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create efficient dental schedules

create efficient dental schedules

create efficient dental schedules

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

A distraught technician explained that her hospital schedules 14 dental procedures per day, and she’s worried about her health. After four procedures in a row, her arm goes numb. The technician sought advice from conference speaker Mary L. Berg, BS, LATG, RVT, VTS (Dentistry) of Beyond the Crown Veterinary Education in Lawrence, Kan., and author of Dental Radiographs Made Easy and Companion Animal Dentistry for Veterinary Technicians.

Avoid overcrowding dental schedules, which can put patient and technician health at risk. “If a practice wants to embrace dentistry, they can’t schedule eight or more per day because they will do poor procedures,” advises Berg. “Take time to look for disease, take radiographs, and address problems.”

Teams can be more efficient with smart scheduling and setting clients’ expectations. Here’s expert advice:

budget enough time

Rushing to complete procedures can leave some disease untreated, Berg warns. The 2019 AAHA Dental Care Guidelines for Dogs and Cats provide a 12-step protocol for oral health assessment, dental cleaning, and periodontal therapy.

Create scheduling guidelines for client service representatives (CSRs) and other employees who book procedures. Berg shares estimated procedure times based on the stage of periodontal disease. Procedure times are “table time” from induction to the start of recovery and include taking radiographs and performing some extractions. Patient preparation and recovery time are additional. Multiple and/or difficult extractions also will increase times.
  • Stage 1 procedure: 1 hour
  • Stage 2 procedure: 1 to 1 ½ hours
  • Stage 3 procedure: 2 to 2 ½ hours
  • Stage 4 procedure: 3 hours

Let’s say the dental team will perform procedures from 9 a.m. to 1 p.m. for four hours of procedure time. The team could do four Stage 1 procedures, two Stage 2 procedures, or one Stage 1 and one Stage 4 procedure. Berg advises limiting to two Stage 3 or 4 procedures per day.

If the procedure will require more than three hours, consider staging care, Berg suggests. The first procedure is a dental cleaning while the second is oral surgery about a week later. Debra Bohnke, DVM and medical director of Cimarron Animal Hospital in Tucson, Ariz., explains in her blog that staging dental treatments also spreads out expenses for clients.

“Seventy-five percent of dogs and cats have more dental disease than can be detected when pets are wake because they don’t let anyone do a thorough 360-degree tooth-by-tooth examination while they are awake,” Dr. Bohnke writes. During the first procedure, Dr. Bohnke calls the client to explain any additional treatments and extractions. She discusses doing everything at once or delaying care along with an appropriate timeline based on the severity of disease. If staged care is performed within the time specified, Cimarron Animal Hospital offers an $85 credit toward the second anesthesia.

ASSIGN A DENTAL TEAM

Use two to three technicians and assistants based on your staffing levels, Berg advises. An anesthesia technician does hands-on patient monitoring and watches electronic monitoring equipment. “Don’t rely on electronic monitors only,” Berg warns. Periodically use a stethoscope as a doublecheck. The second teammate is a dental technician who completes an oral examination, takes full mouth dental radiographs, and performs the procedure. An optional third member is a veterinary assistant who available to assist the dental technician with charting and radiographs.

SET THE ORDER OF PROCEDURES FOR DOCTOR AVAILABILITY

Don’t schedule an orthopedic surgery at the same time as a Stage 4 dental procedure, which will require the doctor’s time simultaneously. Veterinarians will perform most oral surgeries. Consult your state board of veterinary medicine on which duties technicians and veterinary assistants may or may not perform, including extractions.

A smart scheduling approach is to have the doctor performing a spay, neuter, or shorter surgery while the dental team is doing Stage 3 and 4 procedures.
 

SET clients’ expectations when booking procedures

Clients at VCA Sheridan Animal Hospital & Veterinary Specialists of Western New York in Buffalo, N.Y., get an admission process sheet upon scheduling. Instructions explain what to do or not do 10 days before the pet’s procedure, the day before, what to bring, and what to expect on procedure day. Download the form.

The admission process sheet tells clients they will get preadmission calls the day prior, which will last 10 minutes. Hospital Manager Holly Monroe says a triage technician calls clients with CSRs as backup. Questions are prepopulated in electronic medical records based on the type of procedure and patient history. All clients are asked if pets have taken any medication within 24 hours, including NSAIDs, fish oil, or aspirin; any issues to be aware of before procedures; who will bring the pet; confirm vaccines are up to date; and discuss any additional services. A client with a diabetic pet will be asked about the brand of insulin, how much is given, when the last dose was administered, when the pet will eat, and when the next insulin dose will be due. Clients receive individual treatment plans and anesthetic consents by email or through the MyVCA App, which allows digital signatures.


The admission process sheet and preadmission calls have cut surgical and dental check-in times in half. “This has helped the admission process in so many ways,” says Monroe. “We can admit six to seven clients smoothly and quickly. Medical records are more thorough. Every staff member is asking consistent questions. We have fewer no-shows. It’s been a huge deal for us. The more communication you have with your clients, the better.”

