Communicating With Confidence
Wendy S. Myers, President, Communication Solutions for Veterinarians Inc. and Partner, Animal Hospital Specialty Center, 5640 County Line Place, Suite B200; Highlands Ranch, CO 80126; Phone: (720) 344-2347; email: [email protected]; website: csvets.com. Twitter: @wendysmyers. Facebook.com/csvets Meet your consultant
Wendy S. Myers owns Communication Solutions for Veterinarians in Denver. Her
consulting firm helps teams improve compliance, client service and practice management. Communication Solutions for Veterinarians has provided phone-skills training to more than 3,500 veterinary staff in the United States and Canada. Wendy also is a partner in Animal Hospital Specialty Center, a 10-doctor AAHA-accredited referral practice offering internal medicine, surgery, oncology, specialty dentistry, and emergency care in Highlands Ranch, Colorado. Wendy offers monthly CE credit webinars. She is the author of five books and five videos. Subscribe to Communication Solutions for Veterinarians’ e-newsletter at www.csvets.com. She has cats named Opus and Caymus. Follow Wendy on Twitter @wendysmyers and on
www.facebook.com/csvets.
Approved for 3 hours of CE credit
Communication Solutions for Veterinarians Inc. is an American Association of Veterinary State Boards RACE-approved provider. Communicating With Confidence (# 419- 10903) is approved for 3 hours of CE credit. This program was reviewed and approved by the AAVSB RACE program committee. Communication Solutions for Veterinarians will maintain CE records for 4 years should you need documentation of your attendance. Contact Communication Solutions for Veterinarians at 720-344-2347 or [email protected]. Contact AAVSB RACE at [email protected] should you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession.
What you’ll learn
! Before the exam: How compliance is impacted from the moment the client calls to make an appointment
! During the exam: Increase patient care through effective client communication
! After the exam: Proactively schedule the next preventive care exam and follow up with effective reminders and callbacks
The importance of prevention
Without regular preventive care exams, you won’t have an opportunity to diagnose dental disease, obesity, arthritis and other conditions. Preventive care is the cornerstone of veterinary medicine, letting us proactively help patients live healthier, longer lives.
Benefits of regular exams:
! Pet owners save money
! Diagnose problems early, when more treatment options may be available
! Cost of care could be reduced
According to the American Veterinary Medical Association’s (AVMA) 2012 U.S. Pet Ownership &
Demographics Sourcebook, 11% of dog owners and 27% of cat owners surveyed only visit a veterinarian when the animal is sick. Those percentages equal 7.5 million dogs and 20 million cats.1 Overlooked preventive care also hurts the health of practices. The average veterinary expenditure per household for all pets was $375 in 2011.2
An alarming number of pets are missing preventive exams
Source: 2012 study by Communication Solutions for Veterinarians of 107 clinics
Most practices have almost 40% of appointments unfilled, with 62% of appointments filled as the
average.3 The 2011 Bayer Veterinary Care Usage Study identified six causes for the decline in veterinary usage from pet owners’ perspectives:
1. Recession
Patient visits have seriously declined during the past two years, with a net 17% decrease.3 When patients visit, they’re often ill. Veterinarians say they’re seeing patients three days sicker, but others share that patients needed care one to two weeks ago.
2. Fragmentation of veterinary services
The study found 15 competing care providers in a 10-mile radius of practices, including mobile vaccine clinics, pet store clinics, private practices, specialty hospitals, and shelters. Private practices may be losing starter services such as exams, vaccines, spays and neuters to low-cost providers. Veterinarians need to focus on wellness programs to encourage return visits.
3. Use of the Internet instead of veterinary visits
Clients may consult Dr. Google for free advice and diagnosis before veterinarians. • 39% look online first if a pet is sick or injured
• 20% always go online after a veterinary visit
• 15% say they don’t rely on veterinarians as much due to information online
Today, 77% of veterinary practices have websites and 43% are on Facebook. If you know clients are looking online, drive them to your website with a “trusted links” section for reliable information. 4. Feline resistance to veterinary visits
Cats make up 39% of the patient population in most practices, yet are 55% of the pet population. Dogs are 45% of the pet population and make up 59% of veterinary patients.4
Veterinary visits for cats were down 4.4% from 2006 to 2011, according to the 2012 AVMA U.S. Pet Ownership and Demographics Sourcebook. Americans have 74.1 million cats compared with 70 million dogs. Cat owners are more likely to own multiple cats – 2.1 per household – compared to dog owners, who average 1.6 dogs per household.Hundreds of unseen cats may be hiding in your clients’ homes.2 Fifty-two percent of U.S. cats have not seen a veterinarian within the past year for a wellness check, according to a study conducted by Bayer HealthCare and the American Association of Feline Practitioners.5
Nearly half (47%) of U.S. cat owners also have dogs. Likewise, 41% of dog owners have cats.4
Compared with dogs, almost three times as many cats hadn’t received veterinary care in the past year.6 More than half (53%) of cat-owning households have more than one cat.
Cat owners’ perceptions can contribute to fewer veterinary visits: • Indoor cats aren’t at risk for parasites and other diseases.
• Cats are lower maintenance than dogs and don’t require as many veterinary visits. • Cats will show signs of illness, as dogs do.
• Veterinary visits are stressful for cats.
