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HOW TO CHARGE FOR TECHNICIAN APPOINTMENTS

HOW TO CHARGE FOR TECHNICIAN APPOINTMENTS

HOW TO CHARGE FOR TECHNICIAN APPOINTMENTS

By Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

is your practice struggling with doctor shortages?

Using technicians as physician assistants is a solution. Your practice could shift up to 20% of appointments from veterinarians to technicians. Better yet, you can charge for technician appointments.

which appointments to reallocate to technicians

Consult your state’s guidelines on technician and veterinary assistant duties and whether veterinary supervision must be direct or indirect (https://www.avma.org/advocacy/state-and-local-advocacy/veterinary-state-board-websites).  

After reviewing your state’s policies, identify types of appointment that technicians and assistants may see. Create scheduling guidelines with appointment lengths and reasons for visit for client service representatives to follow. Consider a standard of care that patients must have a veterinary-client-patient relationship and a physical exam from a veterinarian within 12 months to be eligible for technician appointments.[1]

Shift four appointment types from veterinarians to technicians and assistants:

1. Preventive appointments. Let’s say a veterinarian examined an adult dog today and gave the first Leptospirosis vaccination. When the dog needs a Leptospirosis booster in a few weeks, schedule an appointment with a technician rather than a doctor. Forward book the technician appointment today to ensure timely immunization. Schedule recurring technician appointments for patients on weight-management programs so technicians and assistants may assess patients’ progress and provide nutrition counseling to clients.

2. Diagnostic appointments. Technicians and assistants can collect samples and perform lab tests for drug monitoring, early detection screens, preanesthetic testing, blood pressure checks, glucose curves, and more.

3. Treatment appointments. Technicians and assistants can change bandages, administer subcutaneous fluids, perform laser therapy, trim nails, clean ears, and more.

4. Instructional appointments. Teach clients about home care such as giving insulin injections and subcutaneous fluids. Have clients record videos on their smartphones of patient care that they will need to do at home.

Let’s say the client schedules a technician appointment to get her dog’s ears cleaned. Ask the client to record a video on his smartphone as you clean the right ear and verbalize instructions. After you finish cleaning the right ear, have the client clean the left ear while you coach him. Clients will better understand homecare instructions after watching, doing, and recording videos for future reference.

use distinct terms

To help clients understand the difference between duties performed by a veterinarian and technician, choose different service names. Use “exam” when a veterinarian performs a physical exam. Used in the human nursing profession, the term “health assessment” is when a technician or assistant evaluates patient health.[2] Download my history questions for checkups at https://csvets.com/historyquestions/.

A health assessment performed by a technician or assistant includes three activities:

  1. Get patient’s vital signs (i.e., temperature, pulse, respiration, weight)
  2. Ask history questions
  3. Update medical record 

Veterinarians should define which patients will need health assessments during technician and assistant appointments. Here are services that may merit health assessments:

  • Change bandages
  • Clean ears
  • Express anal glands
  • Administer subcutaneous fluids
  • Provide laser therapy
  • Administer vaccines
  • Check weight and provide counseling
  • Remove sutures

A health assessment may not be medically necessary for certain services such as:

  • Trim nails
  • Collect urine or blood for lab tests
  • Place microchip

how to set health assessment fees

Clients will pay for services and health assessments performed by technicians and assistants. Let’s say a client books a technician appointment for a nail trim. Charge for the nail trim service but a health assessment is not medically necessary. Another client schedules a technician appointment for her dog’s bandage change. Charge fees for bandage change services and a health assessment, which is medically necessary.

When setting fees for health assessments that technicians and assistants will perform, consider two options:

Option 1: Percentage of doctor’s exam. Let’s say your veterinarian’s exam fee is $60. Charge half the doctor’s rate if a credentialed technician provides the health assessment or $30. If an assistant does it, charge a third of the doctor’s rate or $20. 

Option 2: Create a per-minute rate. Identify three figures:

  • Average hourly wage: Calculate the average hourly wage for your credential technicians and veterinary assistants. The 2022 average hourly pay for a technician was $19.60, according to the U.S. Bureau of Labor Statistics.[3] Veterinary assistants averaged $16.58 per hour.[4]
  • Benefits: Benefits are typically 32% of an employee’s wage.[5] Benefit expenses include all costs associated with health, dental, worker’s compensation, and other insurances; retirement benefits; the owner’s portion of employment taxes; uniform reimbursement; continuing education; discounts or allowances for veterinary services; and paid vacation, holidays, and personal days.
  • Staff costs as a percentage of revenue: Total staff expense with benefits in a financially healthy hospital is kept below 23% to 25% of revenue.[6] Support staff includes all non-veterinary employees, managers, and custodial personnel. About 16% to 19% of income is allocated to staff wages while 5% to 8% is for benefits. 

Here’s the per-minute formula: Take the average wage per hour with benefits ($19.60 technician hourly wage + 32% for benefits = $25.87 per hour) and divide by 23% staff costs as a percentage of revenue. A technician will need to generate income of $112.48 per hour to meet profit goals. Divide $112.48 income per hour by 60 minutes for a per-minute billable rate of $1.87 for technician time. Use a similar calculation to determine a per-minute rate for services that veterinary assistants will deliver.

Rather than the tedious task of setting a stopwatch every time a technician sees an appointment, set fees in blocks of 10, 20, 30, and 40 minutes with a minimum amount charged. For example, a 10-minute technician appointment is $18.70 plus fees for additional services delivered. If the task only takes 5 minutes, still charge the 10-minute technician fee because it’s the minimum amount and starting point for fees.

