See the Full Issue
June 2024
More Options Equals Better Care
When clients face financial challenges, they might decline necessary treatments for their pets, which can present ethical and emotional burdens on the veterinary team. What can teams do to alleviate some of this stress?
Ease Client Financial Stress and Boost Your Wellbeing
“Early in my career, I would often be annoyed about the financial struggles of pet owners and would say that if people couldn’t pay for a pet’s need, they shouldn’t have a pet,” admitted Ryan Frazier, BS, LVT, a certified career coach in Seattle, Washington.
Frazier now says that if he did not currently work in the veterinary medicine field, he doesn’t know if he could afford the care his pets need.
“I now sympathize with these owners,” Frazier said. “It is our job to provide the top standard of care and go from there. If pet owners can’t afford the care, then we need to work with the owner to figure out what they can afford. That is our job. Not everyone can afford the top standard and every test to get a diagnosis, but we can still help the pet.”
Frazier’s comments express an idea that others in the veterinary community seem to be arriving at, especially as they see client financial struggles affect their own wellbeing and that of their colleagues.
“The relationship between clients and veterinarians where financial constraints exist is always so difficult on both sides. When clients face economic challenges, they may postpone or decline necessary treatments for their animals, presenting ethical dilemmas for veterinary professionals,” explained Erin Wasson, MSW, RSW, a social worker at the University of Saskatchewan, Canada. “This financial constraint not only impacts the animals’ wellbeing but also places emotional and ethical burdens on the veterinary team as they strive to balance compassionate care, economic realities, and animal welfare.”
In addition, she said, “when veterinarians set appropriate boundaries around what they can do for clients based on financial constraints, they are often on the receiving end of public ire, with some cases of clients taking to social media to attack the character of a veterinarian. These responses are extremely damaging to the wellbeing of many veterinarians who are already struggling with the internal value conflict of being a trained caregiver and also needing to be able to keep their lights on.”
What options might hospitals want to check out? CareCredit and ScratchPay as well as pet insurance are popular offerings, but some clients might not qualify or be able to afford payments. Here’s a look at some alternatives.
American Veterinary Medical Foundation (AVMF) Reaching Every Animal with Charitable Healthcare (REACH) Program
Amy Hantschel, DVM, of Racine Veterinary Hospital in Racine, Wisconsin, described one challenging situation she encountered with a client. The pet owner had just seen the successful conclusion of a nearly two-month-long struggle with her eight-year-old collie’s health. Then her cat, Loki, broke his femoral head.
“While you can plan for emergencies to some degree, it’s near impossible to handle when multiple pets are in need of extensive medical procedures,” said Hantschel.
The owner absolutely could not afford the surgery, explained Hantschel. It was only through the AVMF REACH program and the hospital’s charitable contributions that Loki had successful surgery.
Dealing with the financial stress of a client is really hard on our team . . .Amy Hantschel, DVM
Racine Veterinary Hospital, Racine, WI
Hantschel, who said the hospital started using REACH in July 2023, said they are thankful they have a program in place where, at their discretion, they can provide some degree of treatment and diagnostics at a discount to owners in financial need.
“We got into this field because we really care for animals and the people attached to them, so it is certainly emotionally exhausting when there is an animal that could have been saved if money were no object,” she said.
“I expect that REACH will be of great benefit to patients moving forward. It’s very helpful to have that cushion for people that need financial relief. Dealing with the financial stress of a client is really hard on our team because they understand more than anyone that the cost can easily prohibit pets from getting the care they should.”
According to Michael San Filippo, AVMA Senior Media Relations Manager, AVMF REACH offers grants to its more than 105,000 AVMA members nationwide. The program officially launched in spring 2023, and $72,000 was paid out that year. The AVMA invites donations to the AVMF REACH Program.
AVMA member veterinarians may apply for a REACH grant through its online grant application. Each member may request up to $2,000 per case, not to exceed $2,000 per calendar year, to assist owners facing financial hardship. Members within the same practice may even pool their funds to help a single case. Grants are provided as reimbursement for veterinary charitable care services that have already been provided.