• Cats don’t need vaccines or preventatives if they live indoors.
• Diagnostic testing is a waste of money because everything is usually normal. • I only need to visit the veterinarian every three years for vaccines.
• My older cat seems okay.
5. Perception that regular checkups are unnecessary
Although 88% of veterinarians feel they talk clients through exams, 56% of pet owners said doctors don’t clearly explain when they should bring in pets.3 Most pet owners would visit the veterinarian more often if they knew you could prevent problems and expensive treatments later (59% of dog owners, 56% of cat owners).
6. Cost of care
Pet owners cited value for money spent and payment options as the most significant areas for
veterinarians to improve. When asked about price, 34% of clients say veterinary care is higher than they expected.
Have you ever slapped a client? You probably have and didn’t realize it. Let me share a story from a practice consultation. A new client visits with her 6-year-old dog for a preventive care visit. The patient needed an exam, vaccines, intestinal parasite screen, heartworm/tick test, and refills on flea/tick and heartworm preventatives. The doctor also found a skin infection during the physical exam. The client had a great first visit and bonded with the veterinarian and technician in the exam room. She goes to the front desk to checkout and gets slapped.
The client care coordinator said, “That will be $302 today,” slapping the client with sticker shock. The client gasped and exclaimed, “Wow! That’s as much as my car payment.” A veterinary visit is a “car payment” to a lot of families. Most clients don’t plan and budget for pets’ preventive care—they think their pets are due for “shots.” Pet owners don’t understand or perceive the value of the physical exam,
diagnostics, preventatives, and diets.
A sick-pet problem was identified during this preventive care visit. The client got a dozen services and products but just heard a collective price at checkout—$302. Instead of slapping the client with the total, the receptionists should have read the list of services and products off the computer screen and said,
“Today your dog had a preventive care exam, vaccines, an intestinal parasite test,
heartworm/tick test, and skin cytology. You have medication for his skin infection and 12 months
of heartworm, flea and tick prevention. Your total is $302. Which payment method will you be
using today?”
Summarizing services before saying the amount shows value for the care delivered. Use easy-to-understand terms such as intestinal parasite test instead of fecal examination. If checking out a new client, add, “Which payment method will you be using today? We accept cash, checks, all major credit cards, and CareCredit.” Besides subtly indicating that payment is due at the time of service, you’ve also let her know all payment choices.
Before the exam
Set expectations when clients call to schedule exams
! Check status of all pets in the family
! Remind clients what to bring
! Check on refills
When a client calls to schedule her dog’s appointment, ask about cats that may be a home. Check the reminder status of all pets in the same household in your practice-management software. If a cat is overdue for preventive care, ask the client to schedule an appointment now.
When you find an overdue cat:
“Wendy, let’s schedule your dog’s preventive care exam. I also see
that Opus is overdue for preventive care. Changes in your cat’s health can occur quickly. That’s
why we recommend a preventive care exam at least once a year. The doctor also will assess
which vaccines, preventatives and diagnostic tests Opus needs to stay healthy. Catching changes
early before they become serious often means they will be easier and less expensive to treat. You
can bring Opus along with your dog to the same appointment. Let’s schedule their appointment
for this week. Which day of the week works best for your schedule?”
Ask about unknown cats:
“Wendy, thank you for calling to schedule your dog’s preventive care
exam. Many of our clients also have cats at home and we want to ensure the entire pet family is
protected. Do you have any cats at home, including outdoor cats?”
Remind clients of what to bring when closing the scheduling call:
“Sandy’s exam will be on Friday at
10 a.m. To help you prepare for her preventive care visit, please remember to bring a
teaspoon-sized stool sample that is fresh within 4 hours. Also bring any medications and supplements that
you’re currently giving Sandy. We’ll give you a courtesy reminder call /email to confirm your
exam as the date nears.”
Check on refills
During the scheduling call, see when the client last purchased heartworm and flea/tick preventatives. This accomplishes multiple purposes: 1) promotes benefits of buying drugs from your in-clinic pharmacy, 2) encourages year-round compliance, and 3) nudges the client to check her stock at home in case other pets also need refills.
“Sandy’s medical record shows that she is due for a refill on <product name>. We can refill her
prescription on Friday. When you buy 6 doses, you get 2 free—a value of $40.”
When new clients schedule exams
Collect contact information during scheduling calls so you can create expectations and provide helpful details such as:
• Driving directions
• Bring your pet’s stool sample to your first exam • Fasting instructions if doing blood work
• Medical records to bring if a new patient
• Complete new client registration now over the phone or online before the exam
When a new client schedules an exam, offer to email your new client registration form or a link to your website so the caller can complete paperwork at home. She can submit the completed form before her
first exam by email or through your website. Then you can start the first visit on time rather than having 10 to 15 minutes of valuable appointment time eaten up with paperwork.
Tell the new client:
“You can watch an online tour of our hospital, get driving directions, complete
your new client form, and meet our doctors and staff on our website at
www.yourwebsite.com
.”
