Caring for the Cash-Strapped Client

Veterinary medicine isn’t for the weak. We spend much of our time at the intersection of commerce and our heart, a stressful, challenging and upsetting combination. Most people outside our profession don’t truly understand the dilemma, so I like to explain it using, as an example, one of my long-time senior clients.

Opal, recently widowed, brought in her miniature poodle, Cocoa, whose breathing was labored. Cocoa had a Grade 5 mitral murmur, crackles upon auscultation and Grade 4 dental disease. Opal lived on a fixed income, so she couldn’t afford the workup I had in mind: radiographs, ultrasound, antibiotics, diuretics, pimobendan, lab tests and, eventually, a dental procedure. I started bargaining with myself over which diagnostics I could live without because the last thing I wanted to do was euthanize Opal’s companion and housemate.

Veterinarians play the following game all day long:

• “Can I live without the ultrasound? Yeah, I will probably be OK.”
• “Can I live without the X-rays? Maybe, but the patient might die if my clinical diagnosis is wrong.”
• “How about the lab work? Does she have to have it?”
• “What if she has kidney issues and I put her on Lasix?”

The internal conversation goes on and on.

Then I have to start working the other angle. How much money does Opal actually have? How do I find out without being too nosey? Does she have kids who can help? Does she get her dinners from Meals on Wheels?

Why do I have to think about all this? I’m just a veterinarian. Oh, yeah, because I don’t want to euthanize the patient.

Then I start looking at myself. Can I pay for some of Cocoa’s tests personally? Can the clinic just do it and not charge her? Would that be fair to all the other clients?

You see, dear reader, that predicament describes my life pretty much every day. People have animals they love immensely, often more than themselves, yet they do not have the money to take care of their pets in the case of a family illness or emergency. You can say things like, “If you can’t afford it, you shouldn’t have it,” all day long, but that won’t change the reality. You can beg clients to get pet insurance or save money for a rainy day, but many don’t. The stress of the situation is unimaginable for the veterinary team. It is one of the primary reasons we burn out.

We can agree these scenarios suck, but we have to deal with them. I’m going to help you. Let’s discuss six strategies you should consider to assist clients who cannot afford your standard services.

Strive for Clear Communication

It’s a partnership. You’re working with the client and advocating for the pet to find the best care option. If a price adjustment isn’t possible — changing fees for some and not all is generally a bad idea — then the relationship needs to look like this: You and the client versus the workup. Not you and the workup versus the client.

Therefore, use phrases that incorporate “we,” “our” and “let’s” to show that you and the client are a team. For example:

• “Let’s look at this workup together and see which ones we can afford.”
• “Once we know how much we have to spend, we can pick the best treatments together to get the most bang for our buck.”

Consider asking point-blank how much money the client can realistically come up with from friends and family. Once you have a figure, you can choose the most critical items on the diagnostic and treatment list. If you don’t know the amount, you might spend too much on diagnostics and have nothing left for treatment. You don’t want to charge $80 for a parvo test and find out the client has only $100.

Be Selective

Next, list what you want to do for the patient and rank the items from most to least important. Divide your treatment plan into must-haves and nice-to-haves.

For Cocoa, the top-to-bottom rankings looked something like this:

MUST-HAVES

• Lasix
• Pimobendan
• A recheck exam in a day or two
• Antibiotics

NICE-TO-HAVES

• X-rays
• Labwork
• Ultrasound

After I figure out how much Opal can spend, we go down the list and stop when the money runs out.

Offer Third-Party Payment Options

Extending a line of credit to a boot-strapped client is easier than ever. Make sure you offer several commercial options at your veterinary practice.

Truth be told, many clients I talk about in this article won’t qualify for third-party financing. However, the act of trying makes your client realize how much you’re working to help. Pet owners might be embarrassed to fill out a finance application, knowing rejection is likely, but reassure them that you’re not judging them. Be sure to say something like, “There is no harm in filling out a credit application. If you don’t get approved, we will keep trying to find a solution.”

I recommend letting the client fill out the application and, if possible, tell you whether the company approved it. I remember getting a “yay” or “nay” from the credit provider back in the old days and then having to tell the client the news. It was another layer of awkwardness.

Besides the standard credit providers (CareCredit, Scratch Pay, All Pet Card, VetBilling and others), consider your local bank for client financing. Meet the bank manager to learn about fast, short-term loan options.

