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Preventing Managed Care

Posted on: May 21st, 2008 by

Posted by Jack Stephens on 5/21/2008 in Articles from Veterinary Newsletter


We have all heard the medical profession lament the concept of managed care as an intrusion into the way they practice and the way it has taken much of the enjoyment out of practicing medicine. But if one looks back to those early days when decisions were being made, the medical profession basically did not become involved in that decision-making process.

They practiced medicine and left the financing of their services to others. Of course, managed care in the medical field has not been all bad; it has increased access and the level of care to and for more people. Overall, it has been rejected as a concept that has more flaws than benefits. As we look to this model, we have to ask ourselves: What is it that we want and do not want for pets, pet owners, and our profession?

Since 1982, I have railed against managed care principles in pet health insurance. Yet most of my colleagues are still not sure what managed care in veterinary medicine is, other than “setting of fees and taking away decisions.”

In an effort to clarify how to recognize managed care, what to avoid and most of all how the profession can control our destiny, I have devoted this editorial piece to managed care principles, how to avoid them and how pet insurance can benefit pets, pet owners and practices, without managed care ever taking hold. Much more could and will be said on the subject in articles, journals and later newsletters.

As a profession, we can have control of how we practice and avoid the pitfalls that have happened to the medical profession.


Historically, managed care involves several key principles that include:

Setting of fees based on procedures, diagnosis and diagnostics
Taking decisions on diagnostics and treatment away from the treating doctor
Limiting choices by both the patient and doctor
Complicating the process with layers of bureaucracy in order to receive payment
Reducing or eliminating the out-of-pocket cost (co-payments and deductibles) to patients, thus eliminating their involvement in the financial decisions for care
Forcing doctors to join networks or accept lower fee schedules in return for higher patient loads
Patients restricted to the level of care provided for in the networks and receive no benefits – or greatly restricted benefits – if care is sought outside the network, except in emergencies
The doctor-patient relationship is virtually eliminated
Doctors in a managed-care environment are not inclined to have a strong doctor-patient relationship. Patients are chosen for them.

Non-managed care physicians and veterinarians, on the other hand, must please their clients. They must communicate, not rush, fully explain options and basically have a good beside or “table side” manner to be successful. If not, clients will go down the street.

In managed care, the patient is forced to visit the network in order to be covered. The patient load is dictated by others, not by experience or quality of care. At the risk of alienating my physician colleagues, the managed care system forces an almost assembly-line mentality to care. Human healthcare hospitals only started becoming more compassionate with better quality of care and services when they had to compete with other hospitals in order to increase profits.

Much more can be stated, but again, no veterinarian with whom I have spoken in over 25 years wanted managed care for our profession that dictates how we deliver care.


Clients Want:
To choose their own veterinarian
Insurance that is easy-to-understand and provides high reimbursements
Fast claims payments with no hassle
Comprehensive policies that allow for routine care
Few exclusions/limitations

Veterinarians Want:
Choice: The ability for the client and treating doctor to determine the level of care
Little or no paperwork in filing of claims
No schedule of fees or benefits dictating or implying what to charge
No restrictions on diagnostics; allow the treating doctor to determine what is necessary, based on the situation
Ability for clients to freely choose where to take their pet for care, including specialists
No complicated payment method or restrictions on how care is provided
Freedom to set fees to suit the style and overhead of the practice
No third party dictating the quality of care
No third party overruling treatment decisions of the treating doctor by disallowing or limiting benefits

-Don’t join networks, PPOs or other schemes that are predicated on bringing you more clients. Controlling the client’s choice of choosing their pet’s veterinarian must be avoided, as this is the number one tenet of managed care! If we only had one thing to avoid, it would be this.
-Don’t provide discounts to groups for increased business. Keep discounts or free care to your individual choice.
-Set your own fees and avoid fee and benefit schedules. If a large portion of your fees are not reimbursed it makes you look like you are overcharging.
-Don’t accept third parties (companies) telling you how to practice, setting procedures, fees or level of care to provide.
-Don’t recommend companies that do not meet your standards, or restrict care due to the age of the pet.

Pets Best Insurance was launched in October 2005, to simplify how pet insurance reimburses pet owners. It was apparent that a straightforward 80% reimbursement of what the veterinarian charged for services was necessary. Veterinary medicine had changed, and changing how pet insurance operates had to happen! The level of care had risen dramatically for pets due to the rapid progression of the human-animal bond, access to specialists, and multiple-doctor practices.

When I first established the category of pet health insurance in 1980, I had three goals. The first was to provide a method for pet owners to have peace of mind; second, the ability to budget for unexpected pet health care cost; and third, to be certain that the managed care principles that so plague human medicine do not take root in our profession.

