Practice Management News and Views from around the World – March 2019

I’m gonna be dancing

Why a happy veterinary profession needs independent practices

From an article by Patty Khuly published online in Veterinary Practice News

Once upon a time, there was a little girl who lived on a lovely cul-de-sac in American suburbia. She loved animals and knew for sure she’d want to be a veterinarian when she grew up. She worked hard and got perfect grades, volunteered at her local shelter, and worked her way through college until she was finally admitted to veterinary school.

“We can’t promise to make you rich, but we will make you smart,” they said at the veterinary school. While there, she learned a lot about everything she ever dreamed of knowing. She tended to patients with “enormous care” in gleaming buildings, learning only the “best medicine.”

Finally, it was time to graduate and enter the great big world. She now had to get her dream job and become a happy veterinarian.

But the dream job was hard to find. She wanted to provide enormous care and practice the best medicine, but she needed to pay back the veterinary school, too.

She looked and looked until one day, a fairy godmother appeared in a blue Lexus wearing Jimmy Choo shoes and an Apple Watch.

She said, “I was just like you until I found my dream job at BestVets. I’m now a happy veterinarian because I was able to provide enormous care, practice the best medicine, and pay back the veterinary school, too.” Then she gave the now-grown girl a shiny brochure with lots of happy veterinarians on it. So the young doctor went to work in a gleaming building where she was given a high salary, pretty equipment, the right staff, and lots of patients to see.

But she never became a happy veterinarian. Sure, she paid back the veterinary school, but she was always sad. Most of her clients couldn’t afford her enormous care and those who needed the best medicine went to see the specialist. What’s more, BestVets kept changing rules, adding tasks, and promoting people who weren’t veterinarians. Worse still, her fairy godmother kept telling her she wasn’t working hard enough at generating income. She became so depressed, she wished she had never become a veterinarian.

“Where did I go wrong?” she asked herself. “Should I become a specialist? Work for a smaller practice?” She’d never even thought about running her own practice, but after all the rules and tasks and unfairness, she was starting to think about a new dream—doing it herself.

A children’s story… or cautionary tale?

Ask a millennial veterinarian and I assure you they’ll know someone in the protagonist’s dilemma—themselves, perhaps. Now calculate the rate at which nonindependent practices are growing, and project that into the future. Does it seem so unlikely we might suffer from an epidemic of unhappy veterinarians?

To be sure, there are plenty of veterinarians with the appropriate constitution for employment at nonindependent practices. Perhaps there are even more veterinarians who prefer to work in environments where non-veterinary management predominates than those that do. Nevertheless, it’s true; the trend toward corporate practice ownership, coupled with a higher debt burden, pushes those with fewer choices into positions that might not suit them.

And let’s be honest: Most of us who obtain higher degrees don’t do well with the deprivations of independence imposed by absent employers. We believe we’ve gone to school long enough to make our own clinical decisions. We bristle at the notion that non-veterinarians get to set the rules for our patients

The independent variable’s erosion

I like to think of veterinarians as independent variables. Resolutely self-possessed amid the industry swirling around us, we continue to define our profession in spite of the many incursions of non-veterinarian owners. We still exert enough force to bend the profession to our collective will. But how long will this last?

Not long, say some proponents of consolidation and corporatization of practice ownership and the vet industry writ large. Veterinarians don’t really want to manage anymore, they say. They claim we veterinarians see the writing on the wall. We understand that in this world of extreme specialization, blue-suited business leaders are better equipped to manage the more entrepreneurial aspects of veterinary medicine. We, the scrub-clad, allegedly prefer to be led.

Rethinking the assumptions around ownership aspirations

To some extent it’s true—most of us claim we don’t want to take charge. Ask veterinary students and they’ll readily admit they don’t want to be practice owners. Once out in the real world, however, that perspective is prone to shift.

In part, I believe the widespread reluctance to own prevails because entrepreneurship/management is rarely presented in terms of its impact on patient care. Instead of encouraging it as a fundamental path to better medicine, our profession’s groupthink (starting with the veterinary school curricula) disregards its almost universal relevance, treating it more as a specialized subject best left to the “business minded” alone.

We have to rethink our assumptions around ownership and entrepreneurship. When these values are no longer expected or encouraged, corporations will happily ride in to take our place. In so doing, they create a new infrastructure, which makes it hard for those who’ve only later decided they’re unhappy with the corporate status quo to take back the reins.