Clients also pay 75% of the treatment plan upon booking. Watch my video on “Stop Saying Deposit! Say This.”

HAVE PREOPERATIVE APPOINTMENTS

Suffolk Veterinary Group Animal Wellness & Laser Surgery Center in Selden, N.Y. created preoperative appointments to avoid surprises on surgery days. “Our veterinarian was tired of not knowing what type of surgery he was walking into that day,” explains Practice Manager Nicole Carucci-Winkler, LVT. New clients would call, schedule surgery, and drop off patients. “We’d have no idea who these people were, who patients were, and what, if any, contraindications to surgery there might be,” says Carucci-Winkler. “A canine neuter could be a 5-pound Yorkie with a portal-systemic liver shunt. You want to know about the shunt prior to surgery, not the morning of surgery. No human doctor would do surgery on a patient without a preoperative appointment. Why should a veterinarian be required to?”


Preoperative appointments are with a veterinarian and licensed veterinary technician (LVT). Before the preoperative appointment, the LVT contacts the referring or previous veterinarian for medical records, reviews and audits patient history, checks vaccination status, and writes a case summary for the veterinarian. The doctor examines the patient to establish a veterinary-client-patient relationship (VCPR), which is required by state law and the AVMA.

“Introducing the LVT as part of the surgical team helps build clients’ trust and educates the public about who an LVT is and the importance of his or her role in veterinary medicine,” Carucci-Winkler says.

During the preoperative appointment 10 to 14 days before the procedure, the doctor and technician explain the procedure, fees, third-party financing, and expected outcomes along with possible complications and post-operative care. The technician collects blood and urine samples to send to its reference lab.

You don’t want abnormal results the morning of the procedure such as the patient with a portal-systemic shunt, Carucci-Winkler explains. “You don’t want to call the client while she’s at work or otherwise occupied and tell her you’re cancelling surgery because blood work indicates the patient needs additional diagnostics before you would put it under anesthesia,” she says.

Preoperative appointments let the team choose appropriate dates and times based on the type of procedure. Clients sign treatment plans and anesthetic consents in advance. When patients are admitted for procedures, clients just sign to acknowledge they are admitting the patient and confirm contact information for today.

Talk with your team about ways to streamline admissions, budget procedure time, and set clear expectations for clients. You and your clients deserve smooth, efficient check-ins.

WANT TO LEARN MORE? 

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How to Handle Late Clients

How to Handle Late Clients

How to Handle Late Clients

How to Handle Late Clients

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

You’ve heard the excuses: “I got stuck in traffic.” “I had to crawl under the bed to catch my cat and wrestle to get him in the carrier.” “I was in a meeting at work that ran late.” Whatever!

When one client runs late, it causes a domino of late starts for the remaining appointments. Multiple consequences happen: 1) Your team looks disorganized, 2) Late arrivals increase wait times for on-time clients, and 3) Your medical team feels rushed.

With current out-of-control appointment demands, you must be the boss of your schedule. You want to be able to give each client and patient the full amount of time set aside for their appointments. Let me share options to handle clients who are late for appointments.

CREATE A LATE POLICY.

While clients may occasionally show up late, habitually tardy clients disrespect your time and services. You can prevent this bad behavior.

Just as your hospital has a financial policy, have a late and no-show policy that holds clients accountable and sets expectations in a professional, respectful way. Add the policy to your new client registration, online patient history forms, and online or app scheduling tools.

Here is a sample late policy: “We ask you to arrive before your scheduled appointment time so you may benefit from your full exam time. New client and patient history forms should be completed in advance to help our medical team prepare for your pet’s visit. A grace period of __ minutes will be granted for unforeseen delays that you may encounter while traveling to our hospital. If you arrive more than __ minutes late for an appointment, we will offer options of being seen as a work-in, day admission, or rescheduled if our schedule permits. We strive to ensure clients and patients are seen in a timely manner and appreciate your on-time arrival. Clients who have three or more late arrivals for appointments cannot schedule future appointments and will only be seen as emergencies or day admissions. Additional fees will apply.”

Start with a warning on the first offense.

Explain, “I understand that you were 15 minutes late to your appointment today. We want you and your pet to benefit from the full exam time with our medical team. To best serve you, please be on time for future appointments. We send confirmations upon booking and reminders two weeks, four days, and two days before your exam. Let me confirm that we have your correct cell number for texts and your email. We appreciate your timeliness so we can give all patients the time they need.”

put alerts in your practice-management software.

Track the number of times that a client is tardy to identify when a one-time occurrence becomes a chronic behavior. I follow a “three strikes and you’re out” policy. Forgive a first offense. You’ve been unexpectedly delayed in traffic, too. When you see three late arrivals within one year, decide whether to keep or end the client relationship. Allowing the chronic behavior to continue is your fault.

text clients when they are 5 to 10 minutes late.

