Presenting estimates and financial discussions with pet owners

This course is designed to provide guidance on how to present estimates to owners, how to discuss the resuscitation order and how to manage challenging conversations with owners around finances

How to present estimates

What is required of you

Prior to the presentation of the estimate, the treatment plan will have been formulated by the vet. The vet will have discussed this treatment plan with the owner, checked that they have understood the plan and obtained verbal agreement to the plan.

Your role is to present the costs associated with this treatment plan. You are not expected to be able to discuss the plan in detail as this will already have been done by the vet. You may be asked to clarify what a particular test involves eg: ultrasound x-rays, coags etc but not why this test is being performed.

You will need to ensure that the form is signed including the resuscitation order and that the client pays the 50% deposit as required. 

You will then need to admit the pet to hospital. Unless there is an emergency situation in the treatment room it is good to allow the client to bring their pet out the back to see where they will be housed overnight. This provides some peace of mind, allows them to see the fabulous facilities and to meet some of the other staff.

Always double check the contact numbers on the estimate and that the client is happy to be contacted at any time while their pet is in hospital. Where a pet is to be picked up at the end of a shift, please organise a discharge time with the owner and write it on the discharge list on the glass screen between the doctors' station and the treatment room.


Resuscitation order


The resuscitation order is a section at the bottom of every estimate. This section of the consent form needs to be filled in for every animal admitted to hospital. A client handout explaining the resuscitation order will ideally be given to the client by the vet prior to leaving the room to put together an estimate. If the client has not received this handout and their pet is going to stay in hospital, then you will need to provide them with a copy of the handout. The handout can be found on the Infoweb under Shared Documents/Client Handouts/Resuscitation Order.

Reading through the resuscitation order section on the consent form can cause owners great anxiety if the context is not clarified with them beforehand. If they have read the handout they will likely have a reasonable understanding. However don't assume this. Suggested phrases for introducing the subject of the resuscitation order are;

"I would like to draw your attention to this section at the bottom of the form. This is called a resuscitation order and requires you to provide instructions  as to whether you would like us to initiate resuscitation in the event of a respiratory or cardiac arrest. Please don't be anxious about this - the vet will have told you if they felt that this might happen to Fluffy. In most cases it is a highly unlikely occurrence.  There is more information in this client handout about the resuscitation order".


Frequently Asked Questions (FAQs)

Question:

If the vet has to explain the treatment plan to the nurse who then has to explain it to the client, isn't this just double-handling and therefore very inefficient?





What if the client has further questions for the vet after seeing the estimate? Won't it just be a waste of time to have to chase down the vet?













Some vets are concerned that by not presenting the estimate themselves that they will lose the client connection which may result in the owner deciding not to admit their pet to hospital. This could negatively affect their PCI and the PCI of AREC as a whole.






What training and support will I receive in learning to perform this role?









Answer:

Your role is simply to provide the financial information surrounding the treatment plan. Discussion of the treatment plan will already have been discussed with the owner by the vet. The vet will only need to provide a very brief summary of the treatment plan to the nurse prior to the nurse presenting the estimate of costs.


As part of the prior consultation process, the vet is required to discuss the treatment plan with the owner and check that they have understood. Most questions that arise during presentation of the estimate will be around clarifying if a test is necessary or what the purpose of a certain test is as their concern is around the total cost of treatment. This will just be a matter of confirming that the vet has advised that the treatment plan is necessary and providing information about what certain tests are. If the client has been confused about what the vet has said, it is important that you feed this back to the vet so that they can understand that they may need to change their communication style or make sure that they are clarifying that the client has understood the plan prior to handing over to the nurse.


It is recognised that initially it may take some nurses a while to feel competent with this skill and it is possible that we see a downward trend in the PCI as a result. However we feel that the benefits of separating the vets from the financial discussion and training nurses to be really good in this skill will outweigh this potential downward trend. We are confident that with time the nurses will be even better than the vets in presenting estimates!


Apart from this online course, you will be provided with in-person training and support during your first few times you present an estimate. This will be with a supervisor standing in the consult with you to assist as necessary. There is a formalised feedback process which we will be using to standardise the assessment and feedback and to help you feel competent with this skill as quickly as possible.


