Cost of Veterinary Care - a Vent

[In_The_Gate]

Totally agree with Anne. At my hospital, we employ a board certified critical care specialist 24/7. That means that within seconds to a couple of minutes (depending on where a pet arrests in the hospital) a critical care specialist is there to lead the CPR effort and give our patients the best chance at recovery if CPR is successful. That is reflected in our charging - these are doctors who are NOT seeing patients separately and as a client you will only meet when you walk into the ICU to visit your pet. While the CPR charge sounds like a lot, it’s only pennies compared to what the actual bill will be if we are successful with CPR. Real life isn’t like the TV shows - animals generally don’t wake up an hour later and go back to normal. Typically a post-CPR patient will be in the ICU for several days, often on a ventilator for part/all of it before we know if they recover. If we are doing CPR I warn clients that the total hospital bill is likely going to be $3000-$10,000 with still a very low chance their animal will go home. In my career I can count the number of successful CPR’s I have done on one hand. All three were animals that either arrested right as they walked in the ER door (IE, had not already been treated for their underlying condition) OR had anesthesia related arrests (both were sick, high risk anesthesia patients but systemically stable prior to the arrest). I have not once gotten an animal home that was already in ICU for 24hr+ where we were doing everything we could to prevent the arrest from happening in the first place. If those patients arrest, it’s a sign the best care we can give isn’t working. I always tell clients this to help them make a decision as to whether or not they want me to do CPR on pets we are hospitalizing that are in critical condition.

So you ask, why do we keep doing CPR if the odds of success are so low? It’s hard on the animals, owners, doctors and staff. We do CPR because for the 1-5% who make it home CPR makes all the difference in the world.

[WorkingDrive]

I am generally one to always side with Veterinarians when someone talks about costs of Veterinary care. This is not because I am a Veterinarian nor have friends that are Veterinarians.

One of the main complaints I see about Veterinary costs goes something like this, “Spot needs a $500 surgery that I can’t afford, and my Vet is an &&%&%^ because he won’t let me make payments on the cost of the surgery.” I realize that some Vets DO take payments at their clinics, but to call a Vet dumb/stupid/greedy because they don’t take payments isn’t looking at the whole picture. How do we know if the Vet has been screwed over in the past by clients who were supposed to make payments…and then didn’t? Not every Vet is a millionaire, and many pay off their Vet school loans for quite a few years after being in practice. Vets have overhead. They have leases for facilities or mortgages, staff, supplies, increase in pharmaceutical supplies, perhaps more expensive but better surgical and medical procedures. I have never looked at a Vet’s books nor spoke to them about their costs, but I imagine it tends to be a bit of a rollercoaster in which they try to budget a happy medium.

I know a lot of people don’t want a credit card, but I will say that CareCredit has helped us more than one time with our dogs. We pay it off in chunks, but maybe there is a time not everyone has $1000 for an emergency/unexpected Vet bill (or in our case a botched neuter that cost us $700 out of pocket - a Vet we no longer use.)

For the people saying they don’t want to pay for this, that, or the other for their Vets, then choose another Vet. Would you say the same thing about your doctor? plumber? automotive repair person?

[Justmyluck]

[QUOTE=shayaalliard;7398572]
I have two emergency clinics near me. I have used both over the years, but will no longer go to the newer/nicer one. the reason?
I had to sign a form indicating that I either did or did not consent to them performing cpr on my pet should it crash.
The cpr fee? 500.00

For something that requires little to no equipment and minutes of work. I asked, no it didn;t include o2 or electric shocks or anything like that. Plain old hands and bag.

That’s exploitative. That’s wrong.
I never minded the $$$$ bill- I pay a premium for quality emergent care- I get it- but that’s just cold.

The other clinic in town has no such fee, and otherwise similar pricing and care. I voted with my feet.[/QUOTE]

I am with everyone else on this. I figured though I’d elaborate on our fee schedule as I worked in emergency. If you walk in our doors and your dog is crashing it is a $500 dollar fee upfront before you even see the doctor. That means that your do is in such bad shape he may indeed crash/pass away before I even have time to get you in a room to see a doctor. Cases like snake bites, poisonings, hit by cars, attacked by dogs, bloat, hemangiosarcomas, foreign bodies, severe lacerations, parvo, gun shot wounds, heat strokes and seizures ect. are triaged straight to the back. Clients are also warned that there is a very real likelihood that the costs will exceed that. That initial upfront fee includes but is not limited to an exam, IV cath placement, fluids, radiographs, bloodwork, drugs, thermal support, oxygen support. If your animal crashes this $500 does not include CPR, that is an additional cost.

