Originally published in the March 2014 issue of Veterinary Practice News While visiting Navarre, Fla., to present seminars, I noticed a roadside sign at a Walgreens advertising a parking lot vaccine clinic with $10 rabies vaccinations and $25 heartworm tests. Down the street, Ace Hardware sells a seven-way dog vaccine for $6.99 with a disposable syringe. Vaccines are stored in a plastic shoebox in the Coca-Cola cooler near the register. Besides the obvious OSHA violation of storing vaccines in a refrigerator with human foods, what instructions do these customers get on vaccine administration or reactions? Pet owners have multiple choices for preventive care services and products. The Bayer Veterinary Care Usage Study found an average of 15 competing veterinary care providers within a 10-mile radius, including mobile vaccine clinics, pet store clinics, private practices, specialty hospitals and shelters.1 A 2013 Communication Solutions for Veterinarians’ study found that 60 percent of dogs and 52 percent of cats received preventive care exams during a three-year period.2 Besides putting patient care at risk, the lack of regular preventive care also affects practices’ health. A dog owner typically spends $208 during a preventive care visit while a cat owner averages $186, according to the AAHA Veterinary Fee Reference, 8th edition.3 Without regular exams, you won’t have an opportunity to diagnose dental disease, obesity, arthritis and other conditions. Pet owners need to understand the value of getting preventive care services and products from your hospital. Here’s how your team can communicate the value of preventive care. Set preventive standards of care. The American Veterinary Medical Association (AVMA) and the American Animal Hospital Association (AAHA) have collaborated on preventive health guidelines for dogs and cats (www.aahanet.org/Library/PreventiveHealthcare.aspx). In addition to explaining your protocols during exams, utilize your message-on-hold, e-newsletters, reminders, website and social media. When clients call to make appointments, check the reminder status of all pets in the family. In the client’s record, you discover a second dog is overdue for preventive care. Respond with, “We’d love to see Mason for his preventive care exam. Did you know that Rocky also is overdue? He needs a preventive care exam, vaccines, heartworm/tick screen, intestinal parasite screen, and preventives. You can bring Mason and Rocky to the same appointment. Which day of the week works best for you? Do you prefer a morning or afternoon appointment?” Once the client responds with a preference for the day of the week and time of day, offer two choices. Known as the two-yes-options technique, this phrasing increases the chance you’ll schedule the appointment. Say, “When would you like to schedule exams for Mason and Rocky? We have an appointment on Tuesday at 9 or 11 a.m. Which fits your schedule?” Use the term “preventive care exam” instead of “wellness exam.” I have two young, indoor cats. Caymus is 3 years old, and Opus is 4. If I’m a typical cat owner, I might assume that my young, indoor cats don’t need wellness exams. Clients may perceive wellness exams as optional, while preventive care exams are actionable. Change the description in your practice-management software, so the new term appears on invoices, treatment plans and reminder emails and postcards. Your goal is to change clients’ perceptions from “Veterinarian = Shots” to “Veterinarian = Preventive Care.” Explain care when greeting clients in exam rooms. When starting exams, technicians or assistants should introduce themselves, shake clients’ hands and explain their role. Say, “Good morning, I’m [your name], the technician who will be assisting Dr. [name]. For your preventive care visit, we will do a nose-to-tail exam, vaccines, heartworm/tick screen, intestinal parasite screen and refill 12 months of parasite preventatives. I will take a brief history, collect samples for testing and get your pet’s temperature, pulse and respiration. Then the veterinarian will begin the exam. Is there anything else you want to discuss with the doctor?” Say “vaccines” instead of specific ones. Based on exam findings, the veterinarian may add or subtract vaccines. Saying “we will refill” encourages 12 months of parasite protection. Asking, “Is there anything else you want to discuss with the doctor?” encourages “Could you also check…?” Many well pets have sick-pet problems—ears, skin and dental disease—so identify