Veterinary Coalition to Target Drop in Client Visits DVM 360 Oct. 1, 2010

  • Veterinary Coalition to Target Drop in Client Visits DVM NEWSMAGAZINE October 1, 2010

    A couple of quotes from the article: "At presstime, a planning meeting is slated for November to bring leaders in practice and industry together in an attempt to carve out a series of strategies to help reverse a trend of dwindling client visits. "

    "Heartworm prevention represents a huge opportunity for practitioners, Payne says, especially if the profession can improve compliance rates and convert pet owners who are not currently giving heartworm preventives to their pets. In fact, he believes a wholesale push could offset losses from flea and tick product revenue for practices. "

  • Sigh. I care about vets getting enough money. They do as much schooling as doctors, pay as much, and make so much less (though they also don't have the costs associated with lawsuits)… but heartworm med info makes me pretty mad.

    Manufacturers state no reason to test puppies under 6 mos, just start them on it... many vets require it. Manufacturers say no reason to test more than every TWO YEARS if on it year round, many vets require yearly (in fact most.. why? Cause they think you are lying or slack I guess?). Vets tell you to give every month.. truth? They last at LEAST 45 days, and actually 60. Research it yourself... sigh.

    I give every 40 days. I am smart enough to mark my calendar every 40 days. Less chemicals in my dogs, less cost, fully effective.

    I just feel that making money off medications isn't okay. Your medical doctor doesn't sell you medicines. Why should your vet? I know people paying $60 bucks for the large (50 to 100 pound) name brand heartwormer at their vet (and also know the vet paid $19 because I have vet friends), when they could get offline for $50 or the generic for half. Vets need to find ways to increase income without hawking meds and dog food. Yes, carry Rx dog foods, those are important.

    But people who are on limited income end up not treating dogs over Rx costs. Getting medications should financially benefit the drug companies... that is business. But to me, not the vets when it prices care out of so many people's ability. My vets often give me Rx for pharmacy because it is cheaper than they can sell it to me. I love my vets most of the time. 🙂

    Vets pushing potentially harmful and expensive yearly vaccines (no need for yearly... been known for 10 yrs, proven, accepted by top research veterinary schools!) lost them a lot of respect of people. I love my vets, but stopped doing rabies with them when they charged triple for a 3 yr rabies over a 1 yr when I know the drug cost them EXACTLY THE SAME AMT. I go to rabies clinics when due.

    I don't have the answers for what they can do to increase revenue, but I sure hope people read up and don't get ripped off on heartworm meds and checks. Trust me, if you have the manufacturer info in hand, they will negotiate 2 yr hw checks and giving every 45 days. (I do 40 just because I want to be sure if crisis I can always meet the 45 day window.)
    ::monthly heartworm preventatives are actually 100% effective if given every 45 days and 99% effective if given every 60 days.:::

    The FDA approvals cite studies showing that Heartgard, Interceptor and Revolution provide protection beyond 30 days. If you are very good about remembering to give medications, and you can watch your dog after administering the pill to be sure that it is not spit out or later vomited, it may be safe to use heartworm preventatives less frequently than every 30 days. Dosing your dog every 45 days is a conservative way to stretch your dog's dosage schedule.

    The original FDA approval for Heartgard states, “The target dose of 6 mcg per kilogram of bodyweight was selected from titration study 10855 as the lowest dose providing 100% protection when the dosing interval was extended to 60 days to simulate a missed-dose circumstance.”

    The drug manufacturers’ pre-approval tests indicate that even longer dosing schedules may convey protection from heartworm – but I wouldn’t stake my dogs’ well-being on dosage schedules extending beyond a somewhat arbitrary 45 days.

    The original FDA approval for Heartgard states, “The target dose of 6 mcg per kilogram of bodyweight was selected from titration study 10855 as the lowest dose providing 100 percent protection when the dosing interval was extended to 60 days to simulate a missed-dose circumstance.”

    The original FDA approval for Interceptor states, “Complete (100%) protection was achieved in dogs treated at 30 days post infection, with 95% protection at 60 and 90 days.” This does not apply to Safeheart, which was tested only at a 30 day dosing interval.