This puts you in control and lets you determine options for the late arriving client. If you see appointments every 15 minutes, send the text when the client is 5 minutes late. For 30-minute exams, reach out when the client is 10 minutes overdue. Send this text: “We expected to see you at 3 p.m. for Max’s appointment. Reply YES and your expected arrival time if you’re on the way here, or RS to reschedule.” Obviously, clients should follow laws about not texting while driving.

show appreciation when clients call ahead to explain, “hey, i’m running late.”

This is honest and conscientious behavior. Reply, “Thanks for calling to let us know. What time will you arrive?” If you get a vague response of “I’m leaving my house now,” ask again, “What time will you arrive at our hospital?” Reply with, “Thanks for letting us know. Please drive carefully. We look forward to seeing you soon.”

Don’t make promises over the phone. If the client is 25 minutes away and has a 30-minute appointment, only 5 minutes of exam time will remain. Explain, “Once you get here, I will let you know options for us to see your pet today.” Never punish on-time clients by letting a late client cut in front of them.

Once the client arrives, look at your options.

Option 1: If the client arrives a few minutes late with three-fourths of the appointment time remaining, go ahead and see the patient (20 minutes of the 30-minute appointment remain). Alert a technician or assistant who can start the appointment now and help get the schedule back on track.

Option 2: See another doctor if one is available. Explain, “Dr. Jones has started his next appointment. Dr. Smith can see you now. Let me take you to Exam Room 3.” Unfortunately, every veterinarian at your hospital is likely fully booked with the current appointment demand. This option may be a rare choice.

Option 3: Ask if the client can wait and be seen as a work-in. Explain, “Dr. Jones has started his next appointment. We want Max to get the care he needs. We will see Max as soon as the first doctor becomes available, which may be 45 or more minutes. Are you able to wait, or do you prefer to reschedule?”

Option 4: Offer to reschedule. Use the yes-or-yes technique, focusing on what you can do. Say, “My next available appointment is <date, time 1> or <date, time 2.. Which do you prefer?”

Option 5: Offer a day admission. Never use the term “drop-off,” which is tacky and unprofessional. Explain, “We can see your pet as a day admission. For 10 to 15 minutes, you will meet with a technician who will get your pet’s vital signs, ask questions about your pet’s symptoms to share with the doctor, set a pickup time, and provide the expected cost of care. Because your pet will stay with us throughout the day and receive nursing care, there is a day admission fee of $XX. Shall we admit your pet to the hospital, and have you talk with the technician?”

I advise charging a 1- to 12-hour hospitalization or boarding fee to cover the cost of nursing care. The Veterinary Fee Reference, 11th ed., reports an average fee of $48.94 for hospitalization without an IV and no overnight stay (day hospitalization) for a 25-pound dog, $49.97 for a 60-pound dog, and $47.28 for a cat. [1] Boarding fees for 30- to 60-pound dog in a medium run average $27.29 while cat boarding is $21.07. For consistency and simplicity, I suggest creating a flat rate for day admissions such as $50. This day admission fee is charged in addition to the exam fee and other services delivered.

Options to see late-arriving clients will vary based on your schedule in that moment. You may only have one option or all five available. When a late client arrives at your hospital, your goal is to be a problem solver. You’ll hear words of thanks from the client for making care happen.

When you set clear expectations and follow your late policy, you will stand up for your time, your schedule, and your employees’ mental health. Remember, you train your clients how to treat you.

WANT TO LEARN MORE?

Enroll your team in the 1-hour course: Secrets to Keep Exams on Time.

Reference:

[1] The Veterinary Fee Reference, 11th, AAHA Press:2020; 245, 264, 248, 104, 105.

 

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4 ways to end the no-show crisis

4 ways to end the no-show crisis

4 ways to end the no-show crisis

4 ways to end the no-show crisis

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

No-show rates have reached crisis proportions. More than half of hospital managers are reporting higher no-shows, with most being new clients, according to a Veterinary Hospital Managers Association (VHMA) study.[1]

Besides the frustration of empty appointments, no-shows cost your hospital thousands. Before the pandemic, the average no-show rate was 11 percent.[2] Let’s say one full-time veterinarian sees 3,000 appointments per year and has an average doctor transaction (ADT) of $180. If one doctor has 330 no-shows per year (3,000 appointments x 11 percent), he risks losing $59,400 annually ($180 ADT x 330 appointments). If your hospital has three full-time veterinarians, no-shows cost you $178,200 annually.

Let me share four ways to end your no-show crisis:

STRATEGY 1) CONFIRM APPOINTMENTS EARLIER AND MULTIPLE TIMES.

Don’t wait until the day before appointments or procedures to remind clients. You will get deadbeat no-shows.

Send a series of four confirmations by text, app, or email:

  • Confirmation 1: Immediately after appointment is booked
  • Confirmation 2: 2 weeks before appointment
  • Confirmation 3: 4 days before appointment
  • Confirmation 4: 2 days before appointment

Texts trump email confirmations because texts have a 99 percent open rate and 95 percent of messages get read within 3 minutes of being sent.[3]

Healthcare emails have a significantly lower open rate of 33 percent.[4] Here are text templates for the series of four confirmations for new and existing clients. 