If the new client doesn’t have Internet access, ask her to arrive 15 minutes early to complete paperwork and get a tour of the hospital.Confirming appointments
Confirm exams with courtesy phone calls and/or email reminders that encourage clients to arrive on time. Call clients one or two days before exams to encourage compliance and let them know what to bring. Tell dog owners,
“This is Your Name calling from Your Veterinary Hospital to confirm your dog’s
appointment with Dr. Your Name tomorrow at 10 a.m. Please remember to bring a
teaspoon-sized stool sample that’s fresh within four hours, as well as any medications and supplements
you’re currently giving your dog. If you have questions or need to reschedule, please call us at
555-555-5555.”
Tell cat owners,
“This is Your Name calling from Your Veterinary Hospital
to confirm your cat’s appointment with Dr. Your Name tomorrow at 10
a.m. Please bring a teaspoon-sized stool sample from the litter box that’s
fresh within four hours. It’s OK if litter is on the stool sample. A helpful
tip is to scoop your litter boxes tonight, and then it will be easy to spot a
fresh stool sample in the morning to bring with you. We will screen your
cat for multiple intestinal parasites, including those that can be passed
from pets to people. Also bring any medications and supplements that
you’re currently giving your cat. If you have questions or need to
reschedule, please call us at 555-555-5555.”
These scripts significantly increase compliance for intestinal parasite testing. Asking clients to bring medications and supplements identifies “extra” doses of preventatives that were never given as well as self-diagnosed and self-prescribed drugs. For example, a client has a 12 pack of preventatives with three remaining doses and a bottle of aspirin she occasionally gives her 10-year-old Golden retriever when he feels painful. This lets you revisit the importance of monthly preventative dosing, diagnostic testing and veterinary drugs for arthritis.
Email appointment confirmations
Email reminders from IDEXX Pet Health Network Pro are personalized with client and pet names, have a link to your website, and match postal reminders for business branding. Clients should receive email confirmations two to four days before their appointments.
Text appointment confirmation
On average, it takes 90 minutes to respond to an email, but 90 seconds to respond to a text message.7 Every 24 hours, 6.4 billion text messages are sent and 98% of all text messages are opened.8
Based on their individual cell phone plans, clients may receive unlimited texts or pay a fee. That’s why text messaging is an opt-in service that clients must choose. Pet owners log into their Petly pages to opt-in for texting. IDEXX offers an email
campaign, “Would you like us to be able to text you appointment confirmations?” that instructs clients on how to opt-in. Clients can choose to receive email or text confirmation for upcoming appointments. In your Pet Health Network Pro preferences, your clinic sets appointment confirmations to be texted 1 to 4 days before exams. When clients receive text confirmations, they reply “Confirm” or can touch a hyperlink to call your clinic. If your practice uses Cornerstone, appointments show as confirmed in your schedule. During the exam
Your entire team needs to be prepared before the client arrives. Screen tomorrow’s preventive exams for services and products that will be due.
Besides vaccines, what diagnostic testing is due? When were the last parasite preventatives purchased and how many doses were sold? Is the client sharing a box of preventatives between pets? Is the patient on any chronic medications that require drug monitoring?
Oops, you missed a few months
You’ll uncover missed opportunities in about half of patients if you look for compliance gaps. For example, you’ll discover “sharing” of preventatives between the pet family and clients who stopped dosing during winter months.
Compliance Checklist
Check YES if the patient is in compliance with your protocols. Check NO if the patient is not in compliance.
Client name ____________________________ Patient name ___________________________ Date __________ Reason for visit _________________________________________________ Preventive care exam
Yes No
☐
☐
Current Vaccinations Yes No☐
☐
Core ______________________________________________________________☐
☐
Non-core ___________________________________________________________ Parasite testing and preventativesYes No
☐
☐
Intestinal parasite screen☐
☐
Heartworm/tick screen☐
☐
Flea/tick control: Brand ___________ Quantity ____ Date of last purchase ________☐
☐
Heartworm preventative: Brand__________ Quantity ____ Date of last purchase ___ Dental careYes No
☐
☐
Recommendation for professional dental cleaning/treatmentNutrition Yes No
☐
☐
Appropriate weight for age and breed☐
☐
Weight-loss program recommended☐
☐
Current on therapeutic diet Preventive diagnosticsYes No
☐
☐
Adult preventive screen☐
☐
Senior preventive blood and urine screen Chronic medicationsYes No
☐
☐
Current on refills☐
☐
Current on drug monitoring test MicrochipYes No
☐
☐
Chip implanted☐
☐
Scanned, confirm that client has current contact info on file with microchip company Source: Adapted from Six Steps to Higher-Quality Patient Care, AAHA, 2009Know the next three appointments
Check the schedule at the beginning of your shift as well as throughout the day so you always know the next three appointments. This task helps every team member greeting clients and patients by name upon arrival. You’ll also be able to give proper greetings based on the reason for the exam. For example, you’d have a welcoming greeting for a new client while another whose visiting for her pet’s euthanasia would have a compassionate greeting and be immediately escorted into an exam room.
Stand to greet clients when they walk in the front door
Getting up on your feet indicates that you’re eager to help. Remove the physical barrier of the reception counter by stepping around to greet clients and patients face-to-face. Pet the patient and offer a warm smile or firm handshake to the client.
Promote refills during exams
Why does your veterinary team need to proactively refill medications during exams? When faxing prescription authorizations to veterinarians, 1-800-PetMeds is now asking you to provide the next exam due date. Be cautious, this may be a marketing strategy to get your clients to refill prescriptions prior to their preventive care exams.
