Practical Tips for Talking About Money

Lisa J. Hunter, LSW, The Argus Institute, Colorado State University Veterinary Teaching Hospital

Jane R. Shaw, DVM, PhD, Colorado State University College of Veterinary Medicine and Biomedical Sciences

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Practical Tips for Talking About Money

Financial conversations play an integral part in achieving clinical outcomes (eg, patient health, adherence to recommendations, client satisfaction), yet they do not often take place.1 Why do veterinary professionals find talking about money so difficult?

Tension may exist between providing necessary patient care and charging appropriately for services provided. A recent taxonomy of practice-related stressors reported that 8.3% are due to clients unwilling to pay and 6.9% to low-income clients.2

Clients prefer that veterinary team members focus on caring for their pet, with the cost of that care their second concern.3 They also may fear being judged if they cannot afford the recommended care. One study found that 1 in 8 clients has little to no experience as a pet owner,3 so they may not know what to expect. Many clients plan for their pet’s routine care expenses; however, very few set money aside for emergent or unexpected scenarios.4

The following practical tips reduce the unease of financial discussions and pave the way for collaborative decision-making.  

Educate About Value

Directly connect the impact of the investment in the pet’s welfare5 by explicitly providing the Why (ie, the value) of each recommendation. Many veterinarians focus on tangibles (eg, services provided, time spent, specialized equipment), but clients want to know how the money they spend contributes to their pet’s health and wellbeing.6 Inform clients what can be learned from the diagnostic test, how the test will help determine the diagnosis and target treatment, and how the treatment will benefit their pet. Clearly state medical recommendations in words clients can understand. The extra time taken to educate clients will pay dividends in enhancing client adherence to diagnostic and treatment recommendations.6 (See Benchmarks.)

  • I would like to share my thoughts behind the recommended treatments, and how they will affect Jengo’s quality of life [signpost].
  • My recommendation is to start with bloodwork to determine the primary cause and target Jengo’s treatment so he will feel better sooner [signpost].
  • I hear you are feeling financially “tight” [empathy]. To make sure we are spending your money wisely [partnership], let us go through the treatment options, advantages and disadvantages, and associated costs together. Then we can determine how best to proceed [partnership].

Success Takes Time

“Effectively communicating treatment plan costs is not a one-step process, nor is it something you can change in a day. The path to success changes over time. It is like a muscle you have to work to develop and maintain.”

SOURCE: Cook B. Effectively communicating treatment plan costs. Benchmarks 2017: A Study of Well-Managed Practices. Columbus, OH: WMPB; 2017:45.

Present the Costs

Clients want veterinary professionals to bring costs and financial concerns to the surface when presenting diagnostic and treatment options.7 Timing is of the essence in being open and upfront and, at the same time, ensuring the client does not perceive that the veterinary team is focused only on money. One study showed that only 8% of financial discussions included a written estimate.6 A written treatment plan outlining diagnostic and treatment options and estimated expenses can lead to better recall, understanding, and informed decision-making. 

Choosing the best professional to present the estimate—the veterinarian, veterinary nurse, or business office team member—is another key issue. To promote informed decision-making, the team member most knowledgeable and qualified to address client questions should be poised to present the treatment plan and its estimated costs.

Include in practice protocols how clients will be informed about changing costs of care. For example, provide daily updates on a hospitalized patient’s progress as well as the hospital bill. Plan how to reach clients during procedures should the original estimate need to be changed mid-procedure, which will avoid the client being surprised by the final bill. Disputing fees is ranked the third most common source of stress among veterinarians,8 but such arguments can be avoided with transparent financial conversations upfront. 

  • As we work together through each treatment option for Jengo [partnership], I will address the financial aspects of his care.
  • I understand that medical care is costly [empathy]. I outlined a few options for Jengo’s care in his treatment plan that we can discuss together [partnership].

Elicit Client Perspectives

Take time to build rapport before moving into this sensitive topic. Inviting clients to present their financial limitations eases client concerns and builds a partnership from the outset. When client perspectives become known and expectations are made clear upfront, clients know to anticipate honest communication about finances. (See Resources.)

  • Before we make any decisions [partnership]I wonder if we could discuss your financial expectations for Jengo’s care [eliciting client perspective].
  • How does this estimate fit into your family’s budget [open-ended question]?

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Foster Decision-Making

Give clients time to consider the diagnostic and treatment plans because they may easily become overwhelmed. They likely will need time to process and research the information, discuss it with other key decision-makers, and identify resources. Determine which decisions are needed for immediate patient care and what can be resolved later. If the client cannot afford the recommendation, revisit the risk-benefit discussion and work together to identify alternative approaches. The veterinary team member’s expertise alongside the client’s perspective will guide the conversation forward. 

  • You do not need to make a decision now, or even today, and I understand that you may like some time to reflect and speak with your family. I would be glad to address any questions that arise from these discussions [partnership]
  • Balancing the care you want for Jengo with the amount you can spend can be difficult [empathy]. Would it be helpful to go over alternative options for Jengo’s care [asking permission]?
  • I am happy to discuss different options for Jengo’s care. Shall we revisit our list of advantages and disadvantages to determine how to move forward [partnership]?
  • We will work together on a plan that provides the care Jengo needs and fits into your budget [partnership].

Conclusion

Connecting costs directly to the patient’s wellbeing by educating clients on the value of the recommended treatment options increases client buy-in. Presenting treatment options, making clear recommendations, discussing risks and benefits, and initiating transparent discussions about costs builds trust and enhances compliance. Also, eliciting client perspectives fosters informed decision-making and determines a patient care plan that is also a good fit for the client.

1 Educate clients first on how treatment recommendations affect the patient’s wellbeing and quality of life to increase client buy-in.

2 Present the cost associated with each treatment option, and provide a written treatment plan (ie, treatment options and associated costs) as a visual aid to help clients make educated choices.

3 Include in practice guidelines how clients are informed and updated about patient costs and ensure the team member who talks to the client is knowledgeable and able to address client concerns.

Resources & References

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