Send the first confirmation immediately after appointments are booked. This allows clients to add appointments to their smartphone calendars and to turn on travel time alerts, so they arrive on time for exams. 

Confirmation 1 text template for new client appointments: We’re excited to meet <pet name> at <time, date>. Complete new client form at <link> at least 24 hours before the exam, which is required to guarantee your appointment. Email medical records to records@yourveterinaryhospital.com. Bring a stool sample that is fresh within __ hours. Download our app <link> to pay after the exam. Get driving directions at <link>. Reply C to confirm or RS to reschedule.

Confirmation 1 text template for existing client appointments: <Pet name> has an appointment at <time, date>. Complete patient history form at <link> at least 24 hours before the exam, which is required to guarantee your appointment. Bring a stool sample that is fresh within __ hours. Download our app <link> to pay after the exam. Reply C to confirm or RS to reschedule. 

Your website should have new client and patient history forms based on the reason for the visit. Use different patient history forms for checkups, illnesses, progress exams, technician appointments, day admissions, and new puppy/kitten exams. Get examples of online forms from Lake Road Animal Hospital in Horseheads, NY at https://lakeroadanimalhospital.com.  

Clients will take 20 minutes to complete most pen-and-paper forms compared to less than 10 minutes for online forms.[5] Your hospital’s online forms will have required fields. Ask your website provider to design your online forms or use website form makers such as www.jotform.com and www.formstack.com. Clients will click a “submit” button after the form is complete. Data will be emailed to a specific email at your hospital such as records@yourveterinaryhospital.com. This allows you to quickly locate completed forms and add data to electronic medical records. 

The second confirmation is sent two weeks before exams. Many hospitals are booking three to six weeks out, so your second confirmation ensures clients are still committed to showing up as appointments near. 

Confirmation 2 text template for new client appointments: <Pet name> has a new patient exam at <time, date>. Please confirm this still works for you. Complete new client form at <link> at least 24 hours before the exam, which is required. Email adoption or medical records to records@yourveterinaryhospital.com. Reply C to confirm or RS to reschedule. 

Confirmation 2 text template for existing client appointments: <Pet name> has an appointment at <time, date>. Please confirm this appointment still works for you. Complete patient history form at <link> at least 24 hours before the exam, which is required. Reply C to confirm or RS to reschedule. 

The third confirmation is sent four days before the appointment. 

Confirmation 3 text template for new client appointments: This is a friendly reminder that <pet name> has a new patient exam at <time, date>. Remember to complete new client form at <link> at least 24 hours before the exam, which is required. Email adoption or medical records to records@yourveterinaryhospital.com. Reply C to confirm or RS to reschedule. 

Confirmation 3 text template for existing client appointments: This is a friendly reminder that <pet name> has an appointment at <time, date>. Remember to complete patient history form at <link> at least 24 hours before the exam, which is required. Reply C to confirm or RS to reschedule. 

The fourth and final confirmation is sent two days before the appointment. The message has urgency for the client to confirm and complete an online form. 

Confirmation 4 text template for new client appointments: We’re excited to meet <pet name> for a new patient exam at <time, date>. Complete new client form at <link> TODAY, which is required to keep your appointment. See you soon! 

Confirmation 4 text template for existing client appointments: We will see <pet name> for an appointment at <time, date>. Complete patient history form at <link>, which is due TODAY and is required to keep your appointment. See you soon!

STRATEGY 2) require clients to complete online forms to guarantee their appointments.

During scheduling calls, tell new clients that the form requests important contact and medical history information, which your medical staff will need. Text and email confirmations will include a link to this online form (see templates above), which must be submitted at least 24 hours before exams. Use a similar approach with existing clients, asking them to complete a patient history form based on the reason for the visit.

STRATEGY 3) CONTACT CLIENTS WHO HAVE NOT CONFIRMED OR COMPLETED FORMS 2 DAYS BEFORE THEIR APPOINTMENTS.

Tell first-time clients that you must receive their completed new client forms by the end of the day, or their appointments will be “released to another patient in need.” This phrase is better than the term “cancelled.” Remind existing clients to submit a patient history form to guarantee their appointments.

STRATEGY 4) CANCEL APPOINTMENTS IF CLIENTS HAVE NOT CONFIRMED AND/OR FORMS HAVE NOT BEEN SUBMITTED.

Call clients who haven’t confirmed and/or returned forms the day before exams. Say this: “We have reserved an appointment for <pet name> at <time, date>. We are experiencing increased appointment requests and have other patients on a waiting list. We need your confirmation and online form submitted by X p.m. today or <pet name>’s appointment will be released to another patient in need. Please text/email/call us with questions.” 

IMPORTANT: If you leave voicemails for clients, send texts or emails as backup communication in case clients don’t check their voicemail. Research shows 19 percent of millennials never check their voicemail.[6]

If clients don’t confirm and/or submit forms by the end of the business day, send texts or emails to inform them that their appointments have been cancelled. 

