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A Financial Pearl For Practices

We are constantly reminded by financial gurus that veterinarians don’t charge appropriately. I suspect this may be true in your OR as well. Here is a quick tip, inspired and adapted from an article on anesthesia in the August 2011 issue of Clinician’s Brief.1 Basically, the author, Dr. Elisa Mazzaferro, a board-certified criticalist in Colorado, expressed in writing something I’ve told my referring vets for a while. Here is the idea.

Many colleagues don’t consistently charge for things we use in the OR: monitoring, cautery, suction, heating pad, heated surgery table, Bair hugger, etc. Yet there is no reason for that. If you provide a valuable service that improves medical care, it is only fair that you charge for the service. Yet, it doesn’t have to be a fortune, in case you’re worried about clients not being able to pay for better care.

Let’s say you paid $1,000 for a piece of equipment. Let’s also say you start charging only $5 for each use of it. And let’s say you use this equipment to monitor one sedated or anesthetized patient each day, five days a week, 52 weeks a year.

I happen to believe that every sedated or anesthetized patient should be at least monitored using something as simple as a pulse oximeter, for example during clipping or X-rays. Incidentally, some recent guidelines2 by the American College of Veterinary Anesthesiologists seem to agree with my impression:

“If a sedated patient is sufficiently obtunded to lose control of protective airway reflexes, it should be monitored as under general anesthesia.” Furthermore, “intermittent monitoring of basic respiratory and cardiovascular parameters in the heavily sedated animal should be routine. Supplemental oxygen, an endotracheal tube and materials for IV catheterization should always be readily available. Particular attention should be paid to brachycephalic breeds that are particularly at risk for airway obstruction under heavy sedation.”

The five monitoring methods suggested by the ACVA are:

• Palpation of pulse rate, rhythm, and quality.
• Observation of mucous membrane color and CRT.
• Observation of respiratory rate and pattern.
• Auscultation.
• Pulse oximetry.

Assuming you agree with these simple precautions, let’s do some straightforward math: 5 procedures a week x 52 weeks x $5 per patient = $1,300 a year.

And remember, our theoretical piece of equipment cost $1,000. And you charged a mere $5 per patient. Clearly this is a back-of-the-envelope calculation, but you can play with the numbers very easily to fit your particular situation.

It’s not just good business, it’s good medicine.

1 “Anesthesia Monitoring: Raising the Standard of Care,” E. Mazzaferro, NAVC Clinician’s Brief, August 2011, p. 51-54
2 www.acva.org. Click on “Small Animal Monitoring Guidelines”


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