This week on the podcast…
This week on the Uncharted Podcast, Stephanie Goss is flying without Andy but she invited a friend to join in a very special conversation. Certified Veterinary Practice Manager Debbie Boone joins Stephanie to talk through something that strikes fear into the heart of a lot of veterinary teams – money conversations. Specifically, the anxiety that teams feel about “sales” in veterinary medicine and the difficult money conversations we find ourselves facing. Thanks to our friends at CareCredit, a Synchrony solution, Debbie and Stephanie are wading into the idea of shifting our mindset from “financial policies” to “providing financial care” for our clients as part of the greater client care we provide every day! Let's get into this…
You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.
Thank you to our sponsor, CareCredit, a Synchrony solution.
RESOURCES
For Financial Ideas to Help Pet Owners – https://debbieboonecvpm.com/help-for-pet-owners/
For more information on offering Care Credit in your practice: www.carecredit.com/vetinsights
This content is subject to change without notice and offered for informational use only. You are urged to consult with your individual business, financial, legal, tax and/or other advisors with respect to any information presented. Synchrony and any of its affiliates, including CareCredit, (collectively, “Synchrony”) makes no representations or warranties regarding this content and accept no liability for any loss or harm arising from the use of the information provided. All statements and opinions in the Uncharted podcast are the sole opinions of the speaker. Your receipt of this material constitutes your acceptance of these terms and conditions.
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RESOURCES
For Financial Ideas to Help Pet Owners – https://debbieboonecvpm.com/help-for-pet-owners/
For more information on offering Care Credit in your practice: www.carecredit.com/vetinsights
Upcoming events: unchartedvet.com/upcoming-events/
Episode Transcript
Stephanie Goss:
Hey everybody. I am Stephanie Goss, and this is another episode of the Uncharted Podcast. Well, this week I am on my own, Andy is on a break, but I am not truly alone because I have a wonderful guest with me. This week. I have been wanting to do a podcast with my friend Debbie Boone for quite some time. And an opportunity arose thanks to our friends at CareCredit. They came to Andy and I with an idea for a podcast about practice finances and about the idea that money conversations with the team are so hard some of the time. The team hates talking about money generally, there's also almost always somebody on the team who gets anxiety when it comes to the idea of being salespeople in the room. And when I thought about who I could jump into and nerd out on this topic with, Debbie immediately came to my mind.
If you don't know Debbie, you are in for a treat. She is a CVPM, so certified veterinary practice manager. She is a practice manager with years of experience in the industry over 30 years, and she is now a industry consultant. She works with practices. And what I love about Debbie's style as a consultant is that, she really wants to work with practices to teach and coach them to learn about smart business practices so that they can do it on their own. Her goal is to set them up for success and then let them fly. And I just love that philosophy. She brings it to how she speaks, she is an industry speaker and how she works with her practices individually and also how she educates. Debbie taught curriculum for Patterson U for a long time, and so she has got a lot of knowledge to bring to this table and the conversation today. And I am super excited to share this one.
This week's episode is brought to us ad free by our friends at CareCredit, and this is a fun conversation. So let's get into it, shall we?
And now the Uncharted Podcast.
And we're back. I am Stephanie Goss and I'm here this week, not with Andy Roark, but with my friend the amazing and wonderful CVPM, Debbie Boone. Now Debbie is a practice manager. We have known each other a long time. She is like me not practicing these days, right Debbie? But tell us a little bit about yourself. Welcome to the podcast.
Debbie Boone:
Yeah, thanks for having me, Steph. Every time Steph and I see each other, it's like, oh boy, big hug. But we only see each other at conferences, so.
Stephanie Goss:
Debbie gives the best hugs. I look forward to it. Every time we see each other.
Debbie Boone:
We preplan it so we can find each other, so we can do things.
Stephanie Goss:
It's true. It's true.
Debbie Boone:
Oh, man. But as Stephanie said, I am a CVPM and I managed hospitals for 23 years before starting my own private consulting business. And I focus a lot on communication, client service, culture building, leadership skills for veterinary teams. And for years I wrote a column called Culture Coach for Vet Team Brief, a magazine I still love and miss. And then I've done a lot of writing and currently thank you to CareCredit's support. I am writing a book called Hospitality and Healthcare that I will be signing at AVMA about how to-
Stephanie Goss:
So excited.
Debbie Boone:
I'm pretty pumped about it. I've got 30,000 words written and a St. Patrick's Day deadline, so I've got to keep pushing the gas on that.
Stephanie Goss:
Oh man, I am so excited for that and for you, and it's funny because we were working on the plans for this podcast and I was talking to our friends at CareCredit and the team over there. And we were talking about financial care versus financial policies is what we're going to talk about today. And we were talking about who would be a good person to have the conversation with? And you were immediately on my mind, A, because you are fun and I've been looking for a reason for you and I to do a podcast together for a while. But also B, you what I love about your style, your consulting style, but also just your presence in our field and the way that you interact with other managers, is that it's always been focused on the customer care aspect.
And that's what I love and what I'm excited about today is podcast is it's important for us to have financial policies, but really one of the things that I love to do as a manager and that I love that CareCredit helps us promote as an industry is how do we think about it from a financial care perspective, from a wellness perspective so that it's more well-rounded and it's not just, oh, hey, we're having an emergency and now we need to have the money conversation. But we're thinking about it from the very beginning. And so when we started talking about it, I was like, I think this would be a great one to do with Debbie. So I'm super excited to have the conversation today.
