Showing posts sorted by relevance for query vet billing. Sort by date Show all posts
Showing posts sorted by relevance for query vet billing. Sort by date Show all posts

Monday, April 16, 2018

How to Go to the Vet

Pound signs in the shadows.  Art by Kevin Brockbank for Dogs Today.

One of the things every dog owner has to do is go to the vet, but it only takes a few hours of sitting in a waiting room to come to the conclusion that most dog owners do not know how to go the vet, and, as a result, they are paying a lot more money than they need to.

What do you need to know before going to the vet? More than you think!

Here’s a small skein of advice that, if followed, might very well save you thousands of dollars (or pounds) over the life of your dog.
.
__________________________________
.

1.  Know why you are going to the vet.
The average dog needs to see a vet two or three times in his first year in order to get a full array of vaccination shots, but does not need to see a vet for a vaccine ever again. Read that sentence again. The fact that core vaccines last a dog’s lifetime is not new information – it is more than 30 years old – but it is information that the veterinary trade associations are not eager to share with the public because vaccines and health check-ups are the primary source of income for most vets. If you are going to a vet every year for a check-up, an annual teeth cleaning, and vaccine boosters (other than for rabies, if you are in the US or mainland Europe) simply because you got a card in the mail saying it is time for these procedure, then you are simply being ripped off. What about leptospirosis – the one vaccine that wears off after a year or so? What about it? This is a “non-core” vaccine that is nearly useless, is more dangerous than any other vaccine offered up by a vet, and which provides only imperfect protection against a very uncommon problem. My own dogs have spent many lifetimes ratting and going in and out of dens of every type, and I do not bother with a lepto vaccine. My advice, if you want something to worry about, is to forget lepto and focus on socks lying about the house, stray pills that have fallen off the medicine cabinet, and antifreeze in puddles. They are far more likely to kill a dog – even a dedicated ratting dog -- than leptospirosis!

2.  Be wary of new vet clinics that have just acquired expensive new equipment.
Veterinary clinics are like everyone else – they want the latest and greatest new piece of equipment, regardless of whether they need it or not. The problem for dog owners is that once a vet gets expensive new equipment, the pressure is on to use it – whether it’s necessary or not. A simple country vet is going to be able to handle 98 per cent of all your problems, and for the more complicated stuff, you are going to want to see a specialist anyway.

3.  Don’t confuse the relationship.
Your vet is not your friend – he or she is simply a person being paid to do a service. Of course, some vets would like to blur that fact, knowing that if they can position themselves as your friend then you may come to see them more often, you will respond to check-up postcards more often, and you are less likely to push back when medically unnecessary goods and services are suggested.

4.  Receptionists and nurses can bill pad.
While a vet may have ethical qualms about pushing unneeded goods and services, they rarely feel any compunction in having the receptionist or nurse do this bit of dirty work. In fact, the job description of these employees may require them to push nail trims, grooming, ‘specialty’ foods, flea and tick medications, and unnecessary medical tests. Do not be shy about being very clear you are not interested in such add-ons, and do not hesitate to pull out a pen and cross out such additions on your prospective bill.

5.  Know something about the problem or procedure before you go.
If your dog has a health problem, spend some time on the Internet doing a bit of research. Some problems, such as ringworm, can be fixed with over-the-counter topical medications, while other problems may have multiple solutions and your vet may have a financial incentive only to offer the most expensive. The more you know going in, the better armed you will be as an advocate for your dog and yourself.

6.  Avoid junk-billing and upcoding.
What’s junk billing? Annual vaccines are junk billing, and so too are tests for Lyme disease in asymptomatic dogs. What’s upcoding? It’s simply taking a modest health issue or incidence and inflating it into a big bill. For example, after a routine spay-neuter, does your vet want to keep the dog overnight? Why? Is someone going to be at the vet’s surgery all night long? In most cases, the answer is ‘no’. Your dog will do just as well - and get much better monitoring - if he or she simply comes home with you and spends the night in a crate.

7.  Every limp and lump is not a cause for panic.
Go to any emergency vet on a weekend, and you are sure to find several people in the waiting room who have come in for expensive care for very minor problems. But every limp and lump is not a cause for panic. Most canine limps are caused by the same thing as most human limps – a pulled or strained muscle that will self-correct with rest and time. As for lumps, most are simple cysts or non-malignant tumours – no reason to rush to an emergency vet on a weekend.

8.  Ask for a prescription for a generic medication, and buy that medication at a pharmacy.
Many of the medications we give our dogs were made for humans, many are available in generic form, and most can be acquired for very little cost from your local pharmacy. If your vet will not write a prescription or charges extra for it, change vets and tell them why!