Here are examples of technician appointment fees based on blocks of time:

Length of technician appointment

Health assessment fee

10 minutes

$18.70

20 minutes

$37.40

30 minutes

$56.10

40 minutes

$74.80

communicate value to clients

If you don’t charge for technicians’ time now and will implement a health assessment fee, host a staff meeting to explain the “why” behind the fee to your team. Technicians and assistants will appreciate that you value their time and expertise and want to charge clients for services they deliver.

Write a script of what to tell clients. You want employees to answer clients’ questions confidently and consistently about the new fee.

Say this, “Our veterinarians have determined which patient treatments need health assessments from technicians and veterinary assistants. Our health assessment includes getting your pet’s vital signs of temperature, pulse, respiration, and weight, along with asking you history questions and updating your pet’s medical record with this information. For this nursing care, we charge a health assessment fee of $XX and fees for additional services provided during the technician appointment. For example, an appointment to change a pet’s bandage would include a health assessment to check that the wound is healing properly along with fees for the bandage change service. I am confident that you will find value in the nursing care that our technicians and assistants provide.”

Doctors need to transfer trust. When veterinarians perform exams and give immunizations, tell clients what to expect for the next booster vaccinations. Say, “<Pet name> will need a booster vaccine on <date>. You will schedule an appointment with my technician, who will conduct a health assessment, give the booster vaccine, answer your questions, and update your pet’s medical record. We take a team approach to preventive care. I value the contributions of our nursing team.”

Communicate value at the start of technician appointments. Set client expectations upfront. The technician or assistant will explain, “I’m <name>, the certified veterinary technician who will perform <pet name>’s health assessment and give the Leptospirosis booster vaccine. I will get <pet name>’s vital signs, including temperature, pulse, respiration, and weight. I will ask questions about your pet’s health and update <pet name>’s medical record with the vital signs and information we discuss. What questions may I answer before we get started?”

When your practice utilizes technicians like physician assistants, technicians will work at the top of their licenses, improving job satisfaction and employee retention. You will increase appointment availability for clients, which is advantageous with today’s overloaded schedules.

WANT TO LEARN MORE? 

Enroll your team in the training bundle: Confident Exam Conversations: 6 Courses.

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in a specialty and emergency practice. Visit CsvetsCourses.com and YouTube.com/csvets to learn more.

References:

1. The Veterinarian-Client-Patient Relationship (VCPR). American Veterinary Medical Association. Available at: https://www.avma.org/resources-tools/pet-owners/petcare/veterinarian-client-patient-relationship-vcpr. Accessed Jan. 3, 2024.

2. Guide to Good Nursing Practice Health Assessment. Available at: https://www.nchk.org.hk/filemanager/en/pdf/health_assessment_e.pdf. Accessed Jan. 3, 2024.

3. Occupational Outlook Handbook, May 2022. Veterinary Technologists and Technicians. U.S. Bureau of Labor Statistics. Available at: https://www.bls.gov/oes/current/oes292056.htm. Accessed Jan. 3, 2024.

4. Occupational Employment and Wages, May 2022. Veterinary assistants and laboratory animal caretakers. U.S. Bureau of Labor Statistics. Available at: https://www.bls.gov/oes/current/oes319096.htm. Accessed Jan. 3, 2024.

5. Woodruff J. Benefits as a Percentage of Wages. Chron. Available at: https://smallbusiness.chron.com/benefits-percentage-wages-14587.html. Accessed Jan 3, 2024.

6. Tips to Help You Manage Veterinary Staffing. Simmons & Associates Inc. Available at: https://simmonsinc.com/can-you-manage-veterinary-practice-staff-expenses/#:~:text=The%20total%20support%20staff%20expense,23%2D25%25%20of%20revenues. Accessed Jan. 3, 2024.

How to get more exam rooms

How to get more exam rooms

How to get more exam rooms

By Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

“I have too many exam rooms,” said no veterinarian ever.

Veterinary hospitals have an average of three exams rooms.[1] A practice needs 2 to 2.5 exam rooms per veterinarian.[2] Chance are, your hospital is short one or more exam rooms. Animal Arts, a veterinary architecture firm in Boulder, Colo., agrees, “You can never have too many exam rooms!”[3]

Renovating to add exam rooms is a smart business decision. Each exam room averages $342,312 in annual medical revenue.[4]You’ll spend about $130 per square foot to renovate an existing building[2]. A 200-square-foot exam room will cost you about $26,000 to remodel—but where can you find the extra space?

shrink your food room.

Look at the footprint that food storage consumes at your practice. Management consultants estimate practices pay 28 percent to 40 percent of the product cost to manage the inventory.[5] Food also has lower markups of 39 percent for therapeutic diets compared to 65 percent for preventives and 107 percent for prescription medications.[6]

Lead more clients to home delivery through your online pharmacy and pet food partnerships such as Purina’s Vet Direct, which lets clients get direct shipments while revenue sharing with your practice (https://www.proplanvetdirect.com). Auto shipment programs often include free shipping and rewards for clients.

Only stock starter cans and bags at your practice. When changing a patient’s diet, bring the product into the exam room and explain food transition instructions to the client. Say, “Here’s your starter bag. Let’s get you signed up for home delivery and place an order today. Your first auto shipment will arrive on your doorstep in three to five days. Recurring refills will arrive every four weeks so you never run out of food!” Home delivery appeals to busy working families, seniors who struggle to carry heavy items, and millennials who order lots online. Hospitals save on inventory and free up part the square footage for new income-generating exam rooms. Another reason to lead clients to auto shipments: Compliance for therapeutic diets skyrockets to 10 bags per year compared to less than two bags sold at the hospital.[7]

GO OUTDOORS.

