You diagnosed diabetes in a 12-year-old cat during a preventive checkup. You performed blood work and a urinalysis that caught the condition in the beginning stages. Now you need to design a follow-up care strategy to manage the longterm condition. The latest Banfield Pet Hospital “State of Pet Health” report found that diabetes mellitus in dogs has increased by 79.7 percent—from 13.1 cases per 10,000 in 2006 to 23.6 cases per 10,000 in 2015. Among cats, the prevalence increased from 57.2 per 10,000 in 2006 to 67.6 in 2015. Although the latter numbers represent only an 18.1 percent increase among felines, diabetes mellitus is more common in cats than in dogs, according to the report. Dental disease also showed a significant increase, Banfield discovered as part of its study of medical data from 2.5 million dogs and 500,000 cats. Since 2006, the prevalence of dental disease in dogs rose by 23.3 percent. Among cats, the increase was 23.1 percent. Dental disease afflicts 76 percent of dogs and 68 percent of cats, the report found. The study defined dental disease as any health issue affecting the mouth, such as inflammation, tartar, gingivitis and periodontal disease. If you have electronic medical records and use diagnoses codes, run a report in your practice-management software to determine which chronic conditions you see among dogs and cats. Then have doctors discuss and set the frequency of exams for patients with those chronic conditions. Use a “disease-management exam” code once a patient is diagnosed with a chronic condition that requires ongoing follow-up care. Consider using disease-management exam codes for health concerns such as renal disease, heart disease, Cushing’s disease, arthritis, diabetes, thyroid conditions and other long-term health issues. Seeing patients with chronic diseases every three to six months could lead to better management of diseases, let you adjust treatments, medication and diagnostics as needed, and spread out the cost of care. Follow these steps to help clients successfully manage their pets’ long-term health issues: 1. Set client expectations on the day of diagnosis. Discuss the chronic condition, treatment solutions and the frequency of follow-up care. Provide handouts for clients to share with family members who were not present for the discussion. List trusted websites on handouts to discourage clients from consulting Dr. Google. Include links on your website and to your YouTube channel. 2. Update your terminology. Clients with a pet of any age may question the need for a wellness test if the animal appears healthy. Instead, use the phrase “early detection screen” for blood work that you’ll perform on adult and senior animals. This phrasing clearly communicates the purpose of the test. When opening exams, technicians should discuss the need for testing. Say the following: “Between ages 3 and 6, your adult cat is in the prime of its life. Early detection screening lets us establish a baseline of what’s normal for your cat and helps detect changes early. “Because cats are masters at hiding illnesses, preventive screening may be the only way to know if your cat is healthy. Catching changes early often means they will be easier and less expensive to treat. “Think of early detection screening as the internal physical exam that lets us check the health of organs and for feline leukemia, FIV—feline immunodeficiency virus—and feline heartworms. “We will collect a blood sample today and will call you tomorrow with results. (If you will run tests in your in-house lab, explain that you’ll have results during today’s exam). The early detection screen costs <amount>. “Shall we proceed with the early detection screen, or can I answer questions to help you decide?” If clients don’t initially accept testing, the veterinarian can revisit its benefits. Repetition of the message often increases client compliance. 3. Make a follow-up call the next day. After sharing news of a pet’s serious medical condition with family and friends, the client may have more questions. Enter a medical callback so the veterinarian who diagnosed the chronic disease will contact the client the following day. The veterinarian might say, “This is Dr. <Name> calling from <Your veterinary hospital>. I was calling to see if you or your family had additional questions after we discussed your cat’s kidney disease yesterday.” Close the call with, “We will work together to manage this condition. We will see your cat again in <number> months. If you have questions or concerns, please call us.” If you get the client’s voice-mail, you could follow up with an email that has links to articles and trusted websites for further information. 4. Switch the patient from a preventive care exam code to a disease-management exam code. Let’s say this disease-management exam code reminds quarterly. In a renal patient, one of the four exams might be similar to a checkup, while the second is a physical exam and urinalysis. The third might include a physical exam, early detection screen and blood-pressure screen. The fourth is another physical exam and urinalysis. The International Renal Interest Society offers guidelines on blood-pressure testing at www.iris-kidney.com. The client should pay a regular exam charge each time because you’ll perform a full physical exam. If you worry that clients may be price-sensitive to four exams a year, you could charge a comprehensive exam fee on the first visit and medical progress fees for the remaining three. A medical progress exam is typically 75 percent of your exam fee. Avoid the term “recheck,” which sounds free and optional. The phrase “medical progress exam” sounds more urgent and important. 5. Forward-book the next disease-management exam. Compliance is highest at checkout, so the receptionist should schedule the next visit first and then collect payment for today’s services. The appointment reminder will be printed on the receipt. The receptionist would say, “Dr. <Name> will need to have Caymus’ next cardiac workup in six months, which will be in February. Would you prefer Feb. 8 at 9 a.m. or Feb. 10 at 2 p.m.?” Guide the pet owner to schedule and avoid asking, “Do you want to make your next appointment?” That’s a yes-or-no choice. If the client doesn’t forward-book the next exam, enter a callback for one week before care is due. 6. Stay in touch with callbacks between exams. Enter callbacks in your practice-management software between exams. Goodwill can guarantee future visits and communicate that you care. Scan electronic medical records before you call clients to see which reminders are coming due. Say, “This is <Technician name> calling from <Your veterinary hospital>. Dr. <Name> asked me to call you to see how Tiger is feeling. We want to help you successfully manage his diabetes. What questions can I answer about the insulin injections or care that you’re providing at home? “How are Tiger’s appetite, weight, water consumption and urine output?” (Client responds.) “We will need to see Tiger next month to check his blood glucose levels. This is a technician appointment to collect the blood sample for the test. We could see Tiger on Sept. 13 at 10 a.m. or Sept. 15 at 4 p.m. Which choice fits your schedule?” The technician used the two-yes-options technique to guide the pet owner to schedule the monitoring test. You may use a combination of technician appointments and veterinarian exams to provide follow-up care. In addition to improving patient care, disease-management exams can ensure your practice’s health. Good medicine always results in good business. Originally published in the September 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
