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Scheduling Weeks Out? Implement Forward Booking

Scheduling Weeks Out? Implement Forward Booking

Scheduling Weeks Out? Implement Forward Booking

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

A practice manager told me her hospital doesn’t have any checkups available for four months. Clients feel frustrated and patients aren’t getting timely preventive care. If your practice is booking checkups two or more weeks out, you need to implement forward booking as a long-term solution.

Have clients schedule pets’ next checkups during today’s appointments. While dental practices aim to schedule 75% of patients in advance, only 11% of veterinary hospitals forward book six- or 12-month checkups.[1],[2] When clients schedule months in advance, you will have ample appointments available. Here are four success factors to implement forward booking: 

1. Pre-block checkups in your schedule template.

Build your schedule 12 months out. Pre-block four checkups in each doctor’s daily schedule:

  • First appointment of the day: Doctors are confident about preventive care, which creates a positive mindset for the day.
  • Appointment before lunch: Because checkups are predictable and more likely to finish on time, the outpatient team can enjoy well-timed lunch breaks.
  • Appointment after lunch: A checkup after lunch starts the afternoon on time.
  • Last appointment of the day: Wrapping up the day with a checkup ensures the outpatient team goes home on time. 

Don’t worry if veterinarians’ schedules change. Doctors will request time off in advance for vacation and conferences, especially if booking travel. Simply contact clients whose appointments need to be moved.

2. have the outpatient team personally schedule future appointments.

In dental practices, hygienists have greater success with pre-appointing patients than scheduling coordinators at checkout.[1} By the time patients reach the checkout counter, they want to leave and may dismiss staff’s attempts to schedule. 

Here’s how to apply this strategy to checkups, pediatric exams, and progress exams:

Checkups: Having technicians and assistants initiate conversations about future checkups emphasizes the importance of preventive medicine. Compare the pre-appointment strategy to dentists’ offices, which clients already experience. Use the yes-or-yes technique to lead pet owners to commit. Say, “Just as your dentist has you schedule your next appointment at checkout, we do the same to proactively manage your pet’s health. By scheduling today, you will get your first choice of doctor, day, and time. Do you prefer <date, time 1> or <date, time 2>?” 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 procrastinators won’t commit, use benefit statements. Say, “I understand you don’t know your schedule 12 months from today. By scheduling now, you will get your first choice of doctor, day, and time. You will get a confirmation today and reminders as the date nears. If you need to change the appointment, just reply to the text/email. Does this same time and day typically work for you?” If the client agrees, recite the time and date out loud to reaffirm the decision. Say, “Fantastic, let’s schedule you for this same time on <date>.”

If your hospital has computers in exam rooms, having outpatient teams schedule future appointments and collect payments is the most efficient. If clients will pay at the front desk, client service representatives (CSRs) can use these same scripts. Always guide clients to pre-appoint before paying for today’s services because appointment reminders will print on receipts and trigger confirmations. Follow the best practice of “Schedule First, Pay Last.”

Pediatric exams: If you’re booking three weeks out, puppies and kittens risk missing timely immunizations. During the first pediatric exam, forward book the remaining series of appointments. If a client visits today with an 8-week-old puppy, say, “Your puppy will need exams and vaccinations at 12 and 16 weeks of age. We need to provide timely exams to monitor <pet name>’s growth and development and vaccines for ongoing protection. We will schedule your puppy’s next two appointments today, so you will get your first choice of time, day, and doctor. Let’s set the next appointment when your puppy will be 12 weeks old. Do you prefer <date, time 1> or <date, time 2>?” Once the client agrees, say, “Great, we will see <pet name> on <date, time> for the 12-week-old appointment. Now let’s book the 16-week visit. Do you prefer <date, time 1> or <date, time 2>?” Let the client know to expect confirmations.

Progress exams: If patients need progress exams, schedule today to ensure timely follow-up care. Seeing the same veterinarian builds client confidence that the medical problem will be resolved and supports exam efficiency. A different doctor will need more time to review the medical record to learn the previous veterinarian’s diagnosis and treatment.

