In general, few people outside of Wall Street or CNN like to talk about money. It is not a comfortable topic. It is especially hard to broach the subject if you are asking someone to give you money in exchange for goods or services being provided during a difficult or emotionally stressful time. Veterinarians make important treatment recommendations for their patients but often have a hard time discussing associated costs, which frequently results in discounted services or avoiding the conversation all together. But how does this impact patient care and practice health overall? Aside from the bottom line of clinic finances, client communication suffers, which could ultimately impact compliance, delegitimizing patient treatment recommendations and the trust between veterinarian-client-patient.
Eighteen months ago, I started work as a manager at a day practice with three DVMs. The doctors were discounting services, and sometimes not charging the client at all for items and services necessary to treat the patient because they felt guilty. The challenge for me was clear: I needed to find out why this was occurring, reduce the number of services discounted, increase client compliance, as well as, act as financial steward to my new practice. I set to task and interviewed my veterinarians and staff directly about why they felt discounting or exclusion of services was necessary. The answer was universal: they were not comfortable having “the money conversation.” Some team members also believed that the client would feel taken advantage of. I asked the team if they considered any of the services we provided to our clients unnecessary. All answered, no. So, how then to go about showing the team the value in the work that they do? During a team meeting, I listed a few services we provide, such as an Annual Wellness Exam. I asked each team member why we recommend that particular service and what that service includes. Other services were discussed and the team quickly saw the “Why” associated with every service we provide from exams to surgeries, from nail trims to preventatives and everything in between. The value proposition became clear.
A light bulb had been switched on with the team but the next step was to create an environment where they could communicate the value of our services to clients with confidence. I began by examining existing clinic policies and established new ones, such as a formal written payment policy. Aside from stating the types of payment accepted at our clinic, this payment policy is also a promise to our clients that we will provide them with the information necessary for their pet’s wellbeing and that our clinical team will work with the client to make it affordable. This policy is displayed in our lobby as well as on our website, and is the foundation of all financial verbiage on treatment plan and consent documents. I created detailed Standard Operating Procedures that are accessible to each team member and included in all new hire phase training to ensure consistency and create a culture of communication with our clients. We use role-play during team meetings and example scripts are made available for the team so that they can practice the language of how to present treatment plans and start the conversation about money. Eventually, each team member brings his or her own unique voice to the experience but my contributions proved to be a good starting point. It was also important to create a policy that our team will not make judgment or assumption based on the appearance of the client and that the veterinarian, nor any of the clinical staff, should make financial decisions for the client. The utilization and team training on ancillary services such as third-party payment plans and pet insurance not only took away team guilt but also the guilt of the client at not being able to pay for the services presented and client’s are able to make decisions knowing that there is assistance from the financial burden.
Facilitating an environment where veterinary staff is able to recommend treatment without concern of money is an almost unattainable task for any manager. Like any business, veterinary practices will continue to be affected by the economy and the ability of their clients to afford the cost of veterinary care. However, I believe that by fostering open, honest communication between the client and the clinical staff, even when it comes to money, can only lead to providing the very best in patient care.
Joanne Graham
Hospital Administrator
Prescott Animal Hospital & Equine Center (Prescott, AZ)
2015 Emerging Leader
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