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How Nurses Can Grow Your Revenue

How Nurses Can Grow Your Revenue

How Nurses Can Grow Your Revenue

What is the difference between an under- and top-performing healthcare team?

Let’s say you schedule appointments every 30 minutes. In an eight-hour workday, one doctor sees 14 patients and has an average transaction of $160, generating $2,240 in revenue. Your average doctor transaction should be 3.2 to 3.5 times your exam fee, according to the Well-Managed Practice Benchmarks Study.(*1) If you leverage your nursing team and schedule time based on the reason for the visit, you could see 21 patients per day, producing $3,360 per veterinarian and averaging three patients per hour. Revenue rises when you add dental income that nurses deliver.

How can nurses help you grow revenue? Follow these steps:

Check your staff-to-doctor ratio.

Every employee feels the hospital is short-staffed. Chances are, you may have the right number of employees but are not efficiently using them. Aim for staff-to-doctor ratios of 4.7 team members per full-time veterinarian, according to WTA Consultants in Columbus, Ohio. (*2) This support staff includes two nurses, one veterinary assistant, one receptionist, and 0.7 managers.

Assign doctor-nurse teams.

Designate daily which staff will be outpatient nurses (exams) and inpatient nurses (treatment area). Pair two nurses or assistants with each veterinarian. This medical team of three works together the entire day. Define roles and tasks each support employee will perform. Doctors need support from the right person with the right skills at the right time.

Veterinarians should focus on three medical responsibilities:

  1. Diagnose health conditions
  2. Share treatment solutions
  3. Perform surgery and procedures

Nurses do everything else. Think of nurses and assistants as “staff extenders” to perform non-doctor functions such as client education, technical skills, and medical-record management. This approach lets you see 30 percent to 40 percent more appointments in the same amount of time. (*3)

Here are examples of outpatient and inpatient nursing duties:

Outpatient nurse duties

Inpatient nurse duties

Get patients’ vital signs

Collect samples for diagnostic testing prior to doctor entering the exam room

Take brief histories

Run lab work

Educate clients

Take x-rays

Fill medications

Perform dentistry

Be a transcriptionist, writing in medical records while the doctor explains exam findings and diagnoses

Place catheters

Review medication and treatment instructions with clients

Run and monitor anesthesia

Admit and discharge surgical and dental patients

Monitor hospitalized patients

Provide discharge and medication instructions

Administer medications and treatments to hospitalized patients per doctor instructions

Handle nurse appointments

Assist with surgery

(Expand and tailor this list of duties for your hospital.)

State laws vary on which duties credentialed veterinary nurses are allowed to perform. Check your state’s practice act here. You will use three types of nursing teams:

Outpatient nursing team:

You may use two credentialed nurses, one nurse and one assistant, or two assistants. For a 20-minute checkup, Nurse #1 spends the first five minutes gathering a brief history, getting the patient’s vital signs, and explaining services and products that will be delivered today. Confirm the reason for the visit at the beginning of each exam. Say, “I’m <name>, the nurse who will assist Dr. <Name>. For your pet’s checkup, we will do a nose-to-tail exam, vaccines, heartworm/tick screen, intestinal parasite screen, and refill preventatives. I will take a brief history, collect samples for testing, and get your pet’s vital signs. Then the doctor will begin the exam. Does your pet have any health or behavior concerns you want to discuss with the doctor?” If the client shares a concern, this becomes the chief complaint that the veterinarian will address before delivering preventive care. Watch my video on “The #1 Question to Ask to Keep Exams on Time”. Nurse #1 takes the patient to the treatment area where an inpatient nurse or assistant will help collect samples.

When the patient returns to the exam room, the doctor is ready to begin. The veterinarian will spend the middle 10 minutes of the appointment performing the exam, vaccinating the pet, discussing exam findings and test results, and answering the client’s questions. Nurse #1 stays to assist the doctor with the physical exam.

