Parterig with: The Isider s Isight Bechmark Report is a publicatio provided by the Veteriary Hospital Maagers Associatio (VHMA). The report tracks key ecoomic idicators to determie how VHMA member practices are performig, as well as results from VHMA surveys o issues impactig the professio. There are approximately 6 VHMA member practices who cotribute to the data for the key ecoomic idicators. Data is represetative of compaio aimal practices oly. Page 1 of 8 April, 218 vs. April, 217 5 4 3 2 1 Reveue Growth April, 218 compared to April, 217 Total 4.3% Caie 4.8% Felie 1.8% Reveue Growth Compaio aimal practice reveue for the 611 VHMA practices icluded i this moth s study showed stroger growth i April tha i the previous moth. Total reveue growth was 4.3% from April, 217 to April, 218; both moths had the same umber of work days i them so that was t a ifluece. Caie reveue growth was 4.8% ad felie reveue growth was 1.8%. Year to date growth for 218 is 3.8%; this is lower tha 217 growth of 5.1%. Patiet Visits April, 218 compared to April, 217 Patiet Visits Total.2% Caie.9% Felie -2.7% There has bee little growth i total uique patiet visits i the first quarter of 218 ad April was o differet. Total visits for April, 218 compared to April, 217 barely icreased by.2%. Caie visits icreased by.9% ad felie visits declied by a disappoitig 2.7%. Year to date growth for 218 is.% compared to total 217 growth of 1.3%. (Note that the term visits is defied as uique purchases of either products or services for a idividual pet.) -3. -2.5-2. -1.5-1. -.5..5 1. New Cliet Growth April, 218 compared to April, 217 Jauary -11% February -13% March -9% April -8% May Jue July August September October November December New Cliet Growth New cliet umbers i April, 218 compared to April, 217 declied by 8%. This cotiues to be a discouragig tred as these umbers have declied almost every moth of the last three years. -15-12 -9-6 -3 Remember that the above figures represet averages across all the practices i the study; i order to uderstad what is goig o i YOUR practice, you eed to look ot oly at what your reveue growth was durig these moths (ad goig forward) but also at the drivers of growth i YOUR practice such as chages i ivoices, visits, ATC, fee icreases, ew cliets ad cliet retetio. This will give you the iformatio to make itelliget decisios about where to focus your time ad efforts to icrease growth. Data review ad commetary is provided by Kare E. Felsted, CPA, MS, DVM, CVPM, CVA of PatheraT Veteriary Maagemet Cosultig, www.patherat.com - May 218
Page 2 of 8 Prevetive Care Services This moth s Maagemet Survey questios explore the services offered to pet owers durig welless exams. Several of these questios were previously asked i early 215 ad the compariso betwee the aswers the ad ow will also be discussed. The first questio was: What are the top three thigs your practice emphasizes durig your welless exams? Respodets were allowed to select up to three aswers. % 8 7 6 5 4 3 2 1 1. What are the top three (3) thigs your practice emphasizes durig your welless exams? 47% 45% 13% 5% 72% Resposes: 216 Blood Work Detistry Fecal Test Heartworm/ Physical Premium Spay/Neuter Urialysis Vacciatios Behavior Other (Welless) flea products exam Veteriary (please specify) (comprehesive) Diet Resposes: 11 97 29 17 155 2 1 121 4 1 1% 5% % 56% 2% 5% The most commo service selected was the physical exam with 72% of the respodets icludig it i their top three picks. The secod most commo service selected was vacciatios with 56% of the respodets choosig it as a top three. No other service broke the 5% mark although detistry, welless bloodwork ad heartworm/ flea products came close with 45-5% of the respodets icludig these i their top three. These results were very similar to 215 with two exceptios: The percetage of respodets selectig the physical exam as oe of their top-three services dropped from 84% i 215 to 72% i 218 The percetage of respodets selectig heartworm/ flea products as oe of their top-three choices jumped from 34% i 215 to almost 5% i 218 A few other items were listed i the other category such as utritio, exercise ad body weight. The most iterestig aswer was ot a particular service but a approach: usig the pet s life style to determie what services would be most appropriate. The ext questio asked: What medical recommedatio(s) do your cliets most ofte follow through o? Respodets were asked to select the top three. % 8 7 6 5 4 3 2 1 2. What medical recommedatio(s) do your cliets most ofte follow through o, select the top three (3)? 36% 31% 25% 53% 52% Resposes: 216 Blood Workup Detistry Fecal Test Heartworm/ Physical Premium Spay/Neuter Urialysis Vacciatios Other (Welless) flea products exam Veteriary (please specify) (comprehesive) Diet Resposes: 78 66 53 114 112 6 4 4 158 4 3% 19% 2% 73% 2% 2 cotiued o pg. 3
