December 28, 2016

Delinquent Clients: The Price of Compassionate Care?

Along with butchers, bakers, and candlestick makers, veterinarians are representatives of the 28 million small businesses in the United States. However, as any of the approximately 78,000 working veterinarians in this country will attest, practicing veterinary medicine is very different from just about any other occupation.
By Meredith Rogers, MS, CMPP
Rub a dub dub,
Three fools in a tub,
And who do you think they be?
The butcher, the baker,
The candlestick maker,
Turn them out, knaves all three.

Along with butchers, bakers, and candlestick makers, veterinarians are representatives of the 28 million small businesses in the United States.1 However, as any of the approximately 78,000 working veterinarians2 in this country will attest, practicing veterinary medicine is very different from just about any other occupation. With that being said, veterinarians provide a service for which they expect payment, just like any other small business, and just like any other small business, sometimes clients refuse to or cannot pay for services rendered.

Six out of 10 (63%) pet owners consider their pets to be family members,3 so the impetus to get care when their animal is sick is strong. But in today’s society, disposable income is often a rarity, and people often do not budget for emergency veterinary care. James F. Wilson, DVM, JD, founder of Priority Veterinary Management Consultants in Yardley, Pennsylvania, who specializes in veterinary management and legal consulting, and is a practicing veterinarian, finds that most people want to and intend to pay, but other bills take precedence. As Dr. Wilson put it, the mindset often is “If the phone bill doesn’t get paid, the phone gets shut off; if the veterinarian doesn’t get paid, he/she just gets angry.”

Failure to pay is not just a problem of inner-cities or poor rural regions. Jennifer Schneider, VMD, is the medical director of a midsize veterinary practice that employs 7 veterinarians for 15,000 active clients and says that even in her fairly affluent, suburban Virginia neighborhood, they experience about 0.5% to 1% in uncollectable receipts.

For many other small businesses, if a client does not pay, the recourse is to refuse to relinquish the item or attempt to impose a lien. However, although pets are considered property under the law, neither choice is acceptable when dealing with a living animal. Options are limited after the service has been provided and the client is ready to head out the door, but much can be done to prepare for this eventuality.

Every veterinary practice should have a formal policy, with the steps that will be taken clearly defined if there are difficulties with acquiring payment. However, both Dr. Wilson and Dr. Schneider said that they approach each situation on a case-by-case basis. They mentioned several factors that influence their decisions to offer different payment options, including how long the person has been a client, if the person makes an attempt to pay, if the person is elderly or on some form of public assistance, and how pleasant (or belligerent) the person is.

With all clients, the estimated costs of various options should be discussed before any procedures are initiated. Clients may need to make difficult decisions regarding the care of their pets, but at least they will have a clear picture of what can and cannot be done within their budget. Be prepared for a tough conversation as people do not like to hear that their pet cannot be helped, and more often than not, they will blame you for not caring.

Ideally, it is best to broach the subject of payment at the same time you present the patient’s medical care plan. Dr. Wilson recommends eradicating use of the word “estimate” when discussing potential costs because medical care plans include a diagnostic plan and treatment options, as well as estimated costs of care. One option you can propose, and of which Dr. Wilson is a strong proponent, is pet insurance. Numerous plans are available, with the cost per month determined by the coverage; deductible; pet’s age, sex, and breed; and geographic region. Some programs cover emergency, sick, and well-care visits, while others are strictly for sick care.

Wellness plans, where clients pre-pay for such services as physical exams, vaccinations, and health screenings, can also be offered, with discounts often given to “members” for sick care. Although credit cards are an often-used method of payment, medical-only (including veterinary) credit cards, of which CareCredit is the most popular, are an alternative. These allow clients to secure a credit line at the exact time they need it—when their pet is at the clinic receiving treatment. However, clients have to have reasonable credit to qualify, and the merchant fees can be double what a traditional credit card charges.

Once a client agrees to a particular treatment plan, if there is any doubt regarding the client’s ability/willingness to pay, secure a 50% deposit and then, as Dr. Wilson put it, “hope and pray you get the rest.” If the client balks at the deposit, a more in-depth conversation will need to happen, and this is when having a formal protocol is critical. If the client cannot secure payment through one of the aforementioned methods, you may offer the client a payment plan directly with your practice, but you still must consider how you will collect the payments (eg, mailed checks, automated bank account withdrawals) and what you will do if the client does not pay on schedule.