CPR is a guns a blazing procedure. Like stated above your animal is attended by no less then three technicians and the veterinarian. intubation, ventilation either mechanical or on a ventilator, IV caths for drugs, drugs, chest compressions, ECG monitoring, suction in pulmonary edema cases, and if the hospital has it defibrilarion, technician and doctor know how. During CPR all other things stop that means that no other cases are seen until its called or the patient is stabilized. This could mean calling in additional technicians and/or doctors. The chance of survival is 1-5% and every client is informed of this by the receptionist. Also like stated we do this because that 1-5% is totally worth it, so no effort is spared.

As far as that fee not including oxygen, while the gold standard is intubation and 40% O2 support, hand bagging is also providing oxygen support. Atmospheric oxygen is 21% and if your dog is not breathing 21% is significantly better then the alternative. Next defibrillation is only indicated for two arrhythmia if I remember right, (haven’t gotten there in school yet). One of these arrhythmia typically occurs in surgical patients due to anesthesia the other is not a typical arrhythmia you see in dieing patients. Flat line is not an indication for defibrillation, as the shock essentially stops the heart until the SA node, AV node or the myocardial cells fire back up. If there is nothing to stop, aka, a flat line there is no indication for a defibrillator. Television and doctor shows do not accurately portray medicine and this leaves people to believe that a defibrillator can bring you back from the dead.

[js]

I don’t think the $755 is out of line, at least not for my area. IV Fluids, 2 visits, surgery and a week stay in the vet hospital with I’m guessing more IV’s , antibiotics and likely pain med’s, that sounds like a pretty fair cost. Just a routine neuter with no hospital stay is around $145 at the clinic I use in my area. I would agree that the vet school hospitals are far more costly than local vet clinics; however, they have a huge array of diagnostic equipment and surgical/treatment options. Our vet school is pretty much $1000 just to walk thru the doors, everything goes up from there. Doesn’t matter if its small or large animal.

[Bicoastal]

Nominate to Favorites?

[QUOTE=Coyoteco;7397458]
There is nothing valuable in this thread as it was taken off-topic. You want to immortalize your insults? Cute.[/QUOTE]

There is so much valuable information, not limited to: detailed comparisons of costs & procedures, explaining why ER fee scales are different than GP, federal and regulatory body laws, and numerous anecdotes. Yes, I think this thread is worth immortalizing in Favorites.

Coyoteco, what insults did I provide?

[QUOTE=Coyoteco;7397458]Bicostal, reread the thread.[/QUOTE] I have reread Ghazzu’s posts and can’t find where the poster prescribes additional refills for owner to keep on hand for an emergency other than the problem the patient presented with. Can you please link? Maybe it was a different poster? Just link it and prove me wrong.

[QUOTE=Coyoteco;7397458]Also, where did I say anything negative about SquishtheBunny or Ghazzu.[/QUOTE] Maybe this is talking to someone else. I did not make such a statement.

[Fessy_s_Mom]

js - if you’re referring to my post, I agree, the price was VERY reasonable. My only reason for starting this thread was because it would have been so much more where I used to live, like add a “0”, and I thought that was just ridiculous.

This thread has really gone off on some crazy tangents (OTC antibiotic availability - are you crazy?) but where it really went off for me was when you all started comparing the cost of human care to animal care. Callous or not, we have a CHOICE whether or not to treat our animals based on whether or not we can afford it. For people, we don’t have the choice of treat or PTS, so hardly a valid comparison. If it was the same thing, then the costs would be the same. Because catastrophic care of an animal is always a choice, it has to be at a more reasonable cost because most of us have to pay for it out of pocket. If c-sections on dogs were $30,000, there would be none done.

Again, callous as it may sound, animal ownership is an option, just like car ownership. We choose to do what we can afford. If the car needs a new transmission, we do it if we can afford it. If we can’t we don’t. Unfortunately, it’s the same for an animal if they need a major surgery. We always have the cheaper option of euthanasia. That simply doesn’t apply with human medicine. I just hope that there are always cheaper options available for those of us who can’t afford the more expensive options but still want to treat their pets.