Meanwhile, Nurse #2 is starting the next appointment, allowing the doctor to consecutively work two exam rooms. Nurse #1 closes the first appointment, reviewing preventative or medication instructions and providing client education. This exam work flow lets your team see three or more patients per hour, significantly increasing productivity and income.

Surgical nursing team:

The veterinarian prioritizes today’s surgical cases. A nurse and two assistants support the surgical doctor. The nurse anesthetizes patients, places catheters, monitors patients, assists the veterinarian during surgery, and updates medical records. In the afternoon, the same nurse may discharge patients. Assistant #1 preps patients and moves them into the surgical suite. Assistant #2 recovers surgical patients. The veterinarian changes gloves and follows sterile surgical protocols between each patient. The nursing team calls, emails, or texts clients as each patient is recovered and confirms discharge appointments.

 

Dental nursing team:

By age 3, most dogs and cats have periodontal disease. (*4) Because doctors will diagnose dental disease daily and advise treatment, you want to schedule dental procedures Monday through Friday to meet the demand. The veterinarian performs pre-surgical exams, sets anesthetic protocols, oversees cases, and does oral surgery.

Nurses lead your dental profit center. The dental team includes one nurse and one assistant. The nurse anesthetizes patients, places catheters, and checks the assistant’s work. The assistant takes dental x-rays, cleans and polishes teeth, recovers patients, and updates clients.3 The veterinarian reviews x-rays and performs extractions and oral surgery. While employees will always help teammates when needed, the key to maximum production is simple: Nurses don’t do assistants’ work, and doctors don’t do nurses’ work.3

 

Schedule nurse appointments.

Use nurse appointments for admissions, discharges, and outpatient services that support staff perform. When clients walk in for nail trims and bandage changes, these unscheduled services may put additional stress on your nursing team and cause clients to wait when employees aren’t immediately available. To bring structure to walk-in chaos, create a column for nurse appointments in your schedule just as you have rows for doctor exams. Concentrate blocks of nurse appointments during afternoons and evenings such as 1:30 to 3:00 p.m. and 5:30 to 7:00 p.m.

Avoid nurse appointments for outpatient services during mornings, when your nursing team is preparing for surgical and dental procedures and checking hospitalized patients. Morning nurse appointments are limited to surgical and dental admissions. Let’s say you have six procedures today. Schedule admission appointments every 10 minutes from 7 to 8 a.m. Because doctor exams haven’t started, the assistant will admit patients in the privacy of exam rooms, where clients may comfortably ask medical and financial questions.

Set guidelines for nurse appointments so receptionists properly budget time:

  • 10-minute nurse appointments: Express anal glands, collect blood samples for drug monitoring or follow-up testing, perform intestinal parasite screens, insert microchips, provide Level 1 nail trims (cooperative patients), remove sutures, booster vaccines that don’t require a doctor’s exam, and check the weight of pets on weight-management programs.
  • 20-minute nurse appointments: Change bandages, clean ears, Level 2 nail trim (patient requires two or more nurses), administer subcutaneous fluids, collect urine, and perform laser therapy.
  • 30-minute nurse appointments: Take scheduled follow-up radiographs, provide grooming services for birds, and deliver services for multi-pet nurse appointments.

In my online course, “Be Efficient in the Exam Room,” I share flex-10 and high-density scheduling concepts along with exam flow by job type. Have your medical team evaluate every step of delivering outpatient and inpatient services. Ask, “Why do we do it this way?” and “How could we be more efficient?” When you leverage your nursing team, you can deliver more patient care, better manage your workday for less stress, and enjoy increased revenue.

References:

*1 – Tumblin D. Problem: Your Average Doctor Transition Is Low. Clinicians Brief, January/February 2018. Available at: www.cliniciansbrief.com/article/problem-your-average-doctor-transaction-low. Accessed Feb. 4, 2019.

*2 – DVM360.com staff. Benchmarks 2016 Shows Strong Revenue Growth, Higher Staff Levels. Veterinary Economics; Sept. 7, 2016. Available at: http://veterinarybusiness.dvm360.com/benchmarks-2016-shows-strong-revenue-growth-higher-staff-levels. Accessed Feb. 4, 2019.

