Keeping your markup reasonable will help clients agree to surgery, which is a win for their pet, the owner, you, and me! A successful pricing strategy is to ballpark the client’s total estimate at approximately 2 – 2.5 times the surgery fee. This makes it financially worthwhile for your clinic while staying within the budget of most pet owners.  

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Beware of “Fee Splitting”

Per AVMA Ethics Guidelines  “A veterinarian shall not offer or receive any financial incentive solely for the referral of a patient (fee-splitting).”
 

Interpretation & enforcement is at the discretion of each individual state board.

• In several states (NY, MO, FL, TX, NV, PA to name a few), this guideline has been applied to mobile surgeons, ultrasonographers, cardiologists, and other specialists who are called in by the primary veterinarian...not just to patients who are referred out for care at a different facility.

• In this context, the application of any markup whatsoever to the specific invoice line item referencing the specialist’s services (i.e., “Outside Specialist Surgery Fee”, “Outside Ultrasonographer”, “Echocardiogram with Dr. X”, etc.) has been interpreted by various state boards as “fee splitting,” or basically a kickback.

• When “fee splitting” has been detected, fines have been charged to BOTH the general practice AND the specialist who was called in. This is unfortunate, as the specialist is penalized for the invoicing practices of the general practice, over which they have no control.
   

So far, the California Veterinary Medical Board has not pursued “fee splitting” cases, however, more and more states are cracking down on this practice.  
 

What’s the solution?  It’s easy! If you build your “markup” into any separate invoice line item, rather than the surgery fee itself, you’re in the clear. This separate line item can be phrased any way you see fit: OR setup fee, ultrasound patient prep, etc. How you adapt is up to you, but it’s a good idea to protect yourself (and us!) from fines by making sure that your invoicing practices will stand up to scrutiny. 
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