The pet medication market is $4 billion, with veterinarians having the majority of the market share. Internet pharmacies and retailers are have tasted success with OTC flea/tick products and now hunger for pet prescription medications, which are projected to grow to $9.25 billion in 2015, according to Packaged Products report, Pet Medications in the U.S., 2nd edition.
Be sure to alert your staff and tell them not to provide 1-800-PetMeds with exam due dates. Here’s the fax 1-800-PetMeds is sending to veterinary hospitals: “Dear Doctor: In an effort to remind pet owners of an upcoming exam date with your clinic, we have added a ‘next exam due date’ field to the facsimile that we send requesting prescription authorization. When filled out by you or your designee, we will happily remind pet owners of that exam date before it comes due. We trust that you will find this proactive approach very helpful in getting pets into your clinic for their needed examinations. The pharmacists here
at 1-800-PetMeds feel strongly that the best thing pet owners can do for the wellbeing of their pets is to develop and maintain a strong relationship with their veterinarians. We also are quite certain that if you let us know when your patient is due for an exam, the reminder as that date approaches will improve
compliance, and require fewer unnecessary communications.”
Your technician would say,
“For your preventive care visit, we will do a nose-to-tail physical
exam, vaccines, intestinal parasite screen, heartworm/tick test, and refill 12 months of
heartworm and flea/tick preventatives. Is there anything else you want to discuss with the doctor
today?”
Telling clients “we will refill your preventatives” is stronger than “Do you need any heartworm prevention?” This compliance technique will have more clients leaving with medication from your in-house pharmacy. If pet owners ask about cost, prepare treatment plans or access prices on computers in exam rooms. Explain manufacturer rebates and the dollar value of free doses.
Then say,
“Before deciding, let’s have the doctor perform an exam, and then help you prioritize
which services and products your pet needs.”
Change your terminology
To help pet owners understand the importance of preventive care, the first step is to change your terminology. Replace “wellness exam” with “preventive care exam.” For example, I have two young, indoor cats. Caymus is 2 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—and pet owners want to keep their best friends healthy. So update your practice-management software, changing the description from wellness exam to preventive care exam. This will revise the term on invoices, treatment plans, and reminder emails and postcards. Your goal is to change clients’ perceptions from “Veterinarian = Shots” to “Veterinarian = Preventive Care.”
Clients want their pets to enjoy long, healthy lives. Regular veterinary checkups could make that possible. Changing our terminology to “preventive care exam” is a small step in significantly shifting pet owners’ perceptions.
Engage clients in exams
Veterinarians need to engage clients in exams, whether it’s for a preventive care visit or an illness. Communicate what you’re doing, explain what you found, and say what needs to happen next.
While I’m observing exams during on-site consultations, I often witness doctors chatting up clients while performing exams, asking about family vacations, holidays and their children. Although client bonding is part of the visit, pet owners aren’t engaged in the physical exam because the doctor is making light conversation instead of verbalizing the physical exam. While you’re chatting up the client and doing the physical exam, the client doesn’t understand what you’re doing—it looks like you’re just petting her animal. When the client checks out at the front desk, she challenges the client care coordinator about the exam charge. That’s because the doctor didn't verbalize and communicate value during the exam. Still chat up the client because that’s bonding and relationship building—but do it before or after the exam. During the exam, be the doctor and give a play-by-play description of what you’re doing as you’re doing it. Say,
“Now I’m going to listen to your cat’s heart and lungs. I won’t be able to hear you
Here’s how to engage clients and get them to participate in exams:
• If you hear a heart murmur, let the client listen through your stethoscope. Explain what you hear and what it means.
• If you perform a heartworm/tick-borne disease test, bring the SNAP® device into the exam room to show the client the test result—negative or positive. A negative test confirms, “everything you’re doing is working—continue your 12-month dosing of heartworms and flea/tick prevention.” • You find a flea—now murder it on the exam table in front of the client. Fleas make a snap sound
when you crush them with a fingernail. Then drag the murdered flea across the exam table and watch a trail of bright red blood appear. Whose blood is that? The pet’s blood! Make discovering fleas a dramatic moment in the exam room, and then say, “We will treat your pets’ fleas today and send you home with parasite preventatives.”
• Dirty ears lead to a diagnosis of ear mites. Take the client by the hand and walk her to your microscope. Do you remember the first time you saw ear mites under a microscope? I backed up and immediately felt itchy. You need your client to see the behind-the-scenes technology of your hospital.
• If you find a tick, show the client! Explain the need for tick-borne disease testing and flea/tick preventatives.
“Our heartworm test also screens for tick-borne diseases including Lyme,
ehrlichiosis and anaplasmosis. Screening every year is important because 1 in 77 dogs in
Colorado is testing positive for ehrlichiosis. Your dog also needs flea/tick preventatives…
Signs of tick-borne disease can include fever, lameness, skin rashes, lack of energy, and
decreased appetite or water intake. Wandering deer and wildlife, along with a warm
winter, means we’ll likely see more ticks this year.”