Debbie Boone:
Yeah, I'm really excited to talk about this because it's one of the things is, I have a whole chapter in the book about why do we hate to talk about money? And we avoid, and a lot of times I actually think about, it's really a cultural thing because we're trained from the time we're young to say, you don't talk about money. It's like, don't ask people's age. You're fine if you're five. You can ask people how old you are if you're five, but when you're 45, you don't ask people how old they are. So it's the same principle. And so we don't talk about salary to our detriment. And we don't talk about finances again to our detriment.
But I've laughed because for years my husband was in sales. And he coached me having had sales classes. And of course if you say sales to any veterinary team, they keel over like one of those fainting goats. And you're like, wow. In fact, I was at the Uncharted Conference, I always remember this story. This veterinarian was talking about her team and she was talking about the difficulty in getting people to say yes to stuff. And she said, “And I don't want them to sell but.” And I went, yes you do. You really do.
Stephanie Goss:
You do.
Debbie Boone:
You do.
Stephanie Goss:
You do. Okay. So that's where I think this conversation starts. When we think about finances in the practice, policies, care, just the discussion with clients, there really are few things that give the team more anxiety or overwhelmed than quote-unquote sales or the money conversations. From the beginning, even when I was at the front desk, it always amazed me, I never had a problem with it. I guess probably because I had had retail and formal sales experience before coming to veterinary medicine. But my colleagues who came solely from veterinary medicine, they had so much anxiety and stress over having those conversations. And so I have always wondered and have asked the question a lot of my colleagues, but also of my team, where does this anxiety come from? What is so scary about the idea of sales in veterinary medicine?
Debbie Boone:
Well, I think it's the idea of if the concept of sales, it's that used car salesman push stuff on people that's unnecessary. But when I am teaching classes about sales, I say, look, it's education. You really are teaching people what their pet needs because they don't know on their own or they're going to go out and they're going to get some wacko misinformation if you are not the educator. So, when you're talking about sales, if you think how many people walk in your door and go, “Hey, I think my new puppy that I've never had a dog before in my life is probably going to need some parasite prevention and heartworm prevention and some appropriate nutrition?”
They don't do that. They expect us to do that. And that's selling, that's selling. But it is presenting and in a way that you're showing the value for it because that is the challenge. Is a lot of times we just want to reel off this grocery list, but we also have to back up and say, this is the feature. This is like, here's your Volvo, here's the feature. It's boxy, but it's good. It's one of my favorite lines from a movie.
Stephanie Goss:
It's totally, totally true. And I think that, that is one of the pieces that as managers, we all know that it starts with the education, but I think that for a lot of us, the conversation doesn't often go beyond the surface when it comes to the concerns both the team's concerns and their concerns on behalf of the client. Because I think some of the anxiety comes from whether it's a preconceived notion or truth that the team members may know about a client, they are also concerned on behalf of the clients about money. But at the same time, it's not our job to be able to control the client's finances or even know what the client's finances or financial situation is. Like you said, we can't control that we don't know. And so how do we get the team to open up and talk about what their concerns are? And where do we start with the battle? Because I feel like if we just say, okay, well you need to educate them, it's always a yes, but or yes and from the team. Yes, but this is what I can't do.
Debbie Boone:
Well, I've taught like 10,000 plus people when I was teaching the Patterson classes, and we talk about this. And I said, “First of all, when you're pre-judging somebody, how arrogant of you, how dare you? Because you have no idea where this pet's place is in the home.” In my experience, I worked at a very high-end practice in my first 19 years, and I've worked in a rural practice my second three and a half years before I started consulting. And in every one of those you had people of modest means who would say, whatever it takes, I will pay it, here's my credit card, here's four credit cards, for the things on this, this and this. And you've also had people who were mega wealthy who said, “I'm not going to pay for that. I don't want to.” Because that was a part of their values.
So it really goes back to we have to start paying close attention to the people in front of us and we can't stereotype or bump them into, well, this one's got some money and they're going to pay and this one doesn't have any money and they're not going to pay. One of my favorite stories, I used to do some work with Zoetis and they always made me tell this story. But one Saturday morning, it was the rural practice and this man came into the practice and he was carrying a chicken under his arm and he had blue jeans on and they were ratty and he had his straw hat on, it's ratty and it's an old faded shirt.
And you're looking at him and going, this man doesn't have two nickels to rub together. But the chicken had apparently attempted to cross the road and really didn't make it to the other side. So she did get bumped by a car. Well, we put her into an exam room and figured out that she did have a broken leg, and we gave her estimate for an orthopedic pit placement. And the client said, “Yes.” Well come to find out.
Stephanie Goss:
Talk about upsetting the stereotype for your team.
Debbie Boone:
So then three days later after she was hospitalized, he comes back to pick up Henrietta. And at that point in time we find out that he had actually been to two other veterinary hospitals who looked at him and said, the first one said, “I don't know. I don't know how to do this.” [inaudible 00:11:55]. Honestly, the second one, and remember this is rural North Carolina, looked at him and said, “Are you crazy? It's a chicken break it's neck, eat it for lunch and move on.”
Stephanie Goss:
Right. I was going to say it's not worth doing the surgery. They were judging the value.
Debbie Boone:
$5, right?
Stephanie Goss:
Right.
Debbie Boone:
So this was a $700 bill. And we find out at that point in time that this is a human physician who works at the local hospital and he's a hobby farmer. And so he's so thrilled with the work that we did, he moved all his animals to our practice and he had 23 animals because he had everything. And then he goes back to work and he tells everybody what an amazing thing that we did, and he sends us this whole referral base of people who are working in the hospital.
So you cannot judge who is in front of you, you just offer the best you can. Now that being said, would we have figured out a way if he wanted to and could not pay you $700 in one fell swoop to figure out how to pay for Henrietta? Yeah, we would have, we would have offered him CareCredit. You have to have a policy in place and people need to know that you have the policy in place. I could remember many years ago, this is probably back in the nineties, and I used to go take classes. I'm sure you used to do the same things, career track classes and all these. And they said, one of the things that you need to do, is to make sure that people understand that you have payment options before they walk in the door. Because that gives them a sense of safety and security that whatever is happening, they have a way to figure out how to cover it.
