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PATIENT CARE

PRACTICE MANAGEMENT

WHEN CARING COSTS MORE

How higher prices are impacting pets, clients and the veterinary profession —
and what you can do about it.

February 1, 2024 |

Issue: February/March 2024

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SARAH RUMPLE

CVJ

Sarah Rumple is an award-winning veterinary writer living in Denver, Colorado,
and the owner of Rumpus Writing and Editing. She has been a veterinary writer
and editor since 2011, when she was hired as a copywriter for the American
Animal Hospital Association. Learn more at rumpuswriting.com

Read Articles Written by Sarah Rumple

Clients want choices when paying for veterinary care.

Sam Stuteville was in the fourth grade on Christmas morning when his mom set
Max, a 6-month-old miniature schnauzer mix, on the kitchen floor. “Max ran right
over to me, jumped on my chest and hugged me,” Sam recalled. “He’s been my best
friend ever since.”

Max has been by his side consistently over the past 17 years. When Sam was
getting ready for middle school dances, learning to drive, studying for final
exams, applying to colleges and living with college roommates, Max was there.

Today, Sam is 24 years old. After earning his bachelor’s degree in vocal music
education in May 2023, he and his girlfriend, Autumn Miller, purchased their
first home and moved to Kansas City, Missouri, with Max. Sam accepted a job as a
student academic support teacher, a noncertified position paying about half of
what a certified teaching position earns. He works two additional jobs to help
make ends meet.

“I also coach high school soccer in the fall and I bartend on the weekends,” he
said. “Sundays are my only days off.”

As a young couple with a new house, Sam and Autumn work hard to save money and
make responsible financial decisions. They have a good idea of what their income
will be every month, and when they bought the house, they made sure they could
afford their bills and have money left over for spending and saving.

However, the couple found themselves in a difficult financial spot in November
2023, when Sam thought something was wrong with 17-year-old Max.

AN UNEXPECTED VETERINARY BILL AND AN UNEXPECTED SOLUTION

It was a Tuesday when Sam arrived home from work. On any other Tuesday, Max
would have greeted him at the door. This day, however, Max was staring at the
floor and wobbling back and forth. Sam immediately took Max outside, hoping that
maybe he needed to relieve himself. But when the symptoms persisted, Sam knew
that Max needed to see a veterinarian.

“I called Eagle Animal on the way and told them about Max’s behavior,” he said.

Sam’s family had been clients of Eagle Animal Hospital for some time, and he and
Autumn had taken their cat there a couple of months prior because of an abscess.
But this was the first time they met Dr. Heather Kvitko-White, the general
practice’s sole internal medicine specialist.

After running bloodwork and performing an ultrasound, Dr. Kvitko-White informed
the couple that she believed Max had multiple health problems, including
pancreatitis, inflamed adrenal glands possibly caused by a tumor and
deteriorating kidneys. She thought pancreatitis was the main culprit behind the
symptoms.

“We’re not set up to hospitalize a bunch of patients,” Dr. Kvitko-White said.
“But in this case, the family asked about payment plans, and we knew this was a
big financial stretch for them. And when you’re looking at a 17-year-old dog
with a serious disease like acute necrotizing pancreatitis, your options are
typically a specialty hospital or euthanasia, and the price for 36 hours at a
specialty hospital could easily reach up to $8,000.”

Many doctors might recommend euthanasia rather than spending a young teacher’s
money on a 17-year-old dog. But Dr. Kvitko-White knew how emotionally connected
Sam was to Max, so she proposed an alternative.

“We knew a lot about [Max] because of the bloodwork and ultrasound, so I felt
like we could put him on IV fluids and pain medications and let him stay here
overnight by himself,” said Dr. Kvitko-White, who offered that option to the
couple.

“I asked her what she’d do if Max were her dog,” Sam recalled, “and she said
she’d feel comfortable leaving him there overnight.”

While that choice was more cost-effective for the couple, the mood was somber at
home that night.

“He’s been such a big part of my life for so long, and I thought that if he did
pass, I would want to be there with him,” Sam said, trying to hold back tears.
“I wouldn’t want him to be alone in the kennel in a strange place he doesn’t
know by himself.”