Star of Texas Veterinary Hospital in Austin, Texas put a southern flair on being a Fear-Free certified practice with three outdoor exam spaces on a 4-acre wooded lot (https://staroftexasvet.com). Each 20-by-20 foot outdoor exam space has an 8-foot wood privacy fence, tent, picnic table, locking supply box, and locking gate. “Backyard appointments” help the four-doctor hospital promote its Fear-Free methods. About 15 patients per day are seen in the three outdoor exam spaces. Star of Texas Veterinary Hospital spent less than $2,000 on fencing, picnic tables, and supplies.

Weather is the only limitation. “When it’s 112 degrees in the summer, clients can only book 8 a.m. appointments when it’s cooler,” explains Hospital Administrator Dana Wile, CVBL. “We move tents around as the sun moves. Clients and dogs love our outdoor exam spaces. It’s like going to the dog park for a walk.” Her only regret is not covering the tops of outdoor exam spaces. An affordable solution might be a carport canopy. Next, Wile is planning an outdoor “catio” where cats can enjoy a fully enclosed outdoor exam space.

Drive-thru service. Marty Greer, DVM, JD, opened the world’s first small animal drive-thru wellness center, Checkout Veterinary in Sun Prairie, Wis. (https://www.checkoutvet.com). The hospital has four garage bays where clients can drive in, and pets are isolated from other patients. Care can be delivered in garage bays or in adjacent exam rooms with Dutch doors where clients can see their vehicles.

reclaim part of your lobby.

Reduce your waiting space. Clients will appreciate being escorted immediately into exam rooms instead of passing time in a noisy, high-traffic lobby. At Fetch Specialty and Cancer Centers in Bonita Springs, Fla., clients enjoy a comfortable and welcoming waiting porch.

Scrutinize your seating arrangement. Have small group seating areas rather than long rows of chairs that make the lobby look cluttered, advises Jeff Clark, AIA, ICC, principal of MD Architects in Indianapolis, Seattle, and Boston.[8] Bench seating welcomes clients of all body types.

Use free-standing kiosks instead of traditional reception desks, Clark recommends. Untether your client service representatives (CSRs) with wireless headsets and tablets. CSRs can greet clients at the front door and escort them to exam rooms for in-room check-in. Veterinary assistants or technicians can wrap up visits with exam room checkout, reducing payment time from the seven to 10 minutes for traditional front-desk checkout. Ask your practice-management software provider about securely stored credit-card information in its platform, compatible apps for payment, and credit-card terminals in exam rooms.

Phones can be answered nearby in a cubby or consider remote CSRs who answer phones and schedule appointments from home (Read “Is Remote Work the Secret to Keeping Staff,” https://csvets.com/remote-workers/).

Repurpose retail space. Run a sales report of your annual retail revenue. Convert the space into one or more exam rooms. Shift sales of collars, leashes, and retail products to your online pharmacy.

RECONFIGURE DOCTORS’ OFFICES.

Forgo traditional doctors’ offices that practices had in 1985. Veterinarians can have private spaces for calls and recordkeeping, but money-making exam rooms take priority. Animal Arts suggests having a shared glass fishbowl workstation adjacent to the treatment area, which is an efficient use of space and controls noise. Build one or two phone booths for additional privacy where doctors and support staff can participate in Zoom meetings and webinars or conduct telehealth visits. A large, shared doctors’ office now becomes smaller work cubbies, and you get the extra exam rooms or dental suite you’ve been dreaming of. 

Ideally, exam rooms should measure at least 10-by-10 feet to allow space for medical staff, patients, and clients.[9] Exam spaces don’t require much storage. Mobile carts can contain supplies, make restocking easier, and be tucked away when not in use.

Think creatively. Where could you find 10-by-10 feet of space—inside or outside? Reward yourself with a new exam room that can be used for doctor and technician appointments as well as a multi-purpose room for consultations, euthanasia, and other medical services.

WANT TO LEARN MORE? 

Enroll your team in the training bundle: Confident Exam Conversations: 6 Courses.

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in a specialty and emergency practice. Visit YouTube.com/csvets and CsvetsCourses.com for more.

References:

1. Mattson K. A Blueprint for Veterinary Spaces. JAVMA News. Available at: https://www.avma.org/javma-news/2021-04-15/blueprint-veterinary-spaces. Accessed Dec. 7, 2023.

2. Hoeksema A. Opening a Profitable Vet Clinic: Numbers You Need to Know. ProjectionHub. Available at: https://www.projectionhub.com/post/opening-a-profitable-vet-clinic-numbers-you-need-to-know. Accessed Dec. 8, 2023.

3. The ABCs of Veterinary Hospital Design. Animal Arts. Available at: https://www.animalarts.com/the-abcs-of-veterinary-hospital-design/. Accessed Dec. 8, 2023.

4. Hawn R. Hospital Considerations: Expand or Build New? AmerisourceBergen. Available at: https://www.mwiah.com/our-insights/hospital-considerations. Accessed Dec. 8, 2023.

5. Brown J. Deliver the Goods. Today’s Veterinary Business. Available at: https://todaysveterinarybusiness.com/deliver-the-goods/. Accessed Dec. 8, 2023.

6. AAHA Veterinary Fee Reference. AAHA Press 2020: 229, 228.

7. Garrison G. No Place Like Home (Delivery). VetAdvantage. Available at: https://vet-advantage.com/vet_advantage/no-place-like-home-delivery/. Accessed Dec. 8, 2023.