Text template for cancellations: We regret that we have not received your confirmation and/or online form, which is required to guarantee your pet’s exam. Your appointment on <time, date> has been released to another patient in need. To reschedule, click here <link> to book online or download our app <link>.

While you may be tempted to collect deposits for new client appointments, don’t. You’ll create the impression that your hospital is “all about the money,” start new relationships with sour experiences, and risk negative online reviews. You’ll also need to create a deposit policy to define whether deposits are refundable or non-refundable, which cancellation reasons will be accepted, and how far in advance appointments must be cancelled. The VHMA study found only 10 percent of hospitals collected deposits for new client appointments. 

When you implement my four strategies, you will get to zero no-shows. Ultimately, you will cancel appointments if clients don’t confirm or submit online forms. Be the boss of your schedule. This uncompromising approach lets you end empty appointments when other patients could have received needed medical care.

WANT TO LEARN MORE?

Enroll your team in the 1-hour course: When Clients Behave Badly: DO THIS.

References:

[1] Felsted K. Client No-Shows: Frequency, Deposits and Fees. Insiders Insights. Veterinary Hospital Managers Association. Available at: https://cdn.ymaws.com/members.vhma.org/resource/resmgr/insiders__insight_2020/VHMAInsidersInsightNovember2.pdf. Accessed Nov. 22, 2021.

[2] What Pesky No-Shows Actually Cost Your Veterinary Practice. Pet Desk. Available at: https://petdesk.com/blog/what-pesky-no-shows-actually-cost-your-veterinary-practice/. Accessed Nov. 17, 2021.

[3] Burke K. 107 texting statistics that answer all your questions. Text Request. Updated Jan. 24, 2019. Available at: www.textrequest.com/blog/texting-statistics-answer-questions/. Accessed May 19, 2020.

[4] Brudner E. Email Open Rates by Industry: See How You Stack Up. Published June 14, 2019. Available at: https://blog.hubspot.com/sales/average-email-open-rate-benchmark. Accessed Jan. 19, 2022.

[5] 6 myths about online patient forms debunked. PatientStudio. Available at: https://patientstudio.com/6-myths-about-online-patient-forms-debunked. Accessed Oct. 20, 2021.

[6] Svyrydenko A. Why Millennials Love Texting. TextMagic. Published May 9, 2019. Available at: https://www.textmagic.com/blog/why-millenials-love-texting-infographic/. Accessed Nov. 17, 2020.

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How to Prevent No-Shows

How to Prevent No-Shows

How to Prevent No-Shows

How to Prevent no-shows

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

His frustration had reached the boiling point. After three no-shows this week, a veterinarian asked me if he should start asking clients to prepay for surgeries. While I empathize with his angst, don’t punish 99.9 percent of good clients for a few bad apples. Imagine you are a client of 12 years who now has to pay before services get delivered. You might get so mad that you leave the practice. Instead, use these proactive techniques to prevent no-shows:

Text or email appointment confirmations immediately after booking.

A client schedules a spay one month from today during her puppy’s last checkup. If you wait until the day before the procedure to remind her of the surgery and fasting instructions, you chance that she may forget or need to reschedule. When she books today, immediately text or email an appointment confirmation that she may add to her calendar. Set up appointment confirmations in your practice-management software or third-party apps. Text: “<Pet name> has a surgical admission appt on <date> at <time>. Reply C to confirm or RS to reschedule.” If a client replies RS, call to have her select a new time and date.  

This double confirmation at the time of booking reiterates the importance of the exam or procedure. My dentist does this. When I booked my next hygiene appointment, I got a text on the elevator ride to the parking garage. I added the appointment to my calendar before I unlocked my car.

Confirm earlier and multiple times. 

Don’t wait until the day before appointments or procedures to remind clients. Set up a series of confirmations and reminders: 1) Upon booking, 2) Four days before the appointment or procedure, 3) Two days ahead, and 4) The day of the appointment, reminding of fasting instructions for procedures or bringing stool samples for checkups. 

Gather new client information during scheduling calls. 

Go beyond collecting a name and phone number. When scheduling, take 2 minutes to enter the client and patient names, address, email, cell number, and patient breed and birthdate. You’ll avoid the negative experience of “clip-boarding” a new client when you hand her a registration form at check-in while she struggles with her Jack Russell terrorist on a retractable leash. You’ll suck away valuable exam time with busy paperwork. Because you have gathered the majority of client contact information during the scheduling call, you’ve established a “know, like, and trust” relationship. 

Perform preanesthetic testing when clients book procedures. 

If you diagnose my cat with dental disease on Wednesday and I schedule treatment for Friday, collect blood and urine samples for preanesthetic screening today. This lets you choose the most cost-effective diagnostics from the reference lab or in-house testing. The client pays for lab tests today, reassuring she will show up two days later for the procedure. Your nursing team also will appreciate one less task to perform the morning of the dental treatment. 

Have clients sign anesthetic and surgical consents before booking. 

