Pet owners moan about fees; experts say it signals need for communication

Las Vegas-A syndicated pet columnist says more and more pet owners are complaining about veterinary fees, whereas veterinarians and management experts dismiss the argument but say it signals the importance of improved communications in practice.

Steve Dale, a syndicated pet columnist with the Chicago Tribune and WGNRadio in Chicago, says that more and more people are writing him about escalatingcosts of veterinary care.

He tells DVM Newsmagazine that while he is great supporter of the profession,he also understands the client's perspective. For Dale, this entire subjectstarted with one letter from a pet owner who just spent thousands of dollarson a surgery. When the pet owner took a look at the itemized bill, she sawa charge for a nail clipping. After spending that kind of money with theveterinarian she was spurred to write because she had felt "nickeland dimed."

The result has been much more than he bargained for.

Dale said he used the letter in his column, got a well-known veterinarianto respond to the inquiry about fees, yet it still opened up the floodgatesfor pet owner comments.

"What is important is there seems to be this division between clientand veterinarian, and it seems to be growing," he adds.

Dale moderated a panel discussion on veterinary fees at the Western VeterinaryConference. He shared the panel discussion with Drs. Robin Downing, JohnCiribassi, Tom Catanzaro, Marsha L. Heinke, David Knight and Sheldon Rubin.

"At the meeting, I asked how many people dealt with veterinary feesmonthly. Everyone raised their hands. I asked how many dealt with fees weekly;everyone raised their hands. I asked daily, and still everyone raised theirhands. I think this is a huge issue. The trick will be how the veterinarianas a professional will be able to maintain the unique trust that clientshave in them and at the same time pass along more and more expenses to peoplewho are in some cases less and less able to afford that care."

So, how can fees be too high, when veterinarians and veterinary staffmembers are not paid commensurate with their education and training? Dalereadily admits that veterinarians are the lowest paid when compared to otherhealth care professionals, but his column should only be viewed as one conduitto client sentiment, he says.

"This is being talked about by veterinary clients," he adds.And that is exactly what the panel discussion attempted to address; thinkabout fees from a client's perspective and address costs right up front.

On the radar?

For Dr. John Ciribassi a practitioner in Carol Stream, Ill., he saysthe fight about fees hasn't been on the rise for his practice. "Inthe context of a day, we do have people who have comments about fees, butI don't think there are necessarily more."

Ciribassi says, "We need to understand that everyone has a differentemotional attachment to their pet, and everyone has a different financialattachment to their pet. For us as veterinarians to try to think we cantell who is who is a mistake."

"So as a result, most veterinarians aspire to offer the best possibletreatment for a pet's condition, but in addition offer options and allowthe client to make a choice based on what their own knowledge is based ontheir own relationship with their animal and financial situation,"he adds.

Dr. Thomas E. Catanzaro, a nationally recognized management consultant,says that veterinary costs are rising. He adds that people complain aboutthe cost of milk if given the opportunity; so you have to keep complaintsabout fees in perspective.

Dr. Marsha L. Heinke, a practice management expert and accountant withOEM Inc. in North Olmsted, Ohio, says, "What we have noted in manycases is that costs of running a veterinary hospital continue to rise ata rate greater than income increases."

Heinke says that many veterinarians have real fears about increasingfees and passing them onto clients to subsidize these costs.

"It seems that the fear is based as much in losing the favor ofthe client, as it is about losing the client to another veterinarian. Andcertainly, many doctors are concerned that patients may not receive allthe medical care they could if veterinarians don't keep fees lower for clientsthat don't value their animals as much as the care costs," she adds.

"Unfortunately, the quality of care that a hospital can provideis directly affected by its willingness to charge appropriately for thatcare," she says. When veterinarians do increase fees in response tothese pressures, they often find little negative feedback results, she says.

The gripe

Serving up an $8 nail trim is one thing, slapping down a behavior consultationfee after asking a technician about simple and typical animal behavior isanother. Overcharging on prescriptions is yet another. Veterinarians saythere has been too much of a reliance to charge for products rather thanservices. On a bill, it may show as an inflated price for a product, whenin reality the practice fee for service was too low.

From the client's perspective it can look like a practitioner was gougingfor the price of a product, but from the veterinarian's side it was tryingto recoup some of the costs that go into staffing and facility costs whilecontaining the service fee.

Ciribassi contends that communication is the root to all the misunderstandings."The big issue is how well you communicate. If veterinarians take thetime to communicate what options for treatment are, and also about the costsinvolved, it would eliminate 90 percent of the misunderstandings that occurbetween veterinarians and clients."