9.  Know how to say “no” and be prepared to say it.
The more you know about your dog’s health, the better prepared you will be to have a sensible discussion, and the more empowered you will feel when it’s time to say “no”. Of course, pushing back is easier said that done! The trick, I find, is to know how to push back. If the vet is pushing a new round of vaccines on your adult dog, tell him you have read Ron Schulz’s work on vaccines (he is a world authority) and surely the vet knows that vaccines in adult dogs that have gotten all their puppy shots are not needed? You may be surprised at how quickly those vaccine charges wither away after that!   Teeth cleaning? Sure, but not every year – once every three or four years after the age of five. An overnight stay? Why does he think his surgery will provide more attentive care than you will at home? Other tests are recommended? Why does he think they are necessary?   Really?  And what will happen differently based on what he/she finds.  Is the test actually more expensive than the treatement which otherwise causes no harm?  In fact, that is often the case, especially if the vet is asking you to come for a test for something like worms ($90 or more just for the visit), while treatment is less than a dollar with over-the-counter medications that do the dog no harm.

Of course, all of this advice is predicated on the fact that you have not acquired a dog that is a complete and utter health wreck, requiring constant attention for a chronic problem.

Vets, of course, do not see such animals as problems, but as business opportunities.

In the world of veterinary care, the breathing problems of Bulldogs, the eye problems of Pugs, the cancer problems in Bernese Mountain Dogs, the wrecked hips of German Shepherds, and the collapsing hearts of Cavalier King Charles Spaniels, are what help put a new wing on the house.

No wonder, then, that in half a lifetime of going to vet clinics, I have yet to see a pamphlet on diseased, defective, and deformed breeds to avoid.

Where’s the money in that advice?

This article appeared in the November 2011 issue of Dogs Today.
.

Thursday, November 12, 2015

How to Go to the Vet

Pound signs in the shadows.  Art by Kevin Brockbank for Dogs Today.


One of the things every dog owner has to do is go to the vet, but it only takes a few hours of sitting in a waiting room to come to the conclusion that most dog owners do not know how to go the vet, and, as a result, they are paying a lot more money than they need to.

What do you need to know before going to the vet? More than you think!

Here’s a small skein of advice that, if followed, might very well save you thousands of dollars (or pounds) over the life of your dog.
.
__________________________________
.

1.  Know why you are going to the vet.
The average dog needs to see a vet two or three times in his first year in order to get a full array of vaccination shots, but does not need to see a vet for a vaccine ever again. Read that sentence again. The fact that core vaccines last a dog’s lifetime is not new information – it is more than 30 years old – but it is information that the veterinary trade associations are not eager to share with the public because vaccines and health check-ups are the primary source of income for most vets. If you are going to a vet every year for a check-up, an annual teeth cleaning, and vaccine boosters (other than for rabies, if you are in the US or mainland Europe) simply because you got a card in the mail saying it is time for these procedure, then you are simply being ripped off. What about leptospirosis – the one vaccine that wears off after a year or so? What about it? This is a “non-core” vaccine that is nearly useless, is more dangerous than any other vaccine offered up by a vet, and which provides only imperfect protection against a very uncommon problem. My own dogs have spent many lifetimes ratting and going in and out of dens of every type, and I do not bother with a lepto vaccine. My advice, if you want something to worry about, is to forget lepto and focus on socks lying about the house, stray pills that have fallen off the medicine cabinet, and antifreeze in puddles. They are far more likely to kill a dog – even a dedicated ratting dog -- than leptospirosis!

2.  Be wary of new vet clinics that have just acquired expensive new equipment.
Veterinary clinics are like everyone else – they want the latest and greatest new piece of equipment, regardless of whether they need it or not. The problem for dog owners is that once a vet gets expensive new equipment, the pressure is on to use it – whether it’s necessary or not. A simple country vet is going to be able to handle 98 per cent of all your problems, and for the more complicated stuff, you are going to want to see a specialist anyway.

3.  Don’t confuse the relationship.
Your vet is not your friend – he or she is simply a person being paid to do a service. Of course, some vets would like to blur that fact, knowing that if they can position themselves as your friend then you may come to see them more often, you will respond to check-up postcards more often, and you are less likely to push back when medically unnecessary goods and services are suggested.

4.  Receptionists and nurses can bill pad.
While a vet may have ethical qualms about pushing unneeded goods and services, they rarely feel any compunction in having the receptionist or nurse do this bit of dirty work. In fact, the job description of these employees may require them to push nail trims, grooming, ‘specialty’ foods, flea and tick medications, and unnecessary medical tests. Do not be shy about being very clear you are not interested in such add-ons, and do not hesitate to pull out a pen and cross out such additions on your prospective bill.

5.  Know something about the problem or procedure before you go.
If your dog has a health problem, spend some time on the Internet doing a bit of research. Some problems, such as ringworm, can be fixed with over-the-counter topical medications, while other problems may have multiple solutions and your vet may have a financial incentive only to offer the most expensive. The more you know going in, the better armed you will be as an advocate for your dog and yourself.

6.  Avoid junk-billing and upcoding.
What’s junk billing? Annual vaccines are junk billing, and so too are tests for Lyme disease in asymptomatic dogs. What’s upcoding? It’s simply taking a modest health issue or incidence and inflating it into a big bill. For example, after a routine spay-neuter, does your vet want to keep the dog overnight? Why? Is someone going to be at the vet’s surgery all night long? In most cases, the answer is ‘no’. Your dog will do just as well - and get much better monitoring - if he or she simply comes home with you and spends the night in a crate.