History questions for tick-borne diseases
! What flea/tick preventative 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? Bring products into exam rooms
When you offer a product in the exam room, it’s medicine. When it’s sold at the front desk, it’s retail. Let’s say you’re a technician who is discharging a dental patient. In the exam room, you explain antibiotics and home-care instructions. Also bring the therapeutic diet into the exam room, just as you would antibiotics. How to explain the therapeutic diet as ongoing therapy:
“Because your dog was treated for dental
disease today, she needs to eat this therapeutic diet to maintain oral health. Let me explain how
to transition to the new food and also tell you how much to feed.”
Likewise, bring OTC products such as flea/tick control into exams. Explain the flea lifecycle, how often to give a dose, and demonstrate how to apply the product. Tell clients “every 30 days” instead of monthly. This can improve compliance and optimal effectiveness of the product. For example, if a client applies her dog’s flea/tick control on the 15th of the month, next month on the 1st, and the following month on the 30th, you may have breaks in consistent protection.
Dispensing best practices
Put RX labels on products so clients know which pet the medication belongs to, which day of the month to give it, and where to get refills. Send reminders on the day of the month that clients need to give each dose.
Promote the dollar value of free doses
Don’t sell promotions short with “When you buy six doses, you’ll get two free.” Free has zero value. Instead, tell clients, “When you buy a six pack of parasite preventatives from our hospital, you’ll get two
free doses—a value of $40.” Because $40 is significant, you’ll increase compliance while saving clients money. Your prices are likely better than competitors’ when you add in the amount of free doses. Increase compliance for accepting dental treatments
Using positive body language and convincing phrases will help you confidently present treatment plans. Because doctors recommend surgery or procedures based on medical need, call the estimate a
“treatment plan.” The word “estimate” focuses on money, not on the care the patient needs.
When discussing treatment and finances, don’t stand behind the exam table and talk across it to the client. This face-to-face posture might be perceived as confrontational. Instead, stand at the end of the exam table, forming a “L” shape between you and the client. Even better: Stand on the same side of the
exam table, shoulder-to-shoulder with the client. This body language is collaborative rather than confrontational. The technician would then say,
“Let me explain the
treatment plan that your pet needs.”
Cover the price with your thumb or an educational brochure such as Virbac’s dental report card (see left, order brochure #VP028) or preanesthetic testing brochure. The client needs to understand the services included in a professional dental cleaning before seeing the price (service first, price last). Explain each item, pointing to the left column that lists medical services. Don’t point to the right column—it has prices.
Use visual aids to show clients the steps of dental treatment. Remember, most clients have never seen a dental procedure performed on pets. You can use a three-ring binder with labeled pictures, a digital photo frame, or slideshows on exam room computers. Match the order of photos to your treatment plan format so you can point to corresponding pictures as you describe each medical service. For example, show a photo of a technician running in-house blood work when explaining preanesthetic testing. Show a picture of a pulse oximeter and EKG when describing monitoring. Pictures help clients better understand procedures, and an educated client is more likely to comply with the doctor’s recommendation.
When finishing presenting the treatment plan, the technician will ask,
“Is this the level of care you’d
like for your pet?”
Even when a favorite client says, “Just do everything,” provide a written treatment plan for every
hospitalized patient and dental or surgical procedure. Clients don’t want surprises at checkout, nor do you want to argue over fees. A treatment plan should clearly explain the medical services, fees, and payment and deposit policies.
Once you’ve presented a treatment plan and the client has accepted care, have him sign the document. While the primary purpose of his signature is to give you permission to treat, it also confirms that the client understands the fees.
“In order to get your permission to schedule/proceed with
treatment, I need your signature on the treatment plan. We will
keep a copy with your pet’s medical record, and I’ll also give
you a copy to take home so you have information on the services and fees that we discussed
today.”
If clients don’t schedule dentistry, perform callbacks
Provide a courtesy reminder call when clients don’t schedule dental procedures at checkout.
Set up recommended service codes in your practice-management software. When the client service representative sees “dental recommended” circled on the travel sheet or entered in the electronic medical record, she knows to schedule the procedure during checkout. If the client doesn’t schedule, enter the “dental recommended” code. This prints the medical recommendation on the client’s invoice and triggers a callback in 7 days. Then a staff member calls the client as a courtesy reminder.
“Dr. Your Name asked me to call you about scheduling Opus’ dental cleaning so we can treat
his infection and slow the progression of his dental disease. When would be a convenient time
for you to schedule Opus’ dental cleaning…I have an opening on Friday or Monday…which best
fits your schedule?”
If the client declines, the team member notes it in the medical record and tells the doctor. As a consultant, I recommend that veterinarians make another medical callback if the patient has Grade 3 or 4 dental disease. When a doctor calls, it elevates the importance of the procedure. Clients may say yes to the “magic white coat” but staff members are often successful.
For travel sheets and hospital forms, order The Veterinary Practice Management Resource Book & CD from Communication Solutions for Veterinarians at www.csvets.com or 720-344-2347. We also offer a 1-hour CE credit webinar on “Promoting Preventive Dentistry.”
Present invoices to show value
Use confident body language and sales-reinforcement techniques. Let’s say that a client visits with Mason, a 3-year-old Newfoundland, for preventive care. As she nears the checkout counter, stand to greet her, smile and make eye contact. Read the list of services and products off the computer screen, and then state the total. Don’t say prices for each item, just the sum. Besides showing value, this allows the client to add items such as preventatives, medication refills and food.