Use words that work. Replace the wiggle word of “recommend” with the action word of “needs.” “Progress exam” communicates that follow-up care is medically necessary, and you are moving forward in resolving the health concern. “Recheck” may be perceived as free and optional. Say, “Dr. <Name> needs to see <pet name> in two weeks for a progress exam for the ear infection. Do you prefer <date, time 1> or <date, time 2>?”

3. implement a confirmation protocol.

Dentist found that patients who leave with appointments are statically more likely to show up.[3] Only 10% of dental patients cancel or no-show, while two-thirds skipped booking because they don’t want scheduling hassles.

Likewise, you can save clients future tasks and make preventive care easier when you forward book. Veterinary hospitals experience 11% no-shows.[4] Text and email confirmations significantly lessen cancellations and no-shows. 

In my online course on Everything You Need to Know About Scheduling, I advise sending four confirmations with actions that improve practice efficiency (https://csvets.info/scheduling). Confirmations should include hyperlinks to online forms based on the reason for visit. Use emojis to increase open rates and clients’ understanding of appointment instructions. A pile of poo will grab clients’ attention and boost compliance for intestinal parasite testing. Here is the series of text confirmations:

Immediately upon booking: <Pet name> has an appointment at <time, date>. Complete patient history form at least 24 hours ahead, which is required to guarantee your appointment. Bring a stool sample 💩 that is fresh within __ hours. Download our app to pay after the exam. Reply C to confirm or RS to reschedule. 

Two weeks prior: <Pet name> has an appointment at <time, date>. Please confirm this still works for you. Complete patient history form at least 24 hours ahead, which is required. Reply C to confirm or RS to reschedule. 

Four days prior: This is a friendly reminder that <pet name> has an appointment at <time, date>. Remember to complete patient history form at least 24 hours ahead, which is required. Reply C to confirm or RS to reschedule. 

Two days prior: We will see <pet name> for an appointment at <time, date>. Complete patient history form, which is due TODAY by X p.m. and is required to keep your appointment. Bring a stool sample 💩 that is fresh within __ hours. Download our app to pay after the exam. See you soon! 

If clients have not confirmed or submitted online forms two days prior, call them. Say, “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.” 

When clients fail to respond, call them after your deadline and send backup texts or emails to inform them that their appointments have been cancelled. Text: “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 < date, time> has been released to another patient in need. Book online or download our app to reschedule.

4. make having future appointments the norm, not optional.

Dentists don’t give patients a choice. Their pre-appointing strategy has been successful for decades. Veterinary practices can implement forward booking to ensure timely preventive care, future hospital revenue, and fewer scheduling phone calls.

WANT TO LEARN MORE? 

Enroll your team in the COURSE: HOW TO MASTER FORWARD BOOKING.

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 an AAHA-accredited specialty and emergency practice. Visit CsvetsCourses.com to learn more.

References:

1. Faustino A. How to Improve Dental Recall with These Tips. Available at: https://capforge.com/how-to-improve-dental-recall-with-these-tips/. Accessed Feb 6, 2024.

2. Forward Booking: How Forward Booking Leads to Better Patient Care. AAHA and Partners for Healthy Pets. Available at: https://www.aaha.org/globalassets/04-practice-resources/Forward-booking. Accessed Feb 6, 2024.

3. 6 Metrics That Determine the Success of Your Dental Practice. ThriveCloud. Available at: https://mythrivecloud.com/6-metrics-that-determine-success-dental-practice/. Accessed Feb 6, 2024.

4. What Pesky No-Shows Actually Cost Your Veterinary Practice. PetDesk. Available at: https://petdesk.com/blog/what-pesky-no-shows-actually-cost-your-veterinary-practice/. Accessed Feb 6, 2024.

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.

