Hello, it's Anthony Chadwick from the Webinar Fest welcoming you to another episode of Vet Chat, the UK's number one veterinary podcast. Those who listen to the podcast regularly will know I'm a big fan of LinkedIn. I, I find it a fascinating place to spend time, share some of my thoughts, but also to meet interesting people, and I've been very privileged and lucky to, to meet a a lovely woman called Suzanne Cannon.
Who is the founder of that building in America. We're gonna talk a little bit more about the vet billing story shortly, but Suzanne, welcome to Vet chat. Thank you, thank you for having me, and I'm so glad we made that connection on LinkedIn.
Like you, I found it a wonderful place to discover just some amazing people. Suzanne, before we dive into that billing, which I think is a fantastic concept and and obviously company, it's been going for quite a long time now. Tell us a little bit about your, your history, you know, your past jobs and things, so we get a bit of an understanding of where you're, where you've come from.
Sure. Well, I certainly never planned to be in the veterinary sector, although I've always had animals, dogs and horses, so that meant that I spend a lot of time with vets anyway, but my previous professional background is actually in pastoral counselling. I have a master's degree in that from Loyola College in Maryland.
And what pastoral counselling is, I sometimes hesitate to use the word pastoral because well, immediately they hear that word and they think, oh, religious. It, it really isn't religious. Pastoral counselling simply means that we regard any one of our clients, from a spiritual perspective, as well as psychological and physical and mental.
So, If we don't do per se, religious counselling, although if I had a client for whom religion was particularly resonant and healing, We would certainly explore that. So unlike a secular psychologist who might need to say, well, that's, you know, kind of off limits or that's out of my wheelhouse, a pastoral counsellor doesn't have to say that. And pastor, the word pastor Actually means shepherd.
So I would think of it as shepherding people or companioning along with people in their journey. So, so that's really only how it differs from traditional counselling. And many pastoral counsellors.
Who have degrees in it actually work in traditional counselling settings. One of the things that has made veterinary medicine and the situation of veterinary professionals very relatable to me is that in my prior work as a pastoral counsellor, I worked at Johns Hopkins, which is a well-known institution around the world, here, here in Baltimore, and I worked in the AIDS clinic. Specifically, the AIDS psychiatry clinic.
So we were dealing with patients who had HIV or full blown AIDS. They had a mental health disorder, psychiatric disorder, like bipolar, they might have had a severe personality disorder, and they also had substance use disorders, substance use dependent. So a lot of these people had acquired AIDS from using heroin.
So it was, these were really intense, complicated patients. And in the clinic that we ran, our waiting room was full from 8 in the morning until 4:30 in the afternoon until we saw the last patient that was sitting out there. And during that time, you saw one patient after the other.
There was no time to emotionally reset. Between one and the next. So you could have been dealing with someone in, in one session.
With very florid symptoms of whatever they were going through, they might have had severe personality disorder, like narcissistic personality disorder, and been very difficult to counsel. You're done with that session, you walk right into the next one. That might be an individual who has more of mild struggle with depression, not nearly as complex.
So you're constantly shifting between severity of cases and Again, that no pause in between because, and we had about 8 clinicians and doctors handling patients during this time. So it was, it was a big, it was a big team and we were all seeing people one after the other. So I understand sort of that feeling that vets have in their, their day to day going from one exam room to the next and you might be going from, I've actually been in a clinic.
When this happened, literally going from a euthanasia with a cat with, I think it was saddle thrombus, to a puppy, you know, like a first visit for a puppy with this dramatic difference, . So I see veterinary medicine as really an emotional minefield for people. It's, it's very intense and then you have that intersection of emotions and finances, which is also very challenging to navigate.
So I feel a lot of empathy for that and could relate these things back to my own experience, except for the money part, because of insurance with humans. So I never had to talk about that with my patients. And I can't imagine what additional stress that would add to it if I was having to negotiate with my AIDS patients, with what, how are they paying for their visit.
So. Mm. Yeah, it's a, it's.
I think it is a challenge for vets because we obviously want to do the best for the pets, and then sometimes there just isn't the finance there, which is obviously, you know, we've had similar systems come in the UK we've obviously got insurance which, you know, you can claim direct for some companies, other companies you don't really know when they're gonna pay. They're not very reliable insurance. You never know how good your insurance company is until you need to claim against it.
