Yet more Daily Mail vet bashing

Re: Yet more Daily Mail vet bashing

Anonymous — Mon, 06 Feb 2012 15:00:50 GMT

Hi Mark,

Take a look at www.vetsure.com and www.totalvetsolutions.co.uk. Your idea is very similar to the strategy employed by Vetsure Pet Insurance. Total Vet Solutions now work with over 170 vet clinics promoting our pet insurance products (predominanttly Vetsure). These products in turn are priced by our actuaries according to the pricing strategy employed by each member practice in the network - this includes an analysis of referral centre use. Unlike your suggestion, policy holders still have freedom to use any practice/ referral centre in the country but are incentivised to stay within the 'network' e.g. through lower excess costs. Together, these strategies enable us to get the price correct up front and to keep a control over costs in a way that is not detrimental to the pet owner and/or patient. No discounting is required by the network of practices - I don't think this would work and would be counter-intuitive to most vets.

So in answer to your question, aside to a few tweaks to your proposal, definitely a 'good thing'!

Ashley Gray MRCVS, MD Total Vet Solutions and Vetsure Pet Insurance.

Re: Yet more Daily Mail vet bashing

Bob Russell — Mon, 06 Feb 2012 09:14:31 GMT

As far as I can tell (from a position of semi-ignorance) the grumbles about fees seem to include the so called corporates and groups. It seems to be these that specialise in cheap deals to get the punter in and high costs when things go wrong (ie those procedures where insurance kicks in!).

If a practice charges little for the headline procedures this must be made up elsewhere.

I do worry that the referral option (and justification for all the expensive toys!) involves such a massive step-up from general practice in costs!

Re: Yet more Daily Mail vet bashing

Mark Hedberg — Sun, 05 Feb 2012 19:06:26 GMT

+1 to Mr. Ness. :)

Re: Yet more Daily Mail vet bashing

Utlendigur — Sat, 04 Feb 2012 23:18:55 GMT

[quote user="Laurence Webb"]The flip side is that if you allow insurance companies to determine which treatments or investigations are appropriate then you limit your clinical freedom.[/quote]

True, maybe - I wasn't really thinking of micromanagement of cases

[quote user="Laurence Webb"]Perhaps having to request pre-authorisation for certain investigations may be another way - then the clinician would have to justify why the MRI is of benefit to the management of the case, [/quote]

That's what I was thinking of when suggesting that the insurance company could have discretion in what it would agree to pay for. We do usually suggest clients clear expensive outlays with the insurance company first, especially if we're referring for a complicated work up or if there are any issues in the history we think might cause problems with a claim. nb I've noticed that a lot of claim forms ask about complementary therapies and ask the vet to justify their use - so not a huge step on from that. Anyone know what happens in human health insurance?

Re: Yet more Daily Mail vet bashing

Laurence Webb — Sat, 04 Feb 2012 22:47:29 GMT

The flip side is that if you allow insurance companies to determine which treatments or investigations are appropriate then you limit your clinical freedom. Whilst some vets may be guilty of over-treatment or over-investigation, it is in the interest of insurance companies to limit any expenditure as far as possible.

Is a MRI and CSF tap indicated for every 18mths old labrador that has had one seizure? Probably not, but I can't say it's wrong to do. Is an abdo CT to look for mets to stage a tumour wrong? That depends if you've got a lipoma or a tumour that would require amputation of a limb. I wouldn't want an insurance company to tell me that I can only run a certain number of blood samples to treat an IMHA - some are straight forward, others are complex.

If insurance claims are rising in excess of 10% in a year then someone's charging more money, and my impression is that this isn't in primary care.

A high excess would be one way to limit claims and keep premiums down. Perhaps having to request pre-authorisation for certain investigations may be another way - then the clinician would have to justify why the MRI is of benefit to the management of the case, not just because they have got one and need to put through X number of cases a week to make it viable. An alternative could be to give guaranteed cover up to a certain financial limit, but then authorisation would need to given up to a new limit. Obviously this wouldn't work in every case - emergency treatment needs to be given then and there, but it may be a start.