Why veterinarian ownership matters, money-wise

Think about it this way: Fewer veterinarians on top mean more veterinarians in the middle. The new corporate structure effectively makes veterinarians the middlemen, cutting into our profits and building a vast middle class in our profession. All this aggravates the depressing debt-to-income ratio that attracts younger veterinarians to corporate practices in the first place. Oh, the ironies!

Not only that, but more big mouths to feed means higher prices at the reception desk, exacerbating the pet health-care affordability crisis, which directly impacts our job satisfaction and also attracts other mouths to the pie (i.e. the pet health-care financing industry). Sure, the pie has been getting bigger as of late (people love their pets!), but our slice is getting disproportionately smaller.

Are they truly better practice owners?

I mean, are they really so much better than us? Are they masters of increased productivity? Do the greater profits they generate by virtue of their genius expertise justify their presence? Do they add anything to our industry, save an extra layer of management that ostensibly improves our quality of life by relieving us of the burdens of ownership?

I think not. Their expertise can be helpful, as any specialized professional influence might be, but only to a limited extent. The degree to which corporate players have come to dominate the veterinary industry at the level of practice ownership is not justified economically when you look at what veterinarians have collectively lost in the bargain.

Sure, some veterinarians are getting richer as a result of high-priced buyouts. But for every one veterinarian that sells out big, an incommensurate number of his or her colleagues are expected to lap up milk while the non-veterinarians enjoy their cream. Indeed, the whole generation that follows these buyouts will have fewer opportunities to rise to the top.

And what about our patients?

Ultimately, everything comes down to patient care because enormous care and best medicine are what make us tick and be happy veterinarians. Ironically, it’s the great promise corporate medicine made when they bought us out: You’ll be free to concentrate on patient care. But has this really materialized?

I think not. If anything, it’s the one area corporate medicine has most disappointed us. They’ve taken the concept that “What’s better for the patient is better for the practice” to an uncomfortable extreme by calling too many of the shots on what’s best. “We won’t tell you how to practice” clearly doesn’t apply to everyone.

Can veterinarians turn the tide?

Though the tide seems relentless, we still have a chance. When faced with the prospect of a middleman’s existence, plenty of ownership deniers (like I was) will find ourselves asking if corporate employment is what’s best for ourselves, our colleagues, and our profession.

We will resist.

As long as we collectively remain steadfast in our resolve to stay in a profession run by the professionals whose patient care and job satisfaction serve as its cornerstone, we can weather the onslaught of interlopers who claim to know what we want and our patients need. And we’ll be happier. I promise.

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The art and science of follow-ups

From an article by Phil Zeltzman published in Todays Veterinary Business website

What you call a return visit and how you charge for it are up to you, but its importance needs to be clearly communicated to the client.

Clients generally hate paying for rechecks after a medical procedure. They think they have paid (too much) already and that your time, staff and supplies should be free from here on out.

Conveying the importance of rechecks to clients can be difficult. The veterinary profession has no universal guidelines for when they are needed, whether to charge for them, how and when to charge for them, or how to persuade clients to return to the hospital as recommended.

For starters, stop calling them rechecks. Better expressions are “progress exams” or “follow-up visits.” In the client’s eyes, “recheck” might imply something that is optional or unimportant. If you offer progress exams at no charge because you feel the cost is offset by the other procedures performed, then the client will equate the free follow-up visit with something irrelevant.

The words and the tone you use are extremely important to convey the importance of following your instructions. You can’t say that Kiki “should” come back or that you would “like” to see Kiki or that it would be “nice” if the owner brought Kiki back. Be firm. You need to be your patient’s best advocate. Say, “We need to see Kiki for a splint change once per week.” Then, clearly explain why the weekly schedule is so important to prevent pressure sores.

Make the recheck part of your explanation of the treatment plan. Convey that it is just as critical as the medications you send home or the bandage you place. Part of clients’ reluctance to return for progress exams is they don’t understand the value.

Plan Ahead

  • To ensure the proper healing of wounds and surgical sites
  • To evaluate the efficacy of physical therapy.
  • To help new veterinarians gain experience with the response to different treatment protocols.
  • To build client relationships.
  • To present clients with educational opportunities.
  • To make sure instructions were understood, especially when the client seems indifferent or confused
  • To confirm that medications are being administered correctly at home.
  • To socialize patients so they are less stressed during future visits.