So, . It that can be a real challenge and in some ways, I, I know that part of the reason why you set up vet billing was because of a personal problem that you had with a sick animal and that was kind of similar to why I set up Webinar vet in that. We had to do 35 hours of training each year, and I had a busy practise.
At the end of an evening surgery I would jump in the car, travel to Manchester 30, 40 miles away, do an hour of CPD we'd have an inadequate buffet. You'd maybe have a little drink in the bar, you'd drive back to your home, it would be midnight, you'd jump into bed and then of course the next morning you were back on that hamster wheel again. And so for me it was about, is there a better way of doing this?
I, I was at an internet conference and I heard about webinars. And I brought that back into the profession because of course the pain I felt wasn't just my pain, you know, the pain that you felt wasn't just your pain. This was a common problem, so perhaps just for people listening, tell us the story about Liber, the schnauzer.
Yes, so Liba, which is German for love, was an eight year old miniature Schnauzer at the time, so she was and she was in good health otherwise, but as vets will all understand, Schnauzer. Can be predisposed to pancreatitis, even if you're very vigilant about what they're eating and how you're managing them, which I was with the on a prescription diet. Even her treats were a prescription.
She didn't get human food or table scraps or anything. And yet she still developed a pretty severe case of pancreatitency vet, and I Thought I had done everything I could to prepare for a situation like this. I had pet insurance.
I was an early adopter of pet insurance in the United States back when there was only one company, and, and I had friends laugh at me and say, you got pet insurance. They they hadn't even heard of it. And I'd already been through a bladder stone thing with another schnauzer, so that's when I got insurance.
And so there we are. Liba has a pretty severe case of pancreatitis requiring her to stay in the emergency hospital for a couple of days rather than transfer her back to my regular vet during the day. It was, it was very terrifying for me.
You're only thinking in that moment, you want your animal, which for me is a family member, to be OK. You're not even thinking about the money at that point. And She's finally doing well enough, she can be discharged.
And I'm handed an invoice for $4000. That sounds actually cheap in today's market. I think the same type of situation would now probably be double that, regardless.
$4000 that I didn't have in my checking account, I didn't have it in cash. So, despite doing everything I could to be the responsible pet owner, I happened to also be going through a divorce at the time. So I had lost my previous financial stability.
I had been married to a physician. Everything was completely different. I had to move back in with my mother.
I was only working part time, and then this happens. So, I remember the receptionist being sympathetic and she said, oh, don't worry, we have this thing called CareCredit, you can apply for it and then you can make like 6 monthly payments. And I'm thinking, oh my goodness, OK, this is the first time I've been introduced to this credit card we have here in America called CareCredit for financing veterinary expenses.
Back then, they would run your application through at the vet's office, so they did, and she came back and she said, I'm sorry, but you were declined. So, I was humiliated. That was the first thing.
I was like humiliated and embarrassed. And in my head, I'm thinking, why, why was I declined? Do I have bad credit?
Did, you know, why? But then you don't have a lot of time to spend on that. But it stuck in the back of my mind.
I, I didn't understand. And, and then you have to go on to the, OK, now what are we doing? And of course, I, she said to me, you know, we don't take payments.
Because if we did, people don't make them, and we would have to close our doors and go out of business, which I also understand, you know, like we don't know you, especially in an emergency setting, you know, these are almost all new clients to you. Yeah. So, the way that I was saved in that situation was my mother.
You know, I was already in my 40s. My mom had to save me financially. So she put it on her credit card, and then I paid her back over the course of probably the next couple of years while I was getting back on my feet, from, you know, post-divorce.
And I remember leaving the emergency hospital. Walking to the parking lot. I'm so grateful to the team for saving my animal and taking really good care of her.
But I also thought, I cannot be the only person that is going through this as you thought you were not alone in the situation of trying to get your CPD hours and still have your practise, you know, and drive to Manchester, you know. So I began talking to my friends about it and, and asking them. Every single one had at least one similar story, where they were very worried about finances.
This is already I don't know, 15 years ago, so things have changed drastically since that time, but everyone had had a story. I thought, OK, clearly I'm not alone. This is a challenge that a lot of people face.