When I founded Pets Best, some twenty-five years later, I wanted to improve the industry I created and to leave a better legacy of pet insurance as being relevant and advantageous for pets, pet owners and veterinarians.

When advising your clients of pet insurance options, make sure to recommend a company that is a member of the newly formed North American Pet Health Insurance Association. (Visit for more information.) Membership standards disallow the most prominent managed-care principles. Standards are set and enforced for high levels of service, turn-around time on reimbursements, dispute resolution and independent third-party rating of member performance after a claim. For pet insurance to prosper, pet owners must know with clarity and certainty how much pet insurance will cover of the actual veterinary cost.

Pet Health insurance is now nearing $300 million in annual revenues and forecasted to reach over $1.2 billion by 2012. With all the new, very large and well financed companies now entering the field, it will only grow, because there is a financial need for pet owners who want to afford the increasing cost of unexpected pet accidents, illness or trauma. Attempting to simply ignore this rapid growth of pet insurance will not be a viable response by the veterinary profession if it wishes to avoid the many pitfalls of veterinary managed care.

In closing, the veterinary profession must be involved to guide and influence the pet health insurance industry. If we do, I know I will have left a legacy that truly enhances the delivery of veterinary care for pets.

Jack L. Stephens, DVM
Pets Best Insurance

Spotlight On: The Morris Animal Foundation

Posted on: May 12th, 2008 by

Posted by Angela Klein on 5/12/2008 in Articles from Newsletters

Since 1948, the Morris Animal Foundation has been answering a critical and unique need in promoting animal health and welfare and advancing veterinary medicine. As the largest non-profit organization dedicated to funding research studies to protect, treat and cure animals, including companion animals, nearly 1,400 studies have been conducted to that end.

Last year, the Morris Animal Foundation launched its Cure Canine Cancer campaign to raise funds to help find a cure for cancer in dogs within the next 10 – 20 years.

As part of this effort, Pets Best has pledged a million dollars to their campaign, knowing that millions of dogs each year die of cancer.

“Half the population of dogs and cats aged 10 and over will die of cancer,” said Alice Villalobos, a noted veterinarian and author. “The bonds that clients have developed with their older pets are especially strong and drive the increasing demand for more proficient and highly compassionate medical treatment of companion animals diagnosed with cancer.”

Learn more about The Morris Animal Foundation and their fight to save dogs and their owners from the devastating effects of cancer at or learn about all of the MAF initiatives at

Torrey’s diary May 2008

Posted on: May 8th, 2008 by

By: Dr. Jack Stephens

Hi, my name is Torrey. You may know me as the Customer Service Advocate here at Pets Best – a job I take seriously. I may be small, but I’ve been told I have the heart of a lion and, truth be told, I rule the roost, whether it’s here at work or at home with my family. Those other dogs, cats and people may be bigger than I am, but have no fear – I put them in their places just fine.

I do a lot here around the office, actually – am glad that my Dad (who most people call Jack or Dr. Stephens) brings me to work with him every day. There are a lot of things I’m good at, and one of them is running off strangers. I may only be a pound-and-a-half, but I can intimidate someone a hundred times my size. I love it!

Take this guy Andrew, for instance. I love to eat his lunch. He came in to talk to Dad just yesterday and I let him hang out, just minding my own business. I have him trained so that when he leaves, he inches for the door little by little because he knows I’ve got my eye on him. It was so great. He inched his way closer and closer to the gate that Dad puts up sometimes in his office door and then you know what I did? I made him jump it! HA! I gave him a good barking to for a couple of minutes and feel pretty confident that I intimidated the *you know what* out of him. I haven’t seen him since. It’s all in a day’s work.

People like to use the words “tea-cup Chihuahua” and “Lil’ Tornado” around me, but all I know is that I have a voice and opinions and know how to use them, know how to be sweet when it will get me what I want, such as in my Dad’s lap or a treat from one of the employees here at the office. Dad has told everyone lately not to give me as many treats because he found out that I make the rounds and have put on too much weight, apparently. Humpft. As if a little extra on a girl ever hurt anyone. I work hard for those treats!

Speaking of working hard, one of my favorite things to do is to work hard to make sure that our policyholders are happy. If you ever need me, e-mail me at I have to find someone to help me type my responses, obviously, but if anyone can get what she wants around here, it’s me!

Prescribing Pets Not Pills

Posted on: May 8th, 2008 by

Posted by Angela Klein on 5/8/2008 in Articles from Newsletters

Heather from, a blog she maintains about wellness for women, knows what it’s like to live with depression. Getting a dog helped, she said, brought her laughter and a reason to get out of bed in the morning. “I can honestly say that my dog is a big reason I am no longer depressed,” she said.

Recent studies have continued to show what Heather and others already know: pets are good for us. Looking at the multiple reasons why, it’s easy to see.

