PRACTICE SUCCESS IN ANY ECONOMY

PRACTICE SUCCESS IN ANY ECONOMY WHO AM I? Vet Tech USAF CSU Graduate 1976 VMI (Veterinary Management Institute) Graduate Private Cmpanin Animal Practitiner ver 35years Built, Owned and Managed a 3 ½ Dctr AAHA THINK BIG- FOCUS Practice in Cnnecticut fr 25 years SMALL & DREAM Assistant Clinical Prfessr, Mississippi State University CVM 7 Yrs. Primary Care, Business, Cmmunicatin Recently Retired Relief Vet / Shelter Vlunteer/ Lecturer/ Veterinary Career Cunselr AAHA Past President Bard Member ICVA (frmerly NBVME) MARK RUSSAK PAST PRESIDENT AAHA AMERICAN ANIMAL HOSPITAL ASSOCIATION NUTMEG VETERINARY CONSULTING OVERVIEW Practice Status Bayer-Brakke Study Trends Finances/Metrics Client Centric/Bnding Actin Plans DECLINING PRACTICES Limited Measurement Of Client Satisfactin N Real Scial Media Presence Owners Belief That Advertising (Marketing) Undermines His Or Her Credibility As A Veterinarian. A Lack Of Referral Arrangements With OTHER Pet Service Prviders Such As Grmers, Dg Walkers, And Pet Stres ECONOMIC STATE DISPOSABLE INCOME? Veterinary Care Usage Study 10 Year Decline In Visits- (imprving) Started 2004-Recessin-2008 Fragmentatin Of Services Mbile, Specialty, Spay/Neuter, Dr. Ggle, Internet Pharmacy, Mre Vets & Hspitals Etc. Inadequate Client Understanding Of Need Fr Rutine Visits Cst Of Veterinary Care Feline Visit Resistance DECLINING PRACTICES Cst Perceptins Veterinary Csts Are Usually Much Higher Than Expected. Cst Expectatins: The Value Prpsitin Payment Required At The Time Of Service Only DECLINING PRACTICES Limited Use Of Business Metrics Dr. Prductin, ACT, Prfit Centers, Labr Csts, Client Visits, New Clients, Open Appintments, Receivables A majrity Of Practice Owners Dn t Use Financial Cncepts T Manage Their Businesses..Thse That D Earn Significantly Mre Than Thse That Dn t- 1

Why clients switch Pr cmmunicatin & custmer service LOCATION DOES NOT DETERMINE GROWTH SO WHAT DOES DETERMINE WHETHER YOU GROW? Fcusing On Yur Clients Cst Driving Regular Preventive Care Visits Leveraging Technlgy Setting Gals And Measuring Yur Business 10 Beynd yur cntrl (e.g., mve, pet dies) 11 Grwers and Outgrwers Decliners Cmmunicating The Value Of Yur Higher Standards FOCUSING ON YOUR CLIENTS CLIENT CENTRICITY Grwers Strengthen the Bnds GROWTH PRACTICES GROWERS FOCUS Reputatin/Well Knwn Wrd Of Muth/Referrals' Client Cmmunicatin DECLINERS FOCUS Specialized Care/Services Grwth In Area/Ecnmy ============================================================================================================== Practices that fcus n engaging clients are mre than twice as likely t be Grwers vs. Decliners 14 Clients Saw The Same Veterinarian During Every Visit: Relatinship Building Share Smething With Client At Every Visit: Exam Reprt Cards Fllw Up With Clients After Visits: Via. Phne / Email / Text Offer Care Payment Optins Invest In Cmmunity Events GROWTH PRACTICES Active Use f Scial Media, such as Facebk, Twitter etc. fr marketing Purpses Leveraging Current Technlgy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Our practice management technlgy and systems have evlved GROWTH PRACTICES Belief That Wellness Examinatins Are The Practice s Mst Imprtant Service. Belief That Marketing And Advertising Are Imprtant T The Practice s Success. Use Outside Client Marketing Sftware Accurate Financial Benchmarking (Metrics) SURVEY OF OVER 1,000 PET OWNERS WHO Have At Least One Dg And/r Cat See Their Veterinarian Regularly Are The Primary Care Prvider Dn t Wrk In The Pet-health Industry 18 2

