Vet Billing Solution, Medical Bill Madness; What if human medicine was like veterinary medicine?

The following blog was written by my good friend, amazing pet advocate, and the founder of Vet  Billing, Suzanne Cannon. Vet billing provides veterinarians with third party billing option to help bridge the gap between paying the clinic in full at the time of service (which sometimes is not feasible for clients) and CareCredit (which not everyone is approved for). 

Medical bill madness: what if human medicine was like veterinary medicine?

by Suzanne Cannon | Apr 30, 2015 | Uncategorized, Veterinary | 0 comments

When it comes to dealing with the cost of veterinary care,  I really wish both vets and pet owners would stop spewing invective and instead begin an open dialogue aimed at finding solutions.

Dog docs. Image courtesy http://threemilliondogs.com

Fenton’s complaint

Most recent case in point? An article written by Peter Fenton in the Washington Post on April 21, 2015, titled “Vets are too expensive, and it’s putting pets at risk.”  Mr. Fenton wrote the article after having his cat, Orangey, treated for injuries at an emergency vet clinic.  While Orangey’s injuries were minor and the treatment he received was limited to “essentials” (Mr. Fenton’s words), the cat’s 48 hour stay at the hospital resulted in a bill of $968.29.

Mr. Fenton, like many pet owners that have been in the same situation (this writer included), was shocked by the cost.  He claims that this isn’t because he doesn’t know anything about the cost of caring for pets – he and his wife have had cats for years.  What took Mr. Fenton aback was how drastically the cost of veterinary care has risen in recent years.

If there is any pet owner out there who hasn’t noticed that, raise your hand.  Yep.  I don’t see any hands.

What Mr. Fenton then set out to do was share his experience, including his outrage over the cost of emergency veterinary care (well, actually, veterinary care in general.)  However, instead of writing a piece that called for an honest exploration of the issue, Mr. Fenton instead took the path of blaming.  Maybe it’s just me, but blaming doesn’t ever seem to accomplish much, apart from inviting counterattacks.  Blaming stirs up strong emotions and knee-jerk responses.  And that is exactly what Mr. Fenton’s article did.

Mr. Fenton did a little bit of research, and based on that, arrived at the conclusion that “vet incomes are a big part of the reason for the rising costs.”  It seems that Mr. Fenton cherry-picked some statistics and quotes to substantiate this claim, and it made a lot of vets mad.  Really mad.  (If you want specifics, just read the explosion of angry responses to his article.)

Vets and income: Mr. Fenton connected the wrong dots

I’m not a vet, but I spend a lot of time working with vets, talking to them, and reading about current issues in veterinary medicine (not to mention having my animals cared for by vets.)  And I can flat tell you that rising vet costs have little to do with padding veterinarian’s wallets.  Very few veterinarians are earning money hand over fist (or paw.)  They come out of vet school with an enormous amount of debt  -  so much so that many of them accept that it will be many years before they can ever buy a house.  The average debt load for graduating vets exceeds $150,000.  Compare this to the fact that veterinarians earn far less than other medical professionals with an equivalent level of education (physicians, dentists.)¹  The mean starting salary for veterinary graduates who accepted a full-time position was just over $67,000 in 2014.

If that sounds like a boatload of money to you, divide that starting salary by the number of hours a veterinarian typically works (10 – 14+ hours a day, 60+ hours per week), and that salary turns into an hourly wage of about $23.51, or even less in some cases.  Equine vets fare the worst in terms of starting salaries, earning about $20,000 less than their companion animal colleagues.  (Still not convinced that vets aren’t getting rich at your expense? Take a peek behind the scenes at a typically long, hard, emotionally draining day in the life of a veterinarian here.  After reading this blog post by Dr. Lindsey Verlander, if you still believe that vets are “in it for the money,” then never mind – what I’m writing about here isn’t for you.)

Mr. Fenton asserts that veterinarians are charging pet owners out the wazoo for two major reasons: 1) to pay off their educational debt; and 2) to offset the inroads that online veterinary pharmacies and big box stores have made in taking revenue away from practices.  While these are two very valid concerns for today’s veterinarians, increases in veterinary costs can’t be attributed to just these two factors.  Let me throw out a much more common-sense reason for rising veterinary costs: significant technological advances in diagnostic and treatment options.