*3 –  Catanzaro T. Veterinary Healthcare Services: Options in Delivery. Iowa State University Press, 2000:23-25, 52.

*4 –  American Veterinary Dental College. Periodontal Disease: Information for Pet Owners page. Available at: www.avdc.org/periodontaldisease.html. Accessed Feb. 4, 2019.

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Can You Compete With $12 Per Hour at Chick-Fil-A?

Can You Compete With $12 Per Hour at Chick-Fil-A?

Can You Compete With $12 Per Hour at Chick-Fil-A?

My neighborhood Chick-Fil-A restaurant has a banner advertising jobs starting at $12 per hour. The fast-food franchise boasts a family culture, college scholarships, career paths to management or ownership, and work-free Sundays. Chick-Fil-A ranks among the top 100 in the 2018 Best Places to Work from The Glassdoor Employees’ Choice Awards. (*1) Selling more than chicken, Chick-Fil-A joins other top employers, including Facebook, Google, Apple, Southwest Airlines, Nestle Purina, and more.

I pulled into the ever-present drive-thru line to see what kind of service $12-per-hour workers deliver. Two employees with mobile devices were taking orders to reduce wait time. A Millennial greeted me, asked my name and what they could get started for me. As I drove to the window for my sandwich, the cashier welcomed me by name. When I thanked her, she replied, “It’s my pleasure” rather than the commonplace “no problem.”

Your veterinary hospital may be competing for the same entry-level workers. Indeed, a top job website, reports an average of $12.43 per hour for veterinary receptionists with typical tenure of one to three years. (*2) Job ads offered hourly wages from $13.22 to $20. Now the largest U.S. generation, Millennials rank compensation as the sixth quality they look for in employers. In a Harvard Business Review survey, Millennial job candidates want the opportunity to learn and grow, quality management, interest in the type of work, and opportunity for advancement. (*3)

 

To compete for entry-level workers, your veterinary hospital needs to:

1. Offer competitive wages.

Low unemployment rates in your community demand higher compensation. Profit sharing and bonuses can increase what employees take home. Give performance reviews to new hires at 30, 60 and 90 days. Once they complete the 90-day introductory period, include salary reviews with performance appraisals. You might hire candidates at $13 per hour, and then tell them a raise to $14 awaits if they complete the training program and earn a positive review.

 

2. Create a supportive culture.

Northfield Veterinary Hospital in Denver complements great pay with a great work environment. Perks include amusement park days, monthly staff dinners, a supportive team environment, and no staying late. “I’m an owner at the hospital and having a certified veterinary technician who has worked in the trenches for many years is appealing to staff,” says Jen Weston, CVT, manager and co-owner. “We have a great staff who are willing to train, answer questions and be supportive.”  At Trinity Animal Hospital in Holly Springs, N.C., the team goes bowling and plays laser tag, which its vendors sponsor.

American Animal Hospital in Omaha, Neb., conducts working interviews to prove its culture is the best in town. “We show candidates our friendly, positive work environment,” says Tabitha Show, LVT and practice manager. “Without a strong culture, you have nothing.”

 

3. Train up.

The staff of 30 at Roanoke Animal Hospital in Roanoke, Texas, has an average longevity of 8 years, with several employees staying longer than 10 years. “If you work in the kennel and have a desire to progress in this field, we will train you,” says Liz Hill Bird, hospital administrator. Teaching kennel workers to become veterinary assistants leads to job satisfaction and career paths.

 

4. Create clear career paths.

At Adobe Veterinary Center in Tucson, Ariz., Dr. Christine Staten designed tiered positions for receptionists and technicians. Employees get a list of skills to master for each level with test-outs. Pay increases as team members graduate to higher tiers.