So they said, always put your little stickers, MasterCard, VISA, Discover, American Express right near your door handle so that when people are walking in, you push the door, they can read it all. And so sure enough, now you got to remember, I've been doing this a really long time, so I predate CareCredit. So.
Stephanie Goss:
I love that so much.
Debbie Boone:
So just shut up, Stephanie. So when CareCredit came out in the 90s, I was so happy because our practice for years had billed people. And every 15 days we would go through it and we would copy statements and we would stuff envelopes, and it was an inordinate amount of time to do all this. And these were a lot of very wealthy people who just didn't want to bother to write a check, and then they would have their people send stuff money in. But when CareCredit came out, we just said, okay, we're not doing this anymore. Here's the brochure. We stuffed envelopes with the brochure and said, “We are out of the banking business. We're not supposed to be bankers anyway, let's do this.” So we had an out and people took advantage of it. But it was about having a strategy ahead of time. I've been in practices as a consultant, and somebody yells across the counter, you'll love this because I know you've seen it. “Hey Doc, can Mrs. Jones bill that $300? She doesn't have any money today.” And he'll go, “Sure, that's fine.” That's the credit policy.
Stephanie Goss:
I'm laughing because I've heard it.
Debbie Boone:
Yes, yes. So even if you're going to do that, have a system in place where people have to sit down and fill out some information about themselves and how you can track them down and all this good stuff. One of my good friends was a credit collection agent, and I learned a lot from Elaine about the bad mistakes that people would make in these credit situations. But really, we have options in our world and we really need to have systems in place. Even, I mean, CareCredit is an obvious one that we all use, but there are other things that we can do to split bills. And I actually had a client who paid me monthly like the mortgage, and she would just build up a credit in her Cornerstone account and then bring three dogs in and wipe it all out. But I've had managers push back on that because shouldn't we escrow that? I went, seriously, you're doing somebody a favor. They're not going to press you for escrowing their money. It's a credit on their account. Just help. Just be there and help.
Stephanie Goss:
Well, it's funny that… So I want to unpack a few things that you said. So first thing that is crazy to me is almost as crazy when we are getting ready to do this episode when we're talking about the software and Zoom, and I was laughing because I'm still amazed every day that we're this far into life online during and after the pandemic where there are people who don't use Zoom. And similarly, I am shocked, Debbie, at how often you and I are both in a lot of the industry practice manager groups ranging from professional organizations like VHMA where you're paying a membership fee to be a part of them to the free Facebook groups. And I'm still shocked, a week hasn't gone by where somebody doesn't ask, “Hey, what do you think about CareCredit?” Or “Hey, what do you guys think about Scratchpay or VetBilling or one of the other options?”
And it amazes me, especially, especially when people ask about CareCredit. Because I'm like, this is not new. This is not new you guys. This has been out for so long. And it is amazing to me how many practices still don't offer it to their clients, especially because it's one of the things that shocked me. So occasionally I get super nerdy and I get into catching up on journals and research studies. And Synchrony did the lifetime of care study. And if you are a manager in veterinary medicine or practice owner in veterinary medicine and you haven't read through this, at least skim through the cliffs notes version, you should because there is some excellent, excellent information about care in veterinary medicine and what our clients think and affordability and lots of different topics. But there was two things that really caught my eye when I was skimming through things.
One was that, one in four pet owners when they were surveyed said an unexpected expense of $250 or even less would be a financial issue for them. And that a bill of $250 was enough to trigger anxiety for them over how to pay. And I think about that, and I don't know about you all, but it's been a long time since an annual visit with vaccines and preventative and lab work and their exam wasn't over $250. And so when I think about those two things together, it amazes me how we are not doing more to have the conversation. And you were saying like have the policy. And I think so many of us say, “Okay, well we have a policy. We don't accept payments or we take held checks or we offer CareCredit.” Whatever your policy is, a lot of hospitals have it defined. But it's an unspoken policy.
I mean it never ceases to amaze me how many practices will talk about it at the time of need when we have to have the conversation with clients, but there are so many of us that are not proactively and preventatively talking finances with clients. And the reality is that, paying for care, any care whether it's human healthcare, pet healthcare, it is expensive and it is a big undertaking. And we have got to do better by our clients to have that conversation earlier and more often. It can't be a one and done, it especially can't be a one and done conversation at the time of crisis. We have got to start when clients come in, to your point, before they walk in the door, do they see it on our website? Do they see it on our social media? And more than just the stickers that we had in the 90s of, “Hey, we take Visa, MasterCard, Discover.” But this is what our actual policy is.
We expect payment at the time of service if… Here are the payment options that we accept. And then defining what are the circumstances where billing is allowed or payment options are allowed beyond those acceptable options? That we're talking about it before they come in at that first visit, especially when they're puppies and kittens. That we're extending the financial conversation at that point in life beyond just financing like CareCredit. But we're talking about pet insurance and things like that, that we're talking about it when they're young and that we're continuing to have that conversation as they evolve lifetime-wise in our practice.
Debbie Boone:
I think one of the misconceptions that we have, first of all, is that people are medically knowledgeable. Because one of the questions I've asked for years in my classes is, how many of you have had someone come into your hospital who doesn't know if their dog is male or female? And 100% of my students raise their hand. So we're starting with a misconception of that premise that people understand what we're talking about. And then the second one is that, people have a concept of how much things should be. I think you probably remembered this study that Karen Felsted did for VHMA about the cost of vaccines and exams. And people were pretty close to vaccine costs because they do that a lot. But their misconception of the cost of a dental cleaning was that it should cost $55 and it's closer to 500 as an average.
