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How to finance your pet’s healthcare.

/ heathamc / 13 Comments

The standard of healthcare we are able to offer our pets in the developed world rivals the standard of healthcare we ourselves have access to. Options such as MRI, organ transplants, chemotherapy and even root canal therapy are utilized many times a day for pets in our world. The problem with having really high healthcare standards is that those standards are accompanied by really high price tags. All too often, my colleagues and I see pets that have issues that go untreated, preventative care that is incomplete or even pets that have to be put to sleep all because of poor finances. We hate that but we’re also not in the position to loan the money to our clients ourselves. Sometimes we do, in the form of letting a client make payments but our financial threshold for payment plans is really quite low. How then, are pet owners supposed to meet those expenses? The following is a list of ideas and recommendations I’ve developed through experience and stressed out brainstorming about trying to accommodate pet owner’s financial situations.

The best time to think about paying for your pet’s heath care is before you have a pet. I understand that we mere mortals don’t ever do this. In the off chance that one of the financial superheroes who will soon be our economic overlords might be reading this, allow me to offer them this piece of advice in the hopes they will look upon me with favor some day. If you are thinking about getting a pet, especially if you are planning on buying a purebred dog or cat from a breeder, try to put away three to four times the initial cost of the pet in a high yield savings account or even an online investment account like Vanguard or Betterment. After the initial account is set up, find out how much health insurance would cost for your new pet and transfer that amount of money into the account monthly. You’ll draw the money out of your account once yearly in good years and it will be there if you have an emergency or illness. If you never have to deal with an illness or an emergency, the money will have been well invested and you will get it back when you no longer need it. The same can not be said of insurance. Of course, if you have the money available to take this route you probably don’t need financial advice from a broke veterinarian.

For the rest of us there is pet health insurance. A quick internet search for pet insurance will yield dozens of viable options. The thing about pet insurance is that if things go well, it is not going to save you money on your pet’s healthcare. If your pet ends up with a few emergencies and a couple of sick visits over the course of a life time, you still aren’t likely to save money. Only when you get into the scary and stressful stuff that comes with taking care of our furry, feathered or scaly family members does the insurance start to pay off. By then, you’re not really thinking about the money. Trust me, I see it everyday. Insurance is great if you’ve been through a really bad illness with a previous pet and want the peace of mind that comes with insurance for your new pet or if you have a breed that is predisposed to health issues, even if it’s just allergies. That stuff gets expensive quickly.

Both of the options above require some planning. For many of us, the health care part of the equation comes into play long after we are smitten by puppy breath, kitten antics and the like. Most of our clients haven’t planned at all for an emergency situation or an illness and many haven’t even checked into the costs of routine preventative care before they bring a new pet into their family. And there is nothing wrong with that! Bringing a new pet into your life isn’t really a financial decision, if it was we would never do it. It’s a lifestyle decision and like many lifestyle decisions, cost is never the biggest factor. Still, things happen and we want to do our best for our pets when they aren’t feeling well or have an accident. Here are a few ideas about what to do if you’re already facing a medical expense with your pet.

Third party payment options are the number one way we typically deal with the expense issue. Right now the most common ones are third party lenders who will cover your bill today and you will pay them back over the next few months. Many of these plans offer interest free payments over a set period of time. Beware however, as the interest rate outside of this time period is often astronomical. I’ve seen an APR as high as 30%! That’s crazy! Still, it makes a huge difference when we can sort of put the money aside for a little bit and focus on what is medically best for your pet.

Recently a new model of the third party payment option has been offered to pet owners and veterinary clinics. Starting in 2013, a service called vetbilling.com began a third party payment plan for veterinary patients that doesn’t have the high interest rates. Instead you as the pet owner, pay an enrollment fee and a small administrative fee is attached to each payment. You pay the company and they make a payment to your veterinarian. It takes a lot of the pressure off the veterinarian’s office. I don’t expect veterinarians to offer this to every client, we can’t afford to have revenue trickling in, but for those unforeseen emergencies it will be a real life saver. Sometimes literally.

Why can’t my veterinarian just offer me a payment plan? It’s simple and complicated at the same time. The easy answer is; we can’t afford to. Current industry averages in veterinary medicine put our payroll expenses at roughly 40% of gross revenue and inventory/supply expenses at about 30% of gross revenue. That means that 7 out of every 10 dollars we earn goes right back into providing services for our clients and their pets. We can’t make payments on our staff salaries and most medical supply companies do not finance. Especially when we’re ordering from them biweekly in many cases. So if we offered payment plans and they were utilized by even a quarter of our clients with a short repayment period of three months, we wouldn’t have the cash flow necessary to make payroll or order supplies within the first month. We’d either have to borrow money to stay in business, go out of business or stop offering payment plans.