 

5. Provide continuing-education opportunities.

Conferences are awesome perks, but few practices can spend thousands for every employee. Start a journal club where you share and discuss client-service and management articles. Use webinars for staff meetings. Go to community events that distributor and pharmaceutical representatives host. Join a local practice managers group. Have doctors present what they learned at conferences and which ideas your team could implement.

 

6. Delegate projects.

Employees may be interested in marketing the practice on social media, making YouTube videos, designing educational bulletin boards, managing inventory, establishing an angel fund, and other projects that could grow your business. “Train them for new skills,” advises Nikki Richardson, hospital administrator at Trinity Animal Hospital. “Team member retention and low turnover will make you more money in the long run.”

 

7. Offer flexible schedules.

If your practice is open 8 a.m. to 6 p.m. Monday through Friday, you need staffing for 10 business hours each day. Consider allowing employees to work four 10-hour shifts for a total of 40 hours per week. One receptionist works Monday through Thursday while another covers Tuesday to Friday. Organize shifts so you have appropriate daily staffing coverage while letting employees enjoy four-day workweeks.

 

8. Provide veterinary care savings.

Follow IRS guidelines of no more than a 20 percent discount, or you risk audit and tax consequences. Define limits on the number of personal pets covered and have a manager enter charges to prevent abuse of the benefit. Some practices pay employees’ pet insurance premiums in lieu of discounted professional services.

 

9. Have uniforms.

Employees represent your brand. Set standards of appearance for uniforms, name tags, jewelry and personal grooming. The employee handbook at Taco Bell explains, “It’s important to be proud of the way you look every day. When you look good, Taco Bell looks good.” (*4)

 

While helping pets and people leads to tremendous job satisfaction, altruism won’t pay the bills. A combination of competitive wages and great perks will help your veterinary hospital attract and retain the best candidates.

References:

*1 – 2018 Best Places to Work: Employees’ Choice. Glassdoor. Accessed March 16, 2019 at www.glassdoor.com/Award/Best-Places-to-Work-LST_KQ0,19.htm.

*2 – Veterinary receptionist salaries in the United States. Updated Feb. 17, 2018. Accessed Feb. 19, 2018 at www.indeed.com/salaries/Veterinary-Receptionist-Salaries.

*3 – Rigoni, B. and Adkins, A. What Millennials Want from a New Job. Harvard Business Review. Published May 11, 2016. Accessed Feb. 19, 2018 at https://hbr.org/2016/05/what-millennials-want-from-a-new-job.

*4 – Taco Bell Handbook. Published October 2015. Accessed Feb. 19, 2018 at www.hralliance.net/cofiles/38305_c6131950/files/Taco%20Bell%20Handbook(1).pdf.

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Could a Bad Phone Call Cost Your Clinic $11,000?

Could a Bad Phone Call Cost Your Clinic $11,000?

Could a Bad Phone Call Cost Your Clinic $11,000?

On a busy Saturday morning, a price shopper calls your veterinary clinic and asks, “How much are shots for a new puppy?” With three clients already holding, the frazzled receptionist says, “We’re really busy right now. Can I call you back in 10 minutes?” The price shopper responds, “No thanks, I’ll try another animal hospital.”

The caller phones a neighboring veterinary hospital with a friendly receptionist who answers questions and books the puppy’s first exam. Quick and welcoming service earned the second hospital nearly $11,000 in lifetime preventive care for the puppy—and the new client has three dogs.

A new client who visits today with an 8-week-old puppy and returns for preventive care over the dog’s 12-year lifespan will spend thousands with your practice. Based on average fees from the AAHA Veterinary Fee Reference, 10th edition, here is an overview of preventive care spending for one new canine patient: (*1)

Preventive care servicesAverage paid per visit# of times deliveredSubtotal
Puppy$1203$360
Adult, age 1 to 6$1256$750
Senior, age 7 and older$1866$1,116
Dental treatments$51610$5,160
Heartworm, flea/tick preventatives annual cost
 (Average of $25 per month)
$30012$3,600
TOTAL$10,986

The practice would receive additional income if the dog needed additional care for emergencies, a therapeutic diet, long-term drugs, ear infections, spay/neuter, illness or chronic conditions. According to the American Veterinary Medical Association’s (AVMA) U.S. Pet Ownership Statistics, 37% of households own dogs while 30% own cats. (*2) Dog owners average 1.6 dogs while cat owners have 2.1. You can estimate the number of pet owning households and number of pets in your community with the AVMA’s pet ownership calculator.