So if we are not talking to people about how much like, this lifetime of care study, how much a dog or a cat costs you in its lifetime. Then we are doing those people a disservice because they don't have a good concept of what the reality is. How much they should even prepare to spend. Because they're thinking about it, okay, maybe I'll go to Tractor Supply and they're what, $2 a mile or something in there. So we really need to have that discussion. And when I was managing hospitals, I always did a lifetime care brochure and we would start out with puppies and kittens and here's what they need and here's what they need as an adult, and here's when they get six or eight, here's what they need. So for years, you are prepping people for advanced care as they get older and older. And you're also sharing how much that costs with people so that they're not blindsided when they get to that point in the game.
And I think that's one of the things that we talk a lot about clients being upset with us and how difficult people are being, and certainly over the pandemic, everybody had lost their mind. But one of the things that we've done is we have continuously blindsided our customers and not prepped them appropriately to understand the cost and be prepared for payment and to give them some of the tools that we have. I think one of my favorite tools, and you and I have talked about this before, is Pawlicy. And so Pawlicy advisors is like a hub of multiple different pet insurances. And what you do is you go in and you put your pet's information, name, age, breed, size, any major problems that they've had, and this algorithm figures out the best pet insurance policy for that pet and gives you the cost. And you can say, okay, do I want to cover all the vaccines and dental cleanings or can I afford that on my own? And do I want just disaster insurance or big problem insurance? And you can obviously probably hear Tucker barking in the background on occasion. I apologize for.
Stephanie Goss:
No, it's so great. Debbie has a naughty little COVID puppy.
Debbie Boone:
Yes, I do. I do. Although-
Stephanie Goss:
He is adorable.
Debbie Boone:
He's so cute. But he gets in a lot of trouble. I've wanted him insured, but I've wanted him insured and Bichons, he's a Bichon. So come subsequently, their genetic problems are cataracts and bad knees and things like that. So putting that information in, Pawlicy was able to find me the best policy for my breed of dog, which actually ended up being pet's best insurance. And so we got him a monthly payment and he's been insured since the day he walked in the door. And I would say, I tell everybody now, I tell friends who get pets, insure your pet. Because when I started in vet med, and we won't talk about how long ago that has been. But life was simple. We talked about fleas, we dispensed prednisone like water. And-
Stephanie Goss:
Heartworm.
Debbie Boone:
The heartworms, and then we talked about hit by cars, hotspots and all the flea allergy dermatitis that was our life was about that, especially in the south. But now, I mean, I have practices that I work with that have CT scans in their general practice. And we're doing complex work, we're doing human-level work. And without insurance, people have no concept and no ability to pay that for the most part. Because we need to tell people that they need these things. And people don't, I mean, I've still have people who don't even know pet insurance exists. We have a huge opportunity… I'm sure Paul Camilla, who for years was Jan Bellow's practice manager. Well, Paul has started with some partners, some veterinary hospitals, and his major focus was that people be insured and 60% of the pets that come into his hospital have a pet insurance policy.
And he said, “Deb, we don't talk about, I can't afford it in my hospital.” People are like, “I have insurance. Let's just do it.” And for his front office team, he said, “I didn't hire medical people. I hired salespeople who know how to share the benefits of this stuff.” So years and years ago, Dr. Wendy Hauser and I wrote a book called The Veterinarian's Guide to Healthy Pet Plans, and it was about the advantages of having monthly paid wellness plans. So my concept is if you have the combination of a wellness plan and pet insurance, then you got it knocked when it comes to taking care of your pet.
Stephanie Goss:
Yeah, I love both of those things. I am a huge advocate. And it's funny, I was anti-wellness plans for a really long time. And then I had done them in-house and had experimented with industry options. But now I'm on board because I saw how when they're done really well and they're modeled off of your practice's standard of care, then to your point in the very beginning, it's not about selling, it's about educating. And if it's what you believe in and are recommending anyways, really it's just another way for clients to be able to access the care because you're providing them a payment plan. Is really all ours, we did not have a huge discount built into ours. There was a small discount, but certainly not big because my doctors were earning on production and we wanted it to be fair on both sides.
And they were like, “Hey, this is good for the patients and so we're going to do it.” And we also need it to be fair for us from a pay compensation perspective. And so I think our discount was capped at 10%. It was like five or 10%, it wasn't huge. But clients were happy to have some sort of discount. And really they were just like, “Oh, I can pay it over 12 months, great, sign me up.” It made the yes an automatic. And to your point about insurance, I think that is a shift. The conversation I've been having with our colleagues for years is, why are we not, it doesn't even, I don't think have to be about selling. It's about changing our language. Because if you ask a client, are we billing pet insurance today? When they come in for their appointment, you're not making a recommendation outright, but you are making a very clear recommendation of, hey, we want our patients to have pet insurance.
And it opens the door for those conversations about, “Oh, pet insurance is a thing. Tell me more about that.” Because that's what you get more often than not is, “I didn't know pet insurance existed. Tell me more.” And so I think I love that, and I love how there has been a focus on accessibility, especially when it comes to pet insurance and making it more accessible to our clients because God love us, as an industry we have really struggled. And I acknowledge the challenge for my colleagues in not wanting to stake their flag and say, “This is who I recommend.” Because the nuances of pet care are so much, and the nuances of insurance are so much, and there is no one size fits all. And it really has to be about the patient. To your point, Tucker, when you have a pet who's predisposed genetically to certain things, what your needs are as the pet owner are different than what my needs are as a pet owner.