Financial conversations with pet owners

How to communicate the estimate amount to the owner

There are a set of general steps to follow:

1) Establish a connection with the client:  If you were not the nurse involved in the triage then you will need to introduce yourself and explain your role eg: "Hello, I'm Eliska and I'm the nurse that will be looking after Fluffy tonight".

 2) Acknowledge the pet: use the pet's name and give them some attention eg: pat on the head or talk to a cat through the door of the carrier. eg: "Hello Fluffy! I'm sad to hear you're not feeling too well". 

3) Summarise your purpose for being there and the overall plan: "I have an estimate for the plan that Wendy discussed with you which includes 24 hours in hospital on a drip, with blood tests, x-rays and medications as necessary". At this point I would show the estimate to the owner as I continue to discuss. "This comes to a total of around $1500. There is the possibility of an abdominal ultrasound if Fluffy deteriorates or the other test results indicate that we should investigate further. Wendy will call you after the results of the initial tests and discuss any further testing with you at that point".

4) Show empathy: At this point the client may show one of 3 responses:

a) Acceptance: this is easy. Finish the process by getting the forms signed (including the resuscitation order) and the pet admitted. Remember to check if the client has been given the handout explaining the resuscitation order and what happens during resuscitation.

b) Anxiety/upset: acknowledge the client's feelings. " I understand that you are very worried about Fluffy. Is there a particular concern I can help you with?"  The client may just need reassurance that we take credit card payment over the phone, or that we can do a Vetpay application.

c) Anger: do not get defensive or strike back. Take a few deep breaths and stay calm. Think about how you can respond rather than react. Allow them time to vent their grievance and then respond. Do not get pulled into lengthy explanations about why we are so expensive or trying to prove that we care.

Some suggested responses (if in the appropriate context) are:

"Out-of-hours care is expensive. I realise this is a cost you were not expecting and it is understandable that you are upset".

" We are fully staffed with receptionists, vets and nurses all hours of the day and night. This is very different from a regular daytime veterinary clinic. The charges we have reflect the costs of running this kind of business". 

"Just as your ability to pay for Fluffy's care does not reflect how much you love her, the necessity for us to charge what we do does not reflect how much we care about animals".

Be aware that you may not be able to appease as owner - but if you can't then no one can at that point! Don't feel the necessity of getting a second person to talk with them. Hold the tension and ask them if there is any further way you can help and if they are ready to get Fluffy's treatment plan underway.

Summary and conclusion


- Your job in presenting the estimate to the client is to discuss the "what" of the treatment plan and not "why" the treatment plan is necessary.

- Always introduce yourself, acknowledge the pet by name and give them some attention. 

- Briefly run through the items on the invoice before presenting the total figure eg: For the consultation, overnight hospitalisation, intravenous fluid, blood testing and some medication, the cost will be around.....

- Ask if there are any questions and respond as appropriate. Be aware that is normal to get a surprised or possibly negative reaction. Show empathy and allow the client to talk. Don't get defensive if the client gets angry. Be aware that you are there to provide the best care for their pet and you won't necessarily be able to make them happy. Ask if there is any further way you can help rather than just deferring back to the vet if the client expresses dissatisfaction.

Quiz

During presentation of an estimate the nurse needs to be able to discuss why certain tests need to be performed.

  • True
  • False

The resuscitation ("do not resuscitate") order at the bottom of the consent form:

  • Is optional in some cases of hospitalised pets
  • Is not helpful in saving time when trying to save the life of a pet who has suffered a cardiac or respiratory arrest
  • Can sometimes cause clients significant anxiety
  • Is a tool that is designed to make us look professional but reality not useful

If a client is upset about the cost of treatment for their pet, it is best to:

  • Get the vet to deal with the situation
  • Empathise by listening to their concerns, clarify their understanding of the treatment plan and ask if they have any other concerns
  • Tell them that the treatment plan is necessary and if they don't like it then they can go elsewhere
  • Try and make them happy at all costs