Every veterinary practice must purposefully pursue four outcomes in order to be successful and sustainable. These are clinical resolution, client satisfaction, financial resolution and colleague satisfaction. This article focuses on financial resolution.
In most practices, veterinary surgeons or veterinary nurses are responsible for billing the client’s account, whilst veterinary receptionists are responsible for requesting and receiving payment. Whilst veterinary surgeons interact with clients and patients inside the consultation room, it is important that they realise that financial resolution is not complete until the client pays their bill at reception. Success, in which financial resolution occurs consistently and satisfactorily, depends on how well the “billing department” (clinical team) interacts with and supports the “payment-collection department” (non-clinical team).
Whilst many clients do what we wish or expect them to do when they exit the consultation room, it is the minority that don’t that create frustration around payment. For example, it is not uncommon for clients to head towards the exit of the surgery without “checking-out” at reception to settle any outstanding balance or book a follow-up appointment. The client’s attempt to leave may or may not be a blatant attempt to dodge the bill. More often than not, it’s because the client doesn’t realise that there is a charge to pay, especially for follow-up recheck consultations, which many clients assume are free if the patient is back to normal. Either way, disappearing clients put receptionists in a difficult situation: do they chase after clients as they leave the building, or do they allow the client to leave assuming the client has been instructed to do so? If a client genuinely doesn’t realise that there is a bill to pay, they will probably feel embarrassed when intercepted or called back by the receptionist. This is more likely to make them defensive and thus express surprise or dissatisfaction that the consultation they have just had wasn’t worth the charge they are now being asked for. This makes everyone involved feel awkward: the receptionists, the clients, the vets (who may be called from their consultation room to explain the charge) and, of course, the practice owner who is wondering “Why are accounts not being settled? Why are procedures not getting booked in?”
I like to call the space between the consultation room door, the reception desk and the exit door of the practice “the Bermuda Triangle” since it can seem that some clients can disappear without trace. Managing this problem means that practices need to figure out a reliable way to “hand clients back” from the vet to the receptionist at the end of the consultation. This requires consulting vets and nurses to make a conscious effort to communicate with receptionists as opposed to hoping that they will reconnect with them after the consultation and pay their bills and book any follow-up as expected. Furthermore, it is important to recognise the impact of the post-consultation period on the entire client experience at the practice. Vets and nurses must not assume their contribution to the clinical and client experience only relates to what they do inside their consultation rooms.
There are several tactics that can be used to navigate the Bermuda Triangle problem and avoid the potential for client dissatisfaction relating to unexpected charges.
1. Estimate the cost
The first tactic is to estimate if a diagnostic or therapeutic procedure is going to be more than a basic minimal amount, say £100. It is important to realise that informed consent doesn’t just relate to discussions about the technical aspects of proposed procedures; comprehensive consent includes advising clients about the financial implications of those proposals as well.
2. Inform the client if their bill is higher than a predetermined amount
The second tactic is to inform the client if their bill is more than a certain amount, say £100, before they are asked for payment at reception. This is crucial if we wish to protect our receptionists from unnecessary – and entirely avoidable – bill disputes. Receptionists should not be expected to be able to resolve disputes over bills that they did not create. This is particularly important with invoices after operations and in-patient care, which are often significantly larger than bills relating to consultations. It is therefore important that practices anticipate and consider how to avoid disputes about the bill at reception when owners come to collect their pets. Practices vary in how proactive they are about advising clients about the balance on their account before they come to the practice at discharge time. This occurs for several reasons. The first reason occurs when the person who calls the client “post-op” deliberately doesn’t tell the client the balance on their account in case the account is not fully billed up and therefore could be different when the client arrives to pay. The second reason is that the post-op caller may not assume that speaking about the bill is their responsibility – or perhaps they simply lack the courage or the communication skills to do so.
Whilst conversations about balances and payments can feel uncomfortable, they can make all the difference to the client’s experience if handled well. The following “PPP” formula is useful to structure the content of the post-op telephone conversation: Pet, Procedure, Payment.
It works something like this: “Hello Mrs Smith, it’s Brian the vet here. Just to let you know that Scooby is fine first of all. The procedure went as expected and he’s coming around from his anaesthetic as expected. He has had two different types of painkillers and he is comfortable. The nurses will continue to monitor him until he is ready to go home, which should be around 5pm.” The second P refers to the explanation about the procedure as well as arranging the discharge appointment time. Once the client’s questions have been answered, the caller can move on to the final P: Payment. This can be explained as follows: “In terms of your account, the procedure was performed as per the estimate, and the balance on your account is £750. My colleagues on reception will look after that when we see you later. Is that all OK?” If the balance is not as per the estimate, it is essential that someone, preferably a veterinary surgeon, explains to the client before they arrive at the practice to collect their pet why the balance on their account is greater than initially expected. It is not fair to simply “bill it and hope” that the client doesn’t complain to our receptionist colleagues when asked to pay.
3. Escort clients from the consultation room back to reception
The third tactic which helps navigate the Bermuda Triangle problem is for the vet to escort clients from the consultation room door back to reception and hand them over to the receptionist. This is particularly important if there aren’t any medicines to dispense (such as after a recheck consultation), when the client might perceive there is no need to return to reception. Practices need to be proactive in ensuring that clients return to reception and pay. Some vets find escorting clients back to reception uncomfortable. They say they cannot afford the time as they need to type up their clinical notes. However, receptionists really appreciate the few seconds it takes to do this. If a receptionist is on the phone or dealing with another client and the vet doesn’t wish, or need, to wait, it is possible to “park” the client at reception by saying “Nice to see you again Mrs Smith. Sarah will be with you in a moment.” Clients often recognise the phrase “will be with you in a moment” as code that there is an account to settle. Sometimes they reply by asking “Is there anything to pay?” Simply replying with “Yes. It’s just the recheck consultation fee today. Thank you” and walking off, back into the consultation room without waiting for a reply, works well.
4. Keep receptionists in the loop with the case
The fourth tactic to navigate the Bermuda Triangle is to ensure that receptionists are kept in the loop about what is going on with the case. This in turn enhances their confidence to steer the client towards what needs to happen next. Whilst phrases such as “Please can you book Mrs Smith and Scooby in with me for a recheck in 10 days’ time” may seem trivial, they actually convey a lot of information. First of all, the receptionist now knows that this is Mrs Smith and that this patient is Scooby. This enables them to access the correct patient from the practice management system/diary without having to ask again if they aren’t sure who it is. Furthermore, clients are more likely to book a follow-up before they leave the practice if the vet instructs the receptionist that a follow-up appointment is required in front of them. In contrast, if clients return to the reception desk unaccompanied and are asked by the receptionist “Do you need another appointment?” many clients respond by say “I’ll call you if I need to” or “I haven’t got my diary – I’ll give you a call.” Whilst this is unavoidable at times, we must be aware of the case-continuity issue it can create. This is relevant as a lack of vet-client-patient continuity is the most common reason clients defect from practices.
In summary, it is essential that veterinary practices work as a team to ensure that the billing and banking tasks that constitute financial resolution occur consistently and satisfactorily. The degree to which this occurs often depends on how well the “billing department” (clinical team) interacts with and supports the “payment-collection department” (non-clinical team).