Another option is to outsource this function to a traditional third-party financing company, although these companies are often inflexible with respect to repayment terms. A relatively new solution comprises the numerous hybrid companies that assist you in assessing a particular client’s risk (eg, run credit checks) and offer payment plans on your terms, managing the practical aspects of fund transfer, including handing late payments, expired credit cards, etc. Examples of these types of companies include vetbilling.com and veterinarycreditplans.com. Bartering, where you exchange veterinary care for some other service, like plumbing repairs, is generally not recommended because it is difficult to ensure equal quality of work performed, and it could be viewed as a form of tax avoidance.

Euthanasia is a last resort, but is far superior to letting an animal suffer. Knowing that you can treat, and possibly even cure, a particular animal but have to euthanize it because there are no funds is one of the most stressful parts of being a veterinarian. These economic euthanasias can be difficult for the entire staff and are often a source of compassion fatigue. An alternative to euthanasia is having the client transfer ownership to the clinic. This can have substantial legal implications, not to mention the potential to lose public goodwill if the previous owner encounters the new owner and creates a stir in the community. Thus, you must have iron-clad contracts and should consult a lawyer who specializes in veterinary practices or, at the least, a book, such as Dr. Wilson’s that references a variety of forms, including transfers of ownership and adoptions.1

At the end of the day, when it looks like the balance is not forthcoming, you can contract with a debt collection agency. There are agencies that specialize in veterinary business (eg, veterinarycollect.com, americanprofit. net). These companies take a percentage of the debt, but recovering some of the lost revenue is better than none. Going to small claims court may be another possibility, but with court fees, potential legal fees, and the time involved, it is often more trouble than it is worth.

For clients who are sincere in wanting to pay but are truly indigent, some practices establish good Samaritan funds. These funds are often raised by the clinic staff, and so deciding who is worthy for assistance can create serious tension among the staff who may not agree with the decisions being made. Therefore, it is critical to have established guidelines that outline who is eligible and how the funds will be divested.

Veterinary costs are increasing due to expanding knowledge and improving technology that have introduced new diagnostic techniques, an escalating array of drugs, and more sophisticated surgical procedures. However, even though clients have a desire to treat their pets like family, their disposable income is decreasing in today’s economic climate. Thus, practices need to be prepared for clients who cannot pay. With human healthcare, there is a mandate to provide care, but there is no such requirement, other than ethical, to provide veterinary services. This often necessitates difficult conversations with clients, but if you are well prepared, you can reduce the stress to both you and your clients while providing the best treatment for the pets in your care.
 
Ms. Rogers has a Master of Science in microbiology and molecular genetics from Rutgers University/UMDNJ and a Bachelor of Science in animal health from the University of Connecticut. She received certification as a medical publication professional from the International Society for Medical Publication Professionals (ISMPP) in 2013 and has more than 19 years’ experience creating medical, veterinary, and scientific content for a variety of healthcare audiences, including doctors, nurses, pharmacists, veterinarians, and patients. She lives in Kingston, New Jersey, and shares her life with a horse, a dog, and a cat, so animal health is always a top priority and a passion for her.
References: 
  1. Small business trends. Small business, big impact! US Small Business Administration website. www.sba.gov/managing-business/running-business/energy-efficiency/sustainable-business-practices/small-business-trends. Accessed October 17, 2016.
  2. Occupational outlook handbook. US Bureau of Labor Statistics website. www.bls.gov/ooh/Healthcare/Veterinarians.htm. Published December 17, 2015. Accessed October 17, 2016.
  3. American Veterinary Medical Association. U.S. Pet Ownership & Demographics Sourcebook. AVMA website. www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-Pet-Ownership-Demographics-Sourcebook.aspx. Accessed October 17, 2016.
  4. Wilson JF. Legal Consents for Veterinary Practices with Spanish Translation. 5th ed. Yardley, PA: Priority Press Ltd; 2015.


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