Page 3 of 8 Vacciatios were most commoly selected with 73% of the respodets icludig this i their top three choices followed by heartworm/flea products (53%) ad physical exam (52%.) Although welless bloodwork ad detistry were highly emphasized by practices, cliets were less likely to follow through with these 36% of respodets icluded welless bloodwork i their top three ad 31% icluded detistry. Agai, these results were fairly similar to 215 with two exceptios: The percetage of respodets selectig the physical exam as oe of their top-three recommedatios followed through o by cliets dropped from 63% i 215 to 52% i 218 The percetage of respodets selectig detistry as oe of their top-three recommedatios followed through o by cliets icreased from 2% i 215 to 31% i 218 The third questio asked: Which medical recommedatio(s) are your cliets least likely to follow through o? Agai, respodets were asked to select the top three. % 8 7 6 5 4 3 2 1 3. Which medical recommedatio(s) are your cliets least likely to follow through o, select the top three (3)? 38% 5% 3% 18% 3% Blood Workup Detistry Fecal Test Heartworm/ Physical Premium Spay/Neuter Urialysis Vacciatios Other (Welless) flea products exam Veteriary (please specify) (comprehesive) Diet Resposes: 83 17 65 39 6 159 18 8 8 18 74% 8% 37% Resposes: 216 4% 8% The recommedatio respodets said cliets were least likely to follow through o was the premium veteriary diet with 74% of respodets icludig it i their top three. 5% of the respodets icluded detistry i the top three followed closely by welless bloodwork (38%) ad urialysis (37%.) These resposes were essetially the same as those i 215. The ext questio asked: Why do you thik your cliets do t follow through o your medical recommedatios? Respodets were agai asked to select the top three reasos. 4. Why do you thik your cliets do't follow through o your medical recommedatios, select the top three (3) reasos? Resposes: 216 % 1 8 6 4 2 87% 75% 13% Fiacial Failure to Lack of Complicated Do't Value Do't Fully Other Limitatios Uderstad Cofidece Treatmet Pla the Pet Comprehed (please specify) the Value i the the Recommedatio Recommedatio Resposes: 187 161 29 13 23 127 25 6% 11% 59% 12% 3 cotiued o pg. 4
Page 4 of 8 Fiacial limitatios topped the list as the primary reaso cliets did t accept veteriary team recommedatios (87%) with failure to uderstad the value a close secod (75%.) The third most selected item was failure of the cliet to fully comprehed the recommedatio with 59% of the respodets icludig it i their top three. Fiacial limitatios ad failure to uderstad the value of the recommedatio were the top two choices i 215 with very similar %s of respodets selectig these two. Failure of the cliet to fully comprehed the recommedatio was t icluded as a choice i 215. Time costraits ad lack of commuicatio/follow-up by the practice were the most commo other commets. Respodets were the asked: I additio to exam room coversatios betwee doctors ad pet owers about prevetive care services, what do you do to educate cliets about these services ad promote their acceptace? The most commo selectios were: cliet hadouts for specific prevetive care services, remider cards ad Facebook messages. Less commoly selected but still used by may practices were: telephoe o-hold messages, assigig techicias specific topics to discuss, improved commuicatio techiques (clear recommedatios, ope-eded questios) ad iformatio posted o the practice website. The last questio asked: What is the most iterestig or successful thig you ve doe to promote patiet prevetive care? These ideas are icorporated below i the discussio about what chages practices ca make to better promote prevetive care. Improvig Pet Ower Acceptace Of Prevetive Care Recommedatios As oted above, the primary reasos cliets did t accept the veteriary team recommedatios were: Fiacial limitatios Failure to uderstad the value of the recommedatio Failure of the cliet to fully comprehed the recommedatio These are all areas practices ca focus o i order to icrease the acceptace of prevetive care by pet owers. Pet ower decisio makig process Oe of the most importat first steps is to uderstad the pet ower purchase decisio process. Protectio motivatio theory research has show that cosumers of all kids go through two stages of iformatio appraisal whe makig a purchasig decisio: The first iformatio appraisal process a pet ower goes through has to do with the severity of the threat beig discussed ad the vulerability of his or her ow pet to that threat. The kids of questios pet owers are thikig about iclude: How may mosquitoes are really out there? Does it matter if my pet gets bitte? How likely is my pet to actually get heartworms? Practices usually do a pretty good job i this area. The secod iformatio appraisal process deals with the pet ower s ability to cope