Comfortably Talking with Clients about Money
World Small Animal Veterinary Association World Congress Proceedings, 2013
Peter Weinstein, DVM, MBA
PAW Consulting, Irvine, CA, USA

Dollar and Cents Takes Common Sense

As a practitioner, I found it easier to discuss life and death than dollars and cents. What is it about money, fees, costs, etc. that is so intimidating, daunting, threatening, and downright scary? Is the barrier to charging more and collecting more your clients or you?

In the 21st century, where pets have taken on the role of four-legged children in my families, we have an increasing obligation to both the client and the pet. Our obligation will always be to the pet's best interest and health. However, we can't forget the human holding the leash or carrier. If we take every action that we take with the pet's best interest and the client's best interest we should always be successful.

To be able to feel comfortable in discussing your fees with clients, you must be comfortable that clients are getting value for the level of care provided. You must make sure that they (the clients) are a part of the decision-making process. You must educate so that they are comfortable in the decisions that they made.

Talking About Money...

Numerous publications have addressed a variety of notable trends in the profession. Some of the truths noted:

 The relationship of pets within families has changed

 Expectations of clients for the services provided by veterinarians have increased

 Level of skills, technology, and care have all increased astronomically

 The actual cost to the practice to deliver the above has increased

 The reflected cost to the consumer to receive the above has increased

We must talk about the financial aspects of pet care and we must do so clearly and in a well-documented fashion. A financial policy is a step in the right direction.

What Are the Components of A Strong In-House Financial Policy?

Before you can develop a strong financial policy, you must have a staff that wholeheartedly believes that you are providing the best care possible and backing it up with value and service at a price that is competitive within your local marketplace.

The components of a financial policy:

1.  Always discussing patient needs with the client to create a level of confidence and understanding of the significance of the care to be provided.

2.  Creating healthcare plans or Treatment Plans formerly known as Estimates for Optimal HealthCare

a.  Presenting the HealthCare Plan in a fashion that focuses on both the why and the what of the procedures to be performed before focusing on the costs of the procedures to be performed.

3.  Offering multiple options to assist in the cost of veterinary care:

a.  Pet insurance (before the fact)

b.  Third-party payment options (after the fact)

c.  A variety of payment types (credit cards, cash, check, first born)

d.  Not acting as the bank for the client by offering held checks, credit cards, etc.

e.  Not being Monte Hall and hosting "Let's Make a Deal"

4.  Creating a formal financial policy and communicating your financial policy to clients and even potential clients before it becomes an issue.

Healthcare Plans

Estimates are just one way of communicating the cost of services to a client. Estimates that used to be given only to new clients or for higher bills have become more and more a necessity for financial and legal reasons. I have worked with practices that give written estimates for everything from a nail trim to a splenectomy. And there are others that just reach into the back of the minds and say, "Mrs. Jones, it will cost about $XXXX for today's work." Only to find out that they grossly underestimated the costs and were faced with having to explain that or grossly overestimated the cost and the services weren't accepted.

Take estimates seriously. Actually, if you think about estimates, they are what your repairman provides you for fixing your car or clothes washer. What we are actually providing is a cost of services based upon a clinical plan that we have ascertained would be best for the patient. Consider changing the terminology in your practice to a health care plan (HCP) from estimate.

With the HCP, you are now, as a clinician, able to focus on the left-hand column of information that has the services that are needed delineated. The exam room nurses or receptionists can focus on the right-hand column that is the costs. Summary: Doctor focuses on the needs of the pet (left column). Staff focuses on the cost for the care (right column).

Should the pet's needs change and the HCP change, advise the client ASAP. Clients are much, much, much happier and the Staff is much, much, much happier when they are forewarned about what their bill might be.

Positive and confident body language and verbiage are important, both when discussing HCPs and when eventually collecting the bill. Practiced scripts are very effective in this arena.

To get past euthanasia as an option, euthanasia can't be provided as the first option. Healthcare plans (Estimates) must provide optimal care for the case in question. These plans must be clearly explained and clarified for the pet parent. When hesitancy is noted, it is imperative that the reason for the hesitancy be identified: is it the risk of the procedure? The prognosis for a positive outcome? The place of the pet in the family hierarchy? Or the cost of care?

Offering Financial Options

Besides the more mundane cash, check and credit cards, what options do you discuss or offer to clients to help with the cost of care? By providing options to clients, you are letting them know that you care about their pet's health and want them to be able to financially afford the best care.

Do you discuss?

 Purchasing pet insurance policies for young healthy pets to provide coverage when needed

 Third-party payment options

 Barter

 Internal banking

 Discount it or just give it away

The following forms of financing are your practice acting as a bank for the client: held checks, delayed credit card payments, barter, etc. These are best avoided because most of the time they only lead to ill will.

Pet insurance has been available in the US and Canada for over 25 years, but only one percent of all American dogs and cats are insured. Insured pets see their veterinarians more frequently and sooner when they have a problem. And pet owners with insurance will pay more for veterinary care than those without insurance. Of course, if you don't have insurance and a problem arises, it is too late. Pet owners should be encouraged to buy policies for their young healthy pets and retain it for those emergencies, diseases or accidents where the wallet and the heart both weigh heavily. Besides, current insurance endorsements will help pay for basic wellness needs until the crisis mode hits.