Paisley Paws Charitable Veterinary Foundation
Since FloridaWild Integrative Veterinary Center and Urgent Care of DeLand, Florida, connected with Paisley Paws in May 2022, the practice has received financial help for several cases, explained Kerry Wagoner, CVT, hospital director.
One case involved a cat named KeKe. After being hospitalized and cleared of his third urinary blockage, he blocked for the fourth time a few weeks later. The owner had done everything recommended but had exhausted her funds from the previous procedures and hospitalizations.
With the help of funds raised and the 20% matching donation of Paisley Paws, much of the surgery bill could be paid. Without the funds, he would have been euthanized, said Wagoner.
“For our team, nothing is more heartbreaking than explaining to a family that their beloved pet will not survive without the emergency services they need but cannot afford.
“As doctors and nurses, we take an oath to do no harm. Having to euthanize or watch animals suffer over finances leaves the entire team feeling like we’ve failed our patients and our clients—a guilt that we take home with us,” she said.
“Paisley Paws has completely changed how we function as a hospital, allowing us to focus more on saving patients and less on finances. Working with the foundation has been a breath of fresh air.”
Paisley Paws was founded by Brian Hamm, DVM, who wanted to positively impact the veterinary landscape after the loss of seven veterinary colleagues to suicide, according to Andrea McKown, foundation executive director.
The foundation has three main pillars. Its “life-saving, life-enhancing” financial support for owners of pets with a medical crisis is already in operation. Its other two pillars—financial support for senior-level veterinary students and financial support to address the emotional and mental burdens of veterinarians—are in the works.
Paisley Paws, which officially launched in October 2022, has welcomed 133 “PAWrtner” hospitals across 29 states, according to McKown. Since January 2023, it has contributed more than $67,000 to help 113 pets as of the end of February 2024.
Among the rules for receiving Paisley Paws aid, hospitals must become a PAWrtner, raise funds locally, and have a client who pays a minimum of 10% of the total cost of veterinary care. Paisley Paws provides a 20% match to all donations made directly to a clinic’s fund, up to $25,000.
VetBilling.com
Carrie Bowgren, Practice Manager at Lake Road Animal Hospital, Horseheads, New York, said her clinic wanted to practice “gold-standard” medicine but many of their clients could not afford that level of care. Instead doctors had to amend treatment plans to fit clients’ budgets rather than provide the most positive patient outcomes.
“This style of practice leads to immense frustration within veterinary teams,” said Bowgren. “Knowing that a patient can be helped but being forced to offer lesser care or even euthanasia because the client cannot afford more is, in my mind, a primary reason that veterinarians leave practice.”
With many people’s mental health dependent upon their ability to share their lives with a pet, she said, “it would be catastrophic to our society to only allow those with financial means to have pets. So many who work in the veterinary industry are but a single paycheck away from financial ruin and could not afford to have a pet if they were not afforded steep discounts by their employers.”
(VetBilling) has allowed our team to utilize their skills to their fullest extent as we can find a way to pay forCarrie Bowgren, Practice Manager
care that did not exist for many clients in the past.
Lake Road Animal Hospital, Horseheads, N.Y.
Bowgren said she tried several possible solutions for their clients before she discovered VetBilling.com in 2017. But the practice owner, Dr. Michael Brennen, and she were so concerned that the hospital would not receive payment in full, they tightened up on its use—which meant they effectively did not use the solution, she explained.
Finally in 2019, the hospital decided to try VetBilling to boost dental compliance. Clients got a payment options chart and were urged to pick one they preferred.
“We increased dental revenue by 30% for July–December 2019 over July–December 2018,” she noted. “The even more stunning aspect was that most clients paid in full at time of service, not utilizing any of the suggested payment options. Apparently just knowing that an option existed was enough to prompt clients to accept recommendations.”
Over the past three years, the hospital has opened the use of VetBilling to all clients. There are no restrictions, even for clients with failing credit scores. Their success rate, as of the end of February 2024, is 94.4%. The practice, she said, is financially healthier because of VetBilling.