Now let’s talk briefly about something common in veterinary practice: holding client checks. The concept involves the client giving you a series of checks, each dated one month apart. (Check writing isn’t popular with millennials and Generation Zers, so you might offer debit withdrawals instead.) If you accept checks, call the client’s bank and ask whether the account balance will cover the check you are about to deposit. I used to do it all the time to offset the pain of trying to deposit a bad check.

Start a Nonprofit Fund

Years ago at my veterinary practice, I established a nonprofit group called Furry Friends for Seniors. I spent quite some time advertising and promoting the fund to clients. I took pictures and told stories of animals that received veterinary care paid for by donors. I posted the campaign on social media and solicited my well-to-do clients to help the less fortunate. The funding option was a success.

Here is how to raise money for a charitable fund:

• Add it to your loyalty program and offer clients the option to donate by rounding up their invoices to the next $100, thereby earning a loyalty stamp.
• Conduct a silent auction at your practice.
• Schedule a team dog wash.
• Hold a dog walk-a-thon.
• Partner with neighborhood businesses to collect donations. For example, a sign might read, “Donate $25 and get a free coffee next door.”
• Sponsor an art contest inviting clients to draw a pet. Charge $5 per entry, and award a free exam for the winner’s pet.

Give Back

When I became the managing veterinarian at my hospital, I knew I had to end the emotional roller coaster of clients unable to afford costly veterinary care. Instead of dealing with heartbreaking cases one by one, I found it easier to look at our profit and loss statement and decide how much we could donate to the less fortunate. Let’s explore how to do it.

First, you need to know your EBITDA (roughly, your profit margin). Most practices have an EBITDA of 5% to 25%, depending on how well-managed they are. Next, choose the percentage you’re comfortable setting aside for your practice’s give-back program.

Let’s say your three-doctor practice’s gross annual revenue is $2 million and you have an EBITDA of 12%, giving you a profit of $240,000. You can decide how much of the surplus you want to donate to your practice’s benevolent cause. There is no right or wrong answer here, but I suggest 5% to 10%, which means $12,000 to $24,000 dedicated to charitable patient care.

Alternatively, you could calculate the amount based on a small percentage of gross revenue. If you choose 1% to 2%, for example, you would set aside $20,000 to $40,000.

Whatever your approach, be consistent. When the year closes, do your calculations and set money aside. Then give each associate veterinarian a giveback fund that they can reach into to help clients in need. Be sure to explain that when the well dries up, there is no giveback until the following year.

Also, stop discounting fees when you implement a giveback program. Otherwise, you duplicate the effort and overdonate.

Another good idea is to create a scoring system to evaluate client needs. My practice formed a committee of CSRs, technicians and doctors. The committee had to agree unanimously on each doctor-submitted request to use charitable funds. Each question in the application carried a point value so we could score the case. Consideration of a request required a minimum score of 10 points.

Here is an example:

• Widowed client: 3 points
• Two or fewer pets: 2 points
• A client for more than two years: 5 points
• The first request for financial assistance: 1 point
• The patient is likely to survive: 3 points
• The pet receives regular wellness care: 1 point

Creating a giveback process can alleviate the emotional burden of trying to help financially strapped clients.

Be Realistic

If your patient has a slim chance of recovering and living a good life, you should spend the least amount of money possible and help the client decide whether to euthanize.

I once employed an associate veterinarian whose client had the cutest 8-week-old pit bull. Unfortunately, the puppy presented with a broken jaw, chest trauma and head injury. A normal life was unlikely, and helping him would have required a significant portion of our charitable fund. We declined. You have to make difficult decisions in the interest of saving the masses.

I always think of Opal and her miniature poodle, Cocoa. I used our hospital’s fund to cover the X-ray, and Opal paid for the medications and recheck. Once we saw tremendous improvement in Cocoa and realized she would survive, we planned the dental procedure. Opal saved half the money over six months, and our fund covered the balance. Cocoa lived many more years.

Coincidentally, I recently saw Opal at Home Depot. Cocoa had been gone for some time, but she gave me the biggest hug, and we teared up thinking about that little dog and how we worked together to save her.

TAKEN BY SURPRISE

According to Synchrony Bank’s 2021 Lifetime of Care Report, 45% of dog owners and 38% of cat owners “originally thought they were financially ready for pet expenses but were not.” In addition, 3 out of 4 pet owners said an unexpected expense of more than $250 would be a financial issue.