Getting clients to comply with your follow-up protocol is an even bigger challenge when they have to pay a fee every time. Some practices have found success in pre-charging for these visits. The benefit is that most clients will return because they do not want to waste money since the payment has been made. The drawback is that it makes the initial cost of treatment seem higher.

What is especially important, therefore, is to make the client understand that you include the follow-up fees in the initial payment.

Examples include:

  • Procedures and medications that were forgotten by a team member.
  • The quantity of medication to give or its frequency was incorrect.
  • Surgical implants such as pins or screws were placed improperly
  • Physical therapy exercises were poorly explained
  • Complications occurred due to the care provided.

Of course, the plot thickens when the complications have nothing to do with you. These might include:

  • The patient chewed the incision open because the owner didn’t keep the E-collar on (classic story).
  • A bandage is filthy because the patient dug a hole in the yard after the client failed to leash him (true story).
  • An orthopedic surgery failed because the owner thought that allowing the patient to run up and down the stairs was OK (real story)
  • An infection got worse because the client didn’t use the medication as prescribed.

In some cases, offering a complimentary follow-up exam might make sense as a teaching opportunity for a young (or not so young) colleague. For example, you want to observe how an open wound is healing.

Try these strategies to persuade clients to return for a follow-up visit:

  • Use staples instead of skin or intradermal sutures. Then schedule a staple-removal appointment.
  • Schedule the next follow-up before the owner leaves the practice.
  • Have your nurse escort the client to the checkout desk and tell the receptionist: “Coco needs a bandage-change appointment with Dr. Smith in one week.”
  • Use your existing reminder system, whether phone, post card, email or text message, to advise clients of their appointment.

You could add a few lines on the estimate page in which the owner commits to follow your instructions to ensure a happy ending, followed by the client’s signature.

Without follow-up exams, you might not be providing the gold standard of care. Implementation might be challenging, but your efforts will be well worth it. The bond you build with clients and patients will strengthen. You will be able to see if your treatment protocols are working or if you should change them.

Follow-up visits have no drawbacks. Progress exams are an integral part of the care you provide.

You can click here to visit Phil Zeltzmans website

You can click here to visit Todays Veterinary Business website

How to Handle Negative Online Reviews for your Veterinary Clinic

From an article by David Williams published on the VetPort blog

Internet, Social Media, Technology, all these are dual edged swords. It comes up with loads of benefits but a misuse can have real side effects also which can be catastrophic for your business.

Bad or Negative online reviews are a norm and it is better to accept them as reality. No business is alienated from such reviews; your Veterinary practice too will have an impact. So handling negative online reviews is equally important as being motivated from the positive ones. We list down some of the tenets of handling bad online reviews:

Embrace them

As mentioned earlier, bad online reviews are not a vice. In-fact, most business owners believe that having negative online reviews adds to the legitimacy of the business. Your practice or clinic will have a higher degree of legitimacy from their presence.

Apart from Legitimacy, such reviews are an important feedback for your clinic. If you as a veterinary believe in constant renewal of your practice, such feedbacks are blessing in disguise for you. So next time some one writes bad about your practice, don’t feel sad!

First action-Professional Reply

So now that some one did not like your service for some or the other reason and has written badly on Google reviews or any other review site for that matter, the first step is to send out a professional reply. The reply should contain your sincere apology that the customer’s experience was not up-to the mark, you diligently take it as a feedback and will surely work towards improving the situation further.

Do not be blunt or too straightforward in this; show empathy and a willingness to improve. Also template replies should be avoided.

Work on the problem

You have the problem known to you now. Identify the root cause, was it a one odd case or it is a real gap in your service delivery. If it is a one odd case, it is pretty much a fact that the corrective action shall be taken at the end of whosoever was at fault. If it is a real gap in your service delivery, find out a long term solution for the same.

Even if you cannot find a long term solution, at-least find a way to avoid it happening in very near future.

Convey your solution to the reviewer

If it is possible to establish a direct contact with the reviewer, reach out to him via a phone call or email, explaining what happened and what corrective measures have you taken. This is important since if you can reach out directly, you can have them reply on their original review so that it gives out a clear signal that you eventually close the feedback loop and care a lot of the customer feedback.

If you cannot establish a direct contact, reply on the original review with your short term or long-term solution. This would give out the same signals however the impact would not be as high as in the previous case.