Let’s say you diagnose dental disease and explain the need for treatment. The client agrees. Get signatures on the treatment plan and anesthetic consent form today. You’ll dodge the time-suck of paperwork and get written commitment to show up. 

An alternative is use text and email together. When you confirm the surgery two days in advance, text the client: “See you Friday at 8 a.m. for <pet name>’s surgical admission. No food after 10 p.m. Water is OK. We emailed surgical forms to <email>. Reply with questions.” The text prompts the client to check her email, where you can provide detailed fasting instructions and attach consent forms and treatment plans.

Your email message would say, “We will see <pet name> for surgery on Friday at <Your Veterinary Hospital>. Please withhold food after 10 p.m. tonight. Water is OK to drink to prevent dehydration. Your surgical admission begins at 8 a.m. with a nurse, who will spend 15 minutes reviewing the consent form, answering your questions, and getting phone numbers where we may reach you the day of the procedure. I’ve attached your treatment plan and anesthesia consent forms. To speed your admission, please bring these signed forms with you, or we are happy to answer questions during check-in. Please allow at least 15 minutes for <pet name>’s admission to our hospital. If you have questions, call or text 555-555-5555.” 

Text driving directions to new clients. 

When you confirm exams two days in advance, text: “We’re excited to meet you and <pet name> on Friday at 4 p.m. Bring a stool sample that’s fresh within 4 hours. Get driving directions at <link>.” When new clients click the link on their smartphones, map apps will give them estimated travel time along with turn-by-turn directions. You’ll enjoy on-time arrivals and create “wow” first impressions. 

Send a final text or email confirmation the day before appointments and procedures. 

Text the client: “We will see <pet name> tomorrow for an appt with Dr. <Name> beginning at 9 a.m.” The word “beginning” trains the client to be in your lobby at exam time, not down the street at Starbucks (unless she’s fetching you a pumpkin spice latte!). 

Mail thank-you cards after the first visit. 

This is the first date that starts a lifetime relationship. Don’t default to a templated email or text that will get scanned and deleted. People receive hand-written greeting cards in the mail on birthdays, holidays, or anniversaries. Make the new client appointment a standout occasion. Have the doctor and hospital manager sign the card and add a personal message such as “We loved meeting your kitten, <pet name>, and look forward to watching him grow up!”

Start no-show strategies today.

A dog owner may spend nearly $700 for a checkup that includes an exam, vaccines, diagnostics, and 12 months of flea/tick and heartworm preventatives. Surgical and dental procedures may have even higher dollar values to your practice. Stop the anxiety of whether clients will show up as promised. Reclaim the confidence that you’ll have long-term, loyal relationships with these approaches.

Author: Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

 

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Avoid a Meltdown When Dr. Popular Isn’t Available

Avoid a Meltdown When Dr. Popular Isn’t Available

Avoid a Meltdown When Dr. Popular Isn’t Available

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

A longtime client calls and requests and appointment with Dr. Popular. While this veterinarian is blessed to be busy, you don’t want clients to have meltdowns when they can’t see their preferred doctor. What should you do? 

focus on what you can do.

Don’t tell the pet owner that the doctor is booked three weeks out because it will create a negative impression and could incite an argument. Say, “Dr. Popular’s next available appointment is Aug. 30 at 9 a.m. If your pet needs to be seen sooner, Dr. Next could see you tomorrow at 4 p.m. Which do you prefer?” 

practice forward booking.

When clients want their first choice of time, day, and doctor, have them book the next appointment during today’s exam. Use forward booking for progress exams, checkups, and disease-management exams for pets with chronic health conditions.  

When wrapping up today’s exam, Dr. Popular should introduce the concept of forward booking. If you have computers in exams rooms, he should schedule it now (Yes, the veterinarian needs to know how to use the scheduling tool in your practice-management software). Here are two examples of client conversations: 

For a disease-management exam, explain the “why” behind the change in the frequency of exams and use benefit statements. Dr. Popular would say, “Because Molly was diagnosed with arthritis today and will begin long-term medication, I will need to see her every six months to manage her arthritis and check blood work in case we need to adjust medication dosages. Booking her next exam now will let you get your first choice of a time and date with me. Six months from today would be Jan. 9. I could see Molly at 10 a.m. or 4 p.m. Which do you prefer?” 

For a checkup, lead the client to book the next six- or 12-month exam. If the receptionist is scheduling the exam during checkout, she would say, “Just as your dentist has you schedule your next appointment at checkout, we do the same to proactively manage your pet’s health. Let’s book your pet’s next checkup for this same day and time next year. We will confirm two weeks before the exam, so if you need to change the appointment it will be easy. By scheduling today, you will get your first choice with Dr. Popular. He could see your pet at 10 a.m. on Wednesday, Aug. 12 or 3 p.m. on Friday, Aug. 14. Which do you prefer?” The first choice is the same day of the week and time as today’s appointment. The second choice is a different day of the week and time of day (morning vs. afternoon). Get scheduling techniques in my article on “Four Ways to Use Forward Booking” (https://www.veterinarypracticenews.com/four-ways-to-use-forward-booking/).   

be persistent when pets require progress exams.