5 Timesavers to Speed Surgical Check-ins

5 Timesavers to Speed Surgical Check-ins

5 Timesavers to Speed Surgical Check-ins

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

Two technicians are preparing for 10 surgeries this morning. They review paperwork with clients during admission appointments, run preanesthetic tests, assist the veterinarian with presurgical exams, and begin prepping patients. This busy routine can be more challenging for 70% of practice teams who are operating short-staffed.[1]

Here are five timesavers to make the morning rush more efficient and less stressful:

timesaver 1:

Get signatures on treatment plans and anesthetic consents when booking procedures. Let’s say you diagnose a cat’s dental disease during a checkup and explain the need for treatment. Present the treatment plan on the day of diagnosis, giving the client information to decide.

To lead the pet owner to book now, offer the veterinarian’s next two procedure days. Book the procedure with the same doctor who diagnosed the condition because he will be familiar with the case and enjoy production pay. Scheduling with the same doctor also increases clients’ confidence.

Say this, Dr. <Name> diagnosed <pet name> with Grade 2 dental disease. To schedule your cat’s dental procedure, I will have you sign the treatment plan and anesthetic consent now. I will email you a copy and provide instructions for the day of the procedure. We can perform the dental treatment on <date, time 1> or <date, time 2>. Which do you prefer?”

If clients schedule over the phone, email treatment plans and surgical consents. Require clients to submit forms 24 hours ahead and call them if paperwork hasn’t been returned. Save 10 to 20 minutes on the morning of admission because clients will complete and submit forms from home

Animal’s Choice Veterinary Clinic in Iuka, Mississippi, uses JotForm for consent forms with electronic signature capture (https://www.jotform.com). The hospital has online forms for anesthesia consent, new patients, boarding, and grooming (https://www.animalschoicevet.com/online-forms). After filling out and signing forms, clients click “submit,” which emails information to the hospital. Set up a specific email such as records@yourvet.com so this timely information doesn’t get lost or buried in your hospital’s general email.

At VCA Sheridan Animal Hospital & Veterinary Specialists of Western New York in Buffalo, New York, clients receive individual treatment plans and anesthetic consents by email or through the My VCA App, which allows digital signatures.

timesaver 2:

Set clients’ expectations upon booking. Whether clients schedule during checkout or over the phone, explain what to expect before, during, and after procedures. A five-minute conversation will educate clients and help them better comply with your process.
 

timesaver 3:

Provide an admission process sheet. Give clients written instructions at checkout or email documents if they call to schedule. Written instructions reiterate your verbal conversation and may be shared with family members. 

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, explains Holly Monroe, hospital manager at VCA Sheridan Animal Hospital & Veterinary Specialists of Western New York. Download its Surgical Admission Process Sheet at https://bit.ly/3Oh7QBq. Here’s an example from the client handout:

The day before your pet’s procedure:

  • Withhold food after __ p.m. Water is fine to continue to give until the time of admission.
  • You will receive a preadmission phone call to discuss patient history and answer admission questions that we will need before the procedure. We will talk with you for 10 minutes to gather this information for the medical team. You will pay 75% of your treatment plan the day before the procedure. You may pay over the phone or receive a text-to-pay link.

timesaver 4:

Collect samples for preanesthetic testing before the day of the procedure. Have veterinarians set a standard of care for how long lab results are valid such as within 30 days of the procedure. If you diagnose a cat’s dental disease today and schedule the procedure for next week, collect samples now and send them to your reference lab. If you forward book a puppy’s neuter two months away, schedule a technician appointment the week before surgery for sample collection. 

Doing preanesthetic testing in advance has four advantages:

  • Clients pay for lab tests today and are financially committed to showing up on the day of the procedure.
  • Choose whether to do in-house testing or send it to the reference lab.
  • Increases clients’ perception of value because the procedure cost will be lower when they prepay lab work today.
  • Because lab tests are already done, your surgical team can skip the morning rush and begin procedures on time.

timesaver 5:

Collect prepayment or a surgical reservation fee. If a client is a no-show for surgery, your hospital could lose significant income. The average no-show rate for outpatient appointments and surgeries is 11%, a whopping $59,400 annually per veterinarian in lost revenue.[2] Collecting money upfront will prevent no-shows and gain clients’ commitment. Don’t call it a “deposit.” The term is misleading because clients may assume they will get money back when pets are returned in good condition. Instead, use the term “surgical reservation fee” or “prepayment.” Watch my video on “Stop Saying Deposit! Say This” at https://youtu.be/NqvLL-f49rY.

