Discussion about this post

User's avatar
Sayli Benadikar's avatar

I had the need to send a blood sample for canine Ovarian Remnant Syndrome testing today, destination lab Cornell. Cornell transparently publishes tests and fees (thank you, Cornell), and this particular test looks to be $86 inclusive of accessioning fees. The experience, from blood draw to billing, was extremely revealing to me!

1. Idexx as a middleman with zero value add: My vet initially tried to route this diagnostic through Idexx. But Idexx just outsources the test to Cornell. So the blood sample I presume is just traveling unprocessed for additional days. I guess if this were somehow a cost saving method it would make sense, but as I learned eventually this whole rigamarole would have cost me more too!!

2. Separating a single test into two tests (for more money?): When trying to route through Idexx, this single test (the Ovarian Remnant Syndrome panel which measures AMH and P4 on the same sample and which is advertised as a single test by Cornell) was split into two separate Idexx tests - one for AMH another for progesterone, each test of course conveniently marked up independently totaling to $752! That’s an 874.4% total markup on an $86 baseline test cost?!!

3. Markup after cutting out the Idexx middleman: When I reviewed the invoice in (2) above, I realized how inane (or evil?) this Idexx-based plan was and asked the vet to pull the sample from the Idexx queue and send it straight to Cornell. This made things a little better by costing me $404 ($153 shipping overnight + $251 for the test) i.e. a 291.9% vet markup on the $86 test, which still seems rather steep to me.

Thanks for your article. It helped me analyze all this better and understand some of the behind-the-scenes business calculations that go into these markups. I am in the camp that believes in paying professionals a fair fee, and would prefer if the vet practice was more straightforward with me -- getting rid of its loss leaders, charging full price for the expertise as you say, and avoiding greed on the services where they're just a cog in the process. I'd also prefer a less predatory experience at the front desk at billing time, right now only the well informed and persistent are able to skillfully opt out of the nonsense that the vet billing defaults to and are able steer/muscle the vet into doing the fair thing. The others are SOL.

Expand full comment
Mike Colucci's avatar

As a patient, okay, more like Medicaid plan for a 10-year-old Black GSD 😆, and someone who has also owned a business and worked for a government enterprise agency, the answer to me is mixed.

For 30 years, we used a private provider that was a partnership between two Vets. I know they had a least 5 staff working with them, ranging from front desk to kennel to vet techs. Maybe an average cost of $25 when you factor in taxes, PTO, etc. That's $125 an hour to put the key in the door without considering building, office, and technology costs. That's a chunk of change over a 50-hour week. We received a generalized bill from them, for the most part.

We moved to NE FL a year ago and found a practice with 3 vets that I think is still owned by the recently retired Vet. As luck would have it, she had developed a small growth on her face that didn't heal since she's a face rubber after she eats. Got the estimate with little sticker shock, and it included a $250ish pathology report that she apologized for and said she could just do an eval of it if we wanted. The bill was exact to the estimate and highly detailed and we received a copy of the soap notes and pathology report. The report was truly impressive; a detailed two page write up and it turned out there were some possibly malignant epithelioma cells but the prognosis in the report ( same as operating Vet) said margins were clear and underlying tissue was sufficient so it should be no further issue. I'm pointing that out only because it was really far more detailed than anything we've seen with human results with cell counts and distances, etc. I told my wife if I ever needed a biopsy read, I'd send it to her, lol.

Of the $1008 bill, $500 went to pathology and Senior Profile 1 w/OP. The biopsy procedure cost was $124. Anesthesia, post-op meds, follow-up, supplies, a cone of shame, and facilities made up the rest. My take on it was the total cost was about what I would have expected. I get that the procedure fee was low, but there's a good amount of profit in the remainder.

While it balances out in this procedure, it gets off kilter when it comes to the annual heartworm screening and injection that seems high.

My bottom line is I would add the cost of the practice up, divide it by the number of provider billing hours, add the provider's hourly fee and there's your billing per hour. Then take the tests and meds and double them. Trying to overload costs onto tests may make people opt not to get them.

Expand full comment
2 more comments...

No posts