7.  Every limp and lump is not a cause for panic.
Go to any emergency vet on a weekend, and you are sure to find several people in the waiting room who have come in for expensive care for very minor problems. But every limp and lump is not a cause for panic. Most canine limps are caused by the same thing as most human limps – a pulled or strained muscle that will self-correct with rest and time. As for lumps, most are simple cysts or non-malignant tumours – no reason to rush to an emergency vet on a weekend.

8.  Ask for a prescription for a generic medication, and buy that medication at a pharmacy.
Many of the medications we give our dogs were made for humans, many are available in generic form, and most can be acquired for very little cost from your local pharmacy. If your vet will not write a prescription or charges extra for it, change vets and tell them why!

9.  Know how to say “no” and be prepared to say it.
The more you know about your dog’s health, the better prepared you will be to have a sensible discussion, and the more empowered you will feel when it’s time to say “no”. Of course, pushing back is easier said that done! The trick, I find, is to know how to push back. If the vet is pushing a new round of vaccines on your adult dog, tell him you have read Ron Schulz’s work on vaccines (he is a world authority) and surely the vet knows that vaccines in adult dogs that have gotten all their puppy shots are not needed? You may be surprised at how quickly those vaccine charges wither away after that!   Teeth cleaning? Sure, but not every year – once every three or four years after the age of five. An overnight stay? Why does he think his surgery will provide more attentive care than you will at home? Other tests are recommended? Why does he think they are necessary?   Really?  And what will happen differently based on what he/she finds.  Is the test actually more expensive than the treatement which otherwise causes no harm?  In fact, that is often the case, especially if the vet is asking you to come for a test for something like worms ($90 or more just for the visit), while treatment is less than a dollar with over-the-counter medications that do the dog no harm.

Of course, all of this advice is predicated on the fact that you have not acquired a dog that is a complete and utter health wreck, requiring constant attention for a chronic problem.

Vets, of course, do not see such animals as problems, but as business opportunities.

In the world of veterinary care, the breathing problems of Bulldogs, the eye problems of Pugs, the cancer problems in Bernese Mountain Dogs, the wrecked hips of German Shepherds, and the collapsing hearts of Cavalier King Charles Spaniels, are what help put a new wing on the house.

No wonder, then, that in half a lifetime of going to vet clinics, I have yet to see a pamphlet on diseased, defective, and deformed breeds to avoid.

Where’s the money in that advice?

This article appeared in the November 2011 issue of Dogs Today.
.

Wednesday, May 04, 2016

How to Go to the Vet

Pound signs in the shadows.  Art by Kevin Brockbank for Dogs Today.


One of the things every dog owner has to do is go to the vet, but it only takes a few hours of sitting in a waiting room to come to the conclusion that most dog owners do not know how to go the vet, and, as a result, they are paying a lot more money than they need to.

What do you need to know before going to the vet? More than you think!

Here’s a small skein of advice that, if followed, might very well save you thousands of dollars (or pounds) over the life of your dog.
.
__________________________________
.

1.  Know why you are going to the vet.
The average dog needs to see a vet two or three times in his first year in order to get a full array of vaccination shots, but does not need to see a vet for a vaccine ever again. Read that sentence again. The fact that core vaccines last a dog’s lifetime is not new information – it is more than 30 years old – but it is information that the veterinary trade associations are not eager to share with the public because vaccines and health check-ups are the primary source of income for most vets. If you are going to a vet every year for a check-up, an annual teeth cleaning, and vaccine boosters (other than for rabies, if you are in the US or mainland Europe) simply because you got a card in the mail saying it is time for these procedure, then you are simply being ripped off. What about leptospirosis – the one vaccine that wears off after a year or so? What about it? This is a “non-core” vaccine that is nearly useless, is more dangerous than any other vaccine offered up by a vet, and which provides only imperfect protection against a very uncommon problem. My own dogs have spent many lifetimes ratting and going in and out of dens of every type, and I do not bother with a lepto vaccine. My advice, if you want something to worry about, is to forget lepto and focus on socks lying about the house, stray pills that have fallen off the medicine cabinet, and antifreeze in puddles. They are far more likely to kill a dog – even a dedicated ratting dog -- than leptospirosis!

2.  Be wary of new vet clinics that have just acquired expensive new equipment.
Veterinary clinics are like everyone else – they want the latest and greatest new piece of equipment, regardless of whether they need it or not. The problem for dog owners is that once a vet gets expensive new equipment, the pressure is on to use it – whether it’s necessary or not. A simple country vet is going to be able to handle 98 per cent of all your problems, and for the more complicated stuff, you are going to want to see a specialist anyway.

3.  Don’t confuse the relationship.
Your vet is not your friend – he or she is simply a person being paid to do a service. Of course, some vets would like to blur that fact, knowing that if they can position themselves as your friend then you may come to see them more often, you will respond to check-up postcards more often, and you are less likely to push back when medically unnecessary goods and services are suggested.