with the challeges of protectig his or her pet. Questios pet owers may ask iclude: Will the recommeded treatmet work? Will I be able to give this to my pet? Ca I afford it? The research shows that addressig these issues with pet owers is actually more importat tha just demostratig the threat although both are importat. The fidigs i this protectio motivatio research clearly correlate with the survey respodets thoughts about why pet owers do t accept prevetive care services. Ivolvig the team The veteriary team eeds to have the iformatio ad commuicatio traiig ecessary to be able to effectively provide iformatio to pet owers ad aswer all their questios. Without a strog ad committed team approach, it is goig to be hard to motivate pet owers to provide the appropriate care. Some of the thigs practices i this survey do to better ivolve their team iclude: Veteriary team Cotiuig Educatio oe practice metioed luch ad lears with ad without vedors to focus ot just o why somethig was importat but o how to make cofidet recommedatios Empowermet of staff Staff cotests to ecourage better commuicatio ad promotio of care to pet owers oe practice doubled the umber of fecals they had bee doig ad everyoe got a Kidle! Got creative with traiig games, prizes, etc. 4 cotiued o pg. 5
Page 5 of 8 Give cliets a reaso to do what you ask Helpig cliets uderstad there is a real risk to their pets from various kids of parasites is easier whe good quality local data is available. The Compaio Aimal Parasite Coucil s website, capcvet.org, has may resources, icludig Prevalece Maps which provide data from the U.S. ad Caada at the atioal, state/provice ad U.S. couty level regardig the icidece of heartworms, itestial parasites ad the tick-bore coditios of Lyme disease, ehrlichiosis, ad aaplasmosis. Usig the maps durig exam room discussios ca help emphasize the eed for parasite prevetio by showig real statistics from the couty where you ad your cliets live ad work. How ad whe the team talks with cliets about this iformatio is importat too. There have also bee a umber of studies doe i the last few years that provide some isights ito what cliets wat; perhaps oe of the most itriguig was released several years ago by Bafield. I the past few years Bafield has haressed the power of their icredibly large data base ad published several reports documetig a declie i pet health. I 215, they did somethig a little differet; they focused o what pet owers are sayig about their pets ad their related eeds. But istead of doig this via a traditioal survey of pet owers, they took to the iteret ad spet over a year reviewig two millio plus olie coversatios posted to blogs, forums ad other social commuities with the idea that i this kid of eviromet, pet owers would be more likely to talk about what they really thik about their relatioship with their veteriaria ad their eeds related to pet care. Oe of the thigs that came out of this study is that pet owers wat care recommedatios that are persoalized to their situatio. They do t just have a dog as a compaio; they have this dog that lives this lifestyle ad they wat their coversatio with the veteriary team to recogize that. While may of the recommedatios the practice team makes may be the same for most dogs or cats, there are some that should be differet based o breed ad pet lifestyle cosideratios. Ad eve if the recommedatios are t differet, the pet ower still wats to kow that you have thought through what is best for this particular pet. Actios you ca take to persoalize the discussio: Collect iformatio about the pet s lifestyle via questioaire before meetig with the pet ad pet ower Pet owers wat care recommedatios that are persoalized to their situatio. Referece the pet s breed ad age whe discussig your recommedatios Discuss potetial problems a pet of this breed or this age may ecouter Provide breed ad age related iformatio o your website ad i hadouts Use breed ad age related guidelies to customize your recommedatios ad stadards i the practice Ask the cliet what questios ad cocers they have ad give them a chace to thik ad respod Some of thigs practices i the VHMA survey do to persoalize their recommedatios iclude: Team members talk about their ow pets ad how they care for them Where appropriate, team members talk about impact of pet care o their ow kids (example, prevetig ticks o dogs meas kids less likely to get them) Takig pictures of the pet s teeth durig boardig ad sedig home with the cliet with a detal quote after discussig the eeded care whe the pet is discharged from boardig Seior care packages aimed at older dogs/cats Improvig commuicatio with pet owers Not everyoe is gifted with outstadig commuicatio skills from birth, but these are very learable skills. Some of the areas to focus o are listed below. I a article i the February 15, 212, editio of JAVMA ( Effect of