Medical Billing and the Veterinary Approach

I am not the first or the last person to discuss this approach to handling medical billing and the provision of health care services, but it seems worth bringing up again, because it’s a model that should get more attention. There’s a stark disparity between how issues of money, billing, and provision of health services are handled at the vet’s versus how they are handled in a clinic or hospital for humans.

Generally, when you go to the vet, all the basic services are provided there. A veterinary clinic has a pharmacy and can fill orders for most drugs. They have medical imaging equipment, they have an operating room, they can usually do basic labwork like a quick urinalysis and basic bloodwork. They may have to send some things out like samples for biopsy, and there are of course veterinary medical specialists for particular services, but by and large, a veterinarian is like the general surgery of old, meeting the needs of most patients very effectively.

There’s something else about the vet’s; because all the services are right there, the vet is well aware of how much they cost. When you’re talking about treatment options, you can get an honest estimate on how much money will be involved. Vets are also good about ranking the necessity of various treatment options and helping you work on the most cost effective way to get care. If a vet says ‘I think we should do this,’ you can ask how much it will cost, and you can talk frankly about how much money is available.

Contrast this with a clinic for humans, where care providers often do not know how much anything costs, and will do things like getting extra lab tests without really checking; a common culprit is the annual exam, where someone might just want to get a pap smear to check for cellular changes, and ends up being screened for STIs under the assumption it’s wanted. This wouldn’t be a big deal, until you get the bill and you realise oh, actually, it is, because the testing can get very expensive and if you are uninsured or your insurance is choosy about what it will cover, you can be left holding the bag.

In human medicine, there seems to be a tendency that people can and should do whatever is recommended, without cost being a concern. While performing medical tests without authorisation isn’t considered acceptable, bundling unwanted or unneeded services into visits can and does happen, and patients are left with very high bills, sometimes for services they didn’t want or didn’t need. There’s not a lot of consideration when it comes to getting consent for incurring medical costs, which I think is a result of a lot of things. It’s not just that care providers do not know how much things cost. I suspect that differing attitudes about people and animals may be involved as well, with vets being aware that people may have limited funds available and that they may opt to refuse care they would expect for themselves.

Getting care at a vet can be less expensive because everything is in house. It’s also much more convenient; if you need basic services you don’t have to go to another location, you can get everything done right there, and there is definitely something to be said for that. Many people are busy and seeking medical care can eat up a lot of time when you have to run from clinic to pharmacy to radiology suite at the hospital. Getting everything in one place can help achieve continuity of care, save time, and cut down on expenses, in addition to making it easier to handle bills because they all originate from the same source.

The idea of being able to ask a care provider about what to expect in terms of expenses is expected at a vet’s, but not at the doctor’s office. The idea that cost might be a factor in the kind of care you can select is also a consideration at the vet’s, but not the doctor’s. These two approaches are radically different, but they are both models to accomplish the same thing, which is getting the best care possible with the resources available. Some blending might not be such a bad way to go.

I know that there are some services, like Kaiser hospitals, where the all in one approach is available; you can see a regular practitioner and pick up scripts and get labwork done and all that good stuff all in one place. But people often don’t know about pricing and the expenses associated with different treatment options. They might not be able to help people decide between critical and simply helpful tests when they have limited funds and want to get the best diagnostic options on the table, while being aware of how much they can afford.

It’s not that I think doctors should be handling medical billing and handing out scripts and doing urinalysis in the back. (After all, vets have techs and assistants to help!) It’s more that I think doctors should be more aware of pricing and costs when they’re talking with patients, to help them select the best options for their circumstances. It’s not necessary to carry around a rate sheet, and due to the arcane and byzantine billing structures when it comes to insurance versus Medicare versus cash versus…it can be hard to get an accurate estimate on how much things cost, and this makes it even harder to help patients make cost effective medical decisions.