4.  Receptionists and nurses can bill pad.
While a vet may have ethical qualms about pushing unneeded goods and services, they rarely feel any compunction in having the receptionist or nurse do this bit of dirty work. In fact, the job description of these employees may require them to push nail trims, grooming, ‘specialty’ foods, flea and tick medications, and unnecessary medical tests. Do not be shy about being very clear you are not interested in such add-ons, and do not hesitate to pull out a pen and cross out such additions on your prospective bill.

5.  Know something about the problem or procedure before you go.
If your dog has a health problem, spend some time on the Internet doing a bit of research. Some problems, such as ringworm, can be fixed with over-the-counter topical medications, while other problems may have multiple solutions and your vet may have a financial incentive only to offer the most expensive. The more you know going in, the better armed you will be as an advocate for your dog and yourself.

6.  Avoid junk-billing and upcoding.
What’s junk billing? Annual vaccines are junk billing, and so too are tests for Lyme disease in asymptomatic dogs. What’s upcoding? It’s simply taking a modest health issue or incidence and inflating it into a big bill. For example, after a routine spay-neuter, does your vet want to keep the dog overnight? Why? Is someone going to be at the vet’s surgery all night long? In most cases, the answer is ‘no’. Your dog will do just as well - and get much better monitoring - if he or she simply comes home with you and spends the night in a crate.

7.  Every limp and lump is not a cause for panic.
Go to any emergency vet on a weekend, and you are sure to find several people in the waiting room who have come in for expensive care for very minor problems. But every limp and lump is not a cause for panic. Most canine limps are caused by the same thing as most human limps – a pulled or strained muscle that will self-correct with rest and time. As for lumps, most are simple cysts or non-malignant tumours – no reason to rush to an emergency vet on a weekend.

8.  Ask for a prescription for a generic medication, and buy that medication at a pharmacy.
Many of the medications we give our dogs were made for humans, many are available in generic form, and most can be acquired for very little cost from your local pharmacy. If your vet will not write a prescription or charges extra for it, change vets and tell them why!

9.  Know how to say “no” and be prepared to say it.
The more you know about your dog’s health, the better prepared you will be to have a sensible discussion, and the more empowered you will feel when it’s time to say “no”. Of course, pushing back is easier said that done! The trick, I find, is to know how to push back. If the vet is pushing a new round of vaccines on your adult dog, tell him you have read Ron Schulz’s work on vaccines (he is a world authority) and surely the vet knows that vaccines in adult dogs that have gotten all their puppy shots are not needed? You may be surprised at how quickly those vaccine charges wither away after that!   Teeth cleaning? Sure, but not every year – once every three or four years after the age of five. An overnight stay? Why does he think his surgery will provide more attentive care than you will at home? Other tests are recommended? Why does he think they are necessary?   Really?  And what will happen differently based on what he/she finds.  Is the test actually more expensive than the treatement which otherwise causes no harm?  In fact, that is often the case, especially if the vet is asking you to come for a test for something like worms ($90 or more just for the visit), while treatment is less than a dollar with over-the-counter medications that do the dog no harm.

Of course, all of this advice is predicated on the fact that you have not acquired a dog that is a complete and utter health wreck, requiring constant attention for a chronic problem.

Vets, of course, do not see such animals as problems, but as business opportunities.

In the world of veterinary care, the breathing problems of Bulldogs, the eye problems of Pugs, the cancer problems in Bernese Mountain Dogs, the wrecked hips of German Shepherds, and the collapsing hearts of Cavalier King Charles Spaniels, are what help put a new wing on the house.

No wonder, then, that in half a lifetime of going to vet clinics, I have yet to see a pamphlet on diseased, defective, and deformed breeds to avoid.

Where’s the money in that advice?

This article appeared in the November 2011 issue of Dogs Today.
.

Tuesday, October 25, 2011

How to Go to the Vet

Pound signs in the shadows.  Art by Kevin Brockbank for Dogs Today.


One of the things every dog owner has to do is go to the vet, but it only takes a few hours of sitting in a waiting room to come to the conclusion that most dog owners do not know how to go the vet, and, as a result, they are paying a lot more money than they need to.

What do you need to know before going to the vet? More than you think!

Here’s a small skein of advice that, if followed, might very well save you thousands of dollars (or pounds) over the life of your dog.
.
__________________________________
.

1.  Know why you are going to the vet.
The average dog needs to see a vet two or three times in his first year in order to get a full array of vaccination shots, but does not need to see a vet for a vaccine ever again. Read that sentence again. The fact that core vaccines last a dog’s lifetime is not new information – it is more than 30 years old – but it is information that the veterinary trade associations are not eager to share with the public because vaccines and health check-ups are the primary source of income for most vets. If you are going to a vet every year for a check-up, an annual teeth cleaning, and vaccine boosters (other than for rabies, if you are in the US or mainland Europe) simply because you got a card in the mail saying it is time for these procedure, then you are simply being ripped off. What about leptospirosis – the one vaccine that wears off after a year or so? What about it? This is a “non-core” vaccine that is nearly useless, is more dangerous than any other vaccine offered up by a vet, and which provides only imperfect protection against a very uncommon problem. My own dogs have spent many lifetimes ratting and going in and out of dens of every type, and I do not bother with a lepto vaccine. My advice, if you want something to worry about, is to forget lepto and focus on socks lying about the house, stray pills that have fallen off the medicine cabinet, and antifreeze in puddles. They are far more likely to kill a dog – even a dedicated ratting dog -- than leptospirosis!

