One of the unfortunate necessities of veterinary medicine lies in the fact that, in most cases, pet owners have to foot the bill for medical care. Yes, there are those lucky few with pet insurance (hovering somewhere around the 5% mark), but for most, the cost of getting their pets better again has to be paid right out of their own pockets. Nowhere is this issue fraught with more angst than in the ER and ICU. It is a constant source of friction, guilt, hand wringing and finger pointing, and a topic to explore in depth another day. What I want to explore with you today are some of the ways that vets will work to lessen that burden. Ultimately, this may mean taking funds from their own pockets to help owners with the potentially high cost of medical care, but we do this to help us feel like we are part of the solution, not the source of the problem.
Teaching at the university, I get a small break from this fractious topic as I don’t usually have to be the guy talking money with pet owners anymore. For years, I was the guy in the ER having ‘the money talk’ with pet owners, but my current position usually involves more interaction with the interns and students treating the patients than with pet owners. It feels a little like cheating, but if I am to be honest, I love being able to just focus on the healing portion and not getting embroiled in the gritty and unsavory fiscal end of things. Wimpy, I know, but I’ve paid my dues.
This is not to say that I am blind to the sometimes astronomical charges that can accrue when we try to keep pets on this rock for a few more revolutions. It is not an uncommon thing to have bills hit the $10,000+ mark after a few days in ICU and perhaps a dalliance with a surgeon or an unexpected complication. I could not afford this sort of mini-mortgage, and I am always amazed at the love and fiduciary fortitude of those clients who can do it. It is far more common for owners to look for less expensive options or even to chose euthanasia for a pet when the costs can (or do) run high, but there are still people who can afford the cutting-edge treatments. On occasion we run into financial trouble when, despite everyone’s best intentions, the bill goes above and beyond what we initially plan. The problem is compounded by our natural desire to not want to give bad news, and sometimes just plain dumb luck.
We had a case in ICU last week that was starting to look like one of those runaway financial chain reactions. We were several days into the treatment of a very sweet dog who had had surgery for GDV (gastric dilation volvulus, where the stomach flips over on itself) in the middle of the night. The owners had elected to push on through a barrier that would have stopped most pet owners – the stomach at surgery was nearly black and quite possibly dead, and the surgeon on point at the time had recommended euthanasia. Despite this, the owners pressed on and the dog, to everyone’s amazement, was doing quite well; he had probably not read the chapter in the surgical text book that told us that dogs with serious gastric necrosis have very little chance of leaving the hospital.
As you might expect, this decision to press on into the "here there be tygers" regions of veterinary medicine came with a pretty gargantuan bill. The dog needed a sophisticated and invasive suite of treatments and medications, and was still in the thick of things even though he had outpaced our expectations a while back. The owners knew what they were getting into financially, but that didn’t take the sting out of the hole that that big pile of cash was going to leave in its wake.
When we depart from the comfortable and predictable confines of normal veterinary medicine, a great deal of learning takes place, and it also becomes downright fun. We don’t get to do a lot of the things that we were doing to, for and with this particular dog. Many factors were figured into the decision: the eventual prospect that he would do well long term, and what sort of unpleasantness he was experiencing while in the hospital. Eventually, we judged that he had a good chance for the future and was not experiencing needless pain or mental anguish in the interim. We hoped we were right and had peered into the soul of this dog at the right angle.
To help stave off the increasingly common specter of a financial euthanasia for this dog, I wrote a letter to the hospital administration to plea for a release of monies from a very tightly controlled fund that is intended to assist the teaching process by helping selected cases with the financial impact of advanced care. To qualify, the case must show extensive commitment from the pet owners (check!), a good prognosis (check!) and financial need (check!). The people holding the purse strings on this fund know that there is a great deal of potential for abuse (I would say about 40% of ER cases involve some form of financial hardship and corner-cutting due to money – at about 20 cases a day, you do the math on how big a need there is for someone to help with the bills) and don’t take frivolous requests for funds lightly. You have to really pour your heart out in these letters. I think this was my second or third letter in 2 years, so I sat down to write a grade-A tear jerker. It wasn’t hard: there was enough genuine pathos wrapped up in this case that the letter wrote itself. In addition, every service is allotted a small amount of money to contribute to cases, and I was able to get the ER service and the surgery service to contribute a small amount to the case. This tends to sweeten the pot and make a larger chunk of the fund I was beseeching fall from the sky.
I also cozied up to the billing person for the teaching hospital, so she knew we were working to get some funds for this dog and his ever-growing bill. She closed the door and, sotto voce, gave me some valuable pointers for maximizing my chances that the administrators would approve the release of funds.
It worked. About 2 hours after the letter was sent, I got a page that the hospital administrative assistant had news for me. The release of funds had been approved!
The final amount of the financial release was not large – it was a fraction of the total bill. But it would pay for another few days in the hospital, another few days of healing, another few days of hope.
That worked, too. His stomach decided to heal up all the way, despite what the textbooks say, and he started eating and feeling like his old self. He went home after about 9 days in the hospital and is expected to make a full recovery.
It takes a well-trained and well-oiled team to deliver medical care, and (I was learning) it takes cunning, know-how and connections to get things done in a bureaucracy. I felt like I had worked the system just a little bit, and my patient would be better for it. We may have had to euthanize other animals during that week for monetary reasons, but at least for this one dog on that one day things went well. That was enough for me, and for my patient as well.