Re: Yet more Daily Mail vet bashing

Utlendigur — Sat, 04 Feb 2012 20:37:59 GMT

[quote user="Clive Ansell"]

[quote user="Malcolm Ness"]

[quote user="Clive Ansell"]an 18 month Labrador with a diagnosis (neuro exam and routine bloods, but no MRI) of idiopathic epilepsy stable for 6 months[/quote]

The diagnostic yield of MRI in young fitting dogs is remarkably low and this information is in the literature. The diagnostic yield will be lower still in those dogs that are young, fitting and have had no other neuro signs developing over the six months you describe.

Veterinary practitioners should recognise that they, too, are customers of the referral centres and they should exert commercial pressure while at the same time reminding themselves of the bit in the GTPC that gives them a responsibility to their clients which surely extends as far as researching and advising their referral options.

[/quote]

I would not have referred or advised referral in this case. A colleague bowed to pressure from a difficult and pedantic client who requested, actually demanded, referral and wanted a 100% cast iron guarantee that a brain tumour was not present. I get the feeling the client wanted their pound of flesh from the insurers. A case of over use/abuse of insurance, hence the soaring premiums etc. In the end the referral along with its MRI and csf analysis came to the same diagnosis as I, idiopathic epilepsy. If the insurer asked the question "was the referral necessary and/or recommended" I would answer no.

[/quote]

I would say this is one area where the insurance companies should be tightening things up themeselves - surely they must have veterinary advisors versed in EBVM. It's very difficult for a vet to refuse to provide a diagnostic test, treatment or referral where a client is determined (unless obviously the animal's welfare would be compromised) but the insurance companies have some discretion over what they will pay for - the client could still go ahead if they were genuinely concerned but would have to pay for the gold plating. To use the car analogy - if someone runs into your car, you expect the insurance to cover removing the dent and repainting the affected areas - you wouldn't expect it to include a full respray in the colour of your choice, alloy wheels etc. This already seems to be happening with OOH treatment and home visits anyway. We had one client with a youngish obese labrador who requested OOH home visits with monotonous regularity because the dog was "off his legs and screaming in pain". On arrival the dog was always bouncing around barking. Any suggestion that he should come down or that previous visits had proved unnecessary were met with "I know my rights/I'll make a complaint" attitude and discussions of costs were met with "It doesn't matter, he's insured". Oh the bliss, when his insurance company added the questions about whether the OOH treatment and/or home visit was necessary and I could tick the "no" box - complete with clinical notes that recorded numerous unnecessary visits and lack of client compliance on dieting his dog.... strangely the requests for visits stopped

Re: Yet more Daily Mail vet bashing

james herriot lied — Sat, 04 Feb 2012 19:34:54 GMT

[quote user="Bob Russell"]

Why not offer a policy with a £500 excess that just covers the exceptional cases?

[/quote]

Been saying this for quite some time now: whilst it's difficult as a locum to analyse the actual size of claims (a mean average is bugger all use, without some indication of median and/ or standard deviation), I firmly believe that in our area of the country - a fairly poor one by the south east's standards - one of the bigger problems is actually people claiming on £70 bills when the excess is £60. The hoovering up of both insurance company's and vet's time in dealing with these kind of cases is likely to be sucking the life out of relatively low cost policies. Pet insurance isn't there to ensure that you never have to pay vet bills again, but this point seems to be lost on a large proportion of the client base.

With respect to the whole endorsement deal situation in insurance, where insurers and service providers get together, this has to be one of the big reasons for increased car insurance premium rates. Just look at what happens next time you have a moderate prang in your car.

Last, but by no means least, we're in a vicious cycle which doesn't seem to have an end in sight: we're over-producing and importing vets, and there's only so much money to go round, so insurance is literally a lifeline for many practices; at the same time, the rise of the corporate - where it can't possibly be claimed that the bottom line for the parent company (and this isn't a dig at the professionals who work for these chains) is about care rather than money - is squeezing the market constantly and will just get worse. If you don't want your clients to face catastrophic bills OOH, do the work yourself; do the work yourself, and not only is your life pretty much tied to work, but (on a national scale) the resulting rise in vets looking for jobs will lead to more practices, and smaller slices of the pie.