8. The Power of First Impressions at the Vet. MD Architects. Available at: https://www.mdarchitects.com/the-power-of-first-impressions-at-the-vet. Accessed Dec. 8, 2023.

9. Animal Hospital Design Strategies for Better Care. AAHA. Available at: https://northamerica.covetrus.com/docs/default-source/landing-pages/equipment-new-build/midmarkhospitaldesignstrategies_small.pdf?sfvrsn=40b16d73_2. Accessed Dec. 8, 2023.

 

Stop Leaving Voicemails For Clients

Stop Leaving Voicemails For Clients

Stop Leaving Voicemails For Clients

 By Wendy S. Myers, CVJ, President, Communication Solutions for Veterinarians

You call a client about her cat’s lab results and leave a detailed voicemail, explaining that you need to discuss the diagnosis and treatment. After two days with no response, you leave a second voicemail. 

Even if clients have your hospital’s phone number saved in their contacts, research shows 67 percent don’t listen to voicemails.[1] I understand why. Clients can’t skim voicemails. They must listen to the entire message, call back, wait on hold, and leave a message because the veterinarian isn’t available. 

Text is a better choice. Text dialogue can happen asynchronously. Both parties don’t have to be on their phones at the same time. Veterinarians and clients can reply when they’re available. Up to 80 percent of callers choose texting over voicemail. Millennials are the largest pet-owning segment and 60 percent prefer to communicate with businesses via text.[2],[3] 

Let’s end your frustration with unreturned calls and phone tag. Turn your callbacks into “textbacks.” Texts rarely go unread or unanswered. Ditch the 10-minute task of calling and leaving a voicemail. Replace it with a 2-minute text. Create templates in your texting platform for these common responses:

TEXT AFTER DISCHARGE

After each hospitalized patient is discharged from surgery, dentistry, or treatment for an illness, your medical team follows up with clients. Set expectations for a textback during the discharge appointment. 

Say this: “You will get a text/app message from us tomorrow to confirm that <pet name> is eating, drinking, and taking medications. If you have questions or concerns, reply to the text, or call us at 555-555-5555.” 

The next day, text this: We are checking on <pet name> after surgery yesterday. Is <pet name> eating, drinking, and taking medications? Reply Y or N. Reply with questions. 

If the client replies “Y” for yes, document the communication in the electronic medical record and reply to thank the client. If a client replies “N” for no, call to discuss the pet’s symptoms and next steps. The client’s answers may prompt an appointment for a progress exam or telemedicine consult. 

Create a series of text templates when patients require multiple follow-up messages. Text campaigns should notify, educate, support, and steer pet owners. In your texting platform, link the series to trigger in sequential order. 

Let’s say you perform a dental treatment with several extractions. Send this series of texts after the dental discharge appointment:

  • 1 day later: We are checking on <pet name> after oral surgery yesterday. Feed a soft food, no hard treats or chews, and refrain from brushing teeth for X days. Is <pet name> eating, drinking, and taking medications? Reply Y or N. Reply with questions.
  • 4 days later: <Pet name> may eat regular food now. No hard treats or chews for X days after oral surgery. Reply with questions.
  • 7 days later: You may gently brush <pet name>’s teeth with pet toothpaste and a soft toothbrush now. Click here <link> to watch our video on how to brush your pet’s teeth. Reply with questions.
  • 14 days later or based on next appointment date: <Pet name> has a progress exam to check on healing from oral surgery on <date, time>. Reply C to confirm or RS to reschedule. 

TEXT AFTER SICK OUTPATIENT EXAMS

Let’s say you saw an urgent care patient for loose and watery stools. You determine the gastrointestinal upset was due to high-fat table scraps at the family barbeque, and radiographs confirm no bones were ingested. You prescribe medication and instruct the client to feed a bland diet for several days. The outpatient technician who assisted the veterinarian with the exam will be responsible for follow-up communication. 

Text this: We are checking to see if <pet name> is feeling better. Feed a bland diet for X days. Is <pet name> having normal stools and a good appetite? Reply Y or N. Reply with questions. 

The client already has a relationship with this technician, who is familiar with details of the case. If the health concern has not resolved, schedule a progress exam.

TEXT PREVENTIVE LAB RESULTS

Share lab results for intestinal parasite screens that you send to your reference lab. I provided consulting and onsite training for a 10-doctor hospital where the medical team told clients “No news is good news” for intestinal parasite test results. Being busy isn’t a good excuse and may harm compliance for preventive diagnostics. Pet owners are paying to learn results. Clients will be more likely to accept screening in the future if they understand today’s results. 

Text clients about negative results and reinforce timely dosing of preventatives. Call clients about positive results so you may discuss treatment and medication. 

Text this: <Pet name>’s intestinal parasite screen was negative with no egg cells or parasites seen. Give <brand> each month for heartworm and intestinal parasite prevention. Click here to view lab results <link to patient portal on your website>. Reply with questions.

TEXT AS BACKUP TO VOICEMAILS

A client calls and tells your client service representative, “Someone from your hospital just called me. What do you need?” While you might find the answer in the electronic medical record, the staff member may not be available. 

Whenever you leave a voicemail, send a backup text to lead the client to listen and promptly call back. Your text should include the best time to return the call based on the staff member’s availability. 

Text this: “Dr. <Name> left you a voicemail about <pet name>’s lab test. Please listen, and then call 555-555-5555 to discuss the diagnosis and treatment. Dr. <Name> will be available between 2:00 and 2:20 p.m.” 

Veterinarians need administrative time blocked in their schedules to review lab results, update medical records, approve prescriptions, and call/text/email clients and vendors. Learn how to add doctor-client communication blocks so veterinarians can batch tasks. Read my blog on Overwhelmed With Callbacks and Emails?

