Originally published in the July 2015 issue of Veterinary Practice News. Loved it? Then subscribe today! Through blood-shot eyes, Mrs. Jones explains her sleepless night of listening to her dog scratch his left ear. You diagnose an ear infection and ask your technician to show her how to clean the dog’s ears and apply ointment. You tell Mrs. Jones that you will need to see Duke again in two weeks. She nods in agreement and goes to the front desk to check out. The receptionist asks, “Do you want to make an appointment for Duke’s recheck?” Mrs. Jones replies, “I need to check my schedule and will call you tomorrow.” Mrs. Jones forgets to call. Patient care and practice health may suffer from the lack of follow-up care. Only 4 percent of practices always schedule medical progress exams at checkout, 35 percent do so often and 49 percent sometimes do.1 Every healthcare team member influences clients’ decisions to schedule follow-up care. Here are strategies to ensure that your staff takes a consistent approach: Change your terminology. The term “recheck” sounds optional while “medical progress exam” communicates that follow-up care is urgent and important. Update the term in your practice-management software and during client conversations. Set expectations at the time of diagnosis. In the exam room, where you have the client’s complete attention, explain the necessary follow-up care. Say, “I will need to see your dog again in two weeks for a medical progress exam, which would be on <date>. I will examine your dog again to make sure the ear infection has healed. Follow-up care is important because ear infections can be painful and recur. The receptionist will make your appointment for <date> during checkout.” State a specific date for follow-up care, and use benefit statements to persuade the client. For example, she will want to avoid having the dog’s painful ear infection reoccur. Note the specific date in the electronic medical record, paper chart or travel sheet to alert the receptionist to schedule a future exam. Too often, clients walk through the mind-erase hallway from the exam room to the checkout desk. Because the receptionist wasn’t in the exam room, she is unaware that follow-up care is necessary and will simply collect payment for today’s services. Meanwhile, the veterinarian assumed the medical progress exam was scheduled. Schedule first, pay last. If sick patients require follow-up care, schedule medical progress exams first and have clients pay afterward. This order has two advantages. First, it prevents pet owners’ hesitation to schedule follow-up care after sticker shock. Secondly, appointment reminders will print on clients’ receipts. The receptionist would say, “Dr. <Name> needs to see your dog again on <date> for a medical progress exam for his ear infection. Let’s schedule his exam first, and then I’ll get you checked out for today’s services. Does this same time, 3 p.m. on <date>, work for you?” Receptionists need to ask with confidence, never saying, “Do you want to make your next appointment?” which gives clients an option to decline necessary care. For progress exams, strive for the same day, same time and same doctor as the initial exam. If the client is here at 3 p.m., on a Monday, she can probably visit again at a similar time and day of the week. Book the appointment with the same veterinarian, ensuring continuity of care and efficient use of exam time. Enter callbacks if clients don’t schedule. In addition to scheduling progress exams at checkout, do the same for pediatric visits. Timing is especially important for puppy and kitten exams. If the client doesn’t schedule the next pediatric appointment at checkout, enter a callback in your software for one week before services are due. If you get voicemail, leave this message: “This is <your name> calling for <Your Veterinary Hospital>. Your kitten is due for his next pediatric exam, vaccines, deworming and intestinal parasite screen next week. Dr. <Name> wants to ensure your kitten has timely visits so we can provide preventive care and check his growth and development. Dr. <Name> needs to see your kitten between July 27 and 31. Please call us today at 555-555-5555 to schedule an exam.” Using the doctor’s name brings credibility and authority to the call. Guide the client to make an appointment with the two-yes-options scheduling technique. Stating a date range stresses the importance of timely care and will encourage the client to return your call. If you speak with the client, say, “This is <your name> calling for <Your Veterinary Hospital>. Your kitten is due for his pediatric exam, vaccines, deworming and intestinal parasite screen next week. Dr. <Name> can see you at 9 a.m. on Thursday, or 3 p.m. on Friday. Which choice do you prefer?” Implement disease-management exams. Given that 35 percent of pets are seniors and may develop chronic conditions, you need to proactively plan for ongoing care.2 Once you diagnose a pet with a chronic disease, switch the patient from a preventive care exam code to a disease-management exam code. Don’t code everything under “office call” because you can’t remind for various types of exams. For example, a senior preventive care exam code reminds every six months while a disease-management exam reminds quarterly. Seeing patients with chronic diseases every three months could lead to better management of diseases, let you adjust treatments, medication and diagnostics as needed; this practice also spreads out cost of care for clients. Consider disease management exam for chronic conditions such as kidney disease, heart disease, Cushing’s disease, arthritis, diabetes, thyroid conditions and other health problems. When scheduling for a renal patient, one of the four exams might be like the traditional preventive care exam, while the second exam is a comprehensive exam and urinalysis. The third appointment includes a physical exam and a blood pressure check. The fourth visit is another physical exam and senior preventive blood and urine screen. More frequent follow up will let you provide optimal disease management. When your healthcare team takes a strategic approach to follow-up care, you’ll improve the health of your patients and your practice. References 2011 Bayer Veterinary Care Usage Study conducted by the National Commission on Veterinary Economic Issues, Brakke Consulting, and Bayer Animal Health. Accessed 05-06-15 at http://avmajournals.avma.org/doi/full/10.2460/javma.238.10.1275. AAHA study, “Compliance: Taking Quality Care to the Next Level,” 2009; pp. 11. Wendy S. Myers owns Communication Solutions for Veterinarians in Highlands Ranch, Colo. She helps teams improve client service, communication skills and compliance through consulting, seminars and webinars. Her new book is 101 Communication Skills for Veterinary Teams and new DVD is “Become a Client Communication Star.” Wendy is an instructor for the American Animal Hospital Association’s Veterinary Management School. You can reach her at wmyers@csvets.com or www.csvets.com.