And so it shouldn't be about, let me try and take a one size fits all approach because that does feel, in my personal opinion, that can feel really salesy. And if the conversation is about, I don't care who you use as long as you're using someone and here is where you can find more information versus go with God, Dr. Google and figure it out on your own, that is a bad approach. But there are so many hospitals that that's the approach that they're taking because they're afraid to have the conversation. And so options like Pawlicy is fantastic for us as an industry. I'm old enough to remember when we had a list of preferred providers with AAHA, and it was really easy to be like, here's some options. And that has always been my encouragement is, ask your clients, who are your clients using?
And so that was how I operated as a practice manager was once a year I would send out a survey to all of our clients who were using insurance, and we had a code in our PIMS so we could pull a report and see who was on insurance. And I would send them a survey and a simple, tell us about your experience with pet insurance, we wanted the good and the bad, and just like, are you happy with your policy? Yes or no? And we would get their perspective. And then I would say to our client, I would compile that and then I would be like, here's some of the companies that our clients use. If you're looking for more information, and here's where to find it. And yes, it was a project and it was an undertaking, but I feel like it really allowed us as a practice to stretch that care conversation and that financial conversation out beyond the one-and-done.
Because as human beings, that's not how we learn. We know what is it you have to hear something seven times before you actually change the habit. So for our clients, if we're just having a one-and-done conversation when they come in for urgent care and they're like, “What are my payment options today?” They're not actually going to absorb that. We have got to do better by them and start to have that conversation earlier and more often. And it doesn't have to be huge on the sales. It can be little things that we change, even as simple as our language of are we billing pet insurance today to open up the door to those bigger conversations.
Debbie Boone:
Well, we have to remember too, when people are in our practice, they're often in stressful situations. And even if it's just, I've got two kids and a dog and I'm trying to juggle all this stuff and I got to get back to work, their mind is not really focused on what we are telling them. And that's often why they go home and call back and go, “What did you tell me to do with this medicine?” So we give too much credence to verbal instructions, and we really need to be giving people supporting materials. There's a reason they give actors scripts and they just don't stand up there and go pretend to be Joe Blow up here in this movie. They really give them very detailed scripts, and we need to do the same thing.
We need to practice, we need to have our teams practice scripts so that they're comfortable saying just what you said, are we billing your pet insurance today? And then they're like, “I didn't even know pet insurance exists.” Well, sure. And then you might want to explain to people that it is really different from human insurance, that it is more like property insurance. And so it's a reimbursement, but it really does help people afford care
Stephanie Goss:
Those unexpected things.
Debbie Boone:
Yeah. We care. Because you and I have been in this business long enough to know that a dog will eat anything. And some of the stuff, I have seen them in jazz including a 13 carat sapphire and diamond ring, which they pooped out in my kennel one day. Thank goodness we had honest team members because Katie Dons ate, her mother owed a jewelry store and she ate this beautiful ring and my God cleaned it up and returned it to the owner.
Stephanie Goss:
Oh man.
Debbie Boone:
See you just never know where her conversation is going to go with me and Steph.
Stephanie Goss:
That's fantastic. That's fantastic. No, I was thinking of our Lola, our, of course, the lab, what else would it be? Who multiple, multiple enterotomies for eating rocks, like the same piles of rocks. I'm thinking about that patient or the underwear-eating bulldog. But fine jewelry? Maybe now I've heard it all.
Debbie Boone:
This is a schnauzer. If it'd had been a lab, it would probably wipe out the case. But it just was a funny one. So yeah, these things are unexpected and people just, I mean, I'll laugh because when I got Tucker, I grilled the breeder just right at left, and I thought, she thought I had lost my mind. I said, “But you don't understand what I've seen. And so these are the questions that I'm asking you because I have seen the bad part of this deal, and I don't want to buy a lemon and I've got to drive all the way up to Detroit and I want to make sure that I don't have this behavior problem or a multitude of allergies or any other things.” But people, they need something in writing, they need us to be teaching them on our website.
Maybe we have a whole page on our website about financial options. One of the things, I just redid my entire website, but for years I had had a document on that site called Helpful Ideas for pet owners. And randomly I will get calls for people going, “I heard you help pay for pets.” I'm like, “No, there's just a whole idea sheet here.” And on those ideas, there's links to the pet insurance companies and links for the practices to use, and there's charities available. And all this stuff helps people. And because we prepared it ahead of time, what they understand from that is we understand that it's expensive and it certainly can be, but we worked to help. And so it's not just you don't care about us, you don't care about anything but the money. No, you really do care and you care enough to provide tools and information and some support for us.
And we get it, even though we may not be happy about our $3,000 bill when the dog ate rocks. We understand. We go into it with the assumption that people are bound to know that it costs money, and they do, but they don't know how much it could possibly cost. Because they're used to their own $40 copay and getting a bill for 1% of their medical bill because their insurance has covered it, their health insurance has covered it. So people don't know, and that doesn't mean they are idiots. I think you probably saw the reset post that got a little pushback on that, and I was glad to see that pushback because people are not idiots because they don't know all the things that we know. They may be uninformed, but that's because we didn't teach them, that's our job.
Stephanie Goss:
Well, and that client shaming is a big soapbox. And at the same time, that could be a whole other episode. But I think that the truth there for me is that before we go pointing the finger at clients, we need to look back at these three fingers that are pointing back at ourselves and say, what are we doing to prepare clients for the understanding? So back to in the beginning when we were talking about the financial policies. So lots of us have financial policies, but are they written down? Are clients A, reading them, and B, are they signing it? Are you getting agreement to them that they understand it, that they've had the opportunity to ask the questions? And then if I think back to my experience in veterinary medicine, I mean, we started going to my family vet that I ultimately was the first vet practice that I worked at. We started going there when I was a kid.