Max didn’t die that night. After spending three nights at Eagle Animal Hospital,
he was discharged, and Sam and Autumn paid their $3,800 invoice. While the cost
was less than what they might have spent at a 24-hour practice, it was still
difficult.

“We used savings, and I spent my last dollar — I’m not exaggerating,” Sam said.
“I had $0 for three days after that. We didn’t have any money for day-to-day
things.

“But it was so worth it,” he said. “I’m so happy that Max is still here and that
I have more time with him.”

INFLATION AND THE COST OF VETERINARY CARE

Sam and Autumn aren’t alone in their struggle to afford veterinary services. A
2023 Packaged Facts pet owners survey found that young pet owners are more
likely than their baby-boomer counterparts to be concerned about veterinary
prices. Of the millennials and Gen Zers surveyed:

* 53% were strongly concerned about the affordability of emergency pet care.
* 42% were strongly concerned about the cost of pet medications.
* 39% were strongly concerned about the affordability of routine pet health
care.

According to a Vetsource Veterinary Analytics online article from November 2023,
“These affordability concerns, combined with a priority placed on convenience,
are driving younger pet owners to seek alternative care options, including
telehealth and chain veterinary practices located inside retail stores, or forgo
veterinary visits entirely.”

Dr. Stacee Santi, founder of the client communication app Vet2Pet and host of
the new podcast “The Accidental Entrepreneurs,” agrees.

“The world is getting more expensive,” she said. “Consumers are having to figure
out where they’re going to allocate their dollars, and I’m sure it’s impacting
compliance.”

According to the Veterinary Hospital Managers Association, “Some practices are
reporting a downward change in client acceptance of pet care recommendations due
to the increasing cost of veterinary care and the ongoing uncertain economy.”

Of 2,000 dog and cat owners surveyed in 2022 for Forbes Advisor:

* Nearly two-thirds said inflation made paying a surprise veterinary bill more
difficult.
* 42% said a $1,000 veterinary bill would send them into debt.
* 28% said a $500 veterinary bill would send them into debt.

“We’re turning into a land of the haves and have-nots when it comes to pet
care,” Dr. Santi said. “Pet care is becoming a luxury.”

Recently, several Mexican veterinarians told Dr. Santi that U.S. pet owners are
traveling to Mexico for veterinary services because the cost is so much lower
there. Data backs up their claim: According to SENASICA, the agency that
inspects pets entering the country, about 20,000 dogs and cats traveled from the
U.S. to Mexico in 2019. That number swelled to more than 33,500 — a 68% increase
— in 2022.

Two veterinary practices near the international border — one in Nuevo León and
the other in Tijuana — reported these prices, on average, for a 44-pound dog:

* TPLO: $1,400
* Intervertebral disc: $1,050
* Cystotomy: $530

On the U.S. side, the prices for those procedures can be as much as two to four
times more.

REPERCUSSIONS

Higher prices impact veterinary care in these ways:

1. Fewer Visits

Data from the Veterinary Industry Tracker, a dashboard managed by Vetsource and
the American Veterinary Medical Association, showed that 2023 year-over-year
revenue was up 6.2%, but year-over-year visits were down 1.5%. Pet owners were
paying more for care but visiting their veterinarians less frequently than they
did in 2022.

2. More Demand for Low-Cost and Subsidized Care

Visits are down at general practices but rising at low-cost and subsidized-care
clinics. The Dumb Friends League Veterinary Hospital at CSU Spur in Denver
offers subsidized services for pet owners in need. While the hospital has
reached capacity every day since opening in early 2022, what’s changed over time
is the client demographic. The Dumb Friends League practice targets underserved
communities, but referrals for people who cannot afford procedures and surgeries
recommended by their established veterinarian have become more frequent. The
hospital also has seen heightened demand for lower-cost spay and neuter
services.

3. Lower Rates of Pet Ownership and Adoption

The American Pet Products Association’s National Pet Owners Survey revealed that
66% of U.S. households owned a pet in 2022, down from 70% two years earlier.

Meanwhile, the nonprofit group Shelter Animals Count reported that intakes in
the first nine months of 2023 were up nearly 10% in two years. And many
shelters, including Dumb Friends League in Denver, have noticed more pet
surrenders related to housing issues, reflecting economic challenges. As people
downsize, combine households or lose a yard, they often relinquish their pets.