Formulate a review handling policy

The world of online is not as clean as a whistle, it has its fare share of fakeness. In online reviews, you will encounter trolls, lobbyists, abusers and what not. It is important to have a review handling policy in place. You should be dividing your reviewers in 3 categories namely: Genuine, Trolls and Abusers. Genuine should be handled the way as mentioned in the above steps, Trolls as wittily as possible so that they do not come back and Abusers should be reported to parent site so as to stop it once and for all.

In Summary, Bad reviews can be your best friends provided you have a strategy, which is well defined in place to handle them. So even if you cannot shower all the love to them, accept them and work upon them for the betterment of your practice.

You can click here​​​ to visit the VETPort website 

Is Accounts Receivable Really Bad?

From an article by Mark Opperman published on his Veterinary Management Consultation website

I think most people assume that accounts receivable is bad and their practices shouldn’t have any accounts receivable. But let me ask you a question: who owns the largest buildings in any city? The answer is banks. And what is it that banks do? They lend money, of course. So maybe we need to reconsider accounts receivable as more of a marketing tool for our practices. Let me explain. Suppose you had a long-term client whose pet needed to have its teeth cleaned. You tell the client that the total cost will be $500 and the client responds that they will to have to think about the procedure first. What they are really saying is that they can’t afford it, but they may be too embarrassed to say that to you, so they don’t have the procedure done.

Now let’s consider a different way of handling this situation. Suppose that, when you review the medical care plan with the client, you acknowledge that $500 is a lot of money and let them know that you can also offer a payment plan. The client can either apply for Care Credit and do 90 days same as cash, or they can pay you one third at time of discharge, one third a month later and the final third 30 days after that.

Don’t wait for clients to ask you for a payment plan, because they won’t - offer it up front. I have several practices that have initiated this policy and their dental revenue has dramatically increased as a result.

I would not offer this to all your clients; I would be selective. But if you have a client who has been coming to your practice for years, has always paid their bill and is now faced with a large expense for their pet, then, yes, I would extend credit to them. Your biggest risks for non-payment are first-time clients and emergencies; I would certainly be careful in extending credit to these clients.

I also think that many practice owners and managers spend way too much time on accounts receivable. There are much more productive things a manager could and should do in the practice rather than spend the day in small claims court. To avoid this, I suggest you develop an internal credit policy and an internal collection policy. The internal collection policy states under what terms we might extend credit to a client and who has permission to do that. The collection policy states what is to happen if a client does not pay the practice. A typical collection policy might read as follows:

  • 1.If an account is not paid in full, the client will be sent a statement at the first of the month stating the amount due and a service charge of 1.5% (minimum $5.00) will be affixed to that statement.
  • 2.If the account is not satisfied in full thirty days later, a second statement along with a first collection letter will be sent to the client and additional service charges will be assessed.
  • 3.If full payment is not made within 15 days of the last statement, a phone call should be made to the client requesting full payment or a payment agreement will need to be signed.
  • 4.If full payment has not occurred 15 days later, a third and final statement will be sent to the client along with a final collection letter and a service charge will be assessed.
  • 5.If the account remains uncollected 30 days after the final collection letter has been sent, the account will be reviewed for collectability. If it is deemed collectable, it will be sent to a qualified collection agency or lawyer, and if not deemed collectable, it will be suspended for later review (you have up to seven years to collect on an account).

If you have not collected on an account after 120 days, you are probably not going to, and you need to turn the account over to people who do this for a living and let them handle it.

The longer an account is owed, the less likely you are going to be able to collect on it. I know for some, this will seem counter-intuitive, but I could name 50 things that I would rather see a manager or practice owner do than sit in small claims court for the day. I think, for many, accounts receivable is taken too personally - “the client said they were going to pay me!”.

When the client fails to pay, the manager or practice owner feels duped and collection then becomes a matter of principle. Unfortunately, you need to realize that accounts receivable is a cost of doing business, but spending too much time on accounts receivable will only make a bad situation even worse.

If you are a small animal hospital and your total accounts receivable are between 1% and 3% of your gross income, then you are fine. If you are at less than 1%, then maybe you should be taking more risk, and, if your accounts receivable are more than 4% of gross, you probably need to dial it back.

You can click here to visit Mark Oppermans website

Communication 101: Digital etiquette for veterinary practices

From an article by Stacee Santi DVM published in the DVM360.com website

Most of us rarely use the phone anymore for talking—texting and emailing have become the primary modes of communication in business. When you compound that with the generational differences in regard to proper etiquette and communication style, it’s more important than ever that your veterinary team is up to speed on the basics of digital communication. Here are some best practices you and your team should use when reaching out to your busy clients:

On the phone? 3 ways to help you catch their name

If you’re in the customer service business (and private practices are), one of the most important ways to create a good customer experience is to remember a client’s name. Let’s be clear, asking “What’s your name again?” doesn’t make anyone feel special. So do try these three things.

