Here’s a question for you: How much should a vet charge for a house call? I’m not talking about the large animal vet who does farm calls or the small animal vet who takes the hospital with her. Here I’m drilling you specifically about the vet who attends your pet pillow-side after hours, at lunchtime or on her free time as a “courtesy.”
While euthanasias are the mainstay of my house call practice, I’ll also drag myself out of the hospital for a client’s convenience (six dogs for annual visits, anyone?) or as a nod to those extra-stressed pets who can’t keep it together in a clinical setting.
For the record, I look forward to house calls—especially when they’re within working hours. Problem is, this means I have to give up precious time in the hospital where I could have seen three or more pets in the time it takes me to drive to a specific place and practice my craft with limited equipment—usually on my knees (yoga should be tax-deductible for vets—it keeps us nimble).
Still, I do enough of these that I felt well justified when I forked over a premium for my small SUV earlier this year (considering environmental impact and gas prices today, this is no small concession). Because it’s typically necessary to transport deceased pets (big dogs are more likely to be euthanized at home when they can no longer walk), a large cargo space was essential.
The other issue with house calls is that the time it takes to perform this function can be a slippery thing to estimate. Consider the three hours it took to attend the bedside euthanasia of last Sunday’s patient:
Drive to the hospital, pick up drugs and supplies, clear out cargo space, drive five miles in holiday-shopping traffic, wait for the entire family to arrive, watch each family member say goodbye, wait for the sedative to take effect, place a catheter without assistance, euthanize the patient, stretcher him out to the car, drive back, somehow get his 85-pound body into the hospital on my own (more support for the tax-deductibility of power-yoga), and drive home.
This case also required an additional trip to the detailer to shampoo the blood out of my cargo mat when his lung cancer inadvertently caused a hefty outpouring of fluid that sloshed off the protective plastic sheeting. (I ordered a rubber bucket mat off eBay yesterday).
Suffice it to say that house calls can be perilous—and expensive for the doc. And what may require an hour in a well-organized case can sometimes take hours given the vagaries of family life and unforeseen medical complications.
But how to charge? I don’t always know. While we apply a standard fee to any house call (an additional $80) plus the exam and any procedures or drugs it might necessitate, some house calls clearly should cost more: When I get a call on Sunday requesting an emergency euthanasia. When I spend more than an hour. When a tech is required. When it’s far away. There are so many variables that it’s hard to estimate the cost—and clients deserve to know roughly what it’s going to cost, right?
I ended up charging $125 for the house call on Sunday (plus the injections, catheter and at-cost cremation). I just didn’t feel comfortable charging more without an up-front explanation. Though the client is affluent, I couldn’t justify more under the circumstances. After all, I was served a superb cup of Cuban coffee, fielded offers for fruitcake and sandwiches, and lounged comfortably on a plush leather sofa while the family (a joy to converse with) regaled me with sweet stories of their dog’s past exploits.
Sure, I’d rather be home on a Sunday. I’d rather not spend hours working during my own family time. Still, if I’ve committed to offering this valuable service (which I believe is indispensable to my way of practicing), I can’t just pick and choose my cases. But I can be fair to myself in terms of what it’s really worth.
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What makes the answer to this question so difficult is that you want to offer this valuable service but also make it worth your time and effort to do so. I have always believed that the client should get to make the decision about choosing to utilize a service and if we can offer several options, then it is a win-win situation for everyone.
In these particular cases, I think that charging an appropriate exam fee, medications, and supplies is pretty straightforward...it's the housecall charge that gets sticky. For the doctors I have worked with in the past, I have used 2x the routine exam fee as the housecall charge, figuring that the doctor was going to miss at least 2 patients during that time. Technicians go along at no charge during normal business hours (mostly for safety reasons). If it is after-hours, then I feel that if a technician is going to be called in, there should be an emergency fee for that as well. So in the case of a sunday euthanasia, charges should be:
Housecall + after hours fee + euthanasia + on-call technician + supplies and other procedures.
Clients can also be told that the housecall fee is $X for the first hour and $1/2x for each additional 15 minutes beyond that first hour (travel time not included). Some clients may request additional time and be willing to pay for that special attention. We did that with our senior care and longevity center. We had a base fee for an hour long appointment with additional time blocks available if the client needed the extra time. A good front office staff can help with this by discussing these charges prior to the scheduled service. Always remember, there should be no surprises when it comes to the invoice.
I think the other thing to realize is that most clients are thrilled that you offer this kind of service and the money actually becomes less of an issue. As morbid as it sounds, I can think of numerous incidences when we needed to euthanize a pet during emergency hours and the clients were thankful...even after a substantial invoice.
