Needs care, no $$

Needs care, no $$

When the client can’t pay, know what to do and say. Expert and Fetch dvm360 conference speaker Danielle Russ, BS, BA, AS, LVT, says that there are silver linings you can give to these bleak situations.
Mar 02, 2017

When a client can’t afford the care for their pet, compassion fatigue, burnout and even depression comes into play. Danielle Russ, BS, BA, AS, LVT, hospital manager of The Cove Center of Veterinary Expertise in Suffolk, Virginia, explains why this happens. “Guilt becomes self-imposed, or clients try to get us to feel guilt when this happens. I’ve had to go through this many times in my career; the reality I’m in now is managing a 24/7 veterinary practice makes me see the entire range. I feel for the team, the client and especially the pet,” she says.

Fortunately there are options. Russ, a Fetch dvm360 educator, offers a few of her top tips.

Know the impact of a client who can't afford care

“If it happens even one time in a day, it can really destroy the morale of the whole hospital,” Russ says. “Maybe it’s someone you’ve known a long time and they’ve hit a rough patch. Maybe it’s someone you don’t know who thinks you’re only in this for the money and makes you feel bad about it. They’re all situations where we’re providing a service with fees that we must implicate.”

Regardless of who, how or why, Russ says everyone walks away with memories of what happened—some worse than others.

Make sure you’re on the same page

“Make sure that the client understands the value of what they’re paying for and why it’s actually a good thing to spend the money,” Russ says. “I’ve seen it in emergency as we’ve gotten bigger: each case is different and it really comes down to how we present the information, how confident the client feels with the diagnoses and test recommendations.”

And it's also important to make sure that you and your entire team are on the same page too. “Work as a team to get everyone to understand the value of themselves and how they contribute to these situations. Make sure everyone understands the key structures of the hospital so that there’s no misunderstanding and you know exactly what you’re talking about. Most importantly, make sure the entire team is standing behind these values—when they’re confident in that, talking about it comes naturally.”


Embrace selling your worth

Lastly, Russ says veterinary professionals need to stop thinking of themselves as insurance salesmen. “Associates complain that they don’t want to be salesmen for pet insurance,” Russ says. “The reality is, pets not getting the care they need because their owners can’t afford it is what you’re complaining about, and pet insurance is a solution.”

And when it comes to higher rates, veterinarians shouldn’t despair. “I don’t think vets have been realistic with their worth, so we should be glad that rates have been going up. All of these things cost money; we need to charge what we’re worth. Would you rather face euthanasia, or would you rather suggest pet insurance? This will never change if you don’t accept it.”

Russ explains this by talking about the research she has personally done on advancements in human medicine compared to veterinary medicine. “In general, vet med is 10 to 18 years behind human medicine in all fields including business,” she says. “I’m going back and looking at how human medicine progressed and where insurance came in and doctors’ roles in that. At one time, doctors were in this exact situation. They themselves had to become salesmen in order to get their clients more affordable care.”

Come together, right now, over patient wellness

When it comes down to it, Russ says that as a community, veterinary professionals need to come together and work this problem out, together. “We’re moving toward a community awareness in general, particularly surrounding the aspects of depression and suicide, and the fact that technicians are leaving the industry because of this kind of stuff,” Russ says. “We’re all going to have to start working together.”

The first step, Russ says, is to remember why you came into the profession in the first place. “In school, we learn quickly not to say that we’re going into the field because we like cats and dogs. But the truth is, I really do like cats and dogs. It’s one of the biggest reasons I’m in veterinary medicine. I respect them as well as the human-animal bond and the absolutely positive effect that each can get out of this relationship,” Russ says.

With a common goal in mind, Russ says that it can be easy to work together to raise everyone up in hard times like this, which is the second step to creating a positive change. “It starts with a convention, like CVC, but you can work within your own local community. Ask questions about what works within clinics and what doesn’t when a client can’t pay.”

Russ then explains that in order to make change happen within the veterinary community, veterinary professionals must, well, make the change happen. “Actually doing something takes a lot of thought, practice and stepping out of your comfort zone. Taking action is hard, but that’s what makes a great change.” 

Increasing the Percentage of Insured Pets

While visiting the exhibit hall at the recent Western Veterinary Conference, I encountered a group of emergency and specialty practices touting the term "compassion" in their marketing materials. I asked them how compassion was applied when patients needing care were referred to one of their hospitals but the pet owner couldn't afford the necessary medical treatment. The response was that it was up to the individual hospitals in the group, some of which had funds to provide financial assistance. I then asked if their hospitals tracked the frequency of economic euthanasia performed in their practices. They did not. I reminded them that when a pet is presented at a specialty hospital it is too late to recommend pet health insurance. I suggested that each specialty hospital had a database of their referral practices and it would be easy to track which referral hospitals were sending patients with no insurance. When those delinquent practices are identified, it's time to have a heart to heart chat to encourage a more pro-active approach to recommending pet health insurance at the primary care level. Referral and emergency practices may also find it valuable to sponsor seminars on how to track the percentage of insured pets in a practice or how encourage pet owners to protect their pets. lindasisti is correct, staff guilt due to economic euthanasia is a serious preventable problem. It's important to remember, however, that there ARE solutions!

Broke Clients

If I have someone who says they are broke (and it's usually they just don't want to forego their weekend beer), I will write prescriptions for any meds and try to use the cheapest meds available. We also use drug company freebies, and in a few cases, newly expired drugs. Rarely has it worked out to have them exchange labor for medical help, as the labor performed poorly or they never get around to it! When someone comes in crying poor, we ask what their budget is--and shoehorn our diagnostics and treatment into it. Anything over their budget we line item on the invoice as a gift. If they insist on treatment that they don't have the cash for, it's credit cards or nothing--and we send them off to friends and family for help. My attitude is that if their family won't loan them money, neither will I. We have no open accounts, it's pay as you go. And we don't use Care Credit, as the people who really need it (as opposed to just like it) don't qualify and it's a huge rip off for the doctor.

One thing to DEFINITELY do is offer the best, give prognosis with each treatment, and record when they decline, so they can't come back later and say you didn't try.

The second thing is DON'T END UP WITH THE PET--we don't hospitalize these pets for any reason.

Need Care No $$$

I'm sorry I found absolutely no help in this article. I manage an Emergency Clinic. When clients bring me their seriously ill pets and have no money to treat them, the last thing I'm going to do is launch into a discussion about the benefits of pet insurance. Also, pointing out to the client who has no money, the benefits of our recommended treatment does nothing to help the client pay for the treatment, nor does it assuage the guilt that is inadvertently placed upon my staff. I had hoped this article would provide at least one suggestion. Sadly it was a complete was a waste of my time.

Short term reward vs Long term sustainability...That is the ??


I'm sad to hear you didn't find the article helpful, though I'm not surprised by your response. I wish I had a silver bullet to solve the issue immediately. While I will provide [band-aid] resources such as non-profits, additional payment options, etc in my presentation, the focus of this presentation [and article] is to start a conversation about setting in motion a long term solution to reduce the stress that you and most in our field feel routinely and is having a serious effect on our emotional well-being and ability to stay in the veterinary medicine.

Client education regarding preparing for emergencies and investing in your team with on-going education particularly, communication skills must start way before they end up in your ER. This is why we must all get involved in this conversation.

I'll speak with the team at DVM360/Firstline about doing a follow up article that will include the [band-aid] resources that I have compiled as well which may be more acutely beneficial for you and your team.

My best, Danielle T. Russ, LVT, BS, BA, AS