    The original FDA approval for Revolution states, “Selamectin applied topically as a single dose of 3 or 6 mg/kg was 100% effective in preventing the maturation of heartworms in dogs following inoculation with infective D. immitis larvae 30 or 45 days prior to treatment, and 6 mg/kg [the recommended dosage amount] was 100% effective in preventing maturation of heartworms following inoculation of infective larvae 60 days prior to treatment.”

  • Debra,

    I think you need to find an AAHA vet in your area. AAHA vets subscribe to certain codes of mores and ethics. AAHA vets were some of the first vets (if not the first vets) to embrace the 3 years vaccine protocol with the hopes of extending that even further through research. I have not known ANY vet (and I have worked for several over the past 15 years and have used many more over the past 30 years) that has charged more for the 3 yr rabies vs the 1 yr vaccine - especially since they are one and the same vaccine. Your statement might reflect your experience but does not reflect all vets across the board/country.

    I can only speak for my clinic -with regards to HW and prevention. Arizona is not an endemic area for Heartworm disease therefore we only test a dog once every two years if they are on prevention year round. Why do we do test since they give it year round? 1) This is the requirement of the manufacturers of HG for the state of Arizona. 2) If your dog should vomit within 5 hours of taking his prevention - he is out of compliance for that month and at risk for contracting HW disease. The more endemic the area, the greater the risk therefore the need to test more often.

    So why do we care about the manufacturer's reccomendations? If you dog comes up HW positive and you have failed to comply HG will not pay to treat your dog - which can run into the thousands of dollars. However - if you can show that you have done all that they ask and your dog becomes HW positive they will pay for your dogs treatment.

    Folks that live in areas that have hard freezes and snow do not always stay on prevention year round. However - before you can restart your prevention you should always test to make sure your dog is not HW positive as you could open a pandora's box if you uknowingly give prevention to a positive dog. IMO, it would be cheaper for folks to just stay on prevention year round.

    As for generics or online shopping - we do not rec'd it at our clinic. And no - money in our paocket is not the reason. In fact - our clients SAVE money when they buy their products through our clinic. How? Our prices are CHEAPER then the online stores such as 1-800 PET MEDS (I know because I am responsible for yearly price comparisons to make sure we are affordable) AND we offer (through HG) $6.00 rebates per 6 months you buy (or $12 rebate for a years purchase). I do not beleive these offers are available through online sources - only through vet clinics. We currently charge $22 for 6 months of HG for 0-25#s (basenji weight). Subtract the $6 check you get back and you are looking at $16 for 6 months (roughly $2.50/month) with no hidden fees such as shipping or being told you have to buy a years worth to get free shipping. If I did the math correct - that is a 27% savings. You can not get that in today's economy.

    Another thing due to the manufacturers inability to monitor how businesses such as receive and store their products, they will NOT guarantee the efficacy of any drug sold outside of a licensed veterinary practice or pharmacy. That means if your dog comes up HW positive and you have done everything right but purchased your meds online - you may very well be footing the bill for your dogs treatment and recovery.

    I am not 100% convinced about the article that started this thread. I know that our 5 doctor clinic - despite going to 3 year vaccine protocols about 8-10 years ago - is NOT lacking in appointments. We do not need to push drugs unnecessarily on folks to break even and I can not imagine my clinic is in the minority. I think folks need to research their clinics a bit more to find the right fit.

    Yes, as in every walk of life, there are vets out there whose bottom line is about money, but there are many more who truly have the patients best interest first and foremost. AAHA vets is a good place to start.

    Ford Mtx Transmission

  • It is because of the economy. Just look at how many dogs are being dropped off at shelters or at rescues because the owners cannot afford to take care of the dog. I receive the Bichon rescue newsletter and they have rescues from owners that need major medical care as the owners do not have the money. There have been several given up to shelters that have medical problems. One is presently at the owners needing to have bladder stones removed and the owner cannot afford it and wants to give the dog to rescue. Others in rescue need bilateral ear ablation-$1600 and a broncholscope-$1900 and other surgeries. A pup was at a TX shelter unable to use his front leg and he needs foot surgery. Five were turned in to a MO kill shelter because the family could not afford them.