2.  Be wary of new vet clinics that have just acquired expensive new equipment.
Veterinary clinics are like everyone else – they want the latest and greatest new piece of equipment, regardless of whether they need it or not. The problem for dog owners is that once a vet gets expensive new equipment, the pressure is on to use it – whether it’s necessary or not. A simple country vet is going to be able to handle 98 per cent of all your problems, and for the more complicated stuff, you are going to want to see a specialist anyway.

3.  Don’t confuse the relationship.
Your vet is not your friend – he or she is simply a person being paid to do a service. Of course, some vets would like to blur that fact, knowing that if they can position themselves as your friend then you may come to see them more often, you will respond to check-up postcards more often, and you are less likely to push back when medically unnecessary goods and services are suggested.

4.  Receptionists and nurses can bill pad.
While a vet may have ethical qualms about pushing unneeded goods and services, they rarely feel any compunction in having the receptionist or nurse do this bit of dirty work. In fact, the job description of these employees may require them to push nail trims, grooming, ‘specialty’ foods, flea and tick medications, and unnecessary medical tests. Do not be shy about being very clear you are not interested in such add-ons, and do not hesitate to pull out a pen and cross out such additions on your prospective bill.

5.  Know something about the problem or procedure before you go.
If your dog has a health problem, spend some time on the Internet doing a bit of research. Some problems, such as ringworm, can be fixed with over-the-counter topical medications, while other problems may have multiple solutions and your vet may have a financial incentive only to offer the most expensive. The more you know going in, the better armed you will be as an advocate for your dog and yourself.

6.  Avoid junk-billing and upcoding.
What’s junk billing? Annual vaccines are junk billing, and so too are tests for Lyme disease in asymptomatic dogs. What’s upcoding? It’s simply taking a modest health issue or incidence and inflating it into a big bill. For example, after a routine spay-neuter, does your vet want to keep the dog overnight? Why? Is someone going to be at the vet’s surgery all night long? In most cases, the answer is ‘no’. Your dog will do just as well - and get much better monitoring - if he or she simply comes home with you and spends the night in a crate.

7.  Every limp and lump is not a cause for panic.
Go to any emergency vet on a weekend, and you are sure to find several people in the waiting room who have come in for expensive care for very minor problems. But every limp and lump is not a cause for panic. Most canine limps are caused by the same thing as most human limps – a pulled or strained muscle that will self-correct with rest and time. As for lumps, most are simple cysts or non-malignant tumours – no reason to rush to an emergency vet on a weekend.

8.  Ask for a prescription for a generic medication, and buy that medication at a pharmacy.
Many of the medications we give our dogs were made for humans, many are available in generic form, and most can be acquired for very little cost from your local pharmacy. If your vet will not write a prescription or charges extra for it, change vets and tell them why!

9.  Know how to say “no” and be prepared to say it.
The more you know about your dog’s health, the better prepared you will be to have a sensible discussion, and the more empowered you will feel when it’s time to say “no”. Of course, pushing back is easier said that done! The trick, I find, is to know how to push back. If the vet is pushing a new round of vaccines on your adult dog, tell him you have read Ron Schulz’s work on vaccines (he is a world authority) and surely the vet knows that vaccines in adult dogs that have gotten all their puppy shots are not needed? You may be surprised at how quickly those vaccine charges wither away after that!   Teeth cleaning? Sure, but not every year – once every three or four years after the age of five. An overnight stay? Why does he think his surgery will provide more attentive care than you will at home? Other tests are recommended? Why does he think they are necessary?   Really?  And what will happen differently based on what he/she finds.  Is the test actually more expensive than the treatement which otherwise causes no harm?  In fact, that is often the case, especially if the vet is asking you to come for a test for something like worms ($90 or more just for the visit), while treatment is less than a dollar with over-the-counter medications that do the dog no harm.

Of course, all of this advice is predicated on the fact that you have not acquired a dog that is a complete and utter health wreck, requiring constant attention for a chronic problem.

Vets, of course, do not see such animals as problems, but as business opportunities.

In the world of veterinary care, the breathing problems of Bulldogs, the eye problems of Pugs, the cancer problems in Bernese Mountain Dogs, the wrecked hips of German Shepherds, and the collapsing hearts of Cavalier King Charles Spaniels, are what help put a new wing on the house.

No wonder, then, that in half a lifetime of going to vet clinics, I have yet to see a pamphlet on diseased, defective, and deformed breeds to avoid.

Where’s the money in that advice?

This article appeared in the November 2011 issue of Dogs Today.
.

Tuesday, February 05, 2019

ProSal is a Veterinary Fraud Billing Machine


Over at DVM360 there's a post in the veterinary economics section that illuminates a billing system designed to abet fraud.