There's a fairly sensible adage about how, in a stable economy, money isn't created or destroyed but rather deployed elsewhere until a maximum threshhold is reached. We have, in the veterinary profession, reached the maximum input possible from clients - and then started the decline. Just as a failing heart triggers responses which ultimately lead to decompensation, so our current course is likely to lead to crisis.

Still, at least there's the Wales-Ireland game tomorrow.

Re: Yet more Daily Mail vet bashing

Malcolm Ness — Sat, 04 Feb 2012 18:24:17 GMT

[quote user="robloxley"]However I can't see the entirety of the pet insurance market collapsing, since they are surely enough shrewd people to realise that insurance can be affordable, offer decent cover and be profitable to offer.[/quote]

Agreed - as the competition increases within the market, more and different insurance options will appear.

[quote user="robloxley"]However I foresee more insurers capping specific fees/procedures - I'm sure they can easily sit down and compare the costs of an MRI, cruciate repair,[/quote]

This is already happening in equine insurance where some companies/policies have placed restrictions on MRI. WRT shopping around - that will surely come but beware the risks that will come with buying on head-line price alone. What happens when things go wrong - see the earlier post by Clive about "complications/infection" relating to a TPLO lifting the bill to nearly £5k. Most TPLO "complications" relate directly to technical error as do most infections in a clean, elective procedure. I know nothing of the circumstances of that particular case but already the potential for a protracted and unpleasant dispute are obvious if that client had been "sent" to a specific surgeon on the basis of a price-only bidding war.

Be careful what you wish for!

Re: Yet more Daily Mail vet bashing

Rob Loxley — Sat, 04 Feb 2012 17:13:43 GMT

[quote user="Clive Ansell"]A colleague bowed to pressure from a difficult and pedantic client who requested, actually demanded, referral and wanted a 100% cast iron guarantee that a brain tumour was not present. I get the feeling the client wanted their pound of flesh from the insurers.[/quote]

And maybe they feel they are paying the premiums in order to cover such 'gold plated' treatment?

But I think there is a lot of risk of people (clients, primary care vets and referral practices) 'killing the golden goose'.

However I can't see the entirety of the pet insurance market collapsing, since they are surely enough shrewd people to realise that insurance can be affordable, offer decent cover and be profitable to offer. However I foresee more insurers capping specific fees/procedures - I'm sure they can easily sit down and compare the costs of an MRI, cruciate repair, blood test or histo sample - and decide on a fee scale they are prepared to pay rather than force people to specific referral centres. I'd rather that than what seems to be happening with some policies creating big areas of zero cover (see previous thread).

Re: Yet more Daily Mail vet bashing

Clive Ansell — Sat, 04 Feb 2012 16:25:00 GMT

[quote user="Mark Rowland"]

I think the car analogy is useful in another way. I think its just a matter of time before an insurance company and a chain of vets get together so that just as your car has to go to an "approved" mechanic, your insured animal may have to go to a vets recommended by the company (the chain who reciprocate by offering discounts to the insurers)

Good thing or not?

[/quote]

I am surprised this has not happened already, where insurers have their own "preferred" practices or large centres, as well as their own or preferred providers of prescription meds. All they would need to do is contact the corporates and the low cost clinics.

Equally, I am surprised that insurers don't get clients to get all in quotes for things like cruciate repairs or pyometras.

Good thing or not? - probably not.

Re: Yet more Daily Mail vet bashing

Clive Ansell — Sat, 04 Feb 2012 16:05:44 GMT

[quote user="Malcolm Ness"]

[quote user="Clive Ansell"]with an obvious cruciate rupture, MRI scan and TPLO surgery[/quote]

Was this a stifle MRI? Although MRI is widely used in human knee investigation, dogs are very, very different. I know of no good evidence to support the use of MRI in the investigation of even an obscure stifle lameness, let alone a patient in which there appears to be a straightforward diagnosis. Was there more to this case? We charge <£2k inc tax for dx and surgical treatment of cruciates in large dogs (modified TTA procedure) and we "guarantee" the outcome to the extent that if complications occur then we will charge the clients only for extra drugs and implants - anything else, including revision surgery, is at our expense.

