In-Clinic Clinics

(Private Practice Partnerships)

In many underserved areas with low population density a local animal clinic may be an important player in the spay neuter movement. We believe that companion animal overpopulation is a true public health, welfare and safety issue because of its far reaching, costly and negative consequences which are a public burden to address. Yet a standard public health approach does not seem to work for most private veterinary practices…but can it? How can we take components of a public health approach (i.e. high volume, easy access and low cost) and import them into the private veterinary practice in order to create a high volume, low cost program which also creates a revenue stream for the service provider? This bridge is vital in creating sustainable low-income spay/ neuter programs in high needs communities.

Traditionally, the most well-know private practice model has been the voucher system, in which a reduced cost surgery is provided for a needy pet during a regular appointment slot, with a humane society or municipal agency making up the cost difference. Also, some clinics provide a limited number of surgeries for free or close to free and simply accept a financial loss. While sometimes these are the only protocols that work, they are difficult, don’t provide the needed volume and generally represent a financial loss for the clinic, setting a low volume “in stone.”

What goes wrong with the models above? First, the client calls the humane organization, the organization then calls the animal hospital, involving at least two calls per surgery for the receptionist; if the client is a ‘no-show,’ they’re not simply zero revenue; staff time was already used. The veterinarian then reduces the number served and thereby the effectiveness. The veterinarian gets frustrated with the humane society and the humane society gets frustrated with the clients, and an important program plummets.

By scheduling clients during the regular work day, the veterinarian competed with him or herself for their own time, and expectations of clients were unrealistic. And even if the program works well, a limited number may be insufficient.

Private practice models must generate a positive income stream in order to increase the volume of surgeries. Using a private clinic on days in which they are otherwise closed or blocking out two or three hours each week enables the clinic and the program to succeed.

This Is How We Do It…

Some folks think a mobile spay/ neuter unit is an animal hospital with wheels. We view each regular animal hospital as a mobile clinic without wheels!!

A collaborative relationship between a private practice and a local humane organization can make low-income services possible without opening a brand new clinic or mobile unit and in a way that is easier for the animal welfare volunteers than a M*A*S*H or visiting mobile.

Essentially, the private practice becomes a reduced cost clinic for a few hours a week, or one day a month, using the allotted time to provide high volume services to families that are not otherwise their clients (or are not able to pay for a spay or neuter at full price).

This is ideal for areas where no non-profit alternative exists and a local clinic has enough time that these surgeries do not cut into their regular workload and can thereby become an added revenue stream. The surgeries are provided at a cost equal or close to the nearest low-income access program.

Benefits of a private practice partnership:

  • This program provides the benefits of a low-cost spay/ neuter clinic with very little start up cost. There is no clinic to build and no mobile unit to purchase. This generates and supports a local relationship and keeps money local.
  • Already compliant with state regulations,
  • Volume equals a monthly visit by a mobile unit or spay neuter transport (25 to 50 per month per participating clinic). Can be combined with a different model for increased volume at start-up.
  • Humane org volunteers do not have to learn about a brand new field of services and can concentrate on outreach, leadership and “getting folks in the door”, and can immediately raise funds for sliding scale and not bricks and mortar (or rent, etc).
  • Does not represent a financial loss during slow times.
  • Aftercare mechanism is built in (providing emergency aftercare for surgery patients is mandated in most states),
  • The host organization does not have to compete with other communities for available days of a mobile spay neuter unit which visits multiple communities!

Drawbacks:

  • Is limited to the number of hours or time slots available to the humane organization and/ or may not provide a sufficient level of service to serve clients in a timely manner.
  • Ongoing, clear communication is a necessity because this model combines people who may have different priorities! If you use the model which includes weekly surgeries, the staff can perceive it as ‘extra work,’ or feel the clients are not truly needy and resent the program (see box). The clinic has signed on only for the surgeries, not as a wellness service and should not be pressured to do other services.

Requirements:

  • A phone line for spay neuter appointments is needed In order for the humane organization to advertise the program and schedule the appointments. An online system such as on Google docs (which is free) enables multiple volunteers to schedule the clinic days without overbooking as everyone can see what each other are doing. A shared site (either online or at a central desk) is the ONLY way that multiple people can book one program without causing pandemonium.
  • One person from the humane society must communicate with clinic staff in order to prevent and/ or quickly resolve problems which can damage these programs.
  • In the programs which rely on clinic staff on a weekday morning, creating an inexpensive but fun incentive for the staff, such as lunch on the last Friday of each month, helps offset the fact that this creates some extra work for them.
  • Everything must be included in the price. That means the surgery, the rabies vaccine if that is required, the pre-exam, pain medication, etc.
  • Communication with staff is vital; “upselling” in order to make a few extra dollars defeats the program and generates ill will. Hopefully the clients will use veterinary services later on, however persuading them to spend a few dollars can turn people off and bring a halt to the word-of-mouth advertising that is needed. Some clients will feel it was a ‘bait and switch.’
  • Do appropriate and honest income screening. This can be a simple household income level (such as $35,000 per year) or based on the home receiving Food Stamps, WIC, Medicare or HUD housing. Using an overall household income level enables your program to include low-income working people who receive no public benefits. A full time job at minimum wage grosses roughly $14,700 yearly, so using a basic income level enables you to serve those who cannot afford to go elsewhere, however including those who are not receiving aid programs.
  • The caller must understand the requirement for proof of income screening over the phone is simple and straightforward. For the programs in which check-in is done by the hospital staff, confirm that the client understands the income guidelines and there is a requirement that they bring proof of income.
  • Most private practice programs ask clients to pay by cash or money order, or charge $2 extra for credit card payments.
  • Make sure that THE CLINIC STAFF understands the income screening which is in place, including limits and the proof of income that is expected.