If you had given my mom a financial policies information when we had our first backyard dogs when I was seven or eight, and then she never saw it again, it's an unrealistic expectation that then years later when she's had three or four different pets, and now I'm the college kid bringing the pet to the vet, and I'm like, “I don't tell me what my payment options are.” It's unrealistic to expect that clients are going to remember those things when it's one and done. And so some of the things that I think we need to do when we're pointing the fingers back at ourselves is look at, do we have financial policies? Are clients agreeing to them and signing them? And then beyond that, are you re-reviewing it? Because if they signed it once in 1999 and they're still your client, that doesn't mean that they actually still accept it and also that you haven't modified your policies because the payment options we took in… When I started in 2000 in veterinary medicine, the payment options then were Visa, MasterCard, nobody took Discover or Amex because it was super expensive.
It was Visa, MasterCard checks and then CareCredit when CareCredit came along. And so I think about it now, we'll accept just about anything under the sun, Apple Pay.
Debbie Boone:
Yeah, there's so many options.
Stephanie Goss:
Amex. Right? There's so many. And if we're not updating those policies, if we're not, then rediscussing them with the clients, I think we're doing them a disservice because that's not how we learn as humans. We've got to continue to present the information. You said something that was super interesting to me that I want to unpack, which is about the written information for clients and not just verbally sending client information home. Because I had that on my list as well in terms of how are we presenting the cost conversations to clients? In my practice, my rule was a treatment plan for every client, every patient, every time, full stop. And everybody would argue with me, and they'd be like, for, “The annual wellness, do I really need to do a treatment plan?” “Yes, you do.” And here's why. Because your point, when you have the mom who's got her two kids plus wrangling the dog in the exam room, she is listening and she is doing her best to listen to you.
She's listening to you with half an ear maybe if you're lucky. And it's certainly not going to necessarily be easy to recall that information when she goes home to have the conversation with her partner and the rest of the family that's taking care of the pet. So I think figuring out how we communicate, particularly when it comes to treatment plans in a more reliable method, is something that we need to do to do better for our clients. And then the other piece of it that goes to your point is discharge instructions. And that the discharge instructions not only include the medical information that you're verbal vomiting on them during the appointment, but also those financial conversations. And we talked about pet insurance today, and I do not expect you to remember that I told you about Pawlicy, here's the link.
And now it doesn't like we've come a long way, especially since COVID as an industry in terms of technology. It doesn't just have to be literally printing a piece of paper and hoping that it makes it home with them. We have everybody's email, so why are we not sending it with the hyperlink so they can just click the button and have it open up on their phone screen or their computer screen? I think those are areas where we really, we can do better by the clients I think.
Debbie Boone:
We can. Well, I can remember years and years ago when we were talking about discharge instructions, and all we did was we created templates and links and I mean, we discharged instructions for everything, and they were linked to service codes. And they were fairly elaborate compared to some of the stuff I'm even seeing today. But the other thing is, there's a message at the bottom of almost every invoice, and why wouldn't it be the bottom? I mean, people ignore that, they never change it. They put maybe their address or something. People know where you are and they're in your building.
So let's put something valuable on the bottom of the invoice. Maybe here's a link to Pawlicy or here's a link to CareCredit. Yeah. It's just put some information on there and you can change that monthly. When I work with practices, I develop a monthly marketing campaign for them, and every month we have a focus on something else. So focusing on payment options and lifetime cost of care and informing people about making a plan. I even have a friend, Debra Hamilton, who creates something called a map plan. And people do not understand, they make this assumption that if something happened to them or they had to be in the hospital for weeks, that some family members just going to step in and take care of all their pets, but do they really know it? And do they have a financial plan for reimbursing those people?
And do they have written down what food these animals eat or any of those things? So there's a lot of planning that people should do for their animals just like they would do having godparents for their kids. I know my husband and I were godparents for our best friend's children, and we sat down and we said, okay, here's the plan, and if something happens to you guys, this is us, then we take over. But people forget that they need to do that for their animals too. And this is all about creating a strategy so that people get what they want. And what they want is a really healthy animal that doesn't have many medical problems that's really well taken care of and that they enjoy living with.
Because that is one of the things that we talk a little bit about in vet medicine and our job is to be the hero of the story and save the day when disaster strikes. But what we really don't realize is we're not the hero of the story. The client is the hero of the story. The pet is often the dilemma, the journey through the story. And we are the wise counselor. We're the Obi-Wan Kenobi to Luke Skywalker, and we are supposed to be the guide. And when we look at ourselves and we put ourselves in that place rather than being this hero, then we're going to find out, first of all, our work is more sustainable because it's hard work being a hero for everybody. And it's much easier to be the counselor and something that you're an expert in. And so that's what our job is to be, is to be this counselor and to teach people all these things. Because we live in it every day and we know it.
And if you've been doing it a long time, you've watched it expand into what we can do. I mean, we can do transplants for animals, we clone animals. We're doing MRIs on animals. There's so much specialty work that's done. And do you want to have to say, no, I'm going to euthanize my 12 year old dog because I can't afford having it go through cancer treatment when it has a great prognosis going through cancer treatment, but it's $12,000 or more. So we want people to not have to make those horrible decisions, and we don't want to have to be on part of it either, because it breaks us. It breaks us when we have to do that too.
Stephanie Goss:
Well, I think that adds a lot to it. And I think when I think about going back to where we started, the anxiety for the team and talking about sales and money, it's uncomfortable and it brings up a lot of feelings and emotions. And I think a lot of it comes down to the lens, which with we choose to look through it. Because if we, as an industry or as an individual practice, if we're looking at your example of, okay, now we have a patient who needs cancer treatment and the costs are upwards of $12,000, that's a huge, huge amount of money. And that for anybody, or almost anybody, I think would hit that panic button of how do I afford this? And when I think about what the clients told us in the lifetime of care study, we're not talking about $12,000.
