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.
Wow, that is an incredible example, thank you for sharing! I would not argue middlemen such as IDEXX offer NO value (in your example, the shipping alone added $153 to the Cornell price), they often provide the logistics coordination, integration into PIMS/LIMS, etc. However, for tests they simply pass on rather than running in their own labs, the mark-ups do strike me as excessive.
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.
Wow, that is an incredible example, thank you for sharing! I would not argue middlemen such as IDEXX offer NO value (in your example, the shipping alone added $153 to the Cornell price), they often provide the logistics coordination, integration into PIMS/LIMS, etc. However, for tests they simply pass on rather than running in their own labs, the mark-ups do strike me as excessive.