[Anne_FS]

[QUOTE=Fessy’s Mom;7399128]
This thread has really gone off on some crazy tangents…but where it really went off for me was when you all started comparing the cost of human care to animal care. [/QUOTE]

IMO not at all was that going off on some crazy tangents. In fact, I think it’s that comparison that has increased people’s anger at veterinarians: for so many of us we go to the doctor and pay $20. Period. That’s it. Plus our prescriptions, etc., but my office visit for me is $20, $35 if a go to a specialist. A specialist!

Yet if I take my small animals in, it’s $65 for each one to walk through the door, before even anything is done, so more than 3x what I pay for me to go.

My human prescriptions also have a co-pay. Sometimes I pay as little as $10 for a human Rx that would cost me $65 for my dog.

Plus my insurance covers 80% of my hospital bills. The 20% I’ve paid for surgeries sure was high enough, but it was only 20% of the charge.

We’ve gotten used to that: doctor’s office, 20 bucks. Prescriptions, 10 bucks. Then we go to the vet for a routine check and some tests and we’re out $400. And people get angry and think “my human doctor I only paid $20. This vet is SO ripping me off.”

[Fessy_s_Mom]

Anne - You aren’t serious?! INSURANCE is paying the balance of your bill and you had to pay for that insurance. That $20 office visit was probably $110-$150. You simply can’t compare the two. :no:

[Anne_FS]

You misunderstand me. I know insurance is paying the balance and that my actual bill is very high, yet because of my health insurance I pay very little out of pocket. I’m saying that people have gotten so used to paying little at the doctor’s office they forget how high their bill really is. When they go to the vet’s, most of us don’t have pet insurance so we have to pay the whole thing and it’s sticker shock.

The premiums taken out of paychecks are in a way “forgotten;” all people focus on is “my office visit is $20 and my dog’s office visit is $65, my flu shot is $10 and my dog’s shots are 3x as much, therefore all vets are cheats.”

Not to mention the fact that frankly a lot of people never pay their medical bills at all and they get away with it. Ask any EMT how many people use “911” as their bus ride to the hospital for “free” treatment. They’re never going to pay those bills. But their dog gets sick and they are livid because they can’t pull that stunt with the vet. Oh, you used to be able to do that, but vets have finally wised up. The whole reason they now insist on payment up front is because they have learned that sadly many many MANY people, if they walk out the door with their pet without paying, are NEVER going to pay that bill. Fact.

[dacasodivine]

I know someone completely getting rid of all pets due to vet costs. One dog is less than a year. The other 3 came with 2 kids they took in a couple months ago. (Relatives). The new dogs all had worms and gave it to their dog.

Vet ran all kinds of test on every dog and strongly urged a parvo test on one and suggested they leave the dog there overnight while waiting for the test results. I wouldn’t have thought too much about anything the vet did until the thing about wanting to test for parvo and how long it took to get results back. According to the owner, the dog did not have diarrhea or vomiting. And last time I had a parvo test run, it took about 10 minutes or so to get the results.

They have now decided they cannot afford dogs and no longer want pets as they are too expensive to keep.

[Anne_FS]

I can understand that. 4 dogs is a lot of added expense to a household esp. when you’ve just added into your home two more children that you have to support. Actually sounds like a wise decision, although IMHO it would be great if the kids got a dog or a cat to share the home. But 4, 3 of which are wormy? I totally get being overwhelmed by that.

[danceronice]

[QUOTE=grayarabpony;7396445]
Actually it’s patients who won’t shut up until they get an antibiotic. DH has worked with physicians who would cave but due to resistance problems I think physicians are going to be more and more reluctant to cave.

Antibiotics should NOT be sold over the counter.[/QUOTE]

I never ask for them and will frequently not take them, but MDs and LNPs give to me all the time. (Prednisone, which I DO need to have on hand? I have to practically beg.) No, they never culture anything. They just throw Amoxicillin or last time, Cipro, at the problem. (I will never take Cipro again unless I have anthrax.)

[LauraKY]

[QUOTE=danceronice;7399925]
I never ask for them and will frequently not take them, but MDs and LNPs give to me all the time. (Prednisone, which I DO need to have on hand? I have to practically beg.) No, they never culture anything. They just throw Amoxicillin or last time, Cipro, at the problem. (I will never take Cipro again unless I have anthrax.)[/QUOTE]

Doxy works for anthrax too…I don’t know why cipro is the go to.