This receptionist’s failure to welcome a new client may have resulted in lost medical care for multiple pets. Practice owners and managers need to invest in telephone training so receptionists can confidently respond to price shoppers, no matter how busy the day gets. Here’s how to handle shopper calls during peak call volume times:

1. Ask if the caller can hold.

Price shoppers often call before or after work, during lunch breaks and on Saturdays—so you will always be busy when potential new clients contact your hospital. Never offer to call the price shopper later. Even if you return the call within 10 minutes, she will call another clinic. Say, “Are you able to hold for a moment? We’d love to share information on what your new puppy will need.”

2. Cross-train your entire team.

If the front desk is flooded with a tsunami of calls, they need to reach out to managers, technicians and assistants who can pitch in for 5 to 10 minutes until the wave of calls passes.

Designate a staff member as a floater who can work at the front desk as well as assist in exam rooms. Because the floater is cross-trained, she can float between the areas of the hospital where demand is the greatest. For example, the floater might help manage calls when one receptionist takes her lunch break and then assist with evening surgical and dental discharges when patient pickup volume is high.

Cross-train receptionists, technicians and managers on how to convert phone shoppers into new clients and provide sample scripts and scenarios.

3. Install a wireless doorbell for front-desk staff to holler, “HELP!”

Animal Hospital of Richboro in Richboro, Penn., has a wireless doorbell at the front desk with a chime in the treatment area. When receptionists get a tsunami of calls, they ring the doorbell to alert technicians that they need an extra set of hands. Having an assistant or technician pitch in for five or 10 minutes lets clients experience prompt service and relives stress on the front-desk team. Buy wireless doorbells from hardware or home-improvement stores for $20 to $60.

To sustain a growing practice, a small animal hospital needs 25 new clients per full-time-equivalent veterinarian each month. (*3) A two-doctor practice should target 50 new clients per month or 600 annually. The practice manager should monitor new client numbers monthly to identify trends.

If your hospital is not achieving the benchmark of 25 new clients per doctor per month, you need to provide phone-shopper training and evaluate marketing programs. Track the source of new clients in your practice-management software so you know which marketing programs are delivering results. If most of your new clients are coming from Internet searches, invest more dollars in search engine optimization to get top Google rankings as well as positive online reviews.

When interested pet owners contact your hospital, you need well-trained employees who can respond with friendly attitudes and book more new client exams. Price shoppers are not checking prices—they are looking for long-term relationships. Shoppers are seeking a veterinarian who they can trust whether their pets need preventive care, are sick or require emergency care. Pet owners stay with a veterinary hospital an average of five years, according to the Well-Managed Practice Study from WTA Veterinary Consultants. (*4)

Look beyond one price shopper call. What will you do to welcome more new clients who will seek at least five years or perhaps a lifetime of care from your practice?

References:

*1 – AAHA Veterinary Fee Reference, 10th edition, AAHA Press 2018:39,47,48,99.

*2 – U.S. Pet Ownership Statistics. Available at www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-pet-ownership.aspx. Accessed March 27, 2019.

*3 – Glassman, G. Q&A: When to add an associate to your team. Veterinary Economics: March 2010. Available at http://veterinarybusiness.dvm360.com/vetec/article/articleDetail.jsp?id=660456. Accessed March 27, 2019.

*4 – Tumblin, D. Client visitation and retention. Veterinary Economics: March 2006. Available at: http://veterinarybusiness.dvm360.com/client-visitation-and-retention. Accessed March 27, 2019.

 

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