Tomcat1765 December 11th, 2007 08:40:00 AM
I would say come up with some standard hourly rate for time spent at the house (higher on weekends or after hours), plus a mileage cost that takes into account both gas and time spent on the road, and add that to your cost of supplies. It's what all sorts of other organizations do - car mechanics charge at least $50/hr; workplaces reimburse 40ยข/mile for work trips. That way you have a standard amount you can charge and explain, and you can always go lower for less affluent customers.
zandperl December 11th, 2007 10:22:00 AM
Another thought as the other commenter mentioned is tacking on a per-case fee. An in-house visit to me should cost more than a trip to the emergency vet, and in my area walking in the door on a weekend or after hours at an emergency vet costs $200. So an in-house emergency call should cost more (maybe $300?), though perhaps an in-house scheduled appointment would be comparable.
zandperl December 11th, 2007 10:25:00 AM
I think it's totally warranted to charge a premium for a housecall. Does it mean you can't compete against any all-housecall vets in your area? It might, but it's also a special service with the vet who your clients obviously trust most.
I was actually very distressed that my vet doesn't offer housecalls, and indeed that no housecalls are available in my area at all, even for euthanasia services. The explanation I got from my vet was that their insurance doesn't cover housecalls. This was in Florida, so maybe you can address how the insurance side of things works, Dr. K.
Having had a cat who was so terrified of vet visits that it literally killed him (undiagnosed congestive heart failure, until the stress from the car ride and vet visit pushed him over the edge), this is a topic of great interest to me, and I'm looking forward to hearing more about it.
Feline December 11th, 2007 11:49:00 AM
Feline: Honestly, I have no idea as to the insurance issue. I imagine the liability of the dog bite to a hospital employee is still a workman's comp issue (since the income goes to the hospital), the professional liability is still the vet's and the liability of any bite to an owner is now, potentially, the owner's. No reason why this can't be put in writing to simplify things. If anything, things seem more advantageous to the vet on the liability front. My guess is that house calls are just not profitable so no one likes to do them.
Dr. Patty Khuly December 11th, 2007 02:36:00 PM
$80 total seems cheap to me. I don't know. I had some unfortunate circumstances a few years back that caused me to hire a lawyer, and when I had to meet him at a courthouse, I received an itemized bill for travel time to the courthouse, back to his office from the courthouse, and gas. The "travel time" cost as much per as his time actually working on my case!!! I didn't get charged for time he spent waiting at the courthouse because he was late (he got held up at another hearing, I'm not mad or anything). I think the 15-minute hearing cost me $300!!!!!!!
I'm not saying vets should charge this way. But the lawyers are onto something - they know what their time is worth. It seems that a sliding scale based on how far away the client is and how much time things take is most appropriate - and it needs to be quantified, rather than a seat-of-the pants thing. Those are more my thoughts on how I'd like to do it in the future than anything else :)
Julia December 11th, 2007 03:27:00 PM
I would guess that if you don't set up a firm house-call payment system now, instead of just guessing what's fair, then when you come up with too low a price, they'll expect that again in the future. I think Tomcat1765's ideas are great. You shouldn't have to wait for whatever without being compensated for your time; if they knew up front about the extra time charges, they'll plan better, or at least know ahead of time that the bill will be higher.
Since house-calls are either a luxury, or a justifiable expense (like for many euthanasias), keep the prices high enough so that people don't take advantage of the situation, sucking up all profits and personal time.
Sherrk December 11th, 2007 04:24:00 PM
I worked for a vet that charged a per 1/4 mile surcharge on house calls. The price was high enough to be prohibitive for anything other than when it was really necessary--typically euthanasias--but even so, they were rarely profitable. But it is a nice thing to offer clients.
abc December 11th, 2007 05:53:00 PM
I have to agree that unless I'm seeing a vet with a mobile practice, I'd expect a house call to be at least as expensive as a trip to an emergency clinic. You could certainly give a discount for multiple animals - like the six annual exams. It's always better to charge more and then discount as needed.
Juli December 12th, 2007 02:18:00 PM
I do most of the house calls at our practice, and the bulk of those are euthansias--we had one dog who was too big/old/arthritic who required at home exams (he was diabetic on top of this) but he got euthanized (on a Sunday, and I live 45 miles from the practice) so we don't have any "regulars" for at home stuff anymore.
I work in the NYC metro area--White Plains, specifically, and in general, our practice is one of the more expensive ones in the area, but we also have a repuation for getting to the bottom of your problem AND supplying a high level of customer service.
Our charges for a house call need to cover me and a tech out of the office for an hour or more. So, in the case of our euthanasia we charge a euthanasia visit (exam + injection), medical waste, cremation charges if I have to bring the pet back (and inevitably it is a large dog. I have a PT Cruiser that has proven to be VERY useful for this) and a housecall charge. Our housecall charge is $175. I did one housecall in Stanford CT (about 20 miles away) and I know the housecall was more then that, but I am not sure HOW much more...maybe $225? So overall, this runs in the neighborhood of $500. I do not routinely use a catheter, but if I did, we'd charge for that.
My Sunday housecall I also added on $100 as an emergency charge.