questions at the beginning of the exam so the doctor can prioritize the order of concerns to be addressed. If clients ask about prices, prepare a treatment plan or access fees on computers in exam rooms. Then say, “Before deciding, let’s have the doctor perform an exam, and then help you prioritize which services and products your pet needs.” Verbalize your exam. Give a play-by-play description while performing exams. Otherwise, it looks like you’re just petting the animal. Say, “Unlike dogs, cats are masters at hiding illnesses. A nose-to-tail physical exam can uncover signs of a health problem before it reaches an advanced stage. For your cat’s physical exam today, I’ll focus on 12 areas, including eyes, ears, nose and throat, teeth and gums, coat and skin, heart, abdomen, limbs and paws, urogenital system, lungs, gastrointestinal system and weight. “Middle age for cats is between 8 and 10 years, so we need to examine your cat at least once a year to detect any changes early.” Ask effective history questions. Develop a history questionnaire so all staff ask clients the same questions every preventive care visit. This ensures continuity of care and increases compliance. Try a laminated sheet with dry-erase markers or use templates in electronic medical records. How you phrase questions matters. Instead of “Does your cat go outside?” ask the client “When was the last time your cat went outside?” Here are insightful history questions: Parasite prevention: Which flea/tick and heartworm preventive do you use? When did you give the last dose? Do you travel with your dog to areas where ticks may be present? Have you ever found a tick on your dog or on any other pet or person in your home? Oral disease: When eating, does your pet drop its food, chew on one side or eat more slowly? Have you noticed bad breath, drooling or sores in your pet’s mouth? Arthritis: Does your pet show signs of limping or lameness? Does your pet have difficulty going up or down stairs? Does your cat spend less time grooming? Nutrition: What diet do you feed your pet (brand, amount, wet/dry)? How big is the cup? What treats or table food do you give your pet? Explain the need for preventive screens. Clients with apparently healthy pets may think, “My pet is well, so why do I need a wellness test?” Replace the term “wellness test” with “preventive screen.” Use the term “screen” for preventive care and “test” for sick-patient diagnostics. The purposes of screening healthy pets are to establish a baseline assessment for future comparison and to detect subclinical abnormalities at a time when preventive and therapeutic intervention may have the most benefit. Abnormal results increase with age. A 2013 study of 7,827 dogs found 31 percent of dogs of all ages had abnormalities including diabetes, renal disease, hepatic disease and anemia when undergoing preventive screening. Almost half of dogs age 13 and older had abnormal test results (see Table 1).4 Table 1: Abnormal results increase with age Summary of CBC/serum chemistry abnormalities by age 0-3 Years 4-6 Years 7-9 Years 10-12 Years 13+ Years Total Total Number Screened 1,301 1,966 1,973 1,694 891 7,827 Number at Risk 308 447 588 635 434 2,412 Percentage at Risk 24% 23% 30% 38% 49% 31% Tell senior dog owners: “Just like people, your dog’s health will change as it ages. Because pets age faster than people, major health changes can happen quickly. Similar to 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. Catching changes early before they become serious often means they will be easier and less expensive to treat. Think of senior preventive screening as the internal physical exam that lets us check the health of organs and thyroid function. “Thyroid disease is common in older dogs. Our senior screen includes testing for heartworms and tick-borne diseases. We will collect a blood sample today and call you within 24 to 48 hours with results. Which is the best phone number to reach you?” If you’re performing in-clinic testing, say, “We will collect blood and urine samples and have results during today’s exam.” Provide an exam report card. Report cards summarize the doctor’s findings, note when the next visit is due, and help other family members who were not present understand instructions. Say, “Mrs. Myers, here is your report card for Caymus’ preventive care exam today. You’ll see that he had a comprehensive exam, vaccines, negative intestinal parasite screen, a body condition score of 3 out of 5, and a dental score of Grade 2. We’ll schedule