We're talking about $250, sometimes less being a threshold for people that we should think about, Hey, this is not just that occasional client who's facing the $12,000 cancer treatment or the client whose patient needs orthopedic surgery and it's going to be super expensive or needs specialized care that they have to go to the university for. We're talking about all of our clients really almost every single day. And So I think when we think about making it be financial care over the life of the patient versus just we have a financial policy and here's the payment options that we accept, we can't redo the client's a disservice if that's where we're stopping it. And so I think we have to think about all of the options. And I love what you said about building out resources for clients, because I think one of the other things that is a challenge for us is a lot of times we only help clients understand the options that are available with us.
A lot of times, we and we're doing it with good intentions and we want to take care of our clients ourselves. And sometimes the best thing for our client, or sometimes the best thing for our patient is to get care somewhere else that's not us. And so many of us operate from this scarcity mentality place where we're afraid to send them to other people because we're like, well, we don't want to send them to our competition. The reality is our competition rarely is who we think our competition is in veterinary medicine. And we've got to stop living that way because the reality is, sometimes what is be best for that client or that patient is to go somewhere else. And wouldn't I rather help that patient get care, even if it means we don't provide the care, we are in it for the patients.
And so I think that goes to what you were saying about we're thinking about it ahead of time and we're deciding how do we feel about those things to pull together that resource information. Whether it's here are the low-cost vaccine clinics in the area, or here are the low-cost spay neuter options in the area, or here are, I mean, my ER that was local to us, had a resource sheet for clients that included options including local pawn shops and was like, here's options for finding money when we need it.
And so we have done our job ahead of time to think about those things. And really, we're trying to work with clients at that point, I think, instead of against them. And that, I think feels better to me, even though in the moment, I've been a part of those conversations with the team, it's hard for the team sometimes because we do care about our patients. And there is this thought of, why can't we just help them? Is it really going to kill us if we just do all of this thing for this one patient for free? But the conversation with them has to go, “Hey, look, we're not talking about just this one patient.
Debbie Boone:
It can happen 10 times a day. I ran emergency. And you're talking about emergency?
Stephanie Goss:
Yes.
Debbie Boone:
Yeah, that happens almost every day.
Stephanie Goss:
Yes.
Debbie Boone:
Yeah.
Stephanie Goss:
Yes. And so I think we have to start to think about it from that whole… I love the shift that's happening in the industry where we're starting to have those conversations to talk about it in a whole lifetime of care, spectrum of care, looking at the bigger picture and saying, how do we as a practice become an active, engaged participant in this conversation? We're also asking the client to show up and be an active, engaged part of the conversation. This is not us doing all of the work and dragging them along behind us, but we still have to play our part, I think, in having the conversations.
So beyond talking to the clients about all of the options and looking at how do we do right by them, and in some cases do better by them and offer them all kinds of options. The other piece of it when it comes to where we started, which was this anxiety about sales and money conversation is, how are we talking to the team about their feelings around the money and finance conversations? Because you mentioned it earlier, referenced it earlier, the emotional impact that it has to the team when we have to say no, when we have to put a pet to sleep because their owner can't afford care or something like that, that absolutely has an impact on us. So how do we talk to the team about their feelings and draw it out into the open?
Debbie Boone:
Well, for one thing, it is about preparation. And we really are not doing a very good job training our teams period, in a lot of different ways. I mean, I can't even show you how many practice [inaudible 00:50:32].
Stephanie Goss:
That's a soapbox.
Debbie Boone:
I don't even have time to do that. When somebody said, “I don't have time to do that.” That means you don't have time to do surgery or do any vaccines because it's just as important as doing the medicine is training your team. But I think scripts help a lot and roleplaying, and even though everybody goes, Ooh, in roleplay, it is helpful-
Stephanie Goss:
Don't call it role playing.
Debbie Boone:
Yes, it is helpful when they explore and act out. And I love going back and saying, let's talk about some scenarios in the hospital, and if we had had this conversation ahead of time, how do you think it would've played out? And so you're kind of going back and you're doing that dissection of these issues that you have. And then coming up and making a plan because the issues repeat themselves. During COVID, everybody was talking about the difficulty of clients, and I was going to give a talk for all mine, I thought, well, let me find out why people are firing clients. And so I asked them, and I found out there was a list of 18 things, and all 18 except for two had been stuff I'd been dealing with for 30 years. So nothing changes under the sun. These were the same list except for, “I don't want to wear a mask and I want to come in the building.” So there's nothing new. So we need to know that there's comfort in having these conversations because we're going to, and you can't turf them all to the manager the manager has stuff to do.
And so everybody on your team needs to be really comfortable with it. And I think the technicians, typically are the ones who are presenting treatment plans to folks. And Carrie Bagrund has a really good policy in her hospital and she says, “We know that this is pricey. And we have systems set in place if you need help.” And she said, “People are so appreciative of it, even if they don't need them, even if they have that credit limit, that's fine to cover that with their credit card. But there's this, I acknowledge that there's a problem and so I'm going to proactively put things in place for you. And we have a plan, we have plan to help. And that in itself is a plus.
If we think about could we save lives by having a plan? Could we save lives by doing the role-play that we all hate? Could we save our own soul by not having to put animals to sleep for lack of affordability then I think the motivation is much higher for us to power through something that's really uncomfortable for us and do it well. As opposed to, “Oh, I just don't like to do that. I just don't like to do it.” Nobody likes to do it. Nobody likes to have an uncomfortable conversation. But getting a skill set that says, I can have uncomfortable conversations with people. And if I learn to have them much further in advance than waiting until the ball has dropped, it's too late then and it's too late to talk about it, then we need to have had this conversation with our clients multitudes of time.