Expensive things are…well, expensive

Today’s pet owners have more choices than ever before when it comes to diagnosing and treating their furry companions’ ailments.  There are a number of medical interventions that have made the leap from human medicine to veterinary medicine.  I can name several that have become available in just the last decade or so (and this is by no means an exhaustive list:)

• Cyberknife technology for cancer treatment
• laser surgery and laser therapy
• stem cell therapy
• orthotics and prosthetics
• organ transplants
• MRIs

It seems obvious to me that advanced treatments would come with a hefty price tag -  that should be a no-brainer.  It’s also clear to me, as a dog and horse mom, that if there is a treatment out there that can save or improve the quality of my animal’s life, I am very likely going to want the option to choose that treatment.  And therein lies the rub: wantingsomething, and being able to afford that something, are two totally different things.

That’s easier to swallow though, when we’re talking about, say, a Mercedes Benz.  Just because I want a fancy car, doesn’t mean I have the money to pay for it.  And if I were to spend my time railing against Mercedes dealerships for not making their cars available at a price I can afford, I’m pretty sure I’d get laughed right off the parking lot, as well as skewered on social media.  And rightly so.  We Americans are very invested in our belief in the American Dream: in order to get what we want, we must be willing to work hard, make sacrifices, and be patient.  And we tend to get pretty irritated at those who think they deserve to get something for nothing.

If you can’t afford a Mercedes, you probably shouldn’t have a pet.  Wait – what?

This philosophy seems to work pretty well when it comes to paying for material things, like cars and clothes.  But when it comes to paying for health care — for ourselves or our family members (which for most of us, includes our pets), things start to get a little fuzzy.  And it’s all because of that powerful emotion we call love.

To really get to the heart of this, let’s pretend for a moment that human medicine is like veterinary medicine (cue Twilight Zone theme)…

Okay, okay — I’m asking you to suspend disbelief for just a little while.  And please don’t start furiously typing out a rebuttal before you’ve read this entire post — keep in mind that this section here is fiction.  I’m thanking you in advance for your patience.

You’re uninsured, but you did have an emergency fund…

So…let’s pretend that you are NOT one of the 2% of people out there who has insurance – instead you’re like the majority – uninsured. (I’m flipping the script here, so bear with me.  Only about 2% of pet parents have insurance on their pets.  See where I’m going with this?  If not, just hang on.)  Let’s also pretend that you maintain an emergency savings account, but all the funds you had in it ($2000, nothing to sneeze at) were wiped out by the fact that the transmission in your car conked out last month.  Your emergency fund today equals ZERO.

You work hard, but life is still paycheck-to-paycheck…

Let’s also assume that you are married, with two incomes.  Let’s say that you have a mortgage payment, two car payments, two children, one dog, and a host of other recurring expenses such as car insurance, a cable bill, utilities, groceries, gas, etc.  You and your spouse earn a decent living, and would be categorized as “middle class,” not “working poor.”  Still, you are like many other families with a similar financial profile, and try as you might, you end up living paycheck to paycheck because there just never seems to be enough disposable cash left over after you’ve met all your monthly obligations (including setting aside dollars for that emergency fund.)

You’re financially responsible, but things got tough when you were laid off a few years back…

Finally, let’s say that a few years back, you were laid off from your job.  You were out of work for a while, and during that time — out of necessity — a lot of expenses got charged to your credit cards.  You got behind on some payments, but once you were working again, you brought your past due accounts current, and haven’t missed a payment since.  But because you are still carrying balances on some of those cards, your debt-to-income ratio doesn’t look so good.  Not to mention those few late payments that were flagged and are now part of your credit report.

