With persuasive conversations, technology tools and effective reminders, veterinarians can get more patients the preventive diagnostics they need. Since 2007, Ellie has taken nonsteroidal anti-inflammatory drugs to manage her arthritis following two knee surgeries. The 11-year-old black Labrador retriever gets a drug-monitoring test every six months.
When Peter Brown, DVM, of Chuckanut Valley Veterinary Clinic in Burlington, Wash., reviewed Ellie’s latest test results, he used Idexx’s VetConnect Plus to see trends over time. Ellie’s liver values had been steadily increasing and were now at the top of the normal range. Dr. Brown sat next to the client, showing her graphs of Ellie’s changing liver values on his iPad.
He discussed adding a liver supplement and plans to recheck blood work next month. From his iPad, Dr. Brown shared lab results to the client’s Petly online pet health page through Idexx’s Pet Health Network Pro.
"While she was still at our clinic, an alert on her phone indicated she had new lab results shared,” says Dr. Brown. "Now she can share results with the rest of the family at home.”
A 2012 State of the Profession study found that diagnostics make up 18 percent of practice income with growth to 20 percent anticipated in three years. "Diagnostics is where our profession is going to grow,” says Dr. Brown. At his mixed-animal practice with six veterinarians, 24 percent of revenue comes from diagnostics.
With persuasive conversations, technology tools and effective reminders, you can get more patients the preventive diagnostics they need.
Repeat the Message
Awareness starts when clients call to schedule exams. Receptionists can remind clients to bring pets’ stool samples for intestinal parasite screening. When a client schedules a senior patient exam at Chuckanut Valley Veterinary Clinic, an alert prompts the receptionist to explain senior testing and fasting instructions.
"Always prepare your clients for what to expect before they walk through the door,” Dr. Brown advises.
Before the veterinarian enters the exam room, a technician informs the client which diagnostic testing is needed, gets approval and collects samples. Test results are available during the exam.
"Clients get a high perception of value when you share results in face-to-face conversations,” Dr. Brown says.
When discussing diagnostics, replace "Do you want?” with "Your pet needs.” At North Royalton Animal Hospital in North Royalton, Ohio, technicians explain which diagnostics patients need and why. At least one dog per month tests positive for heartworms or tick-borne diseases. At the three-doctor hospital, diagnostics account for 30 percent of revenue.
At Golden Triangle Animal Hospital in Southlake, Texas, technicians explain the need for senior preventive screens and use age comparisons. When a client learns her 16-year-old cat is equivalent to an 80-year-old person, she understands the need for screening.
"We’ve trained our clients about the importance of senior blood work,” says Steve Ruffner, DVM. "Screening gives us baselines in case a problem comes up down the road. I can think of a lot of cases where we found kidney issues before kidney failure.”
When her diabetic dog began drinking more water, a client returned to Golden Triangle Animal Hospital for help.
"I played Joe Detective using the VetConnect Plus tool with trending, which created a stronger perception of value,” he says. Diagnostics revealed Cushing’s disease, and Dr. Ruffner shared a graph of previous tests with the pet owner.
"Historically, veterinary medicine has used diagnostics as a problem-based learning approach,” says Jay Stewart, DVM, co-owner of Aumsville Animal Clinic in Aumsville, Ore., and former president of the Companion Animal Parasite Council. "The more we screen for health, the more opportunities it gives us to celebrate and tell clients to keep up the good work.”
Use Benefit Statements
Help clients understand the medical and economic benefits of screening.
Here’s a sample script for senior testing:
"Because pets age faster than people, changes can happen quickly. Just like people in their golden years, senior pets have an increased risk of diabetes, heart and endocrine disease, and cancer. Because these diseases show few signs in early stages, preventive care and routine blood work are important.
"Senior preventive testing helps us establish a baseline of what is normal for your pet as well as to detect any changes early. Catching changes early often means they will be easier and less expensive to treat. Think of preventive blood work as the internal physical exam that lets us check the health of organs and thyroid function.
"Thyroid disease is common in older pets. Urinalysis lets us determine hydration, kidney function, and whether there is any inflammation or infection in the urinary tract. We will collect blood and urine samples now, and then will discuss results with you today or tomorrow.”
Call the Client
If samples are sent to a reference lab, get clients’ cell phone numbers so you’re more likely to connect. Remember, clients have paid for results. Don’t practice "no news is good news” even with routine intestinal parasite screening. You don’t want the only time that clients hear from you to be bad news. In addition, "no news is good news” will make it more challenging to get compliance for repeating tests next year.
"If pet owners understand why we need to do diagnostics, they will accept them,” says Adam Heckho, DVM, of North Royalton Animal Hospital.