Ze s bi-annual checkup My Veterinarian is.. 93% BELIEVE THE BOND THEY HAVE WITH THEIR PRACTICE IS IMPORTANT 19 21 PET OWNERS ARE INTERESTED IN PREVENTIVE CARE Believe discussing disease preventin is imprtant Discussed preventive care with veterinarian at last checkup visit 8 ut f 10 interested in mnthly payment preventive care plans N difference in interest based n incme PET OWNERS ARE OPEN TO FORWARD BOOKING 6 ut f 10 will say yes t Frward Bking 22 23 24 Clsing the gap in Frward Bking Average % f clients Frward Bked U.S. Dental Practices 80% U.S. Veterinary Practices 5% DRIVING PREVENTIVE CARE FORWARD BOOKING EXAMPLE Average % f clients fr whm next appintment is Frward Bked ~ 80% Prjected increase in U.S. veterinary hspital preventive care revenue ~$350M Pet wners want t be infrmed Researching pet health Receiving suggested nline nline befre r after visit resurces frm veterinarian ~10% 25 Surce: AAHA State f the Industry 2013 U.S. Dental Practices ~ 5% U.S. Veterinary Practices 27 3

30% reductin in Dr. Ggle when yu simply recmmend an nline surce Percent f pet wners that cnsult Dr. Ggle befre r after visit 70% MOST IMPORTANT TO STRENGTHEN THE BONDS Pet Ownership the value f diagnstics Explaining Always fllw recmmendatin fr rutine bld testing Wuld prbably agree t testing if value made clear 1. Explains Things In A Way I Understand -30% 2. Shares Test Results With Me 48% 3. Treats Me As A Partner 4. Prvides Guidance On Preventive Care Veterinarian desn t recmmend trusted nline resurce Veterinarian des recmmend trusted nline resurces Surce: Survey f 500 pet wners with regular veterinarians, 12/2013. Data n file with IDEXX. 28 29 30 IT S NOT ABOUT THE NAIL VERY BAD P.R. CORE VALUE=COMMUNICATION Cmmunicatin Is A Cre Relatinship Skill And Develping It T A Prfessinal Level Of Cmpetence Is A Key T Success In Business (And Life!) DIALOGUE IS KEY Clinical Outcmes Result Frm Mutual Understanding And Shared Agreement Cmmn Grund Is Achieved Thrugh Dialgue Wh s Ding All The Talking SHARED DECISION MAKING REALITY CHECK Message Feedback Respnse Interruptins In 55% Of Visits: 72% Of Clients Did NOT Cmplete Their Respnse Decisins Are Made Within A Cllabrative Partnership Using Best Available Evidence Taking Client Perspectives Int Accunt Encuraging Client Input Creating A Dialgue Veterinarians Interrupt Clients Within: 15.3 Secnds (Dysart Et Al, 2011) Physicians Interrupt Patients Within: 18 Secnds (Beckman & Frankel, 1984), 23 Secnds (Marvel Et Al, 1999), 12 Secnds (Rhads Et Al, 2001) Shared Decisin-making Requires Relatinship Culter, 1999; Stewart et al, 2003 4

PRACTICE, PRACTICE, PRACTICE Fur Cre Skills Nn-verbal Cmmunicatin Open-ended Questins Reflective Listening Empathy CORE SKILLS Nn-verbal Bdy Language: Open-ended Questins: Wh, What, When, Where, Why, Hw. Tell Me What Cncerns Yu Have Abut Mlly? Hw Wuld Yu Describe Jake's Daily Activities? Reflective Listening: Repeat Of Clients Wrds, Summary & Interpretatin - S Friskie Threw Up Twice Last Night? - Given Yur Recent Experience With Snwball, I m wndering If That s What Yu re Wrried Abut With Frisky? Empathy: Walk In Smene Else's Shes - I Can See Hw Hard It Is T Make This Decisin I had t d the same thing - It Sunds Like Yu Did All That Yu Culd Fr Barney ENDING VISIT! ALWAYS Check In With Client - Open Ended Questins: What Are Yur Cncerns? What Else Can I D Fr Yu And Fid Tday? NOT - D Yu Have Any Questins? OH, BY THE WAY Nt eliciting the clients cncerns at the beginning f the appintment increased the dds (4x) f a cncern arising during the clsing segment f the interview. Dysart, Ce, Adams, 2011 WATCH YOUR WORDS VETERINARY TEAMS WHY VETERINARY TEAMS? Develping High Perfrming Teams In Practice Is Imprtant Because They Are Crucial T The Quality And The Delivery Of The Hspital s Veterinary Services The Client Usually Has Mre Interactin With The Staff Than With The Dctrs. Veterinary Services Are Prvided By Peple And The Prvider Is Inseparable Frm The Service Itself THE VETERINARY TEAM. KEY TO PRACTICE SUCESS Mark Russak Past President American Animal Hspital Assciatin 5