And while more animals are surrendered to shelters, fewer animals — dogs
specifically, according to Dumb Friends League — are being adopted. Dumb Friends
League statistics show:

* Fiscal-year 2023 dog adoptions were down 9% compared with fiscal-year 2022.
* 1,714 dogs were adopted from July 1 to Oct. 31, 2023. During the same four
months in 2019, 2,207 dogs were rehomed.

Furthermore, the 2023 State of Shelter Adoption Report from Hill’s Pet Nutrition
revealed that the top barrier to pet adoption is the cost of ownership, which
includes concerns like inflation, veterinary care and a lack of access to care.

WHAT VETERINARY PRACTICES CAN DO

As prices increase and more clients struggle to pay for pet care, veterinary
practices should keep these tips in mind:

1. Place Veterinarians at the Center of Money Discussions

“I’m probably going to catch a lot of heat for this comment, but veterinarians
shouldn’t be passing off cost-of-care discussions to technicians,” Dr. Santi
said. “It puts a barrier in the relationship between the veterinarian and the
client.”

Picture this: Your client reports a pet has diarrhea and is vomiting. You
examine the animal and want to order IV fluids, bloodwork, anti-nausea
medication and pain medications. The client agrees, so you leave the room and
send in the technician with the estimate. The client realizes your
recommendations are unaffordable. The technician goes to ask the veterinarian
for an alternative treatment plan while the client, likely feeling ashamed and
embarrassed, sits and waits.

“That’s where the experience goes south,” Dr. Santi said. “The tech will come
out and tell me, ‘The client can’t afford it,’ and then I’ll write a lower-grade
treatment plan, and the client will feel like a bad pet owner. … The whole
experience is terrible for everyone.”

Instead, she recommends that the veterinarian tell the client something along
the lines of: “Here’s what I think we should do. It’s going to run around
$1,000. I know that’s a lot of money. How does that work within your budget?”

Dr. Santi explained that most clients don’t have a reference point for the cost
of veterinary services.

“If I invited you to lunch and said, ‘We’re paying our own way for pizza and
beer,’ you’d have an idea of how much that’s going to cost,” she said. “But if I
tell a client, ‘We need bloodwork, X-rays and ultrasound,’ what’s their
reference point? Nothing. They might be thinking $200, and I’m thinking they
should be thrilled to see it as cheap at $1,000.”

Dr. Kvitko-White speaks directly with her clients about money.

“I’ll explain my differentials, how I value their investment, where the money is
going, why I might spend it in this way, and what the potential consequences are
if we skip something,” she said. “Having that conversation myself is more
efficient and natural, and it’s less awkward than the technician coming in with
a piece of paper after I leave.

“I’ve had far fewer difficult financial conversations since I started speaking
directly to my clients from the first moment of their appointment.”

2. Be Direct, Empathetic and Inclusive

Make clients feel like a partner by using words such as “we” and “us” instead of
“you.”

Dr. Crista Wallis, the co-owner of Monticello Animal Hospital in Shawnee,
Kansas, tries to be transparent and upfront about money. She works with clients
to set realistic goals and form a team for the betterment of the pet.

“I use phrases like ‘This is our problem to solve’ and ‘Let’s figure out how we
can make your pet feel better,’” she said. “That’s important because a lot of
people feel judged when they come into the vet hospital and can’t do everything
that’s recommended.”

Dr. Santi recommends helping clients “keep their pride and not feel like they’re
bad pet owners.”

“Veterinarians need to bring up money proactively — don’t wait until the client
asks how much it will cost,” she said. “We need to make them feel like we care
about them and their finances and the position they’re in.”

3. Offer Various Options

Clients want choices when paying for veterinary care.

“You can’t just say, ‘Oh, get insurance and you’ll be fine,’” Dr. Santi said.

Dr. Wallis surveyed her clients and found that 69% had financial concerns about
paying for their pet’s care. That number prompted her to “go back to the drawing
board to offer different ways to help our clients out,” she said.

Some of the options she implemented include CareCredit, Scratchpay, VetBilling
and a charitable fund. She’s also considering a wellness plan to help clients
prepare financially for costs associated with preventive care.