A panicked trip to the ER after an accident…

Now — Heaven forbid this should happen to any of us — but imagine that this morning, a bright sunny Saturday, your child runs out into the street after a ball, and gets hit by a car.  You rush your injured child to the ER, and immediately consent to whatever medical intervention is necessary to save his life.  Now imagine that, throughout the course of the night, your child’s condition varies, and additional procedures must be performed to ensure the optimal outcome – survival.  At each juncture, you are shown an estimate of the costs.  And each time, your eyes blur as you see the total costs rising astronomically.  The fact that you’re going to have to pay for this flitters through your mind and then vanishes, because at this moment, your emotional – not rational -  brain is engaged.  Your sole, all-consuming concern right now is the well-being of your child.

All’s well – but then there’s the bill…

Thank goodness your child survives his injuries, and is eventually deemed ready for discharge.  As you await discharge instructions, it comes time to pay your bill.  When you see the total amount due, you feel queasy and suddenly the room starts to spin.  You owe the hospital $100,000.  But you don’t have $100,000.  And you don’t have credit cards to charge to — because you’re still paying them off from when you were out of work.  Even if that weren’t the case, your measly credit limit of $5000 wouldn’t help, anyway.

The sympathetic patient care representative sees that you are distressed by the bill, and tells you not to worry – the hospital works with a company that will allow you to make payments over time.  She tells you that she just needs you to complete a short application form, and that you will likely be approved for a payment plan within a few minutes.  Relief washes over you with such force that you feel like your legs are going to buckle.

Saved by a medical credit card, right?  Nope…

A few minutes later, the patient care representative returns with a look on her face that tells you something is wrong.  “I’m sorry,” she says, “but you weren’t approved for a payment plan.  As you know, you’re responsible for paying your entire balance in full at the time of your family member’s discharge.  Is there someone you can call, who can help you make this payment?”

Well, no, there isn’t.  There isn’t anyone in your extended family who can just cough up $100,000.  And most of your friends are in the same financial boat as you are — they don’t have a glut of extra cash available at a moment’s notice.  Not to mention the embarrassment you would feel, calling up a friend and asking for money.  There’s really only one option that’s feasible for you: making payments.  It might take you a loooong time to pay this bill off, but that doesn’t really matter to you – your child is going home with you in one piece, and if making payments is what you have to do, you will do it.  If you temporarily have to work more hours or take on a second job, that’s OK.  You’ll find a way to make those payments.

But making payments isn’t an option…

You explain all of this to the patient care representative, who listens with a sympathetic ear.  She seems truly upset when she has to tell you that the hospital doesn’t make payment arrangements.  They’re not able to provide billing services – they simply don’t have the administrative manpower to manage it.  Besides, she tells you, since you weren’t approved for a payment plan through the third-party financing company the hospital uses, it means – and she says this as gently as possible – you’re not a good credit risk.  The hospital is, after all, a business.  If they gave a payment plan to everyone who needed it, she says, they would have to close their doors, and then they wouldn’t be there to help children like yours.

Hamstrung.

You and the patient care representative stare at each other in silence. Neither one of you knows where to go from here.  You’re doing your best, she’s doing her best.  You want to pay your bill, but you just don’t have all that money right now, today.  You need a way to pay.  The patient care rep wants you to pay your bill, too.  But she doesn’t have any other options to offer you.  You’re both stuck.

Left with no alternatives, you only have two choices, and they’re equally horrendous and unimaginable:  1) Euthanize.  2) Turn your child over to a welfare agency.

I can only guess at the number of times this kind of scenario plays out at veterinary hospitals – particularly emergency facilities.  I know it’s frequent – I’ve read more than my share of horror stories on this topic, written by both vets and pet owners.  Mostly, they just lash out at each other and call each other names.  Both sides want to deny that they play a role in perpetuating the problem.  Sometimes I feel that neither party wants a solution, because it’s somehow more emotionally satisfying to engage in verbal warfare.  Well, I think that’s a cop-out.

Pet owners and payment: when $5000 might as well be $100,000

Vets, you need to understand that most pet parents are a lot like the human parent I described in the fable above.  They see their pets as children, and they love them as fiercely as they do their human kids.  When you complain about us and tell us that we shouldn’t get upset because veterinary medicine is so much cheaper than human medicine — well, do you really expect us to do a happy dance because a $5000 veterinary surgery would cost ten times more if it were for a human?