Finally, when facing larger than you can afford medical expenses for a pet you can always compromise. Your veterinarian’s job is to offer you the best care that they can possibly provide. Every single time you come to them with a problem. It is up to you to determine whether or not that level of care is worth it to you. The best way to do that is to have an open and honest conversation about the situation and how you feel about it. Simply saying the words, “I can’t afford to do it like that” will go a long way at opening the door to other options. Just keep in mind that when we start to cut down a plan to save money, we are also affecting the outcome to a certain degree. That’s not necessarily a bad thing. For example, I recently had a conversation with my doctor about an outpatient procedure I’m planning for this Summer. My insurance has a ridiculously high deductible and it actually ends up being cheaper for me to pay cash for most things because of the discount and save the insurance for big scary stuff. I asked my doctor if paying cash changed things at all. Turns out it does. Now I don’t have to go to the hospital, see an anesthesiologist and deal with recovery. Instead, we’ll do it in his office under a local anesthetic. There are many situations in veterinary medicine that are also like that but we can’t just assume you want the cheapest or bare bones method. You have to tell us and we have to warn you about the consequences. For example, if I have an anaphylactic reaction to local anesthesia during the procedure this Summer, I would be far less likely to die in the hospital than I will in the doctor’s office. Your veterinarian will be the best one to let you know in each specific case how making changes to a plan will affect the expected outcome.

Having pets in your life is always rewarding. It enriches your day and even helps with your mental and physical well being. There are going to be times where pet ownership is stressful and even downright scary. Don’t let money be the scariest part of the equation and don’t let it come between you and your pet.

Thanks for reading.

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How to catch a cat in a HavAHart trap

/ heathamc / 1 Comment

My employer shared the letter with me not because there was really anything I could change or that could be done about what had happened. It was more to let me know that she had received it and because it was too good not to share.

A few weeks previously, a couple had brought us one of their adopted feral cats for a bite wound on its back end. They had warned us about how the cat was and told us to be careful with her. We had listened and had found the small gray tabby to be a wonderfully easy patient. She snuggled up on us during her exam and we loaded her in to her carrier without incident when her owners came to pick her up. I find this to be true of many adopted feral cats. They turn into big loves so long as you let them set the terms.

We did the recheck in our Ludlow office. The owner was present for the recheck, she had not been present for the initial visit. I took the feral cat out of her carrier, she was nervous but after some chin scratching she rubbed up against my hand. When I went to lift her up to examine her abdomen the owner tried to intervene. The cat did not approve of the intervention, my response to the intervention or both. She exploded around the room, knocked the blinds off the windows and then hid behind the sink. I retrieved her and finished the recheck. The issue had resolved and would not require any further attention. The feral cat and her owner returned home.

The letter arrived the following week. I don’t remember the details anymore, I had saved it for a few years but must have discarded it recently. The basic premise was that I was an inept veterinarian who didn’t know how to handle feral cats and shouldn’t be allowed near animals. I do remember that the word “idiot” was used eleven times in the one page letter. It was directed at me every single time. Needless to say I was not this client’s favorite veterinarian.

Fast forward one month, exactly one month from the day of that fateful recheck exam. The same owners bring in another feral cat, this cat had just been captured by these feline rescuers and was still mean as could be. It likely goes without saying that they did not want any of the veterinary services to be performed by me. Completely understandable.

Then the cat got loose in the cat ward. Bear with me while I paint the cat ward into your mind. It’s a rectangular room, eight feet wide by sixteen feet long. There is a single door at one end of a sixteen foot wall and two large windows along the other. At the 8 foot wall nearest the door is a treatment table and scale for weighing cats and a cat kennel bay on the other end of the room. All in there are 10 feline kennels in that room. The cat ward also serves as the location for the server and data lines for the hospital so there is a shelf in one corner and a hole in the ceiling for all of the data lines to go throughout the practice.

We attempted to capture the cat but he wedged himself behind the kennels against the far wall in the cat ward and would hiss and strike at us as we tried to get him out. Fortunately, the kennels are on wheels so I wheeled the kennel away from the wall and climbed on top of the kennel to get at the feral cat. The plan was to corner the cat on one side of the space behind the kennel by advancing a broom towards him. Once he was in a position he could not bolt from I was going to jump down, throw a thick towel over him, scoop him up and return him to his carrier. Seemed easy enough.