THE VETERINARY TEAM Hire Fr Attitude-Train Fr Skills Hire Slwly Fire Quickly Leverage The Team Prfessinal Attire Persnal Appearance/Grming Name tags Business Cards Flexible scheduling Crss Training THE VETERINARY TEAM Empwer & Train Fr Decisin Making Cntinuing Educatin Encurage Creativity Celebrate Tgether Laugh A lt Thank Yu s Cmpensate Fairly Prfit Sharing Pet Insurance PRACTICE CULTURE Fster A Culture Of Mutual Respect Qualities Of Leadership Such As Hnr, Respect, Integrity, And Fcus Are Visible At All Levels Of Management. Owners Cnstantly Ask Themselves And Their Staff Members What They Can D T Imprve. OH THOSE CRAZY CATS! WHY METRICS??? Metrics Are A Set Of Measurements That Quantify Results Yu Can't Manage What Isn't Measured FINANCAL BENCHMARKING Prfit Centers Revenue By Categry New Clients Per Mnth Open Appintments Receivables Inventry Levels Average Patient Transactin (APT) FINANCAL BENCHMARKING Grss Incme Per Mnth: Hspital, Dctr Average Transactin Charge Per Veterinarian Number Of Medical Transactins Per FTE DVM Per Mnth Labr Csts REVENUE BY CATEGORY Lab 18-22% Dental 5% Imaging 6% Anesthesia 6% Surgery 8% Office Visits 12% Med Exams 15% Injectable 46% 2015 SNOWGOOSE VETERINARY MANAGEMENT CONSULTING 6

Well Managed Metrics RULE THE EXAM ROOM Never Allw Client t See r Hear Pain Pain Is Inevitable...Suffering Is Optinal Diagnstic & Care Plan Cmpliance Keys Never Pre-Judge Best Optins First- Plan A,B,C? What YOU Wuld D Fr YOUR PET NEVER, NEVER, NEVER - Recmmend What the Patient Needs & Deserves! Fid NEEDS.. MONEY TALK Cmfrtable Financial / Medical Cmmunicatin Plain Language-N Jargn Risk / Benefits/ Teamwrk Patient Care Plans (Estimates) $$ Updates Daily FOOD FOR THOUGHT Pet Spending Has Increased. While Vet Care Spending Has Lst Grund- Imprving? ¼ + Of Pet Owning Public Spends $0 = Opprtunity! Gd Medicine Is Gd Fr The Bttm Line The Reasn We Practice Is Nt Prfit but We Can t Practice Withut It Pre-anesthesia Testing Pain Medicatin $375/pet/year Full Dentistry Full Diagnstics REVENUE BOOSTERS Same DVM Each Visit Standards & Prtcls = DVM Cnsistency=Client Trust Assessments: Nutritinal, Parasites, Dental, Behavir- EVERY PATIENT EVERY TIME! BP, Breed Screens, Thrugh Exams Missed Charges Fllw Up Reinfrce > Recall > Recheck> Remind Medical Prgress Exams = Recheck Frward Bking, Text Reminders, i-cal etc. CLIENT CENTRIC / BONDING Clean Animals High Tech & Current Image Digital Camera Pictures- Prcedures Persnal Client Vides-Virtual Turs Facebk, Blgging, Tweeting, Practice Apps, Practice Yu Tube Channel, Client G-Mail, Ggle Vice Clients are an investment nt a liability CLIENT CENTRIC / BONDING Stand Out Frm The Crwd Extics Behavir Cunseling Alternative Medicine Puppy Classes Web Site-Pet Prtals Surveys CLIENT CENTRIC-BONDING Internet Pharmacy Pet fd & Rx Delivery Pet Pick Up and Delivery Hspital T Car Cmmunicatin Texting- Sx/DO 7