Clients will get cranky if they leave multiple messages without returned calls. Watch my 2-minute video on  “I need to talk to the doctor now!” Find out what to say when a client demands to talk with the veterinarian, but he isn’t available.

Have a doctor and technician list the top callback scenarios at your hospital. Identify which callbacks could be converted to textbacks, which will improve your team’s productivity and increase response rates from clients. Write templates for your texting platform to save time and have consistent messaging from your hospital.

WANT TO LEARN MORE?

Enroll your team in the 1-hour course: Technology Tools Every Practice Needs.

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in a specialty and emergency practice. Visit YouTube.com/csvets and Csvets.com for more.

References:

[1] 22 Business Phone Statistics. Numa. Available at: https://www.numa.com/blog/22-business-phone-statistics. Accessed Aug. 11, 2022.

[2] Share of Pet Ownership in the United States in 2021-2022 by Generation. Statista. Available at: https://www.statista.com/statistics/1130651/pet-ownership-by-generation-us/. Accessed Aug. 11, 2022.

[3] Svyrydenko A. Why Millennials Love Texting. TextMagic. Available at: https://www.textmagic.com/blog/why-millenials-love-texting-infographic/. Accessed Aug. 11, 2022.

 

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what to tell clients when you raise prices

what to tell clients when you raise prices

what to tell clients when you raise prices

What to Tell Clients When You Raise Prices

By Wendy S. Myers, CVJ, President, Communication Solutions for Veterinarians

A practice owner told me he hasn’t raised prices in two years and worries how clients will react. While he knew procrastinating was a mistake, the situation is quickly getting worse. The U.S. inflation rate rose to 7.5 percent in January 2022, reaching a 40 year high.[1] The cost-of-living surge has been the biggest since 1982, when Michael Jackson released his groundbreaking album “Thriller” and gas was 91 cents a gallon.[2]

Economic changes have triggered laboratory and vendor price increases as high as 12 percent in the veterinary profession.[3] Costs are rising everywhere, from gas to groceries. If your hospital hasn’t raised prices yet, do it now. But what should you tell clients?

tell employees before you tell clients.

Your team needs to understand the “why” behind fee changes. You don’t want employees to stumble when responding to clients. Have a consistent message, which will make it easier for employees to explain price increases and for clients to accept them. Your message should be concise and empathetic. Don’t apologize because raising prices is a normal aspect of running a business. Your products and services provide excellent value, and you should charge accordingly.

create a script of what employees should say.

If clients question fee increases, you want frontline workers to be able to answer. Never say, “You’ll have to talk to the manager or doctor about prices.” You risk creating angry clients if the manager and doctor aren’t immediately available. Every employee must share a concise, confident response. Watch my YouTube video on “Raising Prices? What to Tell Clients” at https://www.youtube.com/watch?v=gev5cwb1ni8&t=11s.

Your script should include four points:

1) Express Empathy: “I understand that you’re concerned about the cost of veterinary care for your pet.” The word “concerned” shows empathy.

2) Be transparent and state reasons for fee changes. Like many businesses, our hospital has had price increases in the products and services we buy from vendors. We also invest in our employees’ ongoing education, so they learn about medical advances to improve patients’ comfort and treatment outcomes.” These two statements about vendor price increases and investing in staff training concisely state specific reasons for fee changes. The statements also show you are transparent about prices.

3) Explain how the price increase will benefit the client and pet. We strive to keep fees affordable while sourcing the best products and supplies to ensure we deliver the high-quality veterinary care that you and your pet deserve.” Emphasizing high-quality care explains how the price increase will benefit the client and pet.

4) Show appreciation for the client’s loyalty. “Thank you for your feedback. I will share it with the doctor and manager. You’re welcome to reach out to Dr. Smith or our manager, Amy, with further questions. We appreciate the opportunity to care for Max.”

Your team also can share information about preventive care plans, third-party financing, and pet insurance to help pet owners manage the cost of care.

how should you answer, “why is your hospital more expensive?”

Every employee needs smart responses when clients or phone shoppers question your fees. 

Say this (See key words in bold): “Our hospital offers affordable fees. Our surgical fee may be higher than another hospital that you contacted because we have the latest monitoring equipment, include preanesthetic testing and pain-relief drugs with the surgery, and have an experienced staff with ongoing continuing education. I’m confident you will see value in the quality of care that our team provides. Let’s schedule a presurgical exam so you can meet our doctor. The veterinarian also will share our surgical protocols and answer your questions. When can we meet you and Charlie? I have an appointment available at 9 a.m. Monday or 2 p.m. Tuesday. Which do you prefer?” 

The client service representative (CSR) explained how the quality of care will benefit the pet. She used positive phrases such as “Our hospital offers affordable fees” and “I’m confident you will see value.” The CSR had an inviting approach of “When can we meet you and Charlie?” instead of the yes-or-no choice of “Do you want to book an appointment?” She offered the next two available exams, which leads the caller to schedule now.

position your hospital as a premium provider.

You get different service and quality from a steakhouse compared to a fast-food drive thru. We all dine out and may choose a restaurant based on convenience, price, experience, and quality. Likewise, your community has low-cost veterinary care providers, shelters, private and corporate practices, and emergency and specialty hospitals. Each serves a need and niche.

A premium practice would include preanesthetic testing and pain medication in procedures while a low-cost provider might offer these services as options. A premium practice blocks urgent care slots in its daily schedule to see sick patients while another provider might tell clients its schedule is full and advise seeking care at an emergency hospital.

raise prices whenever products or vendor fees go up.