Veterinarians are in the people business too, Ciribassi adds. "Asveterinarians we are in this business to treat pets. But we can't lose sightof the fact that we are also treating the people who bring those pets intosee us. Every situation we encounter in practice involves an owner. If welose sight of the fact there is a person attached to that pet, I think asa profession, we lose a lot."

Heinke agrees.

She says, "The negative commentary that does arise can often betraced back to poor communication of what the care will cost prior to beginningtreatment," she says. "And since consumers seem especially sensitiveto pharmacy pricing on the human side of medicine, traditional markups ondispensed veterinary items may lead to client perception of high fees inother areas. One box of flea medicine looks like another, regardless ofvendor source."

Clients also may not be astute enough to understand that convenienceand product supervision by their veterinarian adds value, or that pharmacypricing help subsidize the entire veterinary practice operation. Low priceson vended heartworm, flea, and chronic care medications will mean higherprices for office calls, surgery, hospitalization and diagnostics, she explains.

What it takes?

The reality is only about 10 percent of most of a practice's clientelehave financial trouble in meeting a bill, Catanzaro says.

But if you are getting complaints about fees, take on the issue fromseveral fronts. Start talking about prevention and get clients in more thanonce a year.

"Prevention is what is going to make pet care affordable. Now, youcan do pet care in small bites with multiple visits each year rather thanone big mega visit, and it is a lot smarter from the management side."

Catanzaro also suggests that practices work to extend credit when needed.Companies like CareCredit can help, and he counsels you work with a localbank to do short-term loans for clients. He also suggests practice ownersbudget in good Samaritan work each year, and consider establishing a not-for-profittrust fund to help pay veterinary bills for clients who cannot afford thefees.

He adds that local veterinary associations could perform a huge serviceto the profession by administering this type of fund. Drives and bake salescould be coordinated to bring in revenue for the cause, and it would promotethe benefits of pet care to the public. "Association medicine needsto step forward and establish community programs for people that are economicallydisadvantaged and the individual practitioners don't have to eat it,"he says.

"We have set ourselves up as this James Herriott profession, whichis good. But we need an alternative funding system," Catanzaro adds.

Dale says, "I think it is great that the veterinary profession isstarting to gather scientific evidence that say pets are good for us, especiallyfor senior citizens or people who are lonely. My question is still, howare those people supposed to pay for it? I don't know the answers, but Ido know that pets are good for folks, and the problem is that not all folkscan afford all care."

Dale adds that he also believes alternative funding is going to be necessary.

But not everyone agrees.

Not everyone for insurance

Ciribassi is not shy when he says he is against widespread use of a third-partypayment system. He says that a system should be an option for people, butveterinarians should not be promoting any services. Ciribassi looks at theinsurance debacle in human health care as a telling lesson. He says thatwidespread use of insurance will ultimately allow veterinarians to raisetheir fees, and that will force pet owners into buying policies. That isexactly the point in which veterinarians lose control.

Ciribassi contends, "Once insurance becomes pervasive and we canincrease our fees, what happens to the people who don't have pet insurance?"

Catanzaro believes that a third-party system is essential.

"We can't get to the prices we need to as a profession without offeringthe client some method of subsidizing care."

"Pet health insurance is an indemnity insurance," he says."The slippery slope stuff with human health care isn't there. The humanhealth care model is not based around indemnity insurance."

What they are saying...

Excerpts from pet owner letters on veterinary fees, courtesy of SteveDale, syndicated pet columnist.

"I don't mind paying for real care. But I recently paid $3.50 feefor a tech to put eight pills into a bottle. That's outrageous! When mydog was boarded, I was charged an extra $7 fee for exercise time. I laterlearned, all they did was let the dog into a dog run. I now go over eachbill and ask about every penny. I once trusted veterinarians. I don't now!"

" I think veterinarians who charge more than drug stores for thesame exact medications are unethical. Also, you can get some medicationson the Internet for even less money."

All vets do not charge the same. It pays to shop around and look forspecials. For instance, February is national Pet Dental Health Month, andsome vets give discounts for teeth cleaning. Other vets offer a discountif you have more than one pet. The least expensive might be a new practitionertrying to build a client base. The reality is that economics does matterfor most of us."

"I wish I had a doctor as good and caring as my veterinarian. Ifyou adopt a pet at a local no-kill shelter, this man does not charge forthe first visit. He's a kind man - and I believe the animals sense that."