And then my next step was to start talking to my own veterinarians about it. So I had my small animal vets for my dogs, and an equine vet for my horse, and I talked to both of them, and I found out that this was an equally painful and distressing issue for them from a different perspective. So we have both sides of the exam table distressed over this dilemma.
Of finances and of course vets didn't go into veterinary medicine to talk about money, to do financial counselling, to that that feeling of frustration and I, I, I can't even think of the word that you would have when you know you have the skills to treat a treatable animal, but you cannot move forward because of owner financial constraints. One that I know, Melanie Bowden, who did a wonderful TED Talk on what it takes to be a veterinarian, described that dilemma as soul crushing. I will always remember that because I, I can understand that.
I can do this, but I can't. So, you know, because of money. And, to have to deal with that routinely, as vets here do in the United States and from talking to vets in, in the UK, I understand that they encounter similar challenges.
I wanted to find a solution. That could, could mitigate these feelings on, on both sides. Suzanne, it's like a sort of, we, we actually did a podcast on this recently with an American veteran who has helped er set up a moral injury department at Durham University.
And it is that. That very big problem where you know that you can sort something out but then money stands in the way and we became vets because we love animals, so therefore we often find a way of doing it and we do, you know, I remember one Christmas waiting for a a dog . Well, I'd advise them to come in because it was in dystopia, it was having puppies, and it was a boxer, and then they went to speak to the breeder, no, we're not going to do anything about it, and then suddenly Christmas Day comes at about one in the morning, and I spent the whole of Christmas Day sorting this dog out because they wouldn't listen to me, but then.
Never getting paid for it because of the way things went. And of course there's a moral injury there but there's also frustration and that can really sour. The job, because you know, we love, we love animals, but as, as the people said, if, if nobody brings any money and then the business goes out of business and you can't help any animals.
So how did vet billing then obviously from that initial . Germ, you went away and were chatting to people. Did vet billing get set up and how did you manage to set it up?
What were the hurdles you had to overcome? Years later, I met my current life partner, who is also my business partner, and he had already established a business in accounts receivable management, starting now, it's going to be coming close to 40 years. So he was at the very beginning of electronic transactions happening in the late 1980s.
You know, where we were transitioning from writing checks and using cash to having things electronically processed. So he was already doing electronic payments, and he was managing payments for other businesses in other verticals, not veterinary. And after my experience, Particularly that experience of being declined for credit in that situation.
It made me go and research why that happened. What, what was the issue? So it wasn't that I had bad credit or poor payment history.
It was that I was something that we call here credit invisible. It meant that, so I applied for CareCredit in my own name. Any previous credits that had been established for me was connected to my ex-husband.
It wasn't for me myself. So I basically had no credit footprint. So the credit bureaus here are like, oh, this person is an unknown quantity.
We are not taking a risk on on loaning money to this unknown quantity. We don't have information about a previous payment history or a mix of credit account. We have nothing.
So I'm declined. Again, I went back to thinking, I can't be the only person in this situation, there must be others. And that's when I discovered that there was actually research on credit and visibility, credit on stability, but it is a prevalent problem among certain groups in this country, particularly minorities, because there's a different attitude toward the use of credit.
So about double the number of African Americans and Latino Americans in the United States are credited invisible compared to whites, also millennials, also senior citizens, the elderly that have pets. They probably hit an income threshold and won't qualify for these types of payment arrangements. In addition, they are maybe not big users of credit or haven't been recently.
Those are all other reasons for decline. So this Umbrella assumption that declines are caused someone is a bad risk or financially irresponsible is is not correct. So, With my partner, I said, can we take your model that you've developed for processing recurring electronic payments and managing those payments if they decline or fail, and resolving them.
And take that to, to veterinary medicine, because there's no alternative for vets in there now. It's like either you use this one card, and if you're declined, we have nowhere to go. But what a lot of vets did, because they want to help animals and because they don't want to feel that soul crushing feeling of not being able to proceed, is they would put together sort of a makeshift payment plan.
So they might give you a promissory note. They might hold postdated checks. I talked to a lot of vets who did this.
So a person's writing 6 checks and you're to deposit 1 every month. By the time you get to month 3, that check bounces. For lack of funds, and then now you can't get hold of the owner and, you know, so payment plans have a bad name.
They were often done out of that desperation, but nothing was systemic about it. No one in the practise has time to follow up, which is the bulk of the work in making something like this work. So.