Instead of being cornered, the cat decided that it was fighting time, he attacked the broom that I was advancing towards him without any semblance of fear. My plan had been to use the broom to guide him gently out from behind the kennels, his plan had been different. Once he latched onto the broom and realized it was good for climbing, it took less than a second for him to be crouched next to where I was laying on top of the kennels. We locked eyes. I sat still watching him as he glared at me, waiting for him to attack me. Instead he hissed once in my face, turned and jumped up through the hole in the ceiling and was gone. I sat for a long moment in silence. All I could think to say after that moment had passed was, “I can’t believe that actually happened.”

I got down from my perch and went to the hatch that led to the crawl space attic above the cat ward, stood on a stool and shined a flashlight inside. Two glowing green eyes peered back at me and after looking around the small crawl space, I decided he didn’t have much room to hide and I could probably capture him with the net. So I climbed up into the crawl space with a four foot long loop net and planned to capture the escaped feral cat. I was of course, wrong. The crawl space had roughly one million tiny places for a feline to fit that a human might not even see let alone climb into. And it was approximately 1000 degrees Fahrenheit in there. After a few minutes up there, I retreated to the safety and comfort of the treatment area and thought about what to do next.

We decided to set a catch and release trap with some cat food in the attic and wait until morning. My boss told me she would call the owners of the feral cat when she arrived at our Ludlow office for afternoon appointments and explain everything to them. That seemed fair, I hadn’t even lost the cat. I was just trying to be helpful. What we didn’t take into account was that we were at the tail end of road construction season here in Vermont and the commute took her considerably longer than usual. As a result, appointments started a little late in Ludlow and she struggled to keep up. In Rutland, the owners of the feral cat stopped by to pick up their cat.

I must have rehearsed what I was going to say to these people fifty times in my head before I stepped into the cat exam room. I was going to explain to them that I (the veterinarian they called an idiot in the letter they wrote to my employer) lost their feral cat in the ceiling of our practice. Then I was going to get out of the room. As soon as I closed the door behind me, my mind went completely blank. I stood there for what felt like an hour before I decided that I had to just go for it.

I do not remember a word that I said to them or a single word they said to me but I do remember that they didn’t smile. Not once. They left and we set a HavAHart trap with some canned cat food up in the attic.

You can get your own here: HavAHart

The next morning the cat was in the trap. We called the owners, they picked up the cat and we never saw those cats or their owners again. I saved the letter for years but apparently discarded it recently. I suppose I am ready to move on.

Thanks for reading.

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How to communicate perfectly.

/ heathamc / 5 Comments

You can’t. That doesn’t mean you shouldn’t bother trying to.

I don’t know how to communicate perfectly but over the past few years and especially over the past few months I am starting to understand the keys and the benefits to effective communication. While I approach it from a veterinary/client point of view I imagine these points can be applied to nearly every relationship you have. Heck, I apply them to conversations with my three and four year olds as well. In the spirit of being a cliched blog fit for social media sharing, I am going to share my top five points on effective communication.

Be Honest. I mean honest when it hurts the most. When you just want to tweak the details a touch or leave out one piece of the story. Everyone feels like they are an honest person and I’m sure you are but there are those times where you might “spin” an issue or withhold a small but possibly critical piece of information in the hopes that whatever you are trying to communicate isn’t bogged down with concerns from the receiving party. In my world and practice it often goes like this, Fluffy is having problems a, b and c. To get close to an answer and formulate a treatment plan she needs testing x, y and z done. Then once we have that information we will be doing something. What I often find myself guilty of glossing over is the money part. If you’ve read my posts on this subject here or here you might understand that I am starting to get more comfortable with the fact that my services cost money. If you ever read my previous blog you might see how far I’ve come. By not fully preparing one of my clients for the costs associated with our services, I am not being one hundred percent up front with them. If someone is surprised by their bill at the end of a visit, I haven’t communicated effectively. It still happens to me but I’m getting better. The other area I think honesty can get a little cloudy is when people ask questions we don’t know the answer to. I remember telling someone I didn’t know what was wrong with their dog once early in my career, they went elsewhere. You can imagine how I felt about telling another client I didn’t know what was going on with their pet. Somewhere along the way I figured it’s just less stressful for me to be honest than to seem like I know everything. And then something amazing happened. I somehow found a way to explain things clearly enough so that people understand, it’s not that I don’t know what’s going on, it’s that what is going on is more complicated than it seems. Pets are really complex little systems and a lot of things can go wrong and cause very similar issues. By telling them I don’t know right now, it went from them thinking I had no idea what I was doing to them being able to appreciate how unique their pet’s problem was. It made communication easier and kept the lines open which always allows us to at least reach a point where everyone is satisfied with what we can or can’t accomplish.