[/quote]

MRI was of both stifles. It was a straightforward case initially and at the point the MRI was carried out, but there were post op complications/infection which increased the bill to nearly £5000.

[quote user="Malcolm Ness"]

[quote user="Clive Ansell"]an 18 month Labrador with a diagnosis (neuro exam and routine bloods, but no MRI) of idiopathic epilepsy stable for 6 months[/quote]

[/quote]

Re: Yet more Daily Mail vet bashing

Mark Rowland — Sat, 04 Feb 2012 15:59:09 GMT

[quote user="Christopher Saul"]

[quote user="bob lehner"] I wouldn't be surprised to see a trend back towards where most of us were 10-15 years ago - i.e. more in-house treatments at GP. level.[/quote]

Fair point I agree, but the problem is owners' expectations will not go back to what they were 15 or so years ago. They'll want referral practice standards but for first opinion prices - and the stress on the general practicioner will only get higher and higher

I agree with this, I think there will be an issue with newly qualified vets who may have been offering referral to more specialised centres suddenly being faced with having to carry out procedures and work ups that may have been referred on before and therefore lacking the necessary experience.

[/quote]

Re: Yet more Daily Mail vet bashing

Mark Rowland — Sat, 04 Feb 2012 15:55:22 GMT

Good thing or not?

Re: Yet more Daily Mail vet bashing

Lorna McHardy — Sat, 04 Feb 2012 15:48:45 GMT

[quote user="Bob Russell"]

Why not offer a policy with a £500 excess that just covers the exceptional cases? Most people will have to fork out £300-500 excess if they have a car shunt. This is why car insurance remains profitable and the companies spend so much money on nauseating adverts.

[/quote]

Well... that and the fact that car insurance is mandatory for everyone who owns a car... economics of scale and all that.

Re: Yet more Daily Mail vet bashing

Lorna McHardy — Sat, 04 Feb 2012 15:41:02 GMT

Hm... I actually thought the comments were quite balanced. That is, I thought there were a large number of sensible comments to balance out the uninformed nonsense.

It's not just vets who get this kind of stuff... I can't think of a profession that doesn't come in for newspaper hatchet jobs and associated reams of half-witted commentary. Doesn't make it any better, but at least we're in good company... I think...

Re: Yet more Daily Mail vet bashing

Julian Earl — Sat, 04 Feb 2012 15:33:35 GMT

The worrying uncertainty about all those posts is just how widespread those ideas are? Are they really just the extreme and the moronic and the reality-of-business-costs-ignorant, or do most of the general population feel that way? The comments are so outrageously wide of the mark it is hard to know how seriously to take them. I'm half-tempted to reply but brick wall, banging, and head come to mind.

Re: Yet more Daily Mail vet bashing

Malcolm Ness — Sat, 04 Feb 2012 13:07:49 GMT

[quote user="Clive Ansell"]with an obvious cruciate rupture, MRI scan and TPLO surgery[/quote]

[quote user="Clive Ansell"]an 18 month Labrador with a diagnosis (neuro exam and routine bloods, but no MRI) of idiopathic epilepsy stable for 6 months[/quote]

Re: Yet more Daily Mail vet bashing

jamie winstone — Sat, 04 Feb 2012 13:06:40 GMT

Thank you Malcolm for a touch of reality. I don`t need to read the Daily Mail or any of the other "news sources", every week I hear clients regaling stories of huge bills and what appear speculative procedures. I am sure like others one tries to keep out of it, but there must be some truth to it all.

In my view a significant number of the hugely expensive procedures are fuelled by the fact that the animal is insured not by the owner. It is seen as a passport for any investigation with no cost benefit analysis and now many insurance companies are giving up. Its not really a surprise, in fact I am amazed any are still in the market.

Jamie

Re: Yet more Daily Mail vet bashing

Clive Ansell — Sat, 04 Feb 2012 12:48:47 GMT

[quote user="Malcolm Ness"]

[quote user="Clive Ansell"]When owners have insurance vets often do MRI scans instead of X-rays.[/quote]

[quote user="Clive Ansell"]I used to work in pet insurance, we advised customers not to tell vets they had pet insurance because the vets would all of a sudden create illnesses and tests out of nowhere.[/quote]

Regrettably, as a profession, we cannot take the moral high-ground on this as there is rather more than a grain of truth in it. MRI is massively over-used when a competent clinical and/or neuro exam would reveal more information at less cost.