We ALWAYS give an estimate prior to these, and we ALWAYS make sure we know for CERTAIN we are doing the euthanasia if that is what we schedule. Once I had a client flip flop on me...for 2 hours. I finally left asking her to call back--I had stuff to do!
FWIW, this is an expensive service but the clients who choose it are always VERY grateful--its a nicer setting, I think. My last one was a few weeks ago--we did it in a sunny spot in the backyard, where the dog (an elderly Golden retriever) was sipping up chicken broth and eating beef jerky before he slipped away. It was a very peaceful and lovely thing. His owners brought me flowers yesterday with a thank you card.
DrSteggy December 12th, 2007 02:33:00 PM
I've never had a housecall, but I 'd be willing to pay for the service if I needed it. I have gone to my vet after hours, at 0300 and was only charged $50 additional for the after hours fee. Which is WAY reasonable.
If the time comes that I need to euthanise either of my guys, I would GLADLY pay to have it done in my home where my guys are most at ease. And, that would be best for me, too. I know I will blubber like a fool for at least a day.......
I'd like to see a sliding scale, tho, for elderly people who can't get out. Do your patients get an AARP discount?
AGADORE'S MAMA December 12th, 2007 08:29:00 PM
I just had a bad experiance (12 . 24 . 2008) with a sick dog that suddenly went into Liver failer.
It started aprox 8:30 am w/ quickly arising from a sound sleep to vomit (twice in the house), this was followed by about 2-4 mins of standing in a corner seemn`ly "confused". I than ask`d him if wanted to go out for some air, he responded quickl;y and we were in my front yard. After walking about 10 ft and looking like another vomiting was coming , he than just stood there. I placed a beach towl on the ft porch and ask`d "do you want to lay here for awhile" ? He immediatly came to me and quickly lay`d down (due to the current Cancer in his Liver "quickly getting down wasn`t normal) I immediatly looked at his gums and for the first time they were compleatly white and he was extreamly tired, lay`d his head down and went right to sleep. I called my treating vet and they wanted me to bring him in. At this point I stated that that was most likely not possible, he is a big dog and wasn`t getting up. I waited about 2-3 mns to see what things were going to look like and look`d at the gums again, they were now yellow, I was warned of this and I knewv this was it. I asked the vet to come over , I DID NOT want ANY pain or suffering for this great, loyal, "long-time best friend": the vets office said due to this being Christmas eave they were closing at noon and after that they wouldn`t be available . I informed them this is it and I need help to end the inevitable, and for me to get him up (now, almoast compleatly out of it) was impossible and I would pay any ammount of money to get help. Once again I was told they were leaving at noon and ("sir, we do not make house calls"). I called about 5 local vets and all were the same, This is Christmas eave and no one is available, sorry. I than call`d friends to come over to help me some how get him tro their office. while doing this he was slipping in and out of it and was looking real bad. A friend arrived and right then he had a vommiting episode w/ lots of contractions and discomfort. I noticed a bowl movement also. Immeditly folling he was basicly 90% in a coma, w/ some "awairness" by the time we assesed how th put in another borrowed SUV we had to call for another person to help. I did my best to try to comfort him and kept letting him know I`d be there for him. This was hard to watch him and knowing he always knew no matter we were always there for each other and my feeling of hopelessness was eating me up. We managed to finally slip a piece of plywood under him and comfortly get him in the back of the SUV, at the moment we had him compleatly in and were ready to close the hatch he had a severe seisure and look`d like he was in the last seconds of life. Well, it ended and his head just "fell back" and was now 100% in a coma. I rode w/ him in the back and held him and talk`d the whole way there. I phoned the vet and said to be ready, we`ll be there with-in 20 mns and I want it done in the car and as quickly as humanly possible. I had to see my buddy, friend endure all this extra time , pain, and suffering due to the vet not commingt right over. we arrived in their lot at 12;07 I stay`d w him while my friend went inside to let them know we`re here. As soon as he closed the front door to go inside while i was petting and talking to him he had his last moment. The "shake" and collapse happend right there. When the vet came and looked at him she said she thinks "he`s gone". When she went to examin him w/ stethiscope for a heart beat she noticed a very slow and faint one. by the time she colud (couldn`t) find a vein it was over. This poor dog had to go through an extra 2-3 hrs suffering due to me not being able to have a vet come to my house. I am not by any means financialily comfortable but I was willing and able to pay ANY AMMOUNT to have this happen quickly and painlessly. I assumed when the vet told me what to watch for when the liver was failing that it would be days or even a week, not miniuts that would happen so suddenly. And was very disturbed that her well knowing what I was seeing for the first time did not even make a effort to help. So to all the vets out there trust me, ask for whatever , it will be paid w ease and a great amount of graditude and respect that you were there for a helpless suffering animal and a trusted caretaker. some things are price less or "at any cost" this to me is one of them.
MY DOGS HUMAN COMPANION December 29th, 2008 12:13:22 AM
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