Listen. It’s the most important and often the most overlooked part of effective communication. How can you convey the information the other person needs if you don’t listen for the parts the other person doesn’t understand? I try to spend less time talking in the exam room than the client. With some clients that is really easy, with others it can be like pulling teeth. It’s even worse on the phone. But when you stop and listen to what people are saying you find you are much better at providing them with excellent service because you actually understand what they want. It’s worth a lot to know what people want from you and when you can deliver it and see the results, it will really reinforce the benefit of you shutting up a little more often and listening to what people have to say. When I first got out of school and started practicing, there was so much information to convey, how was I going to get it all out and in a way people would understand? I needed to teach them how to take care of their pets. Wait, what? No, I had it all wrong. Yes, often people come to me with issues they want my expert advice and assistance with, that’s my job. But most of the time, people want me to provide the services they would like for their pets. And in order to know what those services are and to provide them effectively, I have to listen.

Slow down. If you’re talking so fast that someone can’t understand you or can’t get a word in edge wise, you are not communicating effectively. Think about an evening out with friends, everyone has a few adult beverages and starts telling stories. You have a great story that fits right into the conversation but by the time there is a space in the chatter the topic has moved off so much that your story seems out of place and kind of silly. A simple and amusing part of a night spent with friends, not so amusing when trying to communicate with your veterinarian about your pet’s health. Tied in to the problem I had early on with listening was in trying to get all of the super important information I needed to share with my new clients I would just blurt it all out whether they were listening or not. I would rattle stuff off so fast people were probably thinking that I was auctioning their pet off like livestock. Looking back I’m surprised no one ever made a bid. While I don’t currently speak with the same number of pregnant pauses as President Obama, I do try to stop talking for a few seconds every time I am changing the subject or about to make a recommendation. People deserve a chance to disagree or interrupt you and let you know what they are thinking. Also, you are going to be way more effective if people understand you. So slow down, catch your breath. Give the other person a chance to talk and tell you what they want. Especially on the phone. Stop making every phone call a race to hang up. Take the time to have the conversation. You’ll be amazed at how much better your service or outcome is.

Less filler speak. On of my least favorite things to hear when trying to communicate with anyone is a barrage of filler speak. Works such as; like, you know, basically or the uhs and ums of communication get in the way of allowing open communication and road block the other person from having a say. The author, debater and contrarian Christopher Hitchens put it nicely in his article for Vanity Fair, The Other L-word,  “People who can’t get along without “um” or “er” or “basically” (or, in England, “actually”) or “et cetera et cetera” are of two types: the chronically modest and inarticulate and the mildly authoritarian who want to make themselves un-interruptible.” Try to replace your filler speak with silence and you’ll be amazed at what people would like to say if only you’d give them the opportunity. I haven’t really ever been guilty of a lot of fillers in my conversation but it’s similar to talking too fast or omission. There have been times, I am afraid to admit, where I knew something needed to be done for someone’s pet but if I gave them a chance to start digging at my recommendations I might have given them the chance to talk themselves out of following through with them. So I talked too fast, didn’t include all the details and got the job done. Foreign body surgeries used to be like this for me. I see filler words used in much the same manner, they fill in the gaps that should otherwise be replaced with details or with a pause to give an opportunity for rebuttal. So again, shut up a little bit. Stop steam rolling the people you are trying to communicate with with ridiculous non-words and see how much better your communication skills get.

Let the other person end the conversation. If you are the one making a recommendation, providing a service or trying to convey information, the other person is the customer. They chose you out of all of the other options to help with their problem and they are working with you and letting you do your job. They get to decide when the conversation is over. And they will, trust me. No one wants to be on the phone longer than they have to, no one enjoys being stuck in your windowless exam room. You’re not that entertaining. But giving them the chance to say everything they wanted to say leaves them satisfied and if you need me to help you understand the importance of a satisfied client or why having people enjoy communicating with you should matter to you, this blog isn’t for you.

Most importantly, communication is a skill. Like any skill, you will have good days and you will have bad days but as you work towards your goal your skill set will improve. Over time. Don’t try to rush these things. Take the time to master the fundamentals and then work on the implementation and make it your own. Remember, “slow is smooth and smooth is fast.” Baby steps. You’ll get there and you’ll like the results.

Thanks for reading.

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