[/quote]

It grieves me to say it, but I am inclined to agree.

2 recent referral cases: first was an insured Bull Mastiff with an obvious cruciate rupture, MRI scan and TPLO surgery = £4995. Second case, an 18 month Labrador with a diagnosis (neuro exam and routine bloods, but no MRI) of idiopathic epilepsy stable for 6 months with no further seizure activity on Phenobarbitone therapy - "Neuro" referral and MRI scan = £2000. In my view MRI was not needed in either case, although as an orthopod you may say otherwise?

Re: Yet more Daily Mail vet bashing

Malcolm Ness — Sat, 04 Feb 2012 12:36:39 GMT

[quote user="Clive Ansell"]When owners have insurance vets often do MRI scans instead of X-rays.[/quote]

Re: Yet more Daily Mail vet bashing

Christopher Saul — Sat, 04 Feb 2012 12:30:10 GMT

[quote user="Bob Russell"]

Lloyds/Halifax are blaming vets for their own inability to run a business.

[/quote]

So true! We ( as private sector tax payers) bail Lloyds/HBOS out to stop them going out of buisness. They continue to cock it up so we get the blame. great.

Re: Yet more Daily Mail vet bashing

Bob Russell — Sat, 04 Feb 2012 11:42:46 GMT

Pet insurance only becomes uneconomical if the insurance company gets its sums wrong!

Lloyds/Halifax are blaming vets for their own inability to run a business.

The whole point of insurance is to allow (within reason) the owner to afford 20th Century investigation and treatment. This does include CT and an occasional MRI where it is the best way to get information!

At some stage I presume veterinary treatment will enter the 21st Century.

The insurance companies need to get their products right and stop blaming the veterinary profession for choosing to move forwards!

Re: Yet more Daily Mail vet bashing

Christopher Saul — Sat, 04 Feb 2012 11:31:47 GMT

[quote user="bob lehner"] I wouldn't be surprised to see a trend back towards where most of us were 10-15 years ago - i.e. more in-house treatments at GP. level.[/quote]

Re: Yet more Daily Mail vet bashing

bob lehner — Sat, 04 Feb 2012 11:16:00 GMT

Well this whole thing seems to me to have been totally predictable. I read somewhere that 8 insurers have pulled out of the pet market recently and I guess others will follow . If they are not making money they will just pull out - no sentiment is involved here.

To me one of the most interesting changes in the s.a. branch of the profession over the past 10 years or so has been the huge expansion in the very hi tech/hi cost investigations and treatments available - and particularly the staggering growth in the number of the 'all bells and whistles' referral centres.

Whilst these are very admirable and undoubtedly have improved the health of the nation's pets they obviously have to be paid for and I don't think it is unreasonable to say that pet insurance has fueled many of these developments.

If pet insurance starts to disappear, or becomes just too expensive for many owners, I can for-see a major change in what many clients will be wanting from us and I wouldn't be surprised to see a trend back towards where most of us were 10-15 years ago - i.e. more in-house treatments at GP. level.

Re: Yet more Daily Mail vet bashing

Clive Ansell — Sat, 04 Feb 2012 10:42:39 GMT

Here are some of the readers' comments, ridiculous idiots.

When owners have insurance vets often do MRI scans instead of X-rays.

They're all scammers - the insurance companies and the vets, particularly those who work for a "chain."

I used to work in pet insurance, we advised customers not to tell vets they had pet insurance because the vets would all of a sudden create illnesses and tests out of nowhere.

Cats and dogs are mammals and as such, develop many of the same conditions as us. Once you know what the condition is, I suggest you look online and you will find a load of information which may help you treat your pet yourself and keep Vet fees

Vets fees are very expensive these days so before treatment a consulation is £22

Thankfully I am now eligible for PDSA, so that is one worry less. Insurers and vets: lots of greedy people taking advantage of our love and commitment to our animals.

on one visit the vet did an x-ray & it was an eyewatering £50 extra. It is totally wrong to just rake it on because people care enough to take sick animals in ....