While this seems obvious, it can happen without processes in place. A technician unpacks products, updates the quantity in the inventory module of the practice-management software, stocks shelves, and passes the invoice to the bookkeeper. The bookkeeper pays and files the invoice. No one confirmed whether the unit cost on the vendor invoice matched the unit cost in the inventory module.

Let’s say a vendor increased an item from $10 to $11. The practice incurred a 10 percent increase that didn’t get passed along to clients and cut into profits.

To prevent this error, use the purchase order feature in your practice-management software. In AVImark, this lets you “receipt the order,” specifying which items were received, any price change, which vendor sent the products, and apply shipping and taxes that were charged.[4]

make small increases to professional services quarterly.

While it’s smart to raise prices when vendors charge you more, when was the last time you raised professional fees for exams and procedures? 

Owen McCafferty, CPA, CVPM, and founder of Owen E. McCafferty CPA Inc. in Ponte Vedra Beach, Fla., advises hospital leaders to stay ahead of inflation with quarterly fee increases and to monitor staffing. Let’s say your exam fee is $55, and you want to raise it 12 percent. Increase the fee 3 percent or $1.65 each quarter to $56.65, $58.30, $59.95, and $61.60 respectively. Clients are less likely to notice small increments compared to an escalation from $55 to $61.60. 

Many practices are operating short-staffed and want to reward loyal employees with raises. Because employee wages and benefits average 48 percent to 52 percent of costs, you can’t give raises without upping prices, advises McCafferty. Take care of core employees who stick with you when times get tough, he says. Good wages and benefits will help you retain and recruit employees.

be competitive on shopped items.

Consumers shop prices on three veterinary drug categories: 1) Flea and tick preventatives, 2) Heartworm preventatives, and 3) Long-term drugs for chronic conditions such as arthritis and allergies. Parasiticides represent the largest market share of pet medications with 42 percent of sales.[5] Most of your prescription approval requests from internet pharmacies are flea/tick and heartworm preventatives. 

The Veterinary Fee Reference, 11th ed., reports a 65 percent average markup on flea/tick and heartworm preventatives compared to 107 percent on other prescription medications.[6] If you markup preventatives 107 percent, you will lose sales to third-party pharmacies and other area hospitals. 

Don’t procrastinate to review and raise prices regularly. Available from the American Animal Hospital Association, The Veterinary Fee Reference is a resource to benchmark your fees against national averages (https://ams.aaha.org/eweb/DynamicPage.aspx?site=store&Action=Add&ObjectKeyFrom=1A83491A-9853-4C87-86A4-F7D95601C2E2&WebCode=ProdDetailAdd&DoNotSave=yes&ParentObject=CentralizedOrderEntry&ParentDataObject=Invoice%20Detail&ivd_formkey=69202792-63d7-4ba2-bf4e-a0da41270555&ivd_cst_key=00000000-0000-0000-0000-000000000000&ivd_cst_ship_key=00000000-0000-0000-0000-000000000000&ivd_prc_prd_key=7F0F61F6-5D44-4BDE-A54C-C38CF8066FFA).

Clients will be more comfortable with small, steady increments instead of large fee hikes. Most pet owners will anticipate increased costs in the future. They know costs are rising everywhere, from gas to groceries. You need to keep your practice financially healthy, too.

want to learn more?

Enroll your team in the 1-hour course: What to Say When You Raise Prices.

References:

[1] Bartash J. U.S. Inflation Rate Climbs to 7.5% After Another Sharp Increase in Consumer Prices. MarketWatch. Available at: https://www.marketwatch.com/story/coming-up-consumer-price-index-11644498273. Accessed Feb. 15, 2022.

[2] List of 1982 Significant News Events in History. The People History Home. Available at: https://www.thepeoplehistory.com/1982.html. Accessed Feb. 15, 2022.

[3] McReynolds T. Inflation Hitting Veterinary Practices. AAHA News Stat. Published Jan. 12, 2022. Available at: https://www.aaha.org/publications/newstat/articles/2022-01/inflation-hitting-veterinary-practices/?utm_medium=email&utm_source=rasa_io. Accessed Feb. 15, 2022.

[4] AVImark User Manual. Inventory List: pp. 86.  Available at: https://softwareservices.covetrus.com/wp-content/uploads/2019/09/AVImark-user-manual.pdf. Accessed Jan. 14, 2022.

[5] McReynolds T. Veterinarians Outselling Online Retailers When It Comes to Pet Meds—But Not For Long. AAHA NEWStat. August 2019. Available at: https://www.aaha.org/publications/newstat/articles/2019-08/veterinarians-outselling-online-retailers-when-it-comes-to-pet-medsbut-not-for-long/. Accessed March 29, 2021.

[6] The Veterinary Fee Reference, 11th ed., AAHA Press: 2020;229,230,228.

 

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Tell, Don’t Ask to Fix Compliance Blunders

Tell, Don’t Ask to Fix Compliance Blunders

Tell, Don’t Ask to Fix Compliance Blunders

By Wendy S. Myers, CVJ, President, Communication Solutions for Veterinarians

Wishy-washy conversations may cause clients to dismiss necessary follow-up care and to refill medications, putting patient care and practice revenue at risk. Pet owners expect clear, specific guidance from your veterinary team. Here are common compliance blunders and how to correct them:

 

Compliance blunder: “Do you need any refills today?”

