One equine practitioner sends out bills monthly with a personal note and self-addressed envelope. Another requests payment at time of appointment via Venmo, check, or cash. An additional veterinarian offers a cash discount day of service but bills horse owners if necessary. And yet another works for a practice that bills all its clients after service. While their payment policies vary, all four individuals are experienced, successful ambulatory equine practitioners who care deeply about their patients and clients. Additionally, all inevitably have had an accounts receivable (AR) list at some point—if not now.

Amy Grice, VMD, MBA, covered discounting and billing trends in equine veterinary medicine and how to turn accounts receivable around in the sunrise session “Where Emotions and Economics Collide: Bridging the Gap Between Cost and Care,” sponsored by CareCredit, at the 2021 American Association of Equine Practitioners (AAEP) Convention, held Dec. 4-8 in Nashville, Tennessee.

Grice, who worked as an ambulatory practitioner for 25 years and served as managing partner of a large equine referral practice until 2015, is now a veterinary business consultant, where she advises practitioners and speaks at seminars and other events to share what she’s learned. Currently, Grice serves as the treasurer for the AAEP, works on the AVMA’s Economic Strategy Committee, and facilitates the Decade One program, designed to help equine veterinarians in their first 10 years of practice or practice ownership.

Why Is the Money Part So Difficult?

Grice said veterinarians have a hard time with the client payment conversation because they all love horses and feel a great affinity to their clients.

Additionally, “so many of us have families, small children that we want to spend time with,” she said. “It’s so very important to be able to make a living and pay our obligations, whether they’re student loans or whatever, while working a reasonable number of hours and getting paid for those hours. So that’s why we find it so hard in many ways when we don’t get paid for our work or don’t charge appropriate prices—all those things that we struggle with.”

Equine veterinary practice is historically inefficient compared to small animal practice (drive times versus waiting room/exam room traffic), and equine veterinarians’ fees often don’t reflect this reality.

Horse owners don’t pay their bills for a variety of reasons, including:

• They’ve been trained by veterinarians to be billed and then pay when they get around to it.
• Horse owners prioritize other purchases.
• They don’t understand how expensive caring for a horse can be, especially when that horse gets hurt or becomes lame or sick (Grice suggests talking to them about the range of possible costs when conducting a prepurchase).
• When they are surprised or confused by the invoice total, don’t see the value in the service their horse received, and/or don’t have the money to pay for care.

Why Veterinarians Discount

Grice quoted Kyle Palmer, CVT, of Silverton, Oregon, who spoke during an August 2021 CareCredit roundtable session: “‘It’s important to understand that what we’re charging is fair; it’s reasonable; it represents the value that you bring as a practitioner. I’ve always believed that discounting drives back to guilt that the fees are too high in the first place, and that’s a mindset that has to be overcome.’

“Good for Kyle, right?” said Grice. “Because we feel guilty sometimes about fees, and what do we do about it then? We discount.”

In a live audience poll, 71% of attendees said they give a discount to someone every week, and 29% give one about once a month. Equine practitioners discount for a variety of reasons beyond guilt, from personal history to compassion for the horse.

At the August 2021 roundtable, noted Grice, Wendy Krebs, DVM, of Bend Equine Medical Center, in Oregon, aptly said, “‘There’s a fine line we have to walk in showing that money is not our only objective, but we do have to get paid or nobody is going to be there to take care of their horses.’”

Grice added: “And we’re seeing that right now where the equine profession cannot pay compensation high enough to keep, retain, or attract people into the equine veterinary industry.”

How To Turn Things Around

Grice gave examples of how to approach billing effectively, resist discounting, and eliminate AR and the need for collections:

• Establish and uphold well-written, workable financial policies, and communicate them to the client. Grice described a practitioner who sets these payment expectations, as well as what future charges will likely be, at the time of any prepurchase exam: “That kind of transparency is really important.”
• Communicate costs for routine care ahead of the veterinary visit. This includes vaccines, dentals, fecal tests, and other basic maintenance.
• Get paid at time of service. Many veterinarians moved to this practice beginning with the COVID-19 pandemic.
• Enact a policy that clearly states you have credit cards on file for every single client. Pre-authorize cards prior to clinic or farm visits, especially with new clients. (This is especially helpful for boarding farms where the owners might not be present during the veterinary visit.)
• Give a $50 bill out of your wallet to the client every time you’re asked for a discount, instead of adjusting the invoice.Surely this exercise will cure you of discounting, she said.
• Remember the other aspects of your practice that don’t get attention when you discount.For instance, you can’t compensate staff, purchase new imaging technology, etc.
• Provide prepayment plans. Enroll clients in wellness plans and have them pay monthly.
• Provide a variety of treatment options at different costs.
• Provide a modest discount for paying cash at time of service.
• Extend a bit of credit, with terms, if your practice can manage it.
• Request and secure a deposit once you provide clients an estimate for a larger-ticket service.
• Require payment before horses are released from clinic/hospital care. The longer it takes for clients to pay for emergent care, the less they remember the value of that care, said Grice, and the less likely they are to pay.
• Suggest financial services like a CareCredit credit card. “In my practice we had a hospital that did a lot of colic surgery and things that were emergent care, and being able to offer people CareCredit was really helpful in them being able to make the choice to save their horse’s life.”

Paying Customers Boost Practice Health, Team Morale

All these efforts move equine veterinary practices toward more cash flow.

“Remember that cash flow is important in having the practice feel like it can pay its obligations,” said Grice, “and getting paid at the time of service instead of waiting and waiting and waiting will allow (this).

“We’ve got a lot of practices that don’t have any policies, and you need them,” she added. “And then you need to educate your clients and train your staff to ask for money and … follow the policies in a very neutral and normal way. You don’t go to the grocery store and fill your cart and leave without paying.”

Everyone, from owners to practice managers to support staff, must follow these policies to ensure clients pay and to support practice staff morale, said Grice. “Owners need to model the way, they need to follow their own policies, and walk their talk.”

Take-Home Message

Transparency when communicating about fees, educating the client about financial expectations, minimizing discounting, and having clear policies the entire practice team follows will ease the burden of accounts receivable. For clients with unexpected veterinary bills, having a credit option available can allow practitioners to provide services that can save a horse’s life while still maintaining practice cash flow.

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