Because Dr. Popular is booking weeks in advance, the entire healthcare team must be dogged and communicate the importance of scheduling follow-up care today. After explaining how to clean a dog’s ears and apply ointment for an ear infection, the nurse would say, “Dr. Popular needs to perform a follow-up exam in two weeks for your dog’s ear infection. We strive to book follow-up care with the same doctor because Dr. Popular wants to see the condition successfully resolved. This will be a 15-minute appointment to examine your dog’s ears and determine if additional treatment will be needed. Dr. Popular could see your dog on Thursday, Aug. 28 at 10 a.m. or Friday, Aug. 29 at 2 p.m. Which do you prefer?” 

If the client procrastinates and waits to call your hospital in two weeks when care is due, Dr. Popular won’t be available. Booking with the same veterinarian helps you achieve exam efficiency. If Dr. Next will see Dr. Popular’s patient for follow-up care, he will need to spend more time reviewing the medical record to get up-to-date on the diagnosis, treatment, and prescribed medications. The follow-up visit may take twice as long if a different doctor sees the patient.  

add more urgent care slots to dr. popular’s schedule.  

I advise receptionists to block three urgent-care slots per doctor per day for same-day sick patients. Because clients will call every morning with sick patients that must be seen today, plan for them in your daily schedule. You may need more urgent care slots on Mondays, Fridays, and Saturdays, when hospitals typically see higher volumes of sick patients.  

To determine how many urgent care slots Dr. Popular will need, create a spreadsheet that totals the number of exams he sees by day of the week. Let’s say he saw 22 patients on Thursday. Approximately 20 percent of patients are same-day sick appointments. Based on this formula, Dr. Popular would need seven urgent-care slots on Thursdays. Block an urgent-care slot at the top of each hour in Dr. Popular’s schedule on Thursdays. Get more insight in my YouTube video on “Overbooked and Can’t See Sick Pets? Here’s the Solution” at https://www.youtube.com/watch?v=j_oWxml2qyc&t=9s.  

Talk up other doctors.  

You want clients to feel confident and comfortable with every doctor in your practice. Dr. Popular, nurses, and the client-care team need to praise the skills and knowledge of other veterinarians in your hospital. When a client sighs after hearing Dr. Popular isn’t immediately available, promote Dr. Next. The receptionist would say, “Dr. Popular’s next availability is Aug. 30 at 9 a.m. I could schedule you with Dr. Next. He has a special interest in feline medicine and would love to meet Alex. I’m confident you’ll be satisfied with the quality of his medicine. Dr. Next could see Alex tomorrow at 4 p.m. Shall I schedule this exam?”

During his appointments, Dr. Popular also can share praises of his colleague, Dr. Next. Afterall, Dr. Popular may be the practice owner and hired Dr. Next. To transfer the client’s trust to another veterinarian, Dr. Popular might say, “Dr. Next has been part of my medical team for five years. We went to the same veterinary college and share similar medical interests and philosophies. If I’m unable to promptly see your pet, I’m confident that Dr. Next will do an exceptional job.” 

Because Dr. Popular will take vacations or may sell the practice one day, you must build trust in every veterinarian. Have your team discuss ways to equally distribute appointments amongst all doctors because the hospital’s goal is to have every veterinarian fully booked every day.

 

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4 Ways to Use Forward Booking

4 Ways to Use Forward Booking

4 Ways to Use Forward Booking

Is your team struggling with forward booking? Only 5 percent of veterinarians use forward booking compared to 80 percent of dentists. (*1) Besides providing timely patient care, forward booking can dramatically improve your bottom line. Increasing to 10 percent of forward-booked exams would increase annual revenue $40,000 for a typical veterinary hospital. Here’s how to use forward booking for four appointment types:

1. Medical progress exams

Veterinarians excel in this category. A Veterinary Hospital Managers Association Insider Insights Report found 76 percent of teams schedule progress exams. (*2) Tell clients when their pets need to be seen next, avoiding the yes-or-no choice of “Do you want to schedule your next appointment.” Follow the guidelines of “same day, same time, same doctor.”

Seeing the same veterinarian builds client confidence that the medical problem will be resolved and provides exam efficiency. If a different doctor sees the patient for follow up, he may spend twice the amount of time reviewing the medical record to learn the previous veterinarian’s diagnosis and treatment. Tell the client, “Dr. Smith needs to see your dog in two weeks for a medical progress exam for Duke’s ear infection. Does this same time, 9 a.m. on Oct. 25, fit your schedule?”

Select from three approaches to schedule care now:

 

Choice 1:

If you have computers in exam rooms, book follow-up care now. You risk having the client walk through the “mind-erase hallway” on the way to the front desk to check out. Because the client is focused on leaving, he forgets to schedule. The receptionist may not know that follow-up care is necessary unless she reads the diagnosis in the medical record.