Say,
“Today Mason had a preventive care exam, heartworm/tick and intestinal parasite tests, and
vaccines to protect him from canine distemper, adenovirus, parainfluenza, parvovirus, rabies, and
respiratory disease. You have Mason’s parasite preventatives 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?”
This approach shares service first, price last. Asking the client’s preferred payment method subtly indicates that payment is due when services are provided. For new clients, add which payments you take such as,
“We accept
cash, checks, all major credit cards, and CareCredit.”
Once the transaction is complete, hand the receipt to the client along with a smile that communicates, “We appreciate your business.”Schedule the next exam today
Preventive care appointments are lifelines in human dental offices—the same is true in veterinary medicine.Dental hygiene preventive care appointments are lifelines of dental practices. At least 80% of diagnosed dentistry comes from dental hygiene preventive care appointments. Dentists refer to their system as “recare appointments.” When patients leave the dental hygiene appointment without a future appointment scheduled this will dramatically decrease practice profitability by at least 50%.1
Patients schedule their next hygiene appointment before leaving today. This strategy is designed to keep the hygiene schedule full and productive. When the hygiene schedule is not full, a domino affect will occur. Not only is it possible to have patients fall through the cracks with timely hygiene preventive care
appointments, but the dentist will see openings in the treatment schedule in the future. Which question should you ask clients?
• “Would you like to schedule your cat’s next wellness exam?” • “When would you like to schedule your cat’s next exam?”
• “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. Your Name can see you on Saturday, March 22 at 10 a.m. or Monday, March 24 at 3 p.m. for your pet’s next preventive care exam. Which will work best for you?”
Color-code your appointments based on the reason for the visit. Use unique colors or descriptions in your practice-management software so you can identify appointments that were booked far in advance. Let’s say your color legend is green for preventive care exams, yellow for sick-pet exams, blue for medical progress exams, red for urgent care, and orange for exams scheduled far in advance. Each Monday, client-care coordinators would look at next week’s schedule and call or email to confirm all orange exams.
10:00 a.m. Max, 10 yr. Beagle, senior preventive care exam 10:20 a.m. Fluffy, 3 yr. DSH, vomiting for 3 days
10:50 a.m. Duke, 2 yr. Basset Hound, medical progress exam for ear infection 11:00 a.m. Blocked for urgent care
11:30 a.m. Opus, 3 yr. Ragdoll mix, preventive care exam 11:50 a.m. Caymus, 2 yr. DSH, preventive care exam
Confirm exams earlier. When booking exams six months or more ahead, call or email clients one week in advance to confirm in case appointments need to be rescheduled. It’s better to move appointments than to have no future appointments.
Practice schedule first, pay last. This technique has two advantages:
• Prevents clients’ hesitation to schedule follow-up care sometimes caused by sticker shock • Appointment reminders print on clients’ receipts
The Bayer Veterinary Care Usage Study found only 4% of practices always schedule medical progress exams at checkout, while 35% do so often and 49% sometimes do.
How you ask makes a difference. Tell clients,
“Dr. Your Name needs to see Sammy for a medical
progress exam for his ear infection on October 7. Would the same time, 10 a.m., work for you?”
This approach is stronger than “Do you want to make your next appointment?” Enter a callback if the progress exam isn’t scheduled at checkout
Clients walk through the “mind-erase hallway” on their way to checkout counter. Be a patient advocate and follow up about needed care. If clients don’t schedule progress exams at checkout, enter callbacks in your practice-management software. Call the client 1 week before the medical progress exam is due as a courtesy reminder.
“
Mrs. Smith, did you have an opportunity to check your calendar? Dr. Your Name needs to see
your dog for a medical progress exam next week. Ear infections can be painful and develop into
a serious condition unless treated and examined to make sure the infection has cleared. When
would be a convenient time for you and Jake to schedule his medical progress exam? We can see
Jake at 4 p.m. Thursday or 10:30 a.m. Friday. Which best fits your schedule?”
Timing is especially important for puppy and kitten visits. If the client doesn’t schedule the next pediatric visit at checkout, enter a callback in your software one week before services are due. If you get voicemail, leave this message:
“This is Your Name calling for Your Veterinary Hospital. Your kitten is due
for his next preventive care exam, vaccines, deworming, and intestinal parasite test next week.
Dr. Your Name wants to ensure your kitten has timely visits so we can provide preventive care
and check his growth and development. Dr. Your Name needs to see your kitten between October
20 and 25. Please call us today at 555-555-5555 to schedule an appointment.”
Saying the doctor’s name shows genuine care that the veterinarian is monitoring the kitten’s progress. Stating a date range stresses the importance of timely care and will encourage the client to return your call.
If you speak with the client, say,
“This is Your Name calling for Your Veterinary Hospital. Your
kitten is due for his preventive care exam, vaccines, deworming, and intestinal parasite test next
week. Dr. Your Name can see you at 9 a.m. Thursday or 3 p.m. Friday. Which works best for
you?”
The phrase “next week” creates a sense of urgency. Known as the two-yes-options technique, asking “which” appointment time is stronger than “Do you want to make an appointment?”
Check every reminder at checkout
Preventive care services and products generate 38% of revenue.9 Verify that all preventive care reminders and callbacks are correctly entered. If the pet was ill, what reminders or callbacks need to be entered? Were any long-term drugs prescribed for the first time? If so, are drug-monitoring reminders entered? Are other pets in the same family due for services?