And even maybe on that first visit, we used to always do a folder and then it would have some instructions about the hospital and the doctor's bios and some information. But it also had information about the CareCredit credit card, and it had different, what was good for the life of your pet, it was a plan. And we put it in a package and said, these are all good things for you to know. Here are some tools we built for you.
It's my favorite. AVMA has one, but veterinary care is definitely my favorite one. And why not stockpile some charitable funds for these situations when they really won't qualify for any credit card, but can we still do something? We must still do something. And you talked a middle little bit about the spectrum of care work that's being done now in our profession. And thinking about my history in the profession, which is really spanning over 35 years now, we were creative. It wasn't always, we didn't always have to always do gold standard because there was stuff that worked. And it wasn't absolutely the best, it wasn't what the Ivory Tower might have taught. One of my fondest memories is my practice owner, a puppy came in, tested a not strong positive for parvo, but he was starting to be symptomatic and the people just really didn't have anything. And this was in the days before our CareCredit credit card came to exist.
And he sent the dog home and said, every two hours give this dog chicken broth because hydration is what it needs and the puppy left. So there's things that work that we need to be creative. The other thing is, we don't have to do everything all at once, and that's our mindset. I had an older veterinarian say to me, one day, “Well, Debbie, I can't get people to come in one time a year, much less come in two.” Because I was recommending twice a year annual exams or semi-annual exams. And I said, “That's because you make it a horrible experience for them.” When you make a place of hospitality where people enjoy coming into the practice where they feel that you really care about them and you're on their team, they will come as many times as they need to come to get the work done. So we can divide and conquer and that makes things affordable too. And people can spend $100 three times over a year's period of time and spending $300 once might be out of range.
Stephanie Goss:
I think that's great. And I think forward planning and forward booking is a very underutilized tool like that. Remembering we don't have to do it all at once and how can we have that conversation with them about maybe today we do this and then we're going to see you back in two weeks or four weeks or six weeks and here's the next step and then here's the next step in over the next, maybe it's not an acute situation. And so we can say over the next three months, we're going to get to this end result and that works for them or their pocketbook. And going back to something that you said when it comes to CareCredit and the CareCredit credit card and financing options for our clients, there are clients who are going to get turned down. And I think about it, when I think about our team. In my very first practice, one of the processes was we had, of onboarding, was to have a conversation about our own pets and what the pet benefits were, but also then how are we going to pay for care?
Because we had the same conversations with our team that we had with our clients. And so I was like, at the time, I was just out of grad school and I didn't have any pets. So I was like, nah, it's not really relevant. And then I had been at the practice, I don't know, about a year before I suckered into taking home my first pet. And I got a kitten and I had just finished grad school and I was broke. I was like, I have no money and the conversation was how, here's what you get as a benefit, but also then how are you going to pay for your pet's care? And I remember applying for CareCredit and I got declined and I had thousands of dollars in student loans. And so it was not shocking to me, but also mortifying to be like, I work here. And I didn't get approved. I didn't get approved for CareCredit.
And my practice owners were just like, “It's okay. Not everybody gets a proof of CareCredit and you're going to have to have this exact same conversation with clients.” And so what next? What are the options? And it's amazing to me how often we forget the next step of the conversation doesn't have to be it's one and done or there are no other options. It's no longer just the exam, the flea conversation and heartworm conversation. It is advanced-level, human-level medicine and we have to have those conversations with the team so we can put ourselves in the client's shoes. Yeah, I And that we can have that empathy and we can understand how that feels.
And it's funny because I think back to it now and I think about how ashamed I was and how embarrassed I was when I got declined at that first point in time. But now, I can't imagine having a pet without having a CareCredit credit card. I can't imagine not having pet insurance. I can't imagine not having those things. I probably wouldn't have persisted in having those hard conversations with clients if I hadn't experienced that on my own. And so I think the biggest thing for me is, we've got to start to talk about it. Whether it's how is the team going to afford the care? And we've had some podcast episodes on that. How are we going to extend those charity options to our clients? Like you were talking about, Andy just did a great episode with our friend Tannetje Crocker about discounting care and intentional discounting of care and being able to provide charity support when needed.
How do we talk to the team about how they feel about money and support them as managers? What are things that we're doing from an HR perspective to further the conversation about financial stability and awareness just as human beings to support them having a whole life and being able to know what those tools are. I think when we start to think about the money conversation as a well-rounded whole life thing for ourselves, for our clients, I think that's where we really start to achieve that Jedi mastery like you were talking about.
Debbie Boone:
That's exactly right. Obi-Wan Kenobi.
Stephanie Goss:
I love it. Debbie, this has been wonderful. You and I could continue this conversation all day. But thank you so much for having the conversation with me. This has been great. I'm going to drop some links in the show notes for everybody to some of the things that Debbie and I talked about because there was a lot, certainly some of the reference materials. If you haven't checked out the Synchrony Lifetime Of Care Study, you definitely should, especially if you're a practice owner, a practice manager, it is worth your time. Thank you so much for being here and thanks to our friends at Synchrony for making this episode happen ad free because you and I crammed every bit into our hour-long episode.
Debbie Boone:
We did. We did. I appreciate it.
Stephanie Goss:
I can't wait to talk to you again soon, friends. Yeah,
Debbie Boone:
It's always fun. So I guess we'll maybe see each other at AVMA and I guess my afternoon, we'll be spent finishing that book
Stephanie Goss:
Take care everybody. Have a fantastic week.
Debbie Boone:
Thank you so much.
A special thank you to our friends at CareCredit
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