Pets get us up and moving. By walking our dogs or going to the store to buy food and treats for our cats, we’re doing more than just sitting. As the endorphins start to flow from our exercise, we feel better.

Having a pet means that we’re no longer alone, and even if we already live with others, the addition of a pet can still help tremendously. Anyone who has ever seen a dog look at its owner will understand the meaning of pure, unadulterated love. Pets look to us to meet their needs, be part of their pack, and thrive on the attention and affection we give. In return, they provide a love that asks for little and gives much.

A study several years ago at the University of Portsmouth in the United Kingdom studied the physical and psychological health benefits of owning a pet and found that people who walk their dogs, in particular, are less prone to depression and loneliness, and have fewer problems with obesity, heart disease, diabetes and cancer.

Dr. Jack Stephens, president and founder of Pets Best Insurance, has been preaching about the power of pets for years as he has seen person after person, including himself, helped by the love of a pet.

“More and more social and healthcare professions are seeing the value of pets in helping to keep us healthy and improving our health when we are ill, stressed or depressed,” Stephens said.

“The quiet interaction of petting a pet will lower your blood pressure, decrease your stress hormone and increase the levels of good hormones and neurotransmitters which will all help you feel better.”

Stephens goes on to add that spending time with our pets also increases our serotonin levels, which helps combat depression, and walking our pets helps us lose weight, keep it off and improves our overall sense of well-being.

Not only can walking a dog improve our moods and help us maintain our weight, the study by researchers at the University of Portsmouth also showed that we make more friends when we’re out walking our pets, which also eases loneliness and depression.

Giving us passion and purpose, providing a source of unconditional love and acceptance and getting us out and about – that’s what our pets do for us. So the next time you bend down to scratch your furry friends, remember to whisper an extra “thank you” for all they do without even knowing.

The Real Buzz On Bug Bites

Posted on: April 30th, 2008 by

Posted by Amy Shojai on 4/30/2008 in General Articles

On-the-go dogs delight in outdoor adventures, but too often they sniff out pesky bugs that prove aggravating or even dangerous. Recently, my happy-go-lucky German shepherd pup Magic morphed into a miserable crybaby, courtesy of “something” that bit or stung. His eyes swelled shut, his muzzle inflated, and hives made fur stand off his body in an itchy checkerboard pattern that prompted nonstop scratching.

Fur offers some protection but paws and sparsely furred tummies are at risk especially in locations that harbor fire ants. Dogs who play with bees, wasps, spiders or scorpions suffer stings on the face, head or even inside the mouth. Bites and stings beneath the fur may be hard to see or treat, but first-aid usually is all that’s needed to relieve any minor swelling, itching or redness.

Heed these seven bits of advice if your dog gets stung or bit by a bug:

-Bees leave behind the stinger, which may continue to pump venom into the skin. Use a credit card or similar rigid tool to scrape it free.
-A cold pack or compress applied to the bite helps reduce the swelling. A bag of frozen peas or corn works well, and molds against the pet’s body.
-A baking soda and water paste works great to soothe the sting, but it can be messy when applied to fur so use only on exposed tummies.
-Ammonia works great to cool the pain of fire ant bites. Moisten a cotton ball and dab on the stings. Calamine lotion also soothes ant bites.
-For stings inside the mouth, offer ice cubes or ice water for the pet to lick and drink.
-You can also mix a teaspoonful of baking soda into a pint of water, and squirt the solution into his mouth with a turkey baster or squirt gun, if he’ll allow you to do this.

As long as your dog continues to breathe with no problem, a veterinary visit may not be necessary even if the face swells quite a bit. Benadryl, an antihistamine, counters swelling and itching. A safe dose is one milligram for every pound your pet weighs or a Benadryl ointment can be used directly on the sting.

Hives usually go away on their own after a day or so, and sooner if treated with an antihistamine. Magic felt better within 20 minutes of the first dose of Benadryl. Keep in mind that this over-the-counter medication also causes drowsiness as a side effect. In my case, Magic slept through the night and recovered by the next morning.

How do I know when it’s an emergency?

Like people, some dogs can suffer severe allergic reactions when stung or bitten by insects. A single sting can prompt a dog’s muzzle to swell and an anaphylactic reaction usually occurs within 20 minutes of the sting. This causes a dog’s face, throat and airways to swell – making breathing difficult or impossible. Anaphylactic shock requires immediate veterinary treatment as a dog can die without professional medical intervention.

Please take your dog to a veterinarian if he exhibits any or all of these signs:

Acts weak
Suffers diarrhea
Extreme facial swelling
Has trouble breathing

– By Amy D. Shojai, CABC, a certified animal behavior consultant, pet care specialist and author of more than a dozen pet books, including The First-Aid Companion for Dogs and Cats. She can be reached through her website