    The elderly dog I fostered for BRAT did not have any vet care for three years prior to coming into rescue and because of this had an eye problem that should have been treated with medication over this time but was not. She was originally seen for the problem but did not have any follow-up care for it. When the owners tell you that a 14 year old, almost 15, is healthy, yet the dog urinated in the living room when you are there for a 30 minute visit, one has to question that!


  • First Basenji's

    Kris, thanks for the article, especially for the source. I find it VERY interesting to read through some of those articles, even though I am obviously not the intended audience.

    Linda, thanks for the tip about AAHA vets. I'll look into that, though I note that my old vet is listed as an AAHA vet while the new one is not. I've recently selected a new vet after my profound displeasure with my previous one, which included some disgruntlement over their policy on online medications. They were giving me [nearly expired] thyroid medication absolutely NOT at a competitive price (41 cents a pill for 0.2 mg Soloxine!), and making it purposely difficult for me to get the medications from PetMeds (which is Vet-VIPPS certified, which I think should make a difference even though many of your points hold true). I did buy my HeartGuard directly from my vet, got a $5 rebate for each year's worth, and a squeaky toy which I donated to my local shelter since my dogs aren't allowed to have toys that they will fight over… These perks are negligible to me, but the manufacturer's guarantee counts for something.

    I do feel like local vets' policies on annual heartworm testing before they'll dispense the drug is, frankly, paranoid for my county, which hasn't had a single incidence of heartworm since 1992 (as I was told by a vet** ). I can understand why the policies are in place though I wish they, along with the manufacturer, could be a little more flexible for areas that are at lower risk.

  • Curlytails, you know that in the state of California if you request a scrip for Meds from you Vet they are required by law to give it to you. They can not force you to buy from them or anyone else. You can take the scrip and shop around for the best price… however that said, when you buy on lie you do need to be careful about exp. dates.

  • First Basenji's

    Pat, yes, I do know about requesting a scrip from my vet now, thanks to your posts. Unfortunately, the way it shakes down, clinic policies essentially force me to buy my meds from either them or an online pharmacy.

    There was some delay when I got the scrip from my vet the last time, so I would have been unable to mail it to PetMeds in time to get the prescription refilled. PetMeds requires pet owners to mail in the paper scrip, whereas they will accept faxed scrips from the vets (which my vet refused to do). I took my paper scrip around to numerous other vets in town, and nobody would fill it if I was not their client. Walgreen's was willing to fill my prescription with generic Levothyroxine, but since the prescription specifically said Soloxine, and I've been advised to get only the name brand formulated for animal absorption and not generics, there was nothing I could do except get my prescription filled at the old vet at the same inflated price.

  • @curlytails:

    I took my paper scrip around to numerous other vets in town, and nobody would fill it if I was not their client.

    By Arizona law veterinarians can not fill or prescribe medications to anyone that they do not have a current working relationship with. Current to mean within the past year. I would assume this is the case countrywide but do not know.

    I would contact AAHA about your displeasure and why re: your old AAHA vet. Does not sound like they are prescrbing to the values that AAHA stands for. What a bummer.

    Nobuhiko Kawamoto

  • First Basenji's


    By Arizona law veterinarians can not fill or prescribe medications to anyone that they do not have a current working relationship with. Current to mean within the past year. I would assume this is the case countrywide but do not know.

    I don't know what the law says in California, but the clinics I talked to made it sound like there's something similar here, too. I did see that the AVMA code of ethics recommends (requires?) vets to prescribe medications only for pets they have seen within the last year, which makes sense. However, I didn't see anything about policies regarding filling prescriptions from other vets. To me, the prescription basically says that the doctor whose name and clinic is on the paper is vouching for the existence of a patient-client relationship. The pharmacy should be able to dispense the drug assured that a relationships exists, even if it's not "theirs". But no, it doesn't work that way.

    That was the disturbing thing to me about the whole process… Sure, you are "free" to take your scrip elsewhere and have it filled "anywhere you choose," but if there are no other available options other than online pharmacies, which are disparaged by veterinary clinics, your legal right to take your prescription elsewhere is kind of a moot point, isn't it? 🙂

    Linda, I like the sound of your vet. You even have an internal price-checker to make sure your prices are competitive! Maybe that's why visits to your clinic have not dropped, whereas others apparently have...