Before we get there, however, a little background:

  • Veterinarians are no more honest (or less honest) than car mechanics, and they are certainly not more or less honest that human doctors who are nailed all the time for kickbacks, upcoding, double billing, and prescribing medically unnecessary tests, surgeries, and pharmaceutical treatments. The US Department of Justice collects two to three billion dollars in fraud fines from doctors and health care providers every year.

  • There are few operational laws that work to rein in fraud in the veterinary care arena. There is no False Claims Act as there is with Medicare, Medicaid and veteran's care, and because dogs and cats are treated as mere property, there are rarely large recoveries for even the most grotesque violations of veterinary ethics and procedure. As with human medicine and the law, veterinary care is largely self-policing, and the veterinary trade tends to look the other way for anything short of an attack on their business model. I have written about this before. For example, in  a post from 2008, entitled Is Your Veterinarian Clean? Don't Count On It, I note that vets are upcoding, prescribing medically unnecessary services, collecting kickbacks, and engaged in self-referral all the time. In a post from 2007 entitled Veterinary Trades Say It's Time to Rip-off the Rubes, I note how publications like Veterinary Economics serve as a virtual cheering section for selling medically unnecessary services and bill-padding.

So what's new?

Well, it seems there's a veterinary billing program out there called "ProSal" which seems perfectly designed to encourage veterinarians and their staff to maximize billing by encouraging unneeded tests and procedures while making sure that veterinarian time is billed for what otherwise might have been done by a vet tech (or not done at all).

Pro-Sal says its billing system is designed to calculate "production" numbers and compensate the vet and his associates based on those billable "production" numbers.

Right.

Guess what?  

If you do this with human health care, you get nailed for fraud.

You may lose your medical license, you may end up in jail, you will certainly have to pay up to treble damages which can add up to millions of dollars.

Production numbers. You mean KICKBACKS?

Yes, these are kickbacks. The "if.... then" statement is the clue.  It's just like a timber and steel company telling the engineer "IF you tell the town they need a new bridge, THEN I will give you 10 percent of the materials cost."

Do you really think that engineer's advice is not going to be colored by the cash being waved in front of his or her face?  I assure you it will be. Kickbacks are pervasive because they work to generate business that might not otherwise occur.

Which is not to say all incentives are bad.

Incentives might be a logical sales system for tires. 

But it's not a legal model in the health care arena where the need for the product or services being sold is not transparent, where the pricing is not transparent, and where the doctor's recommendation is supposed to be based solely on what it good and right for the patient, not what makes him or her the most money.


ProSal is all about kickbacks abetted by price gouging and the promotion of medically unnecessary goods and services. 

For example, the question is asked: Do I get production on flea preventives?

You mean do you get a KICKBACK?

Well, the answer is that you sure as heck should since "There should be at least a 100 percent markup on those products, so there’s certainly room to pay production credit on them."

"Production credit." Right. Kickbacks.

Incentivized price-gouging. Payola.

Whatever you want to call it, it's not a veterinarian giving you his or her best judgement for your animal and your pocketbook; it's a vet giving you his or her best judgement on what will improve the bottom line for themselves personally.

The folks pushing Pro-Sal want to pre-absolve themselves of the crimes they know they are encouraging. 

They make sure you understand that they are not at fault for creating a billing-fraud machine. Just ask them! 

Under their "myths" section they posit this one:

MYTH: PRODUCTION-BASED PAY PROMPTS PADDING OF THE BILL. 
I've heard people say that ProSal encourages doctors to overcharge, upsell, or "steal" high-dollar cases. Those types of behaviors indicate personality flaws in an individual, and ProSal just makes these flaws more obvious. It's the very rare veterinarian who overcharges or gouges clients—in fact, I have a hard time getting most veterinarians to charge enough for their services.

Right.

If someone steals,
then that's their character flaw and never the large signs pointing out that the vault is open, the getaway car is gassed up with keys in the ignition, and the helpful note that says Barney Fife is half asleep and getting his hair cut down at Floyd's Barbershop.

And never mind that overt rationalizations to steal. Veterinary economics is full of this stuff.

Are you a veterinarian with student loans to pay off?  Then read this guide on how to upcode by doing unnecessary lab tests for every dog that presents.  Its all about "improving your production" we are told.

Right.  Ka-ching! These three tips alone will bring in another $150,000 a year or more to a vet.

So what's next? 

Hard to say, but I remember when ABC's 20/20 did a consumers piece on how veterinarians are rip-off factories where dog owners are routinely sold medically unnecessary procedures, some of which are actually bad for the dog.

Is another one of those in the offering? I should think so.

Who in the veterinary world will speak when TV investigative reporters come knocking? Will there be a parking lot stake out chase as ABC corners a scoundrel vet?

Hope so.  Stay tuned!

There is of course, good news and bad news.

What's the good news?  The good news is that only about half of all vets use ProSal for billing.

What's the bad news?  The bad news is that about half of all vets use ProSal for billing.