[Anne_FS]

I’ve heard this about antibiotics, but my doctors have never thrown them at me. In general I’m a no-medications kind of person and I wonder if they perceive that so aren’t flinging antibiotics at me at the drop of a hat.

As for prednisone: absolutely they have to be extremely careful with that. I consider it a miracle drug and would probably be dead without it, but prednisone is not a drug to consider lightly.

[grayarabpony]

[QUOTE=danceronice;7399925]
I never ask for them and will frequently not take them, but MDs and LNPs give to me all the time. (Prednisone, which I DO need to have on hand? I have to practically beg.) No, they never culture anything. They just throw Amoxicillin or last time, Cipro, at the problem. (I will never take Cipro again unless I have anthrax.)[/QUOTE]

1. What are they giving you antibiotics for? and 2) your experiences are not everyone’s. LPNs can’t prescribe antibiotics.

Fwiw I have not gotten antibiotics without also getting a culture.

[SquishTheBunny]

[QUOTE=shayaalliard;7398572]
I have two emergency clinics near me. I have used both over the years, but will no longer go to the newer/nicer one. the reason?
I had to sign a form indicating that I either did or did not consent to them performing cpr on my pet should it crash.
The cpr fee? 500.00

For something that requires little to no equipment and minutes of work. I asked, no it didn;t include o2 or electric shocks or anything like that. Plain old hands and bag.

That’s exploitative. That’s wrong.
I never minded the $$$$ bill- I pay a premium for quality emergent care- I get it- but that’s just cold.

The other clinic in town has no such fee, and otherwise similar pricing and care. I voted with my feet.[/QUOTE]

CPR will frequently require:
4-5 assistants.
1 to do chest compressions
1 to intubate, and start compressions
1 to place IV catheter and start emergency fluid bolus. Get hypertonic saline boluses ready, maintain warm packs/warmed fluid.
1 to hook up and monitor ECG, end tidal CO2, blood pressure and draw up boluses of emergency medications such as epinephrine, atropine and lidocaine.
Also not to mention one of the above is getting the prep and emergency kit ready for a chest crack.

CPR goes for 5 minutes before reassessment of vital signs. No vitals at 5 minutes means you continue for another, repeat atropine, epi and lidocaine. Go another 5 minutes. At this point, its up to the vet to crack the ribs and do manual cardiac compressions or and repeat as above. CPR is discontinued at 20 minutes.

$500 - sure.

Now, if your clinic doesn’t do anything other than chest compressions for a few minutes then you are absolutely right to look at another. CPR can cost a LOT of money an lost revenue (cancelled appointments, delayed procedures) for vets, so when done properly and thoroughly (especially if the animal comes back - then CPR can go on for HOURS!), it should be charged for accordingly.

We did CPR on a dog that arrived DOA from another clinic after a dental gone wrong. Got it back, and it crashed 3 more times over the next 4 hours. Ended up doing well and going home a few days later. Four hours of intensive monitoring with several techs and doctor.

When it comes to asking about CPR should the animal crash, I would want to be at the best possible hospital regardless of price (look into details, such as staff training, CPR protocols etc.). Often you will be surprised that some clinics don’t even carry emergency drugs, while others have the whole shebang.

[Anne]

[QUOTE=grayarabpony;7400285]

1. What are they giving you antibiotics for? and 2) your experiences are not everyone’s. LPNs can’t prescribe antibiotics.

Fwiw I have not gotten antibiotics without also getting a culture.[/QUOTE]

Read for comprehension. She said LNP, aka licensed nurse practitioner, not LPN.

[grayarabpony]

Gee, thanks for the correction. How sweet of you.

Seems a little hard to believe she’s going to all of these MDs and LICENSED NURSE PRACTITIONERS and they are all throwing antibiotics at her. If so she needs to go to another practice.

Oh yeah, you put up an incorrect post about LICENSED NURSE PRACTITIONERS on another thread. Why is this such a touchy erroneous subject for you?

[Anne]

Bless your heart. I don’t make incorrect posts. On anything.

[grayarabpony]

Sorry to break this to you, but you do. Bless your own heart, btw.