Listen. I mean, really listen. Pay attention when someone says their name. Have you ever been at a restaurant and the waiter didn’t have a notepad? Their ability to remember your order almost seems magical, but they’ve simply mastered the art of really listening.

Associate. When someone tells you their name, it’s much easier to recall if you can associate it with something from your memory, like your favorite aunt, an old friend from high school or a movie star.

Write it down. If you’re in client service in any capacity, you should have a pen and paper on you at all times. A veterinarian doesn’t go into a surgery without a scalpel, and a receptionist or other team members answering the phone shouldn't be without a pen and paper.

Emailing? 4 tips to get your tone right

Email etiquette is all about getting your tone across without the benefit of clients hearing your actual … well, tone. Remember: Being overly nice in email often comes across as the perfect amount of friendly, so go the extra mile.

Never write in ALL CAPS. Typing in all caps is generally interpreted by the reader as shouting. So, unless you’re TRYING REALLY HARD to get your point across, typing in normal case size is best.

Read your emails in a Mary Poppins tone. When we read emails, our own filters get in the way of assigning a tone to the words we’re reading. For instance, if you’re tired and hangry because you skipped lunch, you may be inadvertently interpreting each email you read as angry. Read emails in a kind voice—you know, like the "Spoonful of sugar" nanny—to ensure you’re giving the sender the benefit of the doubt.

Oreo it up. While it may seem trivial, each email should begin with a pleasantry, such as “Hope you’re having a great day today,” and end with “Thanks so much” or a similar pleasantry. This sandwiching of information will help the reader see a positive tone in your writing voice.

Get the last word, if possible. If you’re going back and forth emailing someone, try to get the last word. If they reply, “Thanks so much,” send back “You bet! Happy to help.” This low-hanging fruit will make you come across as friendly.

Sending texts? 3 ways to get your point across

Texting is by far the most dangerous form of communication to engage in, because messages are short and tone can be easily misinterpreted. Try doing these things:

Emphasize with emojis. Using emojis can quickly change the tone of a text message to help you communicate more effectively and avoid being misinterpreted. Consider these two examples:

Good time was had: I just went to the best seminar ever! 🙂
Dripping with sarcasm: I just went to the best seminar ever! 🙁

Same sentence; totally different meaning. But remember, if you're going to dabble in emoticons, be sure to get your emojis right. Mixing up the laughing and crying emoji can get you into trouble (trust me).

Overemphasize your message. It’s important when texting to overdo your feelings. By being extra nice, you ensure you have a successful conversation. Texting “It was so nice to chat with you today” can make your client feel appreciated at the end of the conversation.

Know when to pick up the phone. Many times, things said in text messages would never be said if the person was standing in front of you, because it’s easy to avoid accountability. If what you’re reading in a text is giving you a funny feeling, pick up the phone and make a call.

Reminding with push notifications? 3 ways to do it well

If your practice uses a mobile app, you can probably send a push notification to clients any time with just a few clicks. You probably know what these look like, but if you don't: A push notification will show your app icon and name, followed by the title of your message. When a veterinary client clicks on the message, the app opens and gives more details. This is a great way to communicate about disease outbreaks, hospital promotions and reminders to give medication, to name a few. Here's what makes for a great push:

Good title. Your clients are busy, so use a title that they'll understand in a few seconds.

Don't make your clients guess what your push means. Here are good and bad examples of a push notification to remind clients to give heartworm preventive:

Good: It’s time to give your pet their heartworm medication!

Bad: It’s that time of the month!

Right time of day. Depending on what you’re trying to communicate, consider when your clients are available to read it. A general rule of thumb is after 9 a.m. or before 5 p.m.

Clear call to action. Most messages worth sending to clients will have an associated behavior you want them to take. Be clear about what that action is, whether it’s just “Click here to learn more” or a more specific “Call now to schedule an appointment.”

Communicating digitally is one of the best ways to save your practice time and deliver better value to your clients. By communicating efficiently with your clients, your veterinary practice can strengthen veterinary-client relationships and improve compliance, which means better care for Fido!

You can click here to visit the dvm360.com website