That’s why the figure I used in my little story was $100,000.  It seems ridiculous, doesn’t it, to expect someone to be able to come up with $100,000 at the drop of a hat.  But for many, many pet parents, there isn’t really any difference between $5000 and $100,000.  Their vet bill might as well be $100,000, because they just don’t have all that money TODAY.  You can tell us what a bargain our vet bill is – compared to a human doctor bill – until the cows come home.  We still don’t have the $5000.  Sometimes it really IS about the money.  A LOT of times it really is about the money.  And it’s not because we don’t want to pay you.  It’s because we don’t have a feasible way to pay you, that you will accept.

So – if you don’t want pet parents to apply the human medical insurance payment model (where the only out-of-pocket cost is an affordable co-pay) to veterinary medicine  — stop beating us over the head with the mantra, “but it’s cheaper than human medicine!” You’re taking us right back to an erroneous comparison.  It’s the old apples and oranges thing — and it applies to both sides in this argument.

Unless you’re Donald Trump, stay away from having kids or pets – you can’t afford them

The other thing I hear/read from (angry) vets is that “having a pet is a luxury.  If you can’t afford to care for your pet, you shouldn’t have one!”  Well, I’ve addressed this in earlier blogs, but I don’t think it hurts to repeat myself on this.  That argument takes us down the proverbial slippery slope.  How many people can afford children, for the love of Pete?  I mean really, really afford them?  Are we going to become a society that prohibits people from having pets (or children) based on their income, or their credit score?  Are we going to penalize parents – pet or human – for not being able to foresee every possible disaster that might befall their kids, and for not having the money set aside to pay for all of these possible disasters in advance?

Pet insurance and back to Mr. Fenton – remember him?

Let me assure you that what I’m saying here is NOT intended to give pet parents a pass on educating themselves about the costs and responsibilities of pet ownership.  Pet parents, emergencies CAN and DO happen.  Don’t live in a bubble, thinking that your dog is never going to eat your trash and need an emergency gastrotomy.  Don’t think that your cat won’t get blocked, or will never get in a tussle with the neighbor’s dog (or cat or raccoon) because “he never goes outside anyway.”  Indoor cats do get out.  The most conscientious dog moms forget to put the trash out (me.)  Anything can happen.  Anything DOES happen. And when it does, and your veterinarian saves your animal’s life, he or she deserves to be paid.  So…

Please, please look into pet insurance.  Right now it’s really the only viable way to protect yourself from incurring a catastrophic financial injury along with your pet’s injury or illness. There are many more options than there used to be.  Many plans offer a fairly low monthly premium payment.  Ask your veterinarian – or anyone on their staff – who they use, and/or who they recommend.  The client care representatives at my own vet have been more than happy to share that information with me – who their insurer is, the amount of their monthly premium and deductible, the scary vet bill amount that they submitted a claim for, and what the turnaround time was for reimbursement.

And back to Mr. Fenton.  Remember him, about 3000 words ago? (Lol.)  I really wish he had used his experience tofacilitate an honest, open dialogue about veterinary costs, instead of making the chasm between vets and pet parents even bigger, by pointing the finger of blame at vets, and at the same time telling his readers that pet insurance is “rarely worth the price.” (WRONG.  If you don’t believe me, let me tell you how many times my schnauzers developed acute pancreatitis on a weekend, and how much it cost.)

Can we talk?

There’s already more than enough misunderstanding to go around.  Let’s stop fighting over the cost of vet care, and instead start talking about ways to realistically deal with it.  Both vets and pet owners have a role to play here.  This isn’t going to be easy, and this issue isn’t going to go away.  At VetBilling.com, we’re doing our part to contribute to the solution, but our efforts alone can’t fix this.  Ignoring the problem, or railing against it, doesn’t do anyone any good.  Especially our pets.  And please, remember that the most important thing vets and pet owners have in common is just that — ourpets.  We love them.  Let’s start from there.

¹For comparison to veterinary salaries:  According to a 2010 survey by the American Dental Association, the average annual salary for dentists under age 35 was $178,470.  At that time, 54.8% of dentists reported that they worked between 30 and 39 hrs/wk.  Only 6% of respondents worked more than 50 hrs/wk.  By contrast, 1 in 3 (33%) of vets work more than 50 hrs/wk, often including weekends and holidays.  I was unable to find more recent statistics on dental salaries and hours worked.