  • Interesting, two weeks ago I had a perscription filled by another vet b/c my vet didn't have the stuff in stock and i needed it that week. no problem, no charge.

  • Linda, I don't mean to complain about my vets. In fact at the time I called 4 other vets and got pretty much the same prices between 1 and 3 yr vaccine. Other than that issue, my vets are incredible, offering discounts over the last 15 yrs for rescues and giving full love and care beyond just medical. They are both a large and small animal vet, and the only facility within 40 mins of me that has 24/7 coverage… all the others send you to the next town to an ER clinic.

    As for AAHA... one nearly killed, in fact I believe they DID kill, Sayblee with their wonderful lack of care. The other specialist I took her to was also AAHA, and I would kiss the ground she walks on. Sadly the first caused so much damage she simply couldn't recover. My point being AAHA or not, each practice is different.

    Vet or online, the same company makes and supplies the drugs. If they aren't expired, then they aren't. Warehouses aren't that different. Yeah I have researched it but enough said.

    I do appreciate the information.

  • You can order via sending the fax to Foster/Smith, KVVet, Omaha Vaccine or a number of places. You are not limited to PetMeds. I have used them many times. However, that said, if I find that I can get it cheaper, my Vet will usually match the price or pretty close. And I don't mind a bit of a profit…. to anyone

  • First Basenji's

    The other online pharmacies are the same about receiving faxed prescriptions from pet owners (or at least they should be, according to law). That is, they have to accept mailed prescriptions if coming from the pet owner, whereas they can accept faxed prescriptions direct from the veterinarian. Since my old vet did not deal directly with any online pharmacies at all, I wouldn't have been able to get my prescription to any of those places in time. The problem of time is partly my fault – had I anticipated the trouble, I would have ordered pills more than 10 days ahead of when the month-long prescription was to run out. But by the time I realized I wasn't going to be able to fill it at any local vet, I only had 4 days worth of meds left, including a Sunday to mail out my paper prescription, have the pharmacy process it, and ship it to me. Funny thing is, I could have ordered the portion I needed with next day air shipping and still undercut my vet. Which goes to show, I think, that they had an unreasonable markup on this specific drug.

    I'm not against profits for establishments whom I feel are worth my money. I certainly gave plenty to my old vet before I decided I wasn't satisfied with the level of care... The new vet I selected was actually very clear about how pharmacy revenue helps pay for continuing services, training, and equipment in their operations, so of course they would hope that I buy meds directly from them, and not online. This is fair -- I'm not a total cheapskate, but I have to be pragmatic with limited finances. And as has been pointed out throughout this thread, affordability is a factor that a lot of pet owners take seriously, so ideally a vet can work with their clients in a way that assures them they're not being exploited for profit, but that it's a mutual relationship.

    For some drugs, finding a cheaper sources is not going to be a primary consideration -- antibiotics, for example. I'll pay $3.30 a pill for Baytril rather than go through the trouble of mailing in a prescription and ordering it online because my dog needs them NOW, right? And if it's a short-term thing, like 20 pills, that difference of $10 or whatever I would save by ordering online is not worth the trouble. But for drugs that may not be urgent, but necessary, and chronic, customers will certainly be tempted to shop around.

  • I get meds from all over! Some from the vet, some from Walmart (vet wrote me a years Rx, getting the 3-month orders, for $20 on a med that was more than that per month at vets), some from local drug store, some from on-line meds. I agree, if I need it now, whatever it costs is OK, but for meds that my dog takes every day for years, I have time to shop around! My vet told me 20 years ago that the rabies was good for at least 3 years, but the county required a shot each year…I used to go 18 months at least.

    I don't begrudge vets honest profit and am happy to get many meds there, but for ongoing meds it makes sense to shop around.

  • @curlytails:

    Kris, thanks for the article, especially for the source. I find it VERY interesting to read through some of those articles, even though I am obviously not the intended audience.

    You're very welcome.

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