The Companion Animal Parasite Council offers U.S., state and county prevalence maps for heartworms, tick-borne diseases and intestinal parasites in dogs and cats (www.capcvet.org). Enter your postal code to get U.S. or Canadian data on heartworms and tick-borne diseases from Idexx’s www.dogsandticks.com. At www.kittytest.com, you can find U.S. data by state and county for feline immunodeficiency virus, feline leukemia virus and feline heartworms.
Look to in-house lab reports for insightful statistics.
When Robert Tope, DVM, of Electric City Animal Clinic in Anderson, S.C., ran a report on his in-house SNAPshot Dx Analyzer, he found 80 positives out of 960 heartworm tests last year. Telling clients that 12 percent of patients tested positive in 2012 reinforces the need for annual screening and year-round preventatives.
Discount Preventive Tests
As a veterinary consultant, I advise practice owners to price preventive diagnostics 20 percent to 25 percent less than sick-patient testing. Because 10 Percent of pets that appear healthy during checkups have hidden diseases, most client conversations will celebrate normal results. Sharing good news takes less time. A higher fee for sick-patient testing covers additional doctor time to diagnose the problem and discuss treatment.
At Electric City Animal Clinic, 90 percent of clients accept its $70 preventive diagnostic package that includes blood work, heartworm/tick test and intestinal parasite screen. The senior diagnostic bundle priced at $100 gets 75 percent compliance.
"For some clients, cost plays a big factor,” says Dr. Heckho. "Unless clients have experienced sick pets, it’s hard for them to grasp that preventive care helps them in the long run. We communicate the value of trending and looking for diseases early.”
Paper strips of lab results and X-ray view boxes are being replaced with exam room computers and tablets.
"If I send images to a radiologist for review, I do it in front of the client from the iPad,” says Dr. Brown. "It’s one less step for me to do later. Clients love seeing their pets’ X-rays on an iPad.”
Dr. Brown also emails images and shares lab results to clients’ Petly online pet health pages from his iPad. Although Chuckanut Valley Veterinary Clinic has computers in exam rooms, iPads give doctors mobility to consult with each other in hallways and advise clients anywhere in its large facility.
Share Results Promptly
At Aumsville Animal Clinic, 95 percent of testing is performed in-house. Delivering results during exams reduces callbacks. For five years, the six-doctor practice has had a dedicated lab/pharmacy technician.
"Real-time care pays dramatic dividends,” says Dr. Stewart. "If the dog needs medication, we dispense it during today’s visit. Half of the time in human medicine, prescriptions never get filled at a pharmacy. If we don’t send medication home with veterinary patients, they may not get it at all.”
Create Distinct Codes
Distinguish the reason for testing—whether preventive screening or sick-patient testing—because it influences future reminders and affects the accuracy of compliance results.
Let’s say your hospital is in Virginia, where 1 out of 13 dogs is testing positive for Lyme disease. You perform an annual heartworm/tick test as a preventive screen, but use the same test when a sick patient presents with tick-borne disease symptoms. If you run compliance reports to see what percentage of active dogs have received heartworm/tick tests, results may be inflated because preventive and sick-patient testing are muddled in the same code.
Instead, create distinct codes such as "heartworm/tick preventive screen” and "heartworm/tick test.” When you run compliance reports, search only "heartworm/tick preventive screen” to get accurate results.
When creating diagnostic codes, use client-friendly descriptions that will print on invoices and reminders. Clients won’t understand "CBC, comprehensive with FeLV” but would understand "Feline leukemia/FIV preventive screen.”
Use postal and email reminders to let clients know when testing is due for heartworms/tick-borne diseases, intestinal parasites, retroviruses, blood pressure, adult and senior preventive screens, and drug monitoring. Compliance jumped 20 percent when Chuckanut Valley Veterinary Clinic added diagnostics to its reminder list.
"You need to get clients to say ‘yes’ every year. If a dog lives to age 15, you need eight years of ‘yes’ to senior screens,” says Dr. Brown.
When your team promotes the benefits of preventive diagnostics, success can magnify. Cat owners often own multiple cats—2.1 per household—compared to dog owners, who average 1.6 dogs per home, according to the American Veterinary Medical Association’s 2012 U.S. Pet Ownership & Demographics Sourcebook.
"Compliance trickles down to other pets because most of our clients have multiple pets,” says Dr. Brown. "When a client with an older dog gets a puppy, she already knows about the lifetime of testing ahead.”
Wendy S. Myers owns Communication Solutions for Veterinarians and is a partner in Animal Hospital Specialty Center, a 10-doctor AAHA-accredited referral practice in Highlands Ranch, Colo. You can reach her at firstname.lastname@example.org or www.csvets.com.