At the same time a pet owner is signing up for pet insurance, it would be advised to get approval for third-party payment. The third-party financing world provides low- or no-interest financing for veterinary healthcare services. Clients can apply for it and have it in their back pocket for the unexpected.

A client with third-party payment options allows you to:

 Discuss the patient's needs from the optimal level

 Have prepared clients for the unexpected illness/injury/accident, etc.

 Charge a fair and reasonable fee for your services

The combination of pet insurance, third-party payment, healthcare plans, and a well-trained team will work together to give patients the level of care they deserve. The combination of pet insurance, third-party payment, healthcare plans, and a well-trained team will work together to provide clients with the peace of mind that their four-legged children can be given the care they need. The combination of pet insurance, third-party payment, healthcare plans, and a well-trained team will give your practice a reputation as a caring and compassionate hospital. The combination of pet insurance, third-party payment, healthcare plans, and a well-trained team will provide you with the additional revenue to make the entire healthcare team happy and proud of the work that they do.

Financial Policy (Clients)

If the barrier to Getting to Yes is the cost of care, then the pet owner must be made aware of the options available to allow for decisions to be made from the heart rather than from the wallet.

From the very first visit, it is truly beneficial for a pet parent to understand what the options that they have for payment are. Besides cash, check, what credit cards are accepted? Do you offer third-party payment programs? What are your feelings on pet insurance? What about if the client has no cash, has maxed out credit cards, doesn't qualify for third-party payment? What are your 'final/alternate' financial options?

Having a written and clearly understood and discussed financial policy makes it much easier for the entire hospital team to discuss payment options with the client without having to have a different policy for every client.

What are your practice's options to help clients 'afford' treatment? How are you "giving patients more ways to say yes to treatment"?

Instead of clients learning about your payment options only when a crisis arises or when they ask, a Financial Policy Form is a non-confrontational and non-stressful way to inform clients of the options that they will have to take care of the bill and they know before they get the bill.

Extending credit is a courtesy that you should rarely extend to your clients. It can also strain relationships with clients when you go to collect a delinquent account.

If you do extend credit, you must have fail-safe system that you use for each and every account.

The "Our Financial Policy" Form

By putting your financial policies in writing, you are documenting and validating what you believe for your staff and your clients. The policy/form can be included on your website, posted in the reception area, summarized on your brochures, and presented to clients new and old. The premise: you believe in clear communication, mutual understanding and respect, and, thus, your clients would appreciate knowing in advance what your financial policies are.

It is your goal to make sure that financial considerations are not an obstacle to a client providing important, life-saving care to their four-legged family members. So, clearly define that in your Form. Not until they understand how much you care do you discuss your payment options.

Since this form will be given to new pet owners and established pet owners alike, you should have a statement about pet insurance. This may be as simple as "Pet Insurance is available to assist you in the cost of care for your pet; for additional information, ask one of our healthcare team." It may be more complicated, such as: "We believe that every pet that is eligible for pet insurance coverage should enroll as young as possible with XYZ Insurance Company. The insurance will provide a real benefit to you and your pet's long-term healthcare." This addresses the big picture part.

However, we know that most pet owners are not that proactive. So, what is your plan for the more common, 'I didn't know it would be that expensive, I can't afford that' client?

On the other hand, on those rare occasions when your client has no cash and no credit cards, what can you do? The recent advent of "Client Payment Plans" through a variety of companies has opened up a whole new modality for client financing.

These companies will act as the bank for you. Clients apply either on line or over the phone in your lobby and are approved for a set amount of coverage. The interest rate and length of payment are available in a variety of options. The burden of collection is transferred to these alternative party payers. There is a charge to you of a small percentage of the bill, but you get your payment immediately with no worries about trying to collect the money down the road. The 'buck' has been passed from the client to the third-payment company to you in the blink of an eye.

The days of being your client's bank can be over if you want them to be. On the other hand, if you enjoy sending out monthly statements, reminder notes, late-payment statements, dunning notes, etc., at least have a "Financial Arrangement" Form (FAF) that lets your clients know that you are serious about getting paid. The FAF should outline the Treatment Plan total, the deposit and the amount financed. It should delineate how long the balance will be financed for, what the amount of each installment will be, what the late fee (after 30 days without payment) will be, and what the annual percentage rate for delinquent accounts is. This is similar to any financial arrangement form or credit card form that you have filled out for yourself and should be reviewed by your attorneys for enforceability and have a place for signatures and witnesses at the bottom.

Having the Financial Policy and Financial Guidelines Forms in conjunction with the FAF provides you with the tools needed to communicate clearly that you really want to help them provide the optimal level of care to their pets. You have the knowledge, skills, and desire to provide the healthcare and now you have communicated to them that not only can you solve their pet's problems, but you can also help them with the financial problem that might force them to make a decision between life and death.

  

Speaker Information
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Peter Weinstein, DVM, MBA
PAW Consulting
Irvine, CA, USA


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