The Numbers:

Five surgeries per week at an average of $45 totals $11,250 per year. Many veterinarians are able to do five to ten surgeries in two to three hours. Increasing the number of surgeries increases the revenue while increasing the effectiveness of the program.

A client co-payment of $20 is roughly half of a surgery, and even this small co-payment enables organizations to get around 50 surgeries per $1000. Our goal is to serve Medicaid and welfare level clients so subsidy funds are important, even at these low prices.

The differences between the once a week and the once a month models are outlined below.

How to start

All spay neuter programs should start with an assessment of the area, the population, general pet care habits, local resources and outreach to any possible partners. Private practice partnerships are ideal for small towns within rural counties that have no existing spay/ neuter programs nearby to transport to and a small enough population that the lower numbers can be effective.

The next step is to locate spay/ neuter programs in the region to see if they have spaces open for transport, or if they are seeking partners in order to increase their numbers. If you determine that a private practice partnership is going to be your best solution, investigate the costs at existing spay neuter programs within your region. Those (plus a few dollars) will be the base price for this program.

When demands come from out of the county, reach out to see if a clinic in that county will participate as well. Expand with the demand! Seeking a second participating clinic opens more spaces to the community.

Some procedures:

The animal clinic provides surgeries and holds animals until picked up by the family (unless they are part of a transport). Same day or next day release, fasting and aftercare are up to the clinic.

The humane organization provides the scheduling and reminder calls; a local calling area cell phone may do the job. A list of appointments are e- mailed, FAXED or called in to the clinic the morning of the spay neuter program or the evening before. One volunteer stays in contact with a designated person at the animal clinic to discuss any issues that come up.

The humane organization reaches out to low- income communities through any means that they would do for other types of spay neuter programs. This includes postering, handouts, meeting with officials and churches, etc.

The humane organization will schedule appropriate numbers for the correct time, may need to be onsite during check-in. Intake forms which track income levels and pet care habits provide important information on your success.

The clinic has agreed to provide surgeries (and possibly vaccines) and should not be pressured to provide other services at reduced rates. This is a business that is including a public health model for spay neuter services, but has not changed their overall business model.

A few words of wisdom for the organizers and the clinic staff…

This program will not “fit” every hospital; it is aimed at making spay neuter affordable to those who would otherwise need to use a reduced cost service. If the veterinarian is uncomfortable providing surgeries without certain protocol, this simply may not fit.

The private practice model can be a great start-up program, requiring very little money and a very small crew of people. If organized properly, it can absolutely provide a positive revenue stream to the service provider. However, because it combines the non-profit mission and a private business under one roof, the private practice programs demand attention to detail.

If casual mistakes in the agreed upon income level are commonplace, the result can be the loss of the program, or even hard feelings and a damaged working relationship with that particular clinic. This also includes being sure that check-in goes well,that scheduling gets folks there on time and that volunteers who are expected to be on-site are actually there.

Remember that the clinic staff may be completely new to this effort and may not understand or even agree with your goals. This is the only type of spay neuter program that places people in this field who may not have chosen to be here; communication is absolutely key to the relationship! Everyone has a stake in this effort succeeding!

When income screening or checking in the clients, the car people drive does NOT reveal their income level. If the pet owner has a “fancy car” they may not be able to purchase a home and choose to have a nice car instead, or the car may belong to a relative or friend. Remember, full time minimum wage earners net under $15,000 per year; if they own a decent car that’s their business. We screen incomes, not spending habits.

Do not upsell the services. Many homes must “save up” to get the pet spayed, even at $45. If the $45 service ultimately costs $75, the client will be bitter toward the program as well as toward the clinic. Changing pet care habits requires good “word of mouth” after people leave. Money is made on providing volume within the planned timeframe, not by having each client pay an extra few dollars.

If they “can’t afford to care for the pet they shouldn’t have it,” is a myth to put behind us. This attitude can truly throw a wrench in the works. Our data collection (which includes thousands of surgeries each year) reveals that most of the pets we alter came to their caregiver as a stray or a free puppy or kitten from a street corner or parking lot. Indeed, ‘stray’ is checked off as the origin of over 60% of our patients. The fact that a low-income home has the pet reflects an act of compassion, not an act of irresponsibility.

The private practice partnership requires good communication and the same level of organization, phone skills and attention to detail that any other type of spay neuter program requires. The fact that the staff of the private practice did not get a job in a spay neuter clinic, yet finds themselves in one for a day a week, can present challenges. The good news is that most of the folks working in an animal clinic care about animals and negativity can be overcome by making sure they are in the loop and understand how important this program is to their community and to the animals they are serving. Many will realize that indeed, these are NOT their regular clients and welcome the opportunity to help animals that otherwise won’t come through their door.

Like any remote area service, the program may need to be combined with other types of services. For example, a high volume mobile unit may be needed for start-up. Again, good communication is the key to any program in which folks come together to help animals.

Let us know how it goes.

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