How to charge for technician appointmentsWhen your practice utilizes technicians like physician assistants, technicians will work at the top of their licenses May 29, 2023 By Wendy S. Myers, CVJReview your state’s policies and identify types of appointments technicians and assistants will see to increase clinic availability and free up the practice’s workload. Struggling with doctor shortages? Using technicians as physician assistants is a solution—your practice can shift up to 20 percent of appointments from doctors. As a result, your clinic will have more veterinary appointments and exams available for sick patients, which will have higher transactions. You also can charge for staff time and care delivered during technician appointments. Here’s how. Which appointments to reallocate Consult your state’s guidelines on licensed technician and veterinary assistant duties and whether veterinary supervision must be direct or indirect. In Georgia, for example, a licensed technician may perform euthanasia, dental extractions that do not require sectioning of the tooth or resection of bone and induce and maintain anesthesia under direct supervision of a veterinarian.1 A non-credentialed assistant may administer vaccines, except rabies, and may maintain anesthesia, but cannot induce it.2 After reviewing your state’s policies, identify types of appointment technicians and assistants will see. Create scheduling guidelines with the appointment length and reason for visit (Figure 1). Consider a standard of care that patients must have a veterinary-client-patient relationship and have a physical exam within 12 months to be eligible for technician appointments.3 Shift four appointment types from veterinarians to technicians and assistants: 1) Preventive appointments. Let’s say for instance, 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 the appointment with a technician rather than a doctor. Forward book the technician appointment today to ensure on-time immunization. 2) Diagnostic appointment. 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. Change bandages, administer subcutaneous fluids, perform laser therapy, trim nails, clean or flush ears, and much more. 4) Instructional appointments. Some appointments for puppy and kitten patients could be delegated to technicians, who will give vaccines and discuss nutrition, behavior, parasite protection, potty training, and preventive topics. Technicians and assistants could advise clients with pets on weight-management programs. Teach clients about home care such as giving insulin injections and subcutaneous fluids. During these instructional appointments, have clients record videos of patient care they will need to do at home. Let’s say the client schedules a technician appointment to have 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 clean the right ear, have the client clean the left ear while you coach her. Clients will better understand homecare instructions after watching, doing, and recording a video for future reference. Charging for technician appointments Just as you would pay for an appointment with a physician assistant, clients will pay for technician appointments, which are a valuable medical service. To help clients understand the difference between duties performed by a veterinarian and technician, choose different names for the service. Use “exam” when a veterinarian performs a physical exam. Use “health assessment” when a technician or assistant evaluates patient health by getting vital signs, asking history questions, updating the medical record, and delivering care. The term “health assessment” applies in the human nursing profession.5 A health assessment performed by a technician or assistant includes four services: 1) Getting patient’s vital signs (i.e. temperature, pulse, respiration, weight) 2) Asking history questions 3) Updating medical records 4) Delivering care Veterinarians should define which patients will need health assessments during technician and assistant appointments. Setting technician appointment fees Consider two choices when setting fees. Charge for a health assessment based on a percentage of the doctor’s exam fee or calculate a per-minute rate based on technicians’ average hourly wage. Percentage of doctor’s exam: If your exam fee is $60, charge half of the doctor’s rate when a technician performs a health assessment, or $30. Bill a third of the doctor’s exam, or $20, if an assistant conducts the health assessment. Per-minute rate: The 2021 average hourly pay for a technician was $17.72, according to the U.S. Bureau of Labor Statistics.6 Veterinary assistants average $14.32 per hour.7 If staff costs are 20 percent of revenue, a technician needs to generate $88.60 per hour in income. To calculate your per-minute rate, take your average labor cost per hour and divide it by 20 percent. For example, if the hourly wage is $17.72, the technician needs to generate $88.60 per hour. Divide $88.60 income per hour by 60 minutes for a per minute billable rate of $1.48. Rather than the tedious task of setting a stopwatch every time a technician delivers care, set fees in blocks of 10, 20, 30, and 40 minutes with a minimum amount charged. Suppose the technician has a 10-minute appointment for a booster vaccine. The technician will perform a health assessment on the patient and administer the vaccine. The client will pay $14.80 for a health assessment and $26.22 for the Leptospirosis vaccine for a total of $41.02. If a task takes less than 10 minutes, charge the 10-minute rate because it’s the minimum amount and starting point for fees. Here are examples of technician appointment fees based on blocks of time: Communicating value to clients If you do not charge for technicians’ time now and will implement a health assessment fee later, create a plan so employees may answer clients’ fee questions with confidence. Host a staff meeting to explain the “why” behind the charge to your team. Technicians and assistants will appreciate that you value their time and expertise and want to charge clients for services they deliver. Your communication plan should include actions that demonstrate value for the health assessment fee. Doctors need to transfer the trust. During the veterinary appointment when the doctor performs an exam and gives immunizations, explain what to expect for the booster vaccination. 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, and answer your questions. We take a team approach to preventive care. I value the contributions of our nursing team.” Explain the health assessment to clients. The technician should explain, “I’m <name>, the certified veterinary technician who will perform <pet name>’s health assessment and give the Leptospirosis booster vaccine. I will take <pet name>’s vital signs, including temperature, pulse, respiration, and weight. I will take a history and ask questions about your pet’s health. I will update <pet name>’s medical record with the vital signs and information we discuss. What questions can I answer before we get started?” List employees’ names on receipts. Just as you put doctors’ names on client invoices, include names of technicians or assistants who delivered care. This creates value for professional fees and personalizes the visit because pet owners know exactly who provided services. Use staff ID codes in your practice-management software that have an invoice item description. For example, a client’s receipt would say, “Your veterinarian was Dr. Smith” and “Your technician was Sue.” The receipt should list the clinic’s email, number to text, and practice app. If a client has a follow-up question, technicians and assistants will be easier to reach than veterinarians. 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. Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, Myers teaches practical skills through online courses, onsite coaching, and conferences. She was a partner in a specialty and emergency practice. Visit YouTube.com/csvets and Csvets.com for more. References Scope of Practice: Technicians. Georgia Veterinary Medical Association. https://gvma.net/scope-of-practice-technicians. Accessed April 3, 2023. Scope of Practice: Veterinary Assistants. Georgia Veterinary Medical Association https://gvma.net/scope-of-practice-veterinary-assistants. Accessed April 3, 2023. The Veterinarian-Client-Patient Relationship (VCPR). American Veterinary Medical Association. https://www.avma.org/resources-tools/pet-owners/petcare/veterinarian-client-patient-relationship-vcpr. Accessed April 3, 2023. Putting the Treat Into Treatment. https://fearfreepets.com/veterinary-professionals. Accessed April 3, 2023. Guide to Good Nursing Practice Health Assessment. https://www.nchk.org.hk/filemanager/en/pdf/health_assessment_e.pdf. Accessed April 3, 2023. Occupational Outlook Handbook. Veterinary Technologists and Technicians. 2021 median pay. U.S. Bureau of Labor Statistics. https://www.bls.gov/ooh/healthcare/veterinary-technologists-and-technicians.htm. Accessed April 3, 2023. Occupational Employment and Wages, May 2021. Veterinary assistants and laboratory animal caretakers. U.S. Bureau of Labor Statistics. https://www.bls.gov/oes/current/oes319096.htm. Accessed Jan. 16, 2023.