Bad debt can very quickly spiral in the practise. Right, and then you see your accounts receivable going up and up and up, and you go, payment plans are bad, we, we can't do this. So, and then here was my idea with vet billing is, can we come in and introduce the ability for vets to still give in-house payment plans to clients that don't qualify for that one credit option.
And can we mitigate the financial risk by automatically drafting the payments, by giving them a standardised contract, by backing it up with a collections team, a payment recovery team, which was all already in place. So that the vet doesn't have to handle anything administratively with this payment plan. We do it for them.
We talk to their clients about money, client's payment declines. We reach out to them with the goal of keeping them on track, not to be punitive, like, why did your payment fail? And you know you owe this money.
It's, what's going on, how can we help you? Do we need to split this payment into two payments? So we have a team that's dedicated to understanding how to have these conversations with these people.
Vets don't, and they, they really shouldn't have to. So the goal of that billing was to let them, you know, set up a contract now on a, on a web-based platform software and have the client sign it, click a button and then it comes to that billing. And we have a 90% to 95% repayment rate, which is much better than vets we're seeing on their own.
And so there were twin goals here for me. One was helping the pet owner who's in distress because they feel they have no options for paying. Reducing economic euthanasia and surrenders that were driven by finances.
Secondarily, but equally important. Perhaps in a way more important is reducing that moral injury to vets, that moral distress. It isn't compassion fatigue.
It's moral and ethical distress of not being able to treat. And knowing that you can. And then also taking the anger and the distress of the client onto you, which is happening because the client feels out of control.
Anger sometimes give us, gives us a false sense that we're taking back control of the situation and if we can only be angry enough, we can change it. But it doesn't work. But we're humans, but then the vet is on the receiving end of that.
And vet mitigate that too. So after 10 years of doing this, we, we have a well established proof of concept. One of the biggest gratifications for me is to hear from practises that use us, it has made an enormous difference in the well-being of their staff, especially the front end staff that's dealing with payment of invoices that they know.
That they have an option offer people now and they don't feel powerless because that powerlessness and helplessness is absolutely the worst, you know, OK, do we have a a backup plan? Do we have somewhere we can go that we feel confident we're not going to lose all of our money. And, and that was really the goal of that that billing, so to know that veinary teams are feeling better about these things is accomplishing what I envisioned it to be able to do from the very beginning.
It was very Pollyanna, my mission with the background of being a pastoral counsellor. You know, I sort of thought like, OK, now I'm going into this, like, And yet my master's is in pastoral counselling and, and now what am I doing? Going into veterinary.
But then I realised those skills are absolutely transferable, the communication skills, because I also wanted to support vets and pet owners and being able to better communicate about finances in an atmosphere of emotional safety, because that's so important to collaborative problem solving around money. And it's also Not many money businesses necessarily are purpose centred, but this really can be, because the other thing that it does is it saves, not that we're very good at it anyway, but it saves the vet and the nurse and the receptionist, and the bookkeeper, the time of following up on that money, which of course, You have to pay more to then receive it back again because you've got the staffing costs. So it becomes a frustration for everyone, but the practise is so busy, it doesn't really have the time to collect it.
So that bad debt just goes up and up and up, and eventually, you know, it's not, it's bad debt because it's never going to be collected. It's not a case of I might get this in 6 months. Yeah.
Those people have left, you'll never see them again. Right, right, and then, you know, even if you do see them again, you know, they're embarrassed, . You know, they, they probably know and they remember.
I mean, payments too could be missed for for innocent reasons like they literally forgot, you know, if you mail them an invoice and then they're embarrassed, and all of us have baggage around money. So if we can. I thought if we can remove just a little of that, would it make a difference?
Would it make an incremental difference to vets and animals and their owners? And I remember thinking early days, like before we really launched vet billing, but I had the the plan in mind and the structure. I'm lying in bed one night.
And I'm thinking, oh my God, I, I can't do this. This isn't going to solve the problem. It's not a panacea for these financial issues.
So what am I doing? You know, it's not like I'm, you know, gonna fix everything with this one solution. It's realistic about it.
And then I remembered. A saying that comes from the Jewish tradition from a book called The Pyke A Volt, which is ethics of the Father. It just literally popped into my head.