Veterinarians sell 62 percent of pet medications, reports the market research firm Packaged Facts. Eight out of 10 clients trust what their veterinarians say about pet drugs. (*1) Compliance starts at check-in. Receptionists should view drug-purchase history when clients visit for appointments, boarding or to pick up food and medications. The AAHA compliance study found only 55 percent of dogs get year-round heartworm preventatives. Only 30 percent of practices send reminders to refill chronic medications. (*2)

 

How to fix:

Tell, don’t ask. See when preventatives were last purchased and how many doses were sold. Some clients also may share medication between pets. If only a few doses remain, prompt the client to refill the prescription now. If the client visited five months ago and bought a six pack of heartworm prevention, one dose is left. Tell the pet owner, “I see that Max has one dose left of his heartworm preventatives. Let me tell you about our rebates so you may save the most.”

Check all pets in the family to see which need refills for preventatives and chronic drugs. The average American family has two pets (1.6 dogs and 2.1 cats), according to the American Veterinary Medical Association U.S. Pet Ownership & Demographics Sourcebook. (*3) I may be visiting for my cat Alex’s checkup, but my second cat, Caymus, needs his medication for cardiomyopathy refilled. My veterinarian is 15 minutes from my home, which turns into 30 to 45 minutes each way during rush-hour traffic. Ensure timely refills, help me avoid road rage and improve your refill compliance.

If your hospital has an online store, guide clients to set up accounts and auto refills during today’s visit. Tell the pet owner, “You can pick up future refills at our hospital, or I can help you set up auto refills through our online store now. Your pet’s preventatives will be automatically shipped each month until the next heartworm test is due. Do you prefer to get medication now or have it delivered to you with free shipping?”

 

Compliance blunder: “Do you want to schedule a recheck?”

Medical progress and pediatric exams have specific follow-up timelines. Clients may perceive a “recheck” as free and optional. About 75 percent of practices “always” or “most of the time” forward book patients’ progress exams, according to a Veterinary Hospital Managers Association survey. (*4)

 

How to fix:

Lead the client to book now because the appointment reminder will print on today’s receipt. Your busy hospital also may be booking exams one to two weeks in advance. If the client doesn’t book now, an appointment may not be available when follow-up care is due. Use the term “medical progress exam” to stress the urgency and importance of follow-up care. Tell the pet owner, “Dr. Patten needs to see Max for a progress exam for his skin infection in two weeks. Let’s book the appointment now so you get your first choice of time and day. Two weeks from today would be Thursday, Nov. 15. Does this same time, 9 a.m., work for you?” If the client is here at 9 a.m. on a Thursday, she may be able to return at a similar time and weekday. Book the appointment with the same veterinarian, ensuring continuity of care and efficient use of exam time.

Because you follow specific timing of vaccines, diagnostics and deworming for pediatric patients, book the next puppy or kitten exam today. Tell the pet owner, “Dr. Jeff needs to see your kitten again in three weeks, which would be Nov. 15. Does this same time, 1 p.m., work for you?”

Every practice has a mind-erase hallway that connects exam rooms to the front desk. Clients may forget to schedule follow-up care on the way to the checkout counter. To bridge this gap, choose from three strategies:

  1. If you have computers in exam rooms, the technician or veterinarian should book the next exam now. Nervous about a doctor using the appointment scheduler? Train to trust!
  2. Use a travel sheet or alert in your practice-management software. Hospitals with paper or paper-light records could use laminated travel sheets to note charges, reminders and follow-up care to be entered.
  3. Walk the client to the checkout desk for a verbal handoff. The technician or veterinarian would tell the receptionist, “<Client name> needs to schedule a progress exam for an ear infection for <pet name> on <date>.”

Create Level 1 and Level 2 progress exams,

depending on the amount of exam time needed for follow-up care. Level 1 progress exams would be 10-minute appointments for conditions such as ear infections, while Level 2 progress exams are more complex cases such as diabetes and would be 20 minutes. When scheduling follow-up exams, strive for same day, same time and same doctor.

 

Compliance blunder: “Do you want to book the dental procedure that the doctor recommended?”

The patient’s dental disease will get worse, and the price of treatment will significantly increase over time. Replace the wiggle word of “recommend” with the action word of “need.”

 

How to fix:

Schedule the procedure on the day of diagnosis. To guide the pet owner to book now, offer the doctor’s next two surgical/dental days. Schedule the procedure with the same veterinarian who diagnosed the condition because he will be familiar with the case and enjoy production pay. Booking with the same doctor also increases clients’ confidence.

If the client will check out at the front desk, the receptionist should schedule the procedure first, and then collect payment for today’s services. Lead the client with the two-yes-options technique. Tell the pet owner, “Dr. Lavallee diagnosed Caymus with Grade 1 dental disease. Let’s schedule his procedure first, and then I will get you checked out for today’s services. We can perform the dental treatment next Monday or Wednesday. Which fits your schedule?” Provide fasting instructions and let the client know you will call, email or text to confirm one day before the procedure. An appointment reminder for the procedure will print on today’s receipt.

 

When you confidently explain needed follow-up care and refills, you will guide clients’ decisions. The result is healthier patients and practice revenue. Get more training in my online CE class on “Are Your Wiggle Words Killing Compliance?” Enroll at here.

References:

*1 –  Niedziela, K. Veterinarians Sell 62% of Pet Drugs. Today’s Veterinary Business. Published September 2017. Accessed Sept. 17, 2018 at https://todaysveterinarybusiness.com/veterinarians-sell-62-pet-drugs/.

*2 – Compliance: Taking Quality Care to the Next Level. American Animal Hospital Association, 2009, pp. 11, 19.

*3 – 2012 American Veterinary Medical Association U.S. Pet Ownership & Demographics Sourcebook. Accessed Sept. 17, 2018 at www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-pet-ownership.aspx.