But more importantly, she said, is that the practice “embodies a culture of ‘How can we help?’ This has positively impacted our ability to attract new clients and keep existing clients. It has allowed our team to utilize their skills to their fullest extent as we can find a way to pay for care that did not exist for many clients in the past. No one on our team ever utters ‘they shouldn’t have a pet because they cannot afford care.’ We feel we are able to do what we came to do—help animals.”
VetBilling, which partners with about 1,200 hospitals across the United States, was cofounded in 2013 by Tony Ferraro and Suzanne Cannon. Cannon said she had experienced her own financial challenges with emergency veterinary care in the past.
The organization offers a two-tier monthly support plan. Pet owners pay a one-time nonrefundable fee of $25 to activate the payment plan and a flat $3 fee is added to each recurring payment until the balance is paid.
“Our overall success rate across all plans is above 90%, which is important because veterinarians tend to assume that anything called a ‘payment plan’ will have a high failure rate and that isn’t accurate,” explained Cannon.
“These clinics are willing to accept a minor degree of risk of default in exchange for the ability to treat more animals in need of care; enhance the wellbeing of their staff by empowering them to say ‘yes’ rather than ‘no;’ build goodwill among their client base and community; and practice relationship-centered, contextualized care that allows them to meet the pet owner where they are during the most stressful moments of pet guardianship—illness, injury, or emergency.”
Open Door Veterinary Collective
Over the past years, studies have reported on the increasing cost of veterinary care and increasing burnout of veterinarians and staff who are ultimately leaving the profession. Subsequently, there has been more interest in how to provide affordable care without having to give away services but without many viable solutions, explained Elizabeth Alvarez, DVM, DABVP, clinical assistant professor at the University of Wisconsin College of Veterinary Medicine in Madison, Wisconsin.
Enter the Open Door Veterinary Collective. Alvarez said she took its training level 1 online course and found that it introduced her “to strategies and action steps—most of which are simple to implement—to begin to not only reframe the way the entire clinic perceives financially fragile clients, but also how to clearly take the steps to create a ‘financially friendly’ clinic. The training was interesting and engaging for not only DVMs but all members of the veterinary team.”
The Madison school is now one of 10 piloting the Opening the Door to Veterinary Care online curriculum. It will offer it through its elective Access to Care, One Health WisCARES clinic rotation, said Alvarez.
We often talk about ‘cost,’ but the actual barrier is often a lack of financing options for paying the cost.Aimee St. Arnaud
founder of Open Door Veterinary Collective
The goal is to get the program in all schools at no cost to them, according to Aimee St. Arnaud, founder of Open Door. The 501(c)(3) nonprofit has focused on increasing access to veterinary care through one-on-one consulting, online learning courses, pethelpfinder.org (a locator of financially friendly pet resources), research, and collaborative partnerships.
“This is why we chose the name ‘collective’—because we believe in the importance of working together to bring forth innovative solutions,” said St. Arnaud. “We often talk about ‘cost,’ but the actual barrier is often a lack of financing options for paying the cost,” she said. That leaves staff with noncompliance fatigue and leads to moral distress.
St. Arnaud also is a partner in two for-profit veterinary hospitals—Community Pet Care Clinic in Toledo, Ohio, and Open Door Veterinary Care in Asheville, North Carolina—that model the concepts of increased care without giving away or deeply discounting services.
Ideas piloted at the two for-profit hospitals show the model can be successful, she said—an important step in the group’s goal of creating a national network of for-profit and nonprofit practices increasing access to care.
St. Arnaud explained that those hospitals demonstrated that practices with their access-to-care focus could have a net profit of 5–10% with one veterinarian and 10–20% with two to three veterinarians. This includes three medical support staff per veterinarian and 30-minute appointments.
Open Door has created the first online, self-paced Access to Care certificate with six RACE and CVPM hours. It is negotiating to get on a large continuing education platform and then will market nationwide.
“It’s important now more than ever that practices start thinking about how to address the growing concern of cost of care,” said St. Arnaud. “More clients are delaying or declining care and that can cause moral distress among veterinary teams. Practices that focus on this now will be set up for success in the future.”
Photo credits: MachineHeadz/iStock via Getty Images Plus, SeventyFour/iStock via Getty Images Plus, ilkermetinkursova/E+ via Getty Images