You have been called out to look at Finnegan, a 7-year-old jumper who hasn’t seemed right under saddle for the past three weeks. Present at the appointment are the 15-year-old rider and her (non-horse-savvy) father. You would like to do a full lameness work-up, and you know that the father likes to be involved.
The best way to avoid conflicts over invoices is to ensure that you have demonstrated value in the care you provide and have explained the costs of care before anything is done.
Research in companion animal medicine regarding cost conversations found that clients want discussions regarding the costs of care to be framed in terms of the impact the care will have on the pet.1 By contrast, veterinarians were found to more often discuss why the price was what it was (e.g., “We have to pay an extra technician for two hours of work”) or what the test did (e.g., evaluate his white blood cells). Only infrequently did veterinarians connect the money spent by the client to the pet’s well-being (e.g., “Spending $125 on blood work will tell us how well his immune system is coping, which will help us pick the best antibiotic so we can get him back to his old self”).1,2
It can be challenging to find a way to illustrate the value of your services and to discuss the costs associated with veterinary care; however, doing so is likely to result in a happier and more compliant client, as well as fewer headaches when it comes to getting paid.
Tools You Can Use
Signposting: Signposting is a short statement that foreshadows what is to come in the interaction.3 Using a signpost statement is a way to gently guide the conversation to the topic of costs. It can also enhance the partnership between yourself and the client because it serves as an invitation for him or her to join you as the appointment progresses.
“I want to explain how I’d like to try to figure out what’s going on, and how much the work we could do today will cost.”
Explain and educate: If we don’t invest time in explaining the work we are doing and educating the client about what’s going on with his or her horse, the client will remain in the dark about the thought and consideration we have invested in providing that horse with high-quality care. One way to efficiently share information with your client is to provide him/her with a narrative of what you are doing as you move through your examination; this creates value by educating the client about all the systems you are reviewing and possible problems you are investigating.
You can also use a similar strategy as you share your recommendations by verbalizing the steps you took to arrive at a treatment plan or diagnosis. The you are thinking and share with him/her all the information you have considered, the greater the value the client will see in your services.
“After noting some sensitivity when I palpated his tendons, watching him go and seeing how sore he seemed when he trotted off after we did a fetlock flexion, I feel confident that the problem is in his left front.”
Frame value and cost conversations in terms of what matters to the client: Understanding what matters to your client is the key to being able to share information that he/she will find relevant. Many clients are concerned with the impact of the problem to their horses’ lives, and how the work you suggest is going to help fix it. Use the information the client provides you in the history and your knowledge of the role the horse plays in his/her life as a platform for explanations of what’s going on with the horse, and the costs of care associated with diagnosis and treatment.
“I know from talking to you how much you enjoy showing him throughout the summer. So I think it would be best if we do a full lameness work-up to get a clear idea of what’s going on with Finnegan. That will give us a better shot at treating it properly and ensuring that this doesn’t affect your ability to ride and show him.”
Add descriptions to invoices: Invoices are one of the few tangible things a client is left following an appointment, aside from a hopefully healthy horse. Therefore, as much as possible, it’s important to remind the client of what was done and why—this will serve as a memory prompt for the client about why the work was done, and help him/her see value in the care that you provided to the horse.
“Nerve blocks (Left fore: PD, abaxial, low four-point)—these were used to isolate the specific area that was causing the problem. The results of the nerve blocks indicate the problem was in the fetlock.”
Take-Home Message
Know what motivates the client (low price, showing the horse, daughter’s happiness), and try to educate and inform your client when he/she is present during an exam.
Discuss how what you are doing and what you discover during exams and tests allow you to determine a course of action to get the horse back to normal. Talk about costs of specific procedures, tests and treatments and what they help you to understand about the problem and how they will help you heal the horse.
Don’t forget to continue the explanation in your written bills.
About the Author: Colleen Best, BScH, DVM, is a PhD Epidemiology Candidate in the Department of Population Medicine, Ontario Veterinary College.
References
1. Coe, J.B.; Adams, C.L.; Bonnett, B.N. A focus group study of veterinarians’ and pet owners’ perceptions of the monetary aspects of veterinary care. J Am Vet Med Assoc 2007;231(10):1510- 1518.
2. Coe, J.B.; Adams, C.L.; Bonnett, B.N. Prevalence and nature of cost discussions during clinical appointments in companion animal practice. J Am Vet Med Assoc 2009;234(11):1418- 1424.
3. Silverman, J. Skills for communicating with patients. 2nd ed. ed. Oxford: Oxford: Radcliffe Pub, 2005.