And the saying is, it is not your responsibility to complete the task, but neither are you free to walk away from it. So, I mean saying like we all have something to contribute if there is something that is a problem, but we know we can't solve it on our own. Does that mean we just go, oh well, OK, I give up.
So the fact that popped into my mind at 2 or 3 in the morning, to me that was my green light that said, go ahead and do this, if you're saving one life. Of an animal that matters, which also then reminded me of another saying that comes from the Jewish tradition, which is, if you save a single life, it is as if you've saved the entire world. Because that single life hasn't is connected to so many other lives, and there's that ripple effect.
So all of that. Informed me as we were going forward and in developing this. So it's very mission oriented project, very, and I think it had to be because it it was difficult in the beginning, .
This is a concept that people would immediately reject out of hand as soon as you said payment plan. People have an allergic reaction or they go deaf or they run away from you because of their previous experience trying to do it on their own and There were days that I thought, oh my God, I maybe I just need to give up. Maybe I need to throw in the proverbial towel.
And, but what keeps you back at it is sort of that burning, sense of purpose in the heart, that it was a heart-driven venture, and that I was gonna keep believing in it. And it's the appreciation I think you get from people when it does work and when people are open-minded enough to look at it and try it. I think that what you were saying before with your, with the sayings, the Jewish sayings is, is very true, you know, in the Catholic tradition we have Saint Teresa of Lezur, who was the saint of the little things, you know, if you wash dishes in love, then that's contributes and I, I'm, I'm kind of the same.
With my kind of passion at the moment, which is very much how do we save the planet. And. You know, I maybe can't do a lot, but I can do a little, and if we all do a little, it adds up to a lot and I, I often tell the story about the boy who was at the beach and the the tide had gone out and all the starfish.
Yeah, I love this story. There were thousands of starfish on the ground and the little boy was going and picking them up and throwing them back in the sea, and an older man came over to him and he said, what are you doing? And he said, well all these starfish have been stranded, so I'm throwing them back, and he said, well.
That's ridiculous. There are thousands of them, you're not going to make a difference. And the little boy picked up a starfish, threw one back in the sea, and he said, well, I made a difference to that one.
And I think this just is the same as the, the sayings you're saying that we all, most of us either contribute or consume, and if we want if we want to be contributors, even if we only contribute a tiny bit, you know, the, the, the small amount of money that some people maybe can put into the charity box. It doesn't matter the amount, it's the, the heart that goes into it, isn't it? It is.
And I have to say, so the Starfish story was another one that informed me as I have gone along with this, is that, that it makes a difference to that one. I didn't go into this to, get rich. I wanted to, of course, generate a sustainable livelihood for myself, but, it, it wasn't.
This wasn't the thing where we see a lot of startups now. It's like, oh, the pet sector is booming, let's jump in and do something because there's all this money to be made. I, I didn't even, it didn't even occur to me at the time.
It was about solving the problem. For me, the money was secondary, which might probably makes me a lousy business person, but I was more focused on How do we make this accessible for pets and pet owners? Harvard Business Review has spoken about it a lot.
It's one of my favourite magazines and they talk about purpose centred businesses and profit centred businesses and now we're seeing more and more that even banks are going, we want to invest in businesses that are trying to do good for the planet, rather than. You know, bad for the planet, so maybe oil companies now some, some banks won't invest in those because they realise that the time of oil is passing, it has to pass. It was, you know, it helped us with so much progression in the last 100 years, but now it's part of the problem.
We need to move on to the next thing and so purpose centred businesses often because they think about the purpose first. Can end up being profitable, whereas if your only motivation for opening a business is to make money, it's it can be a really tough gig, can't it? Yeah, but it really can because, you know, in the beginning, I met predominantly doubters and there were very few people that I talked to in veterinary medicine.
Who immediately saw the vision that I had, like they immediately got the concept and they immediately wanted to be a part of it. And that was a huge relief because then you're going, OK, I'm, I'm not totally crazy. There are people out here who see the value and those ended up being our early adopters, .
And I don't know if you know or connected to Danielle Lambert on LinkedIn. She does a lot of marketing and branding for veterinary practises and consultants, and that's what she does now. She was an early adopter.
She then worked as the practise manager in her dad's clinic in Connecticut. Small, you know, I can't remember if he was the, the solo doctor at the time. I think he I think he was one doctor and She was somebody I saw her posting on, I think at that time it was Twitter, even.