Choice 2:

Put an alert in your software or use a travel sheet. This notifies receptionists to schedule medical progress exams before checking out clients for today’s services.

Choice 3:

Do a verbal handoff. The doctor or technician walks the client to the checkout counter and tells the receptionist, “We need to see Duke again in two weeks for a progress exam for an ear infection. Could you please schedule that with Dr. Smith?”

Avoid the term “recheck,” which clients may perceive as free and optional. “Medical progress exam” clearly communicates you’re following up on a previously diagnosed condition. Update this term in your practice-management software.

 

2. Procedures

Give clients information to decide on treatment on the day of diagnosis. After the veterinarian explains his diagnosis and your anesthetic protocols, answer the client’s questions. Have a technician present a treatment plan that lists medical services and fees. The technician would tell the client, “Now that Dr. Smith has answered your questions, he asked me to go through the treatment plan with you, so you understand the specific services and fees. I will show you photos of a pet’s dental procedure that illustrates each of the steps. I can share information about our payment plans through <third-party financing>. Then you can decide how you want us to proceed.” After reviewing the treatment plan, ask for a commitment: “Shall we schedule your pet’s procedure?” Lead the client to book now with the two-yes-options technique: “We can perform the dental procedure on Monday or Wednesday. Which do you prefer?”

Busy practices may have full surgical and dental schedules for two or more weeks. If clients don’t schedule elective procedures on the day of diagnosis, you may have limited availability that cause them to seek faster care elsewhere. Focus on what you can do, not what you can’t. Say, “Dr. Smith’s next available surgery days are Oct. 23 and 24. Which do you prefer?”

3. Disease-management exams

Create categories of exams to distinguish reminders and fees. Use pediatric, adult and senior preventive exam codes for routine checkups. When a pet is diagnosed with a chronic health condition, change the preventive exam code to a disease-management exam. Forward booking will let the veterinarian provide optimal disease management. Clients also will appreciate that the veterinarian has spread out the cost of care.

Set the reminder interval based on the frequency of follow-up care. Let’s say you diagnose a dog with arthritis and prescribe a non-steroidal anti-inflammatory drug and therapeutic diet. You want to see the patient every six months for exams and drug monitoring tests.

After explaining the diagnosis and answering the client’s questions, tell her, “Because Daisy was diagnosed with arthritis today and will begin long-term medication, I need to see her every six months to successfully manage her arthritis and check blood work in case we need to adjust medication dosages. Six months from today would be March 16. I could see Daisy at 9 a.m. or 3 p.m. Which do you prefer?” Explain the “why” behind the change in frequency of exams and use benefit statements.

 

4. Preventive checkups

Six out of 10 pet owners will forward book their pets’ checkups.1 Use a comparison that clients already understand: Dentists. Say, “Just as your dentist has you schedule your next appointment at checkout, we do the same to proactively manage your pet’s health. Dr. Smith could see your pet at 10 a.m. on Wednesday, March 14 or 3 p.m. on Friday, March 16. Which do you prefer?” The first choice is the same day of the week and time as today’s appointment. The second choice is a different day of the week and time of day (morning vs. afternoon).

When a procrastinator won’t book, be persistent and use benefit statements. Say, “I understand you don’t know your schedule 12 months from today. Let’s book your pet’s next checkup for this same day and time next year. We will confirm two weeks before the exam, so if you need to change the appointment it will be easy. By scheduling today, you will get your first choice of doctor, day and time. Your appointment reminder for 10 a.m., Wednesday, March 14 will print on today’s receipt.”

Color code your schedule to identify which appointments were forward booked. Confirm these exams two weeks in advance in case clients need to reschedule. Use text and email confirmation for efficiency. If clients have not responded to electronic notices, call them four days before forward-booked exams to confirm.

You will need to have doctors’ schedules in your software for 12 months in the future. Don’t worry if work schedules change due to veterinarians’ conference attendance or vacations. Doctors will often request time off one or more months in advance, especially when buying plane tickets and registering for conferences in advance. Because you’ll confirm forward-booked exams two weeks ahead, you can easily move appointments. Call the client and say, “Dr. Smith asked me to call you to reschedule Daisy’s disease-management exam on March 16 because he will be out of the office. Can the doctor see Daisy at the same time, 10 a.m. on Wednesday, March 21, which is just one week later?”

 

Forward booking doesn’t fall on the shoulders of receptionists alone.

Doctors, technicians and receptionists must support one another’s efforts to secure follow-up care. Clients need to hear a consistent message that you’re working together as a team to proactively manage their pets’ health.

References:

*1 – AAHA State of the Industry Report 2015. Accessed Aug. 17, 2018 at www.aaha.org/graphics/original/professional/resources/library/aaha_state_of_the_industry_2015.pdf.

*2 –  Felsted K, Gavzer, K. Forward Booking Appointments: How to Fill Your Appointment Schedule. Partners for Healthy Pets, 2015:6,4. Accessed Aug. 17, 2018 at www.partnersforhealthypets.org/forward_booking.aspx.

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