10 Talking to Clients About Money

“The only way not to think about money is to have a great deal of it.”

–  Edith Wharton

There is very little research in medicine discussing how best to communicate with clients about money. That is because there is rarely a need to do so in human medicine in the United States, where many people are insured, and the population’s overall health is good (ignoring obesity for the moment). One can find fairly disturbing information from the human literature describing how individuals with no insurance or low household income are less likely to be offered a high standard of care and to suffer greater anxiety than wealthier individuals, and how physicians have been documented to make cost-cutting decisions without patient input in order to save money for the hospital where they worked. Our society places a highly symbolic meaning on money, such that some doctors may feel that helping the patient and client and making a decent return for their business are not compatible goals.

We have repeatedly stressed the need to be honest with clients and open to their concerns. This relates to discussions about money, too. Even those clients who say, “Money is no object, do whatever you need to, Doc,” need to hear about money. Their expectation of what things cost may be far removed from reality.

Several studies evaluating how we talk to clients about money and what their expectations are of us have been conducted at the Ontario Veterinary College, evaluating their teaching hospital and surrounding small animal practitioners. In one survey of 200 appointments, costs were discussed in only 29% and a written estimate was provided in only 14%. In virtually none of those encounters was there any discussion of how suggested diagnostics or treatments would permit diagnosis or provide future health benefits for the pet.^[1] In another study^[2], evaluation of focus group input from clients and veterinarians revealed the following:

• Clients expect the care of their animal to take precedence over monetary aspects.
• Clients expect the veterinarian to initiate discussions of cost upfront.
• Clients’ focus is on how money spent will enhance the pet’s health and well-being.
• Veterinarians focused on tangibles, like the time spent and cost of materials, when discussing costs.
• Veterinarians sometimes felt under-valued for their efforts.

When talking to clients about money, it may be a difficult client interaction. The ADOBE model can be used, as for any difficult client interaction; this model will be discussed in the next chapter.

Clients want to understand why they should spend their money. It is imperative that we find ways to communicate the value of the diagnostics and treatments we are recommending. Much of this boils down to how you present it. A client is much less happy to have spent their money on diagnostic tests if they’re told, “Well, they were all negative and I still don’t know what’s wrong,” than if they heard, “I’m happy to tell you that all of the tests run so far are negative so I can say pretty confidently that we can rule out these diseases”.

Some suggestions from one author about how to proactively address client concerns about fees are the following^[3][4]:

• Provide written estimates for all procedures and for all clients.
• Explain the value to the animal: “we monitor fluid administration to be sure your pet is responding appropriately and to catch any problems as quickly as possible”.
• Let clients know that financial concerns can be discussed freely and privately, and with whom.
• Make sure every employee is aware of how billing and financial concerns are handled.

You can think about value as an equation, shown below:

• Value = (Results + Customer Experience) / (Price + Customer Access)

If you know customer access is limited (as it may be a very small hospital where the veterinarian has limited working hours), you need to demonstrate good results or great customer service to balance that. Know what the strengths are of where you work and make those strengths known to the clients, so they appreciate how those strengths build value for that client.

Veterinarians traditionally have been prone to give services away fairly readily. To that end, many practice managers will ask the veterinarian to give away their power to charge clients and it has been well-demonstrated that support staff are much better at capturing all the charges for a given case. However, the veterinarian needs to know what things cost in the clinic as they will most likely be the one generating estimates and helping clients work through the decision-making process.

Finally, it is obviously never appropriate to make guesses about what clients are willing or able to spend. Offer what you think you need to do the best for the animal but make sure you have prioritized in your mind which tests you need to do first to most likely reach an answer. Make it clear to clients that you are supportive of their economic decisions. You are not them; you do not know what economic pressure they’re under, and you cannot make them spend money the way you’d like. That means that more often than you’d like, you cannot do all you know is possible for that animal.