When clients schedule procedures at checkout, collect surgical reservation fees. Say, “We have scheduled your pet’s surgical admission appointment for <date, time>. Here are preadmission instructions to prepare for your pet’s surgery. Your surgical reservation fee/prepayment is $__. Which payment method do you want to use today?” 

If clients call to book, explain, “We have scheduled your pet’s surgical admission appointment for <date, time>. To help you prepare for your pet’s surgery, I will email preadmission instructions to <client email>. Your surgical reservation fee/prepayment is $__. I will send you a text-to-pay link, or you may pay through our app. Which do you prefer?” [Client responds.] “You will get a payment receipt and surgical confirmation.” 

Check local laws on deposits and partial payments. You may need to post refund policies and choose terms carefully. In California, businesses are required to post refund policies unless they offer a full cash refund, exchange, or store credit within seven days of the purchase or payment date. In Colorado, there is no right to cancel contracts or purchase agreements. Whether a client can receive a refund is dependent on the practice’s return and refund policies.[3]

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

WANT TO LEARN MORE? 

Enroll your team in the online course: Organizing Your Surgery Schedule.

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. Stapleton-Charles N. Veterinary Clinics: An Alarming 70% Are Battling Staffing Shortages in Healthcare. Weave blog. Available at: https://www.getweave.com/veterinary-clinics-an-alarming-70-are-battling-staffing-shortages-in-healthcare/?utm_source=email&utm_campaign=january_2022_vpn_eblast_blog&utm_medium=eblast&utm_advertising_industry=veterinary&utm_advertising_partner=vpn. Accessed Nov. 4, 2022.

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 July 20, 2022.

3. Customer Return and Refund Laws by State. FindLaw.com. Available at: https://www.findlaw.com/consumer/consumer-transactions/customer-returns-and-refund-laws-by-state.html. Accessed July 20, 2022.

 

5 Steps to Shorter Scheduling Calls

5 Steps to Shorter Scheduling Calls

5 Steps to Shorter Scheduling Calls

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

When clients call your practice to book appointments, the average call length is eight minutes.[i] Client service representatives (CSRs) spend four to six hours a day on scheduling tasks. With staff shortages and high call volumes, CSRs need to shorten and make calls more purposeful. Follow these five steps to trim times and book appointments efficiently:[1] 

1) Lead the conversation immediately.

Deliver a concise greeting that puts you in the driver’s seat from the get-go. Your greeting should be around 4 seconds. Say this, “Welcome to <Your Veterinary Hospital>. This is <your name>. How may I help your pet today?” Replace the four words of “Thank you for calling…” with “welcome,” which invites callers into conversations. State your name to engage callers. Asking “How may I help your pet today?” leads the caller to share the reason for visit upfront.

Auto attendants are an efficient alternative to live operators. Benefits of an auto attendant include:[2]

  • Reduced hold time: Eliminate the average two-minute hold time for veterinary practices because callers get to the right teammate faster with a recorded menu.[3]
  • Immediate service: A CSR might spend two minutes to greet the caller, listen to the request, and then assist or connect the caller to the right department. Menus replace the information-gathering task of live operators. If the caller selects the “schedule an appointment” option, the CSR gets right to the point, “This is <your name>. I will schedule your pet’s appointment. What is the reason for your pet’s visit?”
  • Always available: Your auto attendant will have a different greeting for opening hours compared to overnight when your hospital is closed. Your closed greeting would share emergency hospital information and an option to leave a voicemail.
  • Consistently professional: An auto attendant isn’t going to have a bad day or get distracted by clients standing at the front desk. Best of all, an auto attendant never quits or calls in sick!