Send refill reminders
Internet pharmacies know email reminders work. Refills account for 81 percent or $185 million of
PetMed’s 2013 sales of $228 million, according to its annual report.10 When Dr. David Wright added refill reminders for preventatives at his four Collierville, Tenn., hospitals, compliance increased 17 percent. When setting up preventative reminders in your practice-management software, create distinct codes for singles and 6 and 12 packs.
Quantity purchased Type of reminder Reminder interval
12 months Email / postal 11 months
6 months Email / postal 5 months
Single dose* Callback 20 days
* Single doses should only be sold if the puppy or kitten’s weight is changing.
Intermountain Pet Hospital & Lodge in Meridian, Idaho sends postal and email reminders for
preventatives and chronic drugs, which also improves compliance for drug monitoring and heartworm testing.
Sample preventative refill reminder
Opus is now due for a refill on Revolution for Cats to protect from fleas, heartworms, ear mites, roundworms, and hookworms. We want to protect Opus as well as your family from these harmful
parasites. Stop by our hospital today to get Revolution for Cats, or call us at 555-555-5555 so we can have your medication ready for pick up.
When you buy 6 doses, you’ll get 2 free, a value of $40. If you want home delivery, click here for our online store.
After the exam
Create a communication plan for contact between care. To build value for preventive care and encourage return visits, you need a communication plan between care. The client experience goes beyond the exam room. What happens after the client leaves? How will you stay in touch and make sure she comes back? Let’s say the client visits today for her dog’s preventive care exam. Use a service such as IDEXX’s Pet Health Network Pro, which can send email reminders and e-newsletters as well as provide online access to pet’s records and refill and appointment requests. Here’s how you could stay in touch:
Time from preventive care exam
Communication plan # of touch
points 1 day later Client care coordinator calls client. If you get voicemail, leave a message.
What the client hears is that you value your business relationship.
“This is Your Name calling from Your Veterinary Hospital. We
enjoyed seeing Bella yesterday for her preventive care exam,
diagnostics, vaccines, and preventatives. I’m calling to see how
Bella is feeling and to make sure we got all of your questions
answered. If have questions, please call us at 555-555-5555. You
also can go to our website at www.yourwebsite.com and log in to
see Bella’s updated preventive services and order any products.
Because Bella got a 6 pack of preventatives yesterday, you also can
sign up for refills through our online store.”
1
1 month later, sent every month
Client receives an email reminder that today is the day to give Bella her monthly flea/tick and heartworm preventatives.
12
3 months later, sent bimonthly
Client receives e-newsletter from practice, which is sent bimonthly. 6 5 months, 1
week later
Client purchased a 6 pack of preventatives during her preventive care exam and signed up for refills through the hospital’s online store. Send a refill reminder to the client 3 weeks before she’s out of product.
1
11 months later Client receives 1st postal and email reminder to schedule next preventive care exam.
2 (postal,
Time from preventive care exam
Communication plan # of touch
points 11 months, 3
weeks later
Client receives 2nd postal and email reminder, which is now overdue. 2 (postal,
email) 12 months, 2
weeks later
Client receives 3rd email reminder, which is now overdue. Client care coordinator also calls the client to make an appointment.
If you get voicemail, leave this message:
“This is Your Name calling
for the doctors at Your Veterinary Hospital. We are worried that
Caymus 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?”
If you speak with the client, say,
“This is Your Name calling for the
doctors at Your Veterinary Hospital. Opus is overdue for his
preventive care exam, vaccines, diagnostic testing, and
preventatives. We’re worried that he may be unprotected. When is a
convenient time for you and Opus to come in for an appointment
this week? Dr. Your Name can see you at 6 p.m. Thursday or 9 a.m.
Saturday. Which is more convenient for you?”
Known as the two-yes-options technique, this phrasing significantly increases the chance you’ll schedule the appointment because you direct the client to two possible appointment times. This phrase is stronger than “Do you want to schedule an appointment?” which is a yes-or-no answer.
3 (phone call,
email)
Total touches 26
When you consistently exceed clients’ expectations and provide quality medical care, your practice will thrive. Existing clients will buy more services and products when they’re satisfied with the value that your hospital provides as well as refer like-minded new clients!
Benefits of callbacks
Callbacks can improve patient care while generating immediate revenue. The 2003 American Animal Hospital Association compliance study found 38% of pet owners surveyed would return for a medical progress exam or procedure as directed by their veterinarian if the practice followed up.11
The primary purpose of callbacks is to proactively be patient advocates. Remember, dogs and cats can’t answer phones, check e-mail, or drive to Your Veterinary Hospital. We must talk to their pet parents in order to get patients to return for the care they need.
At Main Street Veterinary Hospital in Flower Mound, Texas, every technician and client-service
representative calls four clients per day with overdue patient reminders. Employees submit completed call sheets daily to a manager. Main Street Veterinary Hospital pays employees $5 for every overdue
preventive care visit that gets completed.
“Some staff earn $75 to $80 extra per paycheck, so it’s a big incentive,” says Practice Manager MaryBeth Soto, CVPM.