Yeah. And I kind of stalked her for a while and, and got the vibe that this is somebody that, you know, might, might resonate with this concept, and we got connected, and it immediately did. And she said, the reason I want to do this is because my dad has such a big heart that he discounts everything.
He discounts all kinds of things to, to help his clients be able to afford services. And she said, as his practise manager, not his daughter, he's driving me crazy with all discounting. And she said, I, I think I want to implement this because this will help us.
Also, a lot of times people are much more motivated by spreading costs over time than an off the top discount of 1% or 20%. And most veterinarians, most practises I know don't track that discounting because an individual doctor will do it here and another one does it here. So they implemented this.
And she got back in touch. I mean, we remained in touch as they were implementing it, but about 9 months later, she sent us the numbers and showed how the discounting drastically declined. Over time until it went to basically zero, because he didn't need to do that anymore.
And he didn't need to feel bad that he wasn't enabling his clients to manage the costs. And, I'm so thankful to Danielle for seeing that vision, and for continuing to believe in what we do 10 years later as she's evolved into another career, Because those are the people you hang on to in the beginning, . And and who assure you that maybe you're not completely off track.
Brilliant. Suzanne, it's been absolutely fantastic. I've got a cast just about to jump on my lap now, so for those, we do podcasts as well.
This is a podcast, but there's those of you who are listening on, Apple, you won't get to see Buddy Buddy, actually adopted me about 3 years ago in the middle of the pandemic. I think he just wanted a quiet retirement home, because we know he came from a busy home where he just. Wanted a bit of quiet as cats sometimes do and now he demands strokes at times like this when I'm running a podcast, but it's it's normal for vets to have these sort of distractions I think.
And people who work with vets. Suzanne, it's a really powerful story, really enjoyed speaking to you because. This is a tool that can really help save time, but also I presume Daniel's dad's practise kit went from being not terribly profitable to being really quite profitable because, The money that he was losing by discounting and not getting those people to pay their bills, er, immediately comes off the bottom line.
Yeah. So, thank you so much, it's been so lovely to speak to you. Are you going to BMX in January?
You know. I wasn't planning on it, but I've had so many people ask me that recently that I feel like I have to figure out a way to go. It's a little difficult to travel because I have a paralysed dog, .
So, anyone that's listening to this, if you're in America and you're a vet tech and you can express a bladder medication, please get in touch with me so that I can go places again. It's a bit far to drive, but yeah, there's so many people that are gonna be there that I'd love to meet in person, so I take it you're going. All being well, yes, I will be there.
It's it's still 2 or 3 months off, isn't it, but all being well, it's, I went for the first time last year after a while, and it's interesting to see what's happening in the American veterinary space and it's great to see people like yourself, obviously being now, you know, in the space for quite a long time, but really there to assist and help. Not just to make money off the the veterinary profession, which I think we are a, a caring purpose centred profession and we, we work best when we work with similar purpose centred individuals and companies. Yes, I agree, and also I personally, I happen to think that there are a lot of vendors that that work with for like ancillary services like appointment scheduling and reminders, etc.
And I, I think they are taken advantage of, I think they pay so much money for so I'm astonished when I find out. And, we are, I think most of our partner hospitals would say we're underpriced for what we do. You know, that that's OK, that we might have to adjust at some point, but we're never gonna be out there to gouge the vets or the pet owners.
I, I couldn't, I couldn't have a business that was like that. So, you know, vets are taking it from every angle, you know, we have online pharmacies now, so the pharmacy business is, you know, dried up, so that revenue is, is less than it was. There's a lot of things going on in VetMed, and, you know, I would like to be something that contributes something positive, not stress, yeah.
It's, it's enough already. Suzanne, thank you so much for a a lovely talk. It's been great meeting you properly, well, virtually in person, or however you want to call that.
Yeah. Yeah, let's keep on conversing on LinkedIn and thank you so much for agreeing to do the podcast with me. Yeah, thank you for inviting me.
It's been so fun. So thank you so much. Thanks, Suzanne.
Thanks everyone for listening. Suzanne's details will be at the underneath of the podcast, so if you need to get into contact with her or anything, you can do that. But I hope you have a great rest of the day and we'll see you at the webinar vet or vet chat very soon.
Take care, bye bye.