*4 – DVM360.com staff. VHMA Files: Forward Thinking, How to Use Forward Booking for Your Practice. Published Jan. 22, 2015. Accessed Sept. 17, 20158 at http://veterinaryteam.dvm360.com/vhma-files-forward-thinking.

Stop Hiding Patient Care “In the Back”

Stop Hiding Patient Care “In the Back”

Stop Hiding Patient Care “In the Back”

By Wendy S. Myers, CVJ, President, Communication Solutions for Veterinarians

While consulting a practice, I observed client after client challenge receptionists over fees for exams and other professional services. The high-volume hospital performed exams, gave vaccines and delivered other services in the treatment area in the interest of efficiency. Conducting professional services behind closed doors left pet owners questioning charges. Some wondered whether their pets were really vaccinated.

To create perception of value and improve client education, I persuaded doctors to deliver services in front of clients in exam rooms. Client complaints immediately stopped. Because 65% of people are visual learners, deliver veterinary care that engages pet owners. (*1) Here are ways to stop hiding patient care “in the back”:

 

Verbalize your physical exam.

Once you begin the nose-to-tail exam, describe every step, giving clients play-by-play details as you cover each body system. If you engage in small talk during the physical exam, pet owners may assume you’re just petting their animals rather than assessing their overall health. Tell the client, “For your pet’s physical exam, I will assess 12 areas, including eyes, ears, nose and throat, teeth and gums, coat and skin, heart, abdomen, limbs and paws, urogenital system, lungs, gastrointestinal system and weight.” Then give them guided tours of their pets.

Let children listen to their pets’ hearts through your stethoscope. You’ll show kids the cool science of veterinary medicine while inspiring future responsible pet owners.

 

Explain diseases you’re protecting against as you vaccinate.

When vaccinating a dog for leptospirosis, ask risk-assessment questions and explain how the bacterial infection is spread. This shows clients you tailor vaccines for every patient.

 

Use teaching tools.

The exam room is your classroom. When you’re an effective communicator, you can increase acceptance for professional services and products. Replace artwork of dogs and cats with framed posters on frequently discussed topics of heartworms, age analogy charts and parasite prevalence maps. Use models, websites, dry-erase boards, x-rays, handouts, exam report cards, and videos as teaching tools.

Let’s say you advise a pet owner to give subcutaneous fluids to her cat to treat its kidney disease. Rather than administering fluids in the treatment area, demonstrate it in the exam room. Tell the pet owner, “Let’s give your cat fluids together today, so you will know how to do it at home. You’re welcome to record a video on your smartphone for reference. I also will text you a link to our hospital’s YouTube video on how to give fluids. Giving your cat fluids three times per week will keep her hydrated and let us better manage her kidney disease together.”

 

Invite clients to look in your microscope.

Your ear cytology reveals a cat’s ear mites. Rather than returning to the exam room to explain your diagnosis, tell the client, “Come with me. You’ve got to see these ear mites.” When she peers into your microscope, the pet owner exclaims, “Those look like monsters! No wonder our cat was scratching his ears.” You’ve shared behind-the-scenes magic while guaranteeing compliance for treatment.

 

Show pet owners where procedures will happen.

From discussing dental treatments to orthopedic surgeries, boost clients’ confidence in your procedures with a quick tour. Walk clients through your in-house laboratory, treatment area and surgical suite. Also post a virtual tour on your website. Half of the family may be present for today’s exam and other caretakers can see the same tour online.

Seeing where procedures will be performed may comfort clients who have a fear of anesthesia. Clients will be impressed with the cleanliness and sophistication of your surgical suite. Many may tell you, “Wow, this looks just like a human hospital.”

After presenting the treatment plan and completing the tour, ask, “What questions can I answer about your pet’s dental procedure and our anesthetic protocols?” The phrase of “what questions” invites pet owners to share concerns or get more information. This wording is more effective than the yes-or-no choice of “Do you have any questions?” Once you’ve provided answers, ask clients for commitments to treat. Say, “Do you need more information, or have I explained enough for you to decide?”

If emergency care is being delivered in the treatment area and you can’t do a tour now, have photo books or digital slideshows of procedures. Take a photo of each professional service listed on your treatment plans, from your in-house lab to patients receiving nursing care during recovery.

 

Let clients watch care being delivered.

Laser therapy can be performed in exam rooms with clients present. Seeing treatments helps them understand its benefits and book ongoing therapy.

Clients may be able to observe certain workups. My cat, Caymus, has cardiomyopathy. Dr. Jennifer Lavallee, owner of The Cat Specialist in Castle Rock, Colo., lets me watch when she performs his cardiac ultrasound. She discusses findings and shares ultrasound images. As a result, I’m a compliant client. Consider which procedures and treatments would be appropriate for your clients to witness. Obviously, you don’t want bystanders hovering in your surgical suite or interrupting emergencies.

 

Banish the phrase “in the back.”

You can see clients’ tense reactions when they hear these words. Pet owners may become anxious about what will happen to their animals behind closed doors. Explain where and why patient care will happen such as “I’m going to take your cat to the treatment area where another technician will assist me in collecting his urine sample. We’ll return in about 5 minutes and start the urinalysis, so you have results during today’s exam.” Replace the negative words of “in the back” with “treatment area,” which is more professional and accurately describes your facility.

 

Demonstrating the quality and compassion of your care in front of clients will develop trusting relationships while increasing compliance. Get more training in my online CE class on “Creating the 5-Star Experience in the Exam Room”.

Reference:

*1 –  Klingbord J. Exam Room Communication for Veterinarians. AAHA Press, 2011:27,29,160-162,34-35.

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