his dental treatment before you leave today. Caymus will be due for his next preventive care exam in six months, which would be on Sept. 15. You can share Caymus’ report card with family members who weren’t here for today’s exam so they understand his care.” Present service first, price last at checkout. To show value for preventive care, read the list of services and products off the computer screen, and then state the total. Say, “Today Mason had a preventive care exam, heartworm/tick and intestinal parasite screens, and vaccines to protect him from canine distemper, adenovirus, parainfluenza, parvovirus, rabies, and respiratory disease. You have Mason’s parasite preventives and therapeutic diet. Does Mason or your other pets need any additional refills today?” After the client responds, say, “Your total is $____. Which payment method are you using today?” Schedule the next exam at checkout. Preventive care appointments are lifelines in human dental offices. The same is true in veterinary medicine. At least 80 percent of diagnosed dentistry comes from hygiene appointments. When patients leave the dental hygiene appointment without a future appointment scheduled, practice profitability decreases by at least half.5 Pre-appointing is a strategy to keep the hygiene schedule full. When the hygiene schedule is not full, a domino affect will occur. Patients will miss timely hygiene appointments, and the dentist will see gaps in future treatments. To get your clients to schedule their pets’ next exams, say, “Just as your dentist has you schedule your next hygiene appointment at checkout, we do the same so we can proactively manage your pet’s health. Dr. can see you on Wednesday, April 20, at 10 a.m. or Friday, April 22 at 3 p.m. for your pet’s next preventive care exam. Which works best for you?” Confirm exams that were scheduled six or 12 months in advance one week prior to appointments. Call clients with overdue preventive care reminders. For the greatest success of booking exams, call clients when patients are newly overdue and have just fallen into the third reminder cycle. Because you’ll need to speak with clients to make appointments, always call their cell phones first. Etiquette is to call between 8 a.m. and 8 p.m. If calling home phone numbers, dial between 5 to 7 p.m. on weekdays and 9 to 11 a.m. on Saturdays. You’re more likely to catch clients arriving home during the workweek or on Saturday mornings before weekend errands. If you get voicemail, leave this message: “This is [your name] calling for the doctors at [Your Veterinary Hospital]. We’re worried that Opus is past due for his preventive care exam, vaccines, diagnostic testing, and preventatives, and might now be unprotected. Will you please call us this week at 555-555-5555 to schedule his exam?” If you talk with the client, say: “This is [your name] calling for the doctors at [your veterinary hospital]. Opus is now overdue for his preventive care exam, vaccines, diagnostic testing and preventatives. We’re worried about his health. When is a convenient time for you to come in for an appointment this week? The doctor can see you at 6 p.m. Thursday or 9 a.m. Saturday. Which is more convenient for you?” The phrase “calling for the doctors” communicates that your veterinarians are aware of the pet’s overdue status and are genuinely concerned. The warning “may now be unprotected” is a call to action. Offer the next two available appointment times. When describing overdue preventive care, focus on four categories: preventive care exam, vaccines, diagnostic testing and preventives. If you describe too many details, the list could intimidate the client and she won’t schedule an appointment. When your team educates pet owners about the value of regular preventive care, you’ll protect the health of your patients and your practice. References 1. 2011 Bayer Veterinary Care Usage Study conducted by the National Commission on Veterinary Economic Issues, Brakke Consulting, and Bayer Animal Health. Accessed December 26, 2013 at http://avmajournals.avman.org/doi/full/10/2460/javma.238/10/1275 2. Data on file. Communication Solutions for Veterinarians. 2013 study of 42 U.S. veterinary practices. 3. AAHA Veterinary Fee Reference, 8th Edition, AAHA Press 2013; pp. 55, 59 and 115. 4. Pet Wellness Report; Canine Health Risk Assessment, A review of 7,827 Cases, May 2013, Zoetis. 5. Seidel-Bittke D. Tips for Strengthening Your Recare System. Posted on January 11, 2011 at www.dentalheroes.com/recare-system-tips/.