CLIENT CENTRIC-BONDING Abve & Beynd Cmfrt Rm N Charge Nail Clips, Euthanasia In Hme Euthanasia Hspice Service Sympathy Ntes-Tribute Dnatins Virtual Memrials KEYS TO EXCELLENCE Nurture A Winning Team Staff Make The Hspital Peple Are Yur Organizatin s Mst Imprtant Resurce; They ARE Yur Organizatin ~Ken Blanchard Create Raving Fans Pr Service Has Created: Lw Expectatins Prmise High & Deliver High: Exceed Expectatins FACTORS INFLUENCING AVERAGE TRANSACTION CHARGE Fee Schedule Culture: Philsphy, Appintment Length Recmmendatins And Cmpliance/Adherence Client Educatin Staff Training Thrugh Physical Examinatins Client Centric/Service Client Bnding Skills FACTORS INFLUENCING AVERAGE TRANSACTION CHARGE Cmmitment T Best Practices Recmmendatins Cmmunicatin Skills Cnfidence In The Medical Recmmendatins Animal Health Care Team Supprt: # Of Staff, Hw They Are Scheduled, Skill Sets, Cnfidence In Dctr Selling An Additinal Necessary Service Or Prduct Lngevity/Established Client Base WAYS TO INCREASE TRANSACTION NUMBERS Effective Reminder System Preferred Methd t Cntact Clients Mre Appintment Flexibility New Services Client Educatin Discuss All Diagnstic Test Results with Clients Cmpetitive Prices Fr Prducts That Culd Als Be Purchased Elsewhere Prescriptin Drugs, OTC prducts, Internet Pricing Own internet Pharmacy Extended business Hurs Use Business Metrics Marketing The Practice: Thrugh Referral Prgrams With Other Pet Service Prviders Prviding Referral Incentives Fr Existing Clients Increasing Use Of Scial Media And Other Cmmunicatins Vehicles Rutinely Measuring Client Satisfactin Thrugh Afterservice Surveys Marketing The Practice Thrugh Referral Prgrams With Other Pet Service Prviders, Prviding Referral Incentives Fr Existing Clients. Making It Easier Fr Clients T Schedule And Keep Appintments By Scheduling The Next Appintment Befre The Pet Leaves The Practice Emphasize Full-year Life Stage Health Plans Explain T Owners Hw T Care Fr Their Pets & Why & When Visits T The Practice Are Indicated AFFORDABLE- NOT CHEAP VETERINARY CARE Helping Clients Manage Veterinary Csts By: Develping Written Financial Plicies And Prviding Patient Care Estimates, Payment Optins & Mnthly Installment Payment Plans Pre-Paid Wellness Plans Third Party: Care Credit, Insurance 8

PET HEALTH INSURANCE FACTS** **(Nrth American Pet Health Insurance Assciatin) Insured Pets: Dg Owners Spend 29% Mre On Veterinary Care Cat Owners Spend.81% Mre On Veterinary Care Owners 50% Mre Likely T Get Insurance If Veterinarian Recmmends It. Decisin NOT Abut The Cst Of Insurance Cmpliance Tips: ALWAYS Ask Abut Pet Insurance Designated Staff Member Insurance Liaisn Insure Staff Pets Website Links Stick With 1 Or 2 Cmpanies Make The Practice Fear Free T Reduce Stress Educating Cat Owners On Methds T Acclimate Their Pets T Carriers And T Make Bringing Them T The Practice Less Stressful Cat Friendly Practices ACTION STEPS Identifying Pets With Lapsed Appintments By Asking Abut Other Pets During Every Visit And Reinfrcing The Imprtance Of Rutine Wellness Examinatins. Mine Yur Recrds Making It Easier Fr Clients T Schedule And Keep Appintments Using A Wider Array Of Reminder & Recall Methds text, ical Etc. Capture Missed Charges CAPTURE MISSED CHARGES Percentage f U.S. Lab Tests Never Billed T Clients 17% ~10% Estimated 2012 Ptential Target % Increase in U.S. Veterinary Practice Revenue Assciated with Reducing % f Lab Tests Never Billed T Client $450M PARTNERS FOR HEALTHY PETS (PHP) Ensure Pets Receive The Preventive Healthcare Thrugh Regular Veterinary Visits. Led By AVMA & AAHA Cllabrative Alliance Of Over 100 Veterinary Assciatins, Clleges Of Veterinary Medicine And Animal Health Cmpanies Prvides Tls And Resurces That: Help Cmmunicate The Value And Benefit Of Preventive Care Enhance The Veterinary Client Relatinship Prmte The Imprtance Of Annual Veterinary Checkups PERCEPTION OF VALUE PERCEPTION OF VALUE PERCEPTION OF VALUE 9

- FINAL THOUGHTS Build Relatinships Get Persnal Enhance Phne Skills- Staff Training Smile, Psitive, Helpful Attitude f Gratitude! EVERY CLIENT EVERY PET EVERY VISIT It Is Nt That We Aim T High And Miss It. But That We Aim T Lw And We Reach It Cmmunicatin = Understanding = Value = Cmpliance ~Michelangel~ LIFE: THIS IS WHAT REALLY COUNTS! HAVE FUN!!!! 10