19 Apr 2017
Talking about money with clients is not always a part of the job veterinary professionals enjoy. Here, Stewart Halperin gives his top tips for helping your team take the pain out of asking for payment.
Stewart Halperin
Job Title
A client calls the practice to make an appointment. At the end of the conversation, your receptionist asks how the bill will be settled – cash, credit card, insurance or payment plan – and this should occur even if the booking is for an annual vaccination and check up. The client replies and a note is made on the file.
This conversation is important both for clients and for the practice. It means, in the mind of the former, they are aware of the following:
Importantly, this creates, in a subliminal, way some commitment from clients.
With regards to the practice, meanwhile, the “how will you be settling the bill?” conversation is important for the following reasons:
The client arrives, goes through the welcome process, sees the vet, and – for the purpose of this article, whatever the reason for initial presentation – the consult is now non-routine, defined here as a one where the vet makes a treatment recommendation outside of both preventive healthcare and prescribing medication as an outpatient.
The vet discusses in as much detail as appropriate for the case and the client what his recommendation for treatment or investigation is and then does the following:
The vet then walks the client with the patient to the admissions office. Here an admissions nurse or team member will go through the recommendation and the consent for admission form, discuss the fee estimate, agree the payment option and have the consent form signed. This is the time for insurance details to be confirmed, or for a patient finance application to take place.
Ideally, the admissions nurse will be aware of and trained in any one of a number of models of personality type. Some clients just want to know the how much, what’s going to be done, and by when-type stuff, while others want a thorough, step-by-step walk through of the entire process, and so on.
The client leaves the practice and the patient is handed over to clinical staff by the admissions nurse, so the process is “complete”. However, I’m hoping by now you’ve noticed the vet has not had to discuss finance with the client once.
Then, if the client cannot afford the treatment recommendations, does not have insurance, does not qualify for a finance option, or refuses treatment for financial or other reasons, a recheck appointment is made by the admissions nurse to discuss alternative treatment options.
If you are or have ever been in practice, and unless you went straight from qualifying through internship and residence in a referral hospital, or have only ever worked in referral practice where these or similar procedures are followed, all of us have experienced one or all of the following:
The client says they cannot afford the treatment recommendation made. The vet wants to carry out the work in the interest of the patient and so agrees to cap or discount the bill.
It also can happen when the vet estimates the client will only be able to afford a certain amount, or agree a certain amount as to allow treatment for recommendations to proceed. This amount is often totally arbitrary, and usually a direct reflection of what the vet would feel was a lot for the repair of his or her car.
Often this creates an artificial ceiling above which the vet feels uncomfortable discussing. This ceiling generally comes in multiples of £100 – £100 for an outpatient visit, £500 or £1,000 for a hospital admission for a medical work up, £2,000 for a surgical case and so on.
I’m not making any judgement on these amounts, rather illustrating that, in our minds, these ceilings of comfort do exist and that they affect the way we charge our clients.
After seeing the vet for a patient appointment or an appointment to discharge the patient from hospital, in the very short time period during which the client walks (or, ideally, is walked) from the consultation room to reception, acute memory loss occurs regarding:
On arrival at reception, the uninsured client is handed the bill and the client experiences what is commonly described as “bill shock”. This may manifest as anger, or verbalised discontent, but most commonly as an internal realisation of “Wow, that was a lot” when they leave the practice.
In general practice, where there is no dedicated finance person, or separate room for the conversation and patient admission, the following essentials are entirely possible and easy in practice:
If possible, and sometimes it won’t be, don’t discuss bills or ask for money from one client in front of another, either on the telephone or in person. Doing so at reception is just opening yourself to all kinds of issues, some of them not obviously apparent.
How often do we hear, on presentation of an invoice: “Oh what a lovely surprise – the bill is so much less than expected and the service and care was way better than I ever imagined possible”? Not that often. Yes we get thanks in the form of letters and Google reviews and flowers and chocolates, but this rarely happens at the time of payment. Therefore, the more common response, namely negative, means everyone in the waiting room could hear the discontent of one client paying his or her bill. Plus, if someone in the waiting room was unaware of what work was carried out, just hearing a figure another client was paying could lead to fear he or she too may get such a bill. Consequently, this may put clients off agreeing to a vet recommendation that happens just a few minutes later in the consultation room.
So, if you can and if you have any space to do it, have a trained team member go through the payment procedure in a separate room, away from reception. Your staff will appreciate it – and so will your clients.
If any of your practice team questions your consultation fees, remember that, for most practice members, most of your clients earn more than they do. Therefore, it’s very common for practice members to feel you are expensive, despite them knowing the value you offer, how hard you all work, and despite them seeing and being a part of your “constant and never-ending improvement” culture.
Try asking them when they have their hair cut how much does that cost each time they visit? It’s almost always more than an average visit to the practice. And, how long did it take you to qualify/train with us? How do you feel about the fact we do everything we do for a similar price to a haircut? It usually works.
