can. Ask clients if they’re familiar with your practice’s financial support system, whether that includes CareCredit, Scratchpay, an angel fund, or your own in-house payment plans.
If you are offering in-house payment plans, you can outsource that task to VetBilling® so we can help you achieve the best payment compliance and minimize your financial risk. Our platform also allows you to easily set up pre-payment plans, pet savings accounts, and any type of recurring payment option you want to offer. The creative solutions we can help you with are limited only by your imagination.
In the final analysis, though, this issue is so much bigger than VetBilling®. You don’t have to work with us. But please do something to let clients know that you understand the financial challenges they’re facing, and that you will help them identify workable solutions.
We can disrupt the Vicious Circle. It’s long overdue.
Please reach out to me at my personal email, email@example.com, if you are interested in having a conversation about how we can work together to improve financial access to veterinary care. This is my passion and my soul’s work. We can argue and disagree about the approach, but let’s not give up. We can do this.