veteriaria-cliet-patiet iteractios o cliet adherece to detistry ad surgery recommedatios i compaio-aimal practice ), it was clearly show that the odds for adherece with a surgery or detistry recommedatio made by the veteriary team were seve times higher whe the pet ower was give a clear recommedatio. Adherece i this study was measured by reviewig the medical records for six moths after the pet ower received the recommedatio to see if there was documetatio of the procedure beig performed. Here is a example of a wishy-washy recommedatio: We do t usually diagose a lot of itestial parasites like hookworms or roudworms, but if Fluffy has bee spedig much time i the compay of other dogs, it would t hurt to cosider havig her tested i the ear future. 5 cotiued o pg. 6
Page 6 of 8 Very few pet owers are goig to follow through with a recommedatio like this! A example of a clear recommedatio is: Fluffy regularly speds time with other dogs, both at the dog park ad whe you go hikig; the best way to make sure she has t bee ifected with itestial parasites is to do a simple test o her feces. Let s also talk about usig a prevetive goig forward. There are may ways to make a clear recommedatio; the exact words ca vary, but it must be obvious to the pet ower what the veteriary team thiks should be doe. It has also become clear that if pet owers do t get the iformatio they eed ad wat from your veteriary practice team, they will go elsewhere. What is oe thig everyoe ca do to make sure pet owers get their questios aswered? ASK! The exact words ca vary; ay of those below will work. Askig, both whe cliets check i ad whe they leave, is what is importat: Is there aythig else goig o with Fluffy that you have questios about? Did you have ay questios about what we have discussed? Do you have ay other cocers? Are there ay other questios you have? Ca I do aythig else for you? I additio to talkig to cliets, remember that they eed iformatio i other formats as well. People also absorb iformatio differetly (by hearig, readig or seeig), so the practice should develop ad provide cliet-friedly commuicatio materials i multiple types of media or formats, such as brochures, posters, pictures, practice website, podcasts, ewsletters ad remiders. Some of thigs practices i the VHMA survey do to commuicate i ways beyod talkig to cliets iclude: Exam room videos of heartworm surgery Before detal ad after detal pictures of teeth Stages of detal disease posters i exam room Detal radiograph posters showig commo tooth problems Case of the week posts o social media Cliets have to have a good experiece ad fid value i the care they get oce they get to your practice. Cat cliet educatioal meet ad greet with light sacks Ope house with behid the scees cliic tours Cost of veteriary care This is a very big topic ad ca ecompass geeral strategies for settig fees to targeted discouts ad promotios to better educatig pet owers about paymet alteratives. The March, 218 VHMA Isiders Isights report was devoted to the topic of settig fees so that wo t be discussed agai here. Discouts have geerally bee cosidered a bad thig i veteriary medicie. However, used judiciously, they ca be helpful i allowig cliets to provide better care for their pets ad i icreasig practice reveue ad profits. The power i programs like these discussed here is that they offer cliets a icetive to visit the practice. The reduced price aloe, however, wo t ecessarily keep pet owers visitig regularly; the cliets have to have a good experiece ad fid value i the care they get oce they get to your practice. I additio to marketig the program effectively, the use of the discout must be tracked over time to see if it actually icreases reveue, visits ad the amout of care provided to patiets. Some of thigs practices i the VHMA survey do from a promotioal icetive stadpoit iclude: Detal discouts of various kids Tartar Tuesday or if scheduled withi a certai time of whe detal recommedatio was made New cliet $5. Nose to Tail exam Pay-by-the-moth prevetive care plas these ca either have a discout icluded or ot but either way spread the paymets for care out over 12 moths Affordably priced bloodwork CATober flat fee for all welless services eeded for the cat Budled prevetives at competitive price compliace doubled! Free heartworm test with purchase of heartworm prevetive Free doses of prevetives Promote vedor coupos 6 cotiued o pg. 7