Related Posts:
** Veterinary Trades Say It's Time to Rip-off the Rubes
** Grifting: The New Veterinary Stock in Trade
** How to Go to the Vet
** The Billion Dollar Heartworm Scam
** The Billion Dollar Lyme Disease Scam
** The Billion Dollar Vaccine Scam
** The Billion Dollar Dental Cleaning Scam
** Cruciate Ligament Injuries in Dogs
** Vetering Pricing Has Nothing to Do With Care
** Is Your Vet Clean? Don't Count On It.
** Flea Powder for Less and Canine "Dry Shampoo"
** Low Cost All-Worm Treatment
** Lyme Disease: Hard to Catch and Easy to Halt
** Ring Worm and Toe Fungus Among Us
** What's Your Vet Charging You?
** Canine Influenza Vaccines are the Latest Scam
** Saving Big Money With a Ball Point Pen
** Rimadyl: Relief From a Swollen Wallet
** A Business Plan Based on Fencing Out the Truth
** Veterinary Billing Without Oversight or Regulation
** Veterinary Notes From the Field
** The Price of Putting on the Dog
** Veterinary Care Reaches Human Care Cost
** Attempted Veterinary Extortion
** Murder by Can Opener: How Pet Owners Kill Dogs
** Get Over It: Bagged Food is Fine for Fido
** Dog Food Secrets "They" Don't Want You to Know
** SuperGlue to Close Wounds
** Rimadyl: Relief From a Swollen Wallet
** A Business Plan Based on Fencing Out the Truth
** Small Vet Kit for Pack
** Antibiotics for Less Without a Prescription
** Year Round Dosing for Big Veterinary Profits
** A Season to Every Thing

Wednesday, March 02, 2016

Veterinary Bunko About Dog Training



Going to a vet for a behavior issue with a dog is a bit like going to a lawn mower mechanic for advice on how to shampoo a carpet.

Vets are not the beginning or end all of dogs. Most veterinarians know little or nothing about nutrition, breed-genetics, or dog training.

To put a point on it:  Going to a vet for a behavior issue with a dog is a bit like going to a lawn mower mechanic for advice on how to shampoo a carpet; if they know anything at all, it's just an accident.

All of this by way of introduction to the fact that the American Animal Hospital Association (AAHA) has just put out a publication called "Canine and Feline Behavior Management Guidelines." In that publication they say

More dogs and cats are affected by behavioral problems than any other condition, often resulting in euthanasia, relinquishment of the patient, or chronic suffering.

Yes. Excellent. And what do vets know about it and what are they saying?

And here is where we come to the nonsense.

Under no circumstances should aggression or any condition involving a clinical diagnosis be referred to a trainer for primary treatment. Referral to a dog trainer is appropriate for normal but undesired behaviors (e.g., jumping on people), unruly behaviors (e.g., pulling on leash), and teaching basic manners.

Eh? A dog with "aggression" issues (whatever that is as it is undefined and would likely include all kinds of leash-reactivity, fear, etc.) should never be taken to a dog trainer? Never?? Then, pray tell, who should see this dog other than a vet with a blue solution?

Behavior cases can be complex, often involving public health and safety issues. Board-certified veterinary behaviorists (diplomates of the American College of Veterinary Behaviorists, www.dacvb.org) are specifically trained and qualified to treat clinical behavior problems in companion animals. Referral to a veterinary behaviorist may be recommended in cases involving self-injury, aggression, multiple concurrent behavioral diagnoses, profound phobias, or for patients not responding to conventional treatment despite the primary care veterinarian’s best efforts. Dogs either inflicting deep bites or those injuring immunocompromised individuals should be referred to a specialist. Under no circumstances should aggression or any condition involving a clinical diagnosis be referred to a trainer for primary treatment. Referral to a dog trainer is appropriate for normal but undesired behaviors (e.g., jumping on people), unruly behaviors (e.g., pulling on leash), and teaching basic manners.

So, the ONLY person that can help you with your dog is a certified veterinary behaviorist who is diplomate of the American College of Veterinary Behaviorists?

Fantastic.

Because, you see, according to the DACVB web site, there are only 66 such people in the entire world.

Let me say it now:  Bunko and bullshit.

This country is full of very good dog trainers using a wide variety of techniques. The notion that there is only one way to train a problem dog, and that you need a Veterinary Behaviorist to do it, is complete nonsense.

If you are a good dog trainer, stop by the local vets and explain what you do and how you do it.

If you are a veterinarian, make it part of your job to learn about dog trainers in your area, and what they can do (being very attentive to what it is your customers actually need, which will vary).

As for the notion that there are  less than 100 people in the world that can deal with a problem dog, let's call "shenanigans" and remember exactly what kind of bunko outfit the American Animal Hospital Association really is.

These are pill-pushers and price-gougers, upcoders, and bill padders. Their modus operandi is to write guidelines for over-prescribing, and then to sell the very prescriptions that they have just suggested.

Grifters gotta grift, and there is a tremendous amount of  grifting in the veterinary business.  Caveat emptor.

Friday, March 31, 2017

Saving Big Money With a Ball Point Pen




When a veterinarian submits a "prospective bill" before doing the work, look it over and see what you can cross out.