If the hospital paid a $75 bonus, the employee would have booked 15 overdue preventive care exams. According to the 2013 AAHA Veterinary Fee Reference, 8th edition, the total for an adult canine preventive health visit is $208, while cat owners spend an average of $186.12 Based on industry norms that 60 percent of patients are dogs and 40 percent are cats, you’d have nine dog exams at $208 each and six cat exams at $186 each for a total of $2,988—a great return on a $75 investment.
Economic potential of callbacks in a two-doctor practice Type of callback Patients
eligible Compliance benchmark Average per transaction12 Current revenue Total targeted compliance Additional income with 20% growth Total revenue Canine preventive care exam 2,160 57%13 $208 $256,090 77% $89,856 $345,946 Feline preventive care exam 1,440 41%4 $186 $109,814 61% $53,568 $163,382 Dentistry 3,060 38%3 $426 $495,352 58% $260,712 $756,064 TOTAL $861,256 $404,136 $1,265,392
Totals are rounded to the nearest whole number. Assumptions:
• Two-doctor practice
• 1,200 active clients per doctor • 1.5 pets per client
• 60% dogs, 40% cats
• 85% of pets over one year of age have dental disease Who should call clients?
Everyone should assume the role of patient advocate—veterinarians, practice managers, technicians, veterinary assistants, and client service representatives. To make sure follow-up calls happen
consistently, delegate specific types of calls to specific team members.
Just as you use doctor codes to track production, create staff ID codes so you may assign a specific staff member to a specific procedure. For example, Susan, a certified veterinary technician, performs a dental cleaning on a cat today. ID codes for the veterinarian and Susan would show in the patient’s medical record and be tied to callbacks. In your dental group code, turn on an automatic callback for one day later that also will pick up the staff ID code that was entered for the procedure. Tomorrow, when you print your daily call report, Susan’s name would appear next to the dental patient callback.
Assigning a specific staff member based on the type of callback ensures accountability and strengthens client relationships. Because Susan likely admitted or discharged the dental patient, when she calls the client the next day she already has an existing relationship. Assigning calls to individual team members also prevents one group from getting overwhelmed with too many calls. If you delegate all callbacks to the reception team, they may have too many to complete within the same day and may not be familiar with the details of recently hospitalized cases. Remember, veterinary medicine is a relationship-based business, so assign the type of callback based on who provided care.
List each service that you want to follow up with a phone call and create automated callbacks with staff members’ codes in your practice-management software. Run the callback report daily, giving lists to respective team members each morning.
Here is a sample callback protocol that you could tailor and expand to fit your veterinary practice:
Service Team member
responsible
Callback interval Pets overdue for preventive care Client service
representative
3 weeks after due date Recommended services that were
not scheduled at checkout
Client service representative
1 week after client appointment Professional dental cleaning Technician 1-2 days after patient is discharged
from hospital
Orthopedic surgery Doctor 1 day after patient is discharged from hospital
Outpatient treatment for ear infection Technician 3 days after outpatient visit, again in 10 days
For training on callbacks, we have a webinar on “Callbacks That Get Clients to Come Back” for 1 hour of CE credit. Call 720-344-2347 or visit www.csvets.com/webinars.
References:
1. Millions of Pets Skip Wellness Checks, AVMA Reports. Accessed on 12/20/12 at
http://www.veterinarypracticenews.com/vet-breaking-news/2012/12/07/millions-of-pets-skip-wellness-checks.aspx?cm_mmc=13026462.
2. U.S. Pet Ownership Demographic Sourcebook 2012. Accessed on 01/02/2013 at
https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-Pet-Ownership-Demographics-Sourcebook.aspx
3. 2011 Bayer Veterinary Care Usage Study conducted by the National Commission on Veterinary Economic Issues, Brakke Consulting and Bayer Animal Health. Accessed on 01/02/2013 at http://avmajournals.avma.org/doi/full/10.2460/javma.238.10.1275.
4. AVMA. U.S. Pet Ownership & Demographics Sourcebook. 2007 ed. Schaumburg, IL: American Veterinary Medical Association; 2007:1-27.
5. Half of American Cats Don’t Get Regular Veterinary Care, Veterinary Practice News, July 2013. Accessed 07-26-13 at http://www.veterinarypracticenews.com/vet-breaking-news/2013/07/26/half-of-american-cats-dont-get-regular-vet-care.aspx.
6. 2009-2010 APPA national pet owners survey. Greenwich, CT: American Pet Products Association Inc.; 2010.
7. Mobile Marketing Statistics 2012. Access on 10-05-12 at https://snaphop.com/2012-mobile-marketing-statistics/.
8. The Power of Text Messaging Marketing. Accessed on 10-05-15 at http://mashable.com/2012/07/13/text-message-marketing-infographic/.
9.Myers, WS. How to Conduct Effective Reminder Calls & Callbacks. Communication Solutions for Veterinarians Inc. 2009: Chapter 1, page 9.
10. PetMeds Annual Reports, accessed 08-15-13 at http://investor-relations.petmeds.com/petmeds-annual-reports.html.
11. “The Path to High-Quality Care: Practical Tips for Improving Compliance,” 2003 American Animal Hospital Association, pages 20-21.
12. AAHA Veterinary Fee Reference, 8th edition, AAHA Press 2013; pp. 55, 59 and 115. 13. Data on file, Communication Solutions for Veterinarians’ study of 107 practices, 2012.