Page 7 of 8 The last thig to remember about cost is that eve cliets who are fully committed to providig quality care are lookig for paymet alteratives. Cliets are dealig with the icreasig costs of veteriary care resultig from the availability of more sophisticated medical optios, the exteded life spa of pets which results i more routie care spedig as well as a icreased likelihood of the pet developig a serious ad/or chroic disease ad fee icreases well above the rate of iflatio. Almost all practices accept cash, credit cards ad checks; other paymet optios iclude pet isurace, third party paymet plas, welless plas ad i-cliic billig optios ad yet may cliets are t usig them. The first step is to educate cliets about the eed for paymet alteratives. There is o poit i talkig to cliets about these choices if they ca t see why it s importat. Iterestig cliets i paymet alteratives meas talkig to them about the eed for future veteriary care both prevetive care ad care whe the pet becomes ill or ijured. Talkig to cliets about moey ca be awkward, particularly whe we seem to be sayig save some moey to sped it with us! Ad yet, we are doig cliets a disservice if we do t help them uderstad how they ca best pla to take care of their furry family members. The Parters for Healthy Pets (www.partersforhealthypets.org) has a great video etitled Preparig the Cliet for Future Health Care Costs that demostrates how to have these kids of coversatios with cliets this ca be used as a script template ad i staff traiig. PHP has may other useful practice traiig tools as well ad all are available at o cost to the practice. For years, may practices used i-house delayed billig plas to help cliets who could t come up with the cash ecessary for their pet s care at the time of service. These geerally took the form of held checks or statemets set post treatmet with the idea that cliets would pay whe they received the statemet, either i full or i istallmets. Practices had varyig degrees of success i actually collectig these amouts ad the tred has bee away from i-house optios ad towards third party paymet plas, pet isurace ad welless plas. While practice owers do t wat either themselves or their staff to fuctio as isurace sales people or credit card vedors, those who work i practices already regularly recommed to cliets products ad services ot carried i the practice. Examples iclude obediece traiig, pet day care ceters, groomers, pet sitters ad a wide variety of dietary ad other products. Doctors ad I order to effectively recommed paymet optios, veteriarias ad their staff must first of all uderstad the products themselves. 7 staff take the time to uderstad those products eough to be comfortable with the recommedatios ad help cliets uderstad the optios because they thik they are of value to the cliet i takig better care of their pets. Why is it ay differet with fiacial products that allow cliets to provide more comprehesive care? Not oly do pets beefit from the improved care; veteriary practices beefit because cliets who have the fiacial ability to pay for better care help us practice the kid of veteriary medicie we wat to practice ad improve the profitability of the practice. I order to effectively recommed these paymet optios, veteriarias ad their staff must first of all uderstad the products themselves. Recommedatios to cliets are most helpful whe they iclude ot oly a geeral recommedatio for a kid of product but a recommedatio for a specific brad alog with the reasos why the practice thiks this product is the best oe ad a compay the practice has had a good experiece with. This is o differet from medical products; cliets do t just wat to kow that their pets should be o heartworm prevetative; they wat to kow which brad your practice recommeds ad why. Remember too, that words matter whe talkig to cliets commets such as the followig are t goig to ecourage cliets to cosider your advice! Here are some brochures about pet isurace to read at home whe you have a chace You might wat to thik about this ew welless program we have You probably do t wat aother credit card but here s some ifo o this veteriary oe Other tips for successful commuicatio iclude: Do t just had out brochures talk to cliets about optios ad the thigs they eed to cosider i makig the best choice Icorporate factual iformatio ad stories o website, i ewsletters ad social media Focus o oe or two compaies you are comfortable with ad are ca recommed to pet owers Practice this commuicatio i your team traiig meetigs The Parters for Healthy Pets (www.partersforhealthypets.org) has some excellet videos that ca be used as part of this educatioal process cotiued o pg. 8
Page 8 of 8 Make it fu! Sometimes small, iexpesive gestures that are fu ad touch people have more impact tha other thigs we do of a more serious ature. Oe practice gives away toys to cliets who purchase a 12 moth supply of prevetive; the cliets love the toys! Aother practice gives away raffle tickets to those who buy a year s worth of prevetive. There are may thigs practices ca do to improve acceptace of prevetive care recommedatios. Pick the oe or two that appeal to you ad try them. Focus o those chages util they become secod ature ad the add a couple more. Measure cliet acceptace as you go so you ca tell what is workig. 8