  1. Are you being double billed? It happens.
  2. Has the vet or vet tech tacked on procedures that you do not want, such as teeth cleaning? It happens. Teeth cleaning in dogs is almost never medically necessary. Dog teeth and human teeth are not the same for one simple reason: a dog is dead at age 15, not at age 80.
  3. Has the vet tacked on a bunch of expensive pre-anesthesia tests? If your dog is not old, is in fine health (other than perhaps a wound), and has done well with anesthesia before, consider skipping it.
  4. Is this vet trying to test for heartworm in a dog that is under 9 months of age? That's a scam or a mistake -- cross it out and consider changing vets.
  5. Is the vet anxious to sell you Rimadyl for pain? Cross it out and say you'll give the dog buffered children's aspirin in the proper dose instead.
  6. Is the vet trying to sell you year-round heartworm medication even though you have a real winter in your area? That's a scam -- cross it out.
  7. Is your veterinarian pushing annual vaccinations and "boosters?" Forget it; all vaccines after the first year are good for the life of the dog. Your vet knows this, or should. A rabies vaccine is the only one that needs to be renewed (for legal reasons) and then only every three years, and you do not need to get it done at the vet. The cheapest rabies tag in your community can be gotten from the local animal shelter.
  8. Has your new puppy been spayed or neutered? Ask to take it home that day. Some veterinarians are big on keeping pets overnight, but this is medically unnecessary and just another "tack on charge." In many cases, your dog will spend the night at the vets without an overnight attendant even being on duty. Why would you pay to leave your dog in a cage far from home with no one to even check up on it?
  9. Ask the vet for a prescription for a generic and get the prescription filled at WalMart or Costco for a few dollars. You can do this with a large number of pet medications, including antibiotics, and you can even get antibiotics without a prescription. If WalMart or Costco don't have the drug you are looking for, and you will need it for the life of the dog or cat, see if it can be ordered mail order. And yes, you can ask for a double-dose and split the pill for your dog, same as is done for humans.
  10. Are you kenneling your dog at the vets while on a short vacation? Just say NO to the "guilt" charges they will suggest adding -- nail trimming, baths, "vaccine boosters," and those "extra walks" that will either not be done or will be just a "once around" a 12-foot yard. A kennel is not a spa, and a short trip out of town is no reason for you to allow yourself to be gouged. Remember: the dog will be walked so the crate does not have to be cleaned and the dog washed (for free!).

    _ _ _ _ _ _ _ _ _
    Related Links
.

Friday, April 03, 2015

Saving Big Money With a Ball Point Pen




When a veterinarian submits a "prospective bill" before doing the work, look it over and see what you can cross out.

  1. Are you being double billed? It happens.
  2. Has the vet or vet tech tacked on procedures that you do not want, such as teeth cleaning? It happens. Teeth cleaning in dogs is almost never medically necessary. Dog teeth and human teeth are not the same for one simple reason: a dog is dead at age 15, not at age 80.
  3. Has the vet tacked on a bunch of expensive pre-anesthesia tests? If your dog is not old, is in fine health (other than perhaps a wound), and has done well with anesthesia before, consider skipping it.
  4. Is this vet trying to test for heartworm in a dog that is under 9 months of age? That's a scam or a mistake -- cross it out and consider changing vets.
  5. Is the vet anxious to sell you Rimadyl for pain? Cross it out and say you'll give the dog buffered children's aspirin in the proper dose instead.
  6. Is the vet trying to sell you year-round heartworm medication even though you have a real winter in your area? That's a scam -- cross it out.
  7. Is you veterinarian pushing annual vaccinations and "boosters?" Forget it; all vaccines after the first year are good for the life of the dog. Your vet knows this, or should. A rabies vaccine is the only one that needs to be renewed (for legal reasons) and then only every three years, and you do not need to get it done at the vet. The cheapest rabies tag in your community can be gotten from the local animal shelter.
  8. Has your new puppy been spayed or neutered? Ask to take it home that day. Some veterinarians are big on keeping pets overnight, but this is medically unnecessary and just another "tack on charge." In many cases, your dog will spend the night at the vets without an overnight attendant even being on duty. Why would you pay to leave your dog in a cage far from home with no one to even check up on it?
  9. Ask the vet for a prescription for a generic and get the prescription filled at WalMart or Costco for a few dollars. You can do this with a large number of pet medications, including antibiotics, and you can even get antibiotics without a prescription. If WalMart or Costco don't have the drug you are looking for, and you will need it for the life of the dog or cat, see if it can be ordered mail order. And yes, you can ask for a double-dose and split the pill for your dog, same as is done for humans.
  10. Are you kenneling your dog at the vets while on a short vacation? Just say NO to the "guilt" charges they will suggest adding -- nail trimming, baths, "vaccine boosters," and those "extra walks" that will either not be done or will be just a "once around" a 12-foot yard. A kennel is not a spa, and a short trip out of town is no reason for you to allow yourself to be gouged. Remember: the dog will be walked so the crate does not have to be cleaned and the dog washed (for free!).

    Related Links
.