A VHMA survey published in November 2023 found that 44% of the responding
veterinary practices have a charitable fund for clients and 6% are considering
one. Of those practices with a fund, 62% distribute money on a case-by-case
basis and 9% use the fund for emergencies only.

4. Slow Down on Technology

Are veterinary practices spending too much money on technology and other
improvements? Dr. Santi thinks that might be the case.

“For many years, we’ve focused on advancing the technology, diagnostics,
therapeutics, preventives, specialized equipment and highly specialized drugs,”
she said. “It’s all just raised the cost more and more.

“We haven’t kept pace with the people and what they need. Now the people can’t
afford it, and we’re left here with this beautiful, expensive thing without a
heart.”

As the founder of a tech company, Dr. Santi realizes her message might seem odd.

“There’s a time in all of our lives when we have enough,” she said. “And if our
clients are screaming at us and can’t take it anymore, we have to pump the
brakes and let the rest of the world catch up with us. We can’t just keep
raising prices, getting new stuff, getting new stuff, raising prices again. We
have to slow down for a while.”

5. Make Smart Decisions With Your Clients’ Money

Dr. Kvitko-White thinks veterinary professionals should stop talking about the
gold standard of care. Instead, focus on choosing the most effective treatment
options within a client’s budget.

“If you know your client has $100 to spend, you need to determine the best way
to get the most bang for your client’s buck,” she said.

In addition, triage your diagnostics and treatment recommendations. Determine
the must-haves and nice-to-haves, and then rank each item.

6. Think Before You Increase Fees

Price hikes don’t have to be an all-or-nothing, across-the-board, every-year
thing. Before raising fees, consider:

* The economic realities of the community you serve. Has a massive layoff or
natural disaster struck your area?
* Prices in other industries. If your clients are paying more for groceries,
housing and other necessities, charging more for pet care might cause them to
visit you less frequently or forgo pet care altogether.
* Your visits data. Are regular clients becoming less regular? If pet visits
are decreasing, your clients might be struggling financially.
* Where you have room to grow. Increasing your profitability on fecal or
heartworm tests but limiting price hikes on medications or preventives might
be more feasible.

“If I start to see a trend in visits or I notice clients pulling back from the
services we typically recommend, I’ll send out a survey to find out why,”

Dr. Wallis said. “A quick survey with just a few short questions will help me
get a feel for what my clients need and want at that time.”

--------------------------------------------------------------------------------

ASK YOUR CLIENTS

Shawnee, Kansas, practice owner Dr. Crista Wallis is considering offering a pet
wellness program. To gain a better understanding of her clients’ feelings about
wellness plans and the cost of veterinary care, she surveyed them through
JotForm and asked the following questions:

1. Would you be interested in Monticello Animal Hospital offering wellness
plans?

* Yes
* No

2. If yes, which wellness plan option would you be interested in?

* Preventive care plan (vaccines, heartworm test, fecal test and yearly
preventives)
* Comprehensive medical wellness plan (yearly bloodwork, urinalysis and fecal
exam)
* Both

3. We know you want to provide the best care for your pet, but do financial
constraints affect how much care you can provide?

* Yes
* No

--------------------------------------------------------------------------------

AN UPDATE ON MAX

I interviewed Sam Stuteville and his partner, Autumn Miller, in late November
2023. By that time, their 17-year-old dog, Max, had been out of Eagle Animal
Hospital for nearly two weeks.

“We’re taking it one day at a time right now. [Max] is definitely not the same
as he was before all this happened. He’s a lot more lethargic,” Sam said as he
held Max during our Zoom interview. “And we know Eagle Animal Hospital did
everything they could. If it wasn’t for them, I wholeheartedly believe Max
wouldn’t be here today. But this has made me realize that I’ve had unrealistic
expectations. Max acted like a puppy for so long — even recently I thought he’d
live for another 10 years. But now, I’m grateful for every day we have left.”

One day later, he emailed an update: “I wanted to let you know that today at
5:15 p.m. Max passed away peacefully and without any pain. I hope this doesn’t
change anything with your story, and I still look forward to reading it.”

Thank you for introducing me to Max and for sharing your story, Sam.

“I would do anything for Max,” Sam Stuteville said about the dog he fell in love
with when he was in fourth grade.

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