References:

Vets are too expensive, and it’s putting pets at risk: Costs have risen wildly in the last decade, and clinics are taking advantage of owners who can’t pay.  Fenton, Peter.  The Washington Post.

Really, Mr. Fenton? A response to Peter Fenton’s Washington Post article entitled “Vets are too expensive, and it’s putting pets at risk.” Brenegan, Heidi, MBA CVPM.  Animal Emergency and Referral Center of MN blog.

Rebuttal to Peter Fenton’s Washington Post article, “vets are too expensive and it’s putting pets at risk.” Magnifico, Krista, DVM.  April 30, 2015.  Diary of a Real-life Veterinarian Blog.

How veterinary medicine is like a T-bone steak.  Dicks, Mike PhD. DVM360 November 2014.

Making yourself scarce: how relative scarcity affects veterinary incomes.  Dicks, Mike PhD.  DVM360 April 2015.

Truth or trash: Examining debt-to-income ratios for new veterinarians.  Dicks, Mike PhD.  DVM360 February 2015.

¹American Dental Association Dental 2010 Survey of Dental Practice: Income from the private practice of dentistry.  ADA Survey Center.

Stem Cell Therapy Changed The Way I Practice Veterinary Medicine.  Miliaresis, Cristina.

Laser Therapy is Good Medicine.  Dr. Karen Becker.

Can pets receive or donate organs? Transplants are possible, but options to donate organs are limited, and finding donors is complicated.

The History of Medical Imaging in Veterinary Medicine

Paying for Pet Emergencies: The Importance of a Financial Plan for Your Dog.  Nicholas, Jason, BVetMed.

Emergency Veterinary Hospitals Are Not Charity Clinics.  Elfenbein, Felissa.

CyberKnife RadioSurgery in Pets.  Susan Ettinger, DVM, Dip. ACVIM (Oncology)

New technology could help reduce bone fractures in horses: Purdue DVM collaborating on system that uses sound waves to monitor for microcracks. Lewish, James M.

Orthopets! More vets turn to prosthetics to help legless dogs and cats: More veterinarians are using wheelchairs, orthotics and prosthetics to improve the lives of dogs that have lost limbs to deformity, infection or accident, experts say.  AP.

About VetBilling.com:

VetBilling.com was launched specifically in response to the rising cost of veterinary care.  It is our sincere hope that the alternative payment plan option that we offer to both pet owners and veterinarians will ease the tension surrounding the cost of veterinary care.  Our overarching mission is to end economic euthanasia and shelter surrenders that are due to cost.  We hope that by giving pet owners a reliable, systematic way to pay their vets, fewer beloved pets will have to be put down or sent to a shelter.  For vets, we provide all the support necessary to enable them to successfully implement our payment plan program. To maximize the potential for success, our payment plans are based on a signed contract, and payments are set up as automatic withdrawals from the pet owner’s checking, savings or credit/debit card account.  VetBilling.com handles every single administrative detail of these payment plans.  Our primary objectives are to keep pet owners on track with their payments, while simultaneously treating them with respect and compassion.  It is of utmost importance to us to protect and preserve the client-practice bond. 

There is no cost to the vet practice to offer our plans – vets receive 100% of their treatment fee.  There are no minimums, no monthly fees, and no payment plan is ever declined by VetBilling.com.

To learn more, please contact Bobbie Luterman (bobbiel@ebcs-solutions.com) or Suzanne Cannon (suzannec@ebcs-solutions.com), or call us between 9 am and 6pm Eastern at 800-766-1918 FREE.

Related blogs;

My Rebuttal to The Washington Post Article.

If you have a pet question or concern you can ask it free at Pawbly.com. Pawbly is a community of animal experts who provide knowledge and assistance so that people can take better care of their pets.

If you have a pet concern that you would like me to evaluate you can find me at the clinic, at Jarrettsville Vet in Jarrettsville Maryland. Or find me on Twitter @FreePetAdvice.