The dilemma: How much is too much?

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The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the veterinary practices’ workplace cultures and procedures. At the Lee Animal Hospital, client load increased, efficiency decreased, and hospital overhead costs skyrocketed. To help offset the unexpected costs associated with the pandemic, the clinic decided to institute new surcharges including a medical waste fee, a personal protective equipment (PPE) surcharge, and cancellation fees.

Pet owners started to notice the new charges and voiced their frustrations and concerns to management. Several clients questioned the need for a medical waste fee and PPE assessment and said they were being nickeled-and-dimed to death.

Clients also asked why medical waste fees and PPE assessments weren’t a part of their general overhead costs, and said it was tantamount to charging a vaccine fee and an additional fee for the syringe. Many clients asked if surcharges were fixed or if they varied based on pet size and procedure. One pet owner asked whether it would be easier to simply roll these individual surcharges into the overall line item of professional services.

The hospital’s administrator tried to be as transparent as possible about the new fees. Most clients understood his reasoning but others disagreed with him. Many pet owners frowned upon cancellation fees and some even refused to pay them.

To address clients’ frustrations, the hospital’s administrator met with his staff. Many team members said the new surcharge policies weren’t consistent with the hospital’s culture and recommended increasing the professional service line item charge instead of itemizing surcharge fees. After listening to clients’ and staff members’ concerns, hospital management decided to increase professional service clinic fees by 5% and eliminate all additional surcharge line items.

Do you agree with management’s decision? What would you have done?

Rosenberg’s response:

When reviewing an invoice, the first thing a client looks at is the bottom line, and the pandemic has intensified this scrutiny. Additionally, veterinarians’ costs have increased because of altered pandemic protocols. Many small businesses are informing their customers that they are adding a small assessment due to COVID-19.

I have never been a fan of “medical waste” surcharges, “hazmat surcharges,” or “PPE surcharges.” These are typical overhead costs that any veterinary medical facility requires to treat patients. These costs, as with other overhead considerations, should be reasonably factored into a professional service line item.

We shouldn’t feel comfortable importing certain practices that our human medical counterparts employ.

Third-party payments and fee variations depending on whether the bill is being paid by an insurance carrier or the individual payment have led to a distrust of human medical service billings.

Our invoicing should be fair, equitable, and easy to understand. Let’s not add to the anxiety and stress that this pandemic has already brought upon our clients.

Marc Rosenberg, VMD, is director of Voorhees Veterinary Center in Voorhees, New Jersey. Although many of the scenarios Rosenberg describes in his column are based on real-life events, the veterinary practices, doctors, and employees described are fictional.