Put menu choices in priority order based on urgency and call types with the highest volume. Here’s an example of an auto attendant script:

Welcome to <Your Veterinary Hospital>. To best serve you, please choose from the following options:

  • If your pet is experiencing a medical emergency, press 1.
  • To schedule an appointment, press 2.
  • To refill a prescription, press 3.
  • To check on your hospitalized pet, press 4.
  • To speak with our client service team, press 5.
  • To leave us a message, press 6.
  • To repeat these options, press 7.

2) determine the reason for the appointment.

Get caller and pet names so you may access the electronic medical record (EMR). Two shortcuts to open records faster include using caller ID to look up the client in your practice-information-management software (PIMS) or installing Fetchit, a software program that integrates your PIMS and phone system for efficiency (https://schultztechnology.com/veterinary-practice-management-software/). If a client calls and the phone number is in your software, a blue bubble appears on the desktop. With one click, your CSR opens the EMR. Fetchit also provides reports on your call volume by day, hour, and CSR.

Scan the EMR to see which services are due and choose the right appointment length. Ask, “What is the reason for your pet’s visit?” Select a 20-minute appointment for an adult pet checkup while urgent care gets 30 minutes.

3) ask about doctor preference.

Progress exams should be scheduled with the same veterinarian whenever possible to ensure efficient exam time. For all other appointments, ask, “Do you prefer a specific doctor or want the first available appointment?” With today’s crammed schedules, most clients will choose the first available.

4) use the yes-or-yes technique.

Never ask the client, “What day of the week do you prefer?” and “What time of day do you prefer?” You’ll start a three- to five-minute banter trying to match up your schedules. Based on the reason for visit, offer the next two appointments that will work well for your schedule’s flow. For example, I advise pre-blocking checkups as the first appointment of the day (start your workday with an easy exam), first appointment after lunch (a reset button to start the afternoon on time), and last appointment of the day (go home on time). Say, “My next available checkup is <date, time 1> or <date, time 2>. Which do you prefer?”

 

This technique is especially important if your schedule is full for several weeks. Presenting the next two available appointments is positive compared to the negative impression of, “Sorry, we don’t have any appointments available for three weeks.” Focus on what you CAN do!

5) summarize details and set expectations.

Say, “We have scheduled <pet name> for a checkup at <time, date>. Please bring a stool sample for your pet’s intestinal parasite screen. You’ll receive a text confirmation shortly. Have a great day, <client name>!” You will increase compliance for parasite testing, save technician time for sample collection, and improve patient experiences (no fecal loop!). 

Send text or email confirmations the same day so clients may add appointments to their calendars, including travel time alerts. Confirmations reinforce instructions as the appointment date nears. Confirmations should include the pet’s name, time and date of appointment, link to a patient history form that needs to be submitted at least 24 hours ahead, bring a stool sample, link to download practice app, and reply to confirm or reschedule. Get text and email templates in my free eBook on Everything You Need to Know About Reminders at https://csvets.com/reminders/.

With today’s phone frenzy and staff shortages, phone handling needs to be done differently. Share these five steps with your CSR team so they may have more efficient and purposeful phone calls.

WANT TO LEARN MORE? 

Enroll your team in the online course: Take Control of Scheduling Calls.

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. 6 Ways to Improve Patient Scheduling. SolutionReach. Available at: https://www.solutionreach.com/blog/how-to-schedule-patients-effectively. Accessed Sept. 14, 2023.

2. Evolve IP. Why You Need an Auto Attendant. Available at: https://www.evolveip.net/blog/why-you-need-an-auto-attendant. Accessed Sept. 14, 2023.

3. Why Silence Isn’t Golden When Your Clients Are On Hold. Pawstime. Available at: https://pawstime.com/#:~:text=Phone%20calls%20remain%20the%20primary,veterinary%20practice%20is%202%20minutes. Accessed Sept. 14, 2023.

 

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? 


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.

get 100+ courses

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.