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Adding New Services

Posted By Administration, Tuesday, August 27, 2019

Increasing revenue has become harder in the last decade or so. Most practices are dealing with pushback on the cost of veterinary care from pet owners, and therefore the large fee increases are harder to implement than they used to be. With the increase in the number of veterinarians and veterinary practices, competition for clients is also more difficult. Adding new services, however, remains an option—not only do new services allow a practice to generate more revenue from current clients, but it may also attract new clients who are looking for that particular service. VHMA’s August 2019 Insiders’ Insight Report covered this topic.


When asked: “In the next 12 months is your practice thinking about expanding your service offerings?” a large number, 59%, of responding managers indicated that they are thinking about expanding their service offerings. By far, extended hours was the most popular area for expansion, 36% of managers identified this service. Convenience continues to be an important issue for consumers in picking places to do business with and extended hours fits into that category. Telemedicine was the second most popular choice, with almost 25% of the respondents selecting this service. Two other convenience items—online appointment booking and online pharmacy were also in the top group. Not surprisingly given pet owner cost concerns, wellness plans, and payment options were also two of the top areas practices were considering expanding services in.


Offering new services often means acquiring new technology, and thus, the next question asked: “In the next 12 months is your practice considering acquisition of new technology?” While almost 60% of the responding practices are considering adding new services, fewer are thinking about adding new technology. Digital radiography, Sedivue, and blood machines were the technologies least selected—perhaps because practice already have this equipment. The most frequently selected items included Ultrasound, Online appointment scheduling, Telemedicine technology, and Dental digital radiography.


For more details, read the full report, VHMA’s August 2019 Insiders’ Insight Report.



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Management Team Structure and Function

Posted By Administration, Wednesday, July 24, 2019

Twenty years ago, most veterinary practices didn’t have a practice manager; these tasks were performed by the owner of the practice. As practices have gotten bigger and the environment in which veterinary medicine operates has gotten more complex, it is rare to find a practice that doesn’t have at least a part-time management person. The management team in many practices has also grown both in size and skill set. VHMA’s July 2019 Insiders’ Insights survey explored both management team structure and function.


Only 26% of the managers surveyed have a formal, written contract, and very few of those contracts were written by an attorney. Contracts for both veterinarians and managers almost always ensure better communication regarding the terms of employment and the expectations of both parties. Better communication = fewer problems in the future. They also can help drive an orderly transition when it’s time for the employee to leave (either voluntarily or not.) Contracts don’t have to be complex; contracts can be written in as much non-legalese as possible, so everyone understands what the words mean. Attorney involvement in the drafting of the contract is important. An attorney helps make sure the contract doesn’t include illegal expectations and can also make sure you don’t innocently commit to something you didn’t mean to. Well-written contracts protect both parties when things go bad.


Whereas only about ¼ of the managers have contracts, the figures are reversed for job descriptions with only about ¼ of the managers NOT having a job description. Contracts usually only list general employment duties, but job descriptions are typically more detailed. The primary benefit of a job description for both the employee and the employer is communication of responsibilities and expectations. Job descriptions should be updated every couple of years or when job duties change significantly, and the employee should be actively involved in either creating or updating the job description; they know best what they do! The manager and their supervisor should review the job description periodically to make sure expectations are aligned.


When asked: “Have your management responsibilities changed in the last year?” Very few respondents said their duties had decreased, and about only about 12% said their responsibilities had not changed. The majority of the respondents said their duties had changed in some fashion, with 60% saying their responsibilities have increased — not a surprise with the growing complexities involved in running a small business. The types of changes noted included: delegating more tasks, core tasks remain the same, but day-to-day tasks have changed, duties influenced by addition or leaving of other employees, and some changes are one time—building of new facility, acquisition of a new clinic, the addition of online pharmacy


When asked: “Has the management structure in your practice changed in the last year?” 45% of the practices said they'd added middle or top-level management with most of the additions being middle-level department managers. A few practices have decreased the number of dedicated positions but not tasks. The tasks themselves were assigned to other individuals. 45% of the practices have not made any changes to the management structure.


When asked about the factors that influenced change in the practice’s management structure: corporate acquisition, revenue increases, revenue decreases, staffing growth of the hospital, and expanded services were all identified.” It is no surprise that the vast majority of the change in management structure is influenced by practice growth in revenue and/or staffing. In the “other” section, some respondents noted reorganizing and/or flattening their management structure to be more efficient and productive.


Only a few practices have no dedicated practice manager. The management team in 43% of the practices consists of the owner and a dedicated manager and in 50% of the practices consists of the owner, a practice administrator and multiple other office or department managers.


For more details, read the full report, VHMA July 2019 Insiders’ Insight



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Digital Media Management

Posted By Administration, Sunday, June 23, 2019

Most practices are spending more time and money on marketing activities than they used to keep their practices growing and keep clients bonded to the hospital. Digital media can be time-consuming to manage, and the practices who do it most successfully have clearly assigned team roles and a detailed digital marketing plan that keeps everyone on schedule and moving towards the same goal. This month's Insiders’ Insight survey takes a look at how practices do this.


When asked “Who created your practice website?” about 23% of the practices did this all themselves; for 45% of the practices, it was a combined effort between the practice team and an outside marketing company. About 1/3 of the respondents said that an outside marketing group did essentially all of the work.


When asked, “Who manages or maintains the content on your practice website?”. A little over 50% of the practices indicated this work is done by various members of the practice team with practice managers having the primary responsibility. In 38% of the practices, it is a joint effort between the practice team and the outside marketing company.


Most practices use digital media beyond a website, and this question asked: “Who manages your practice’s social media programs?”. In 80% of the practices, this is done by the practice team. In about 19% of the practices, an outside marketing firm works with the practice to manage the social media programs.


Online reviews are of big interest and concern to practices, and there, of course, needs to be a process in place to address these comments. 60% of the respondents indicated this is the practice manager’s responsibility, and in another 32% of the practices, other team members do this job. Very few practices use an outside marketing company to deal with online reviews.


Some practices have blogs and/or online newsletters. 40% of the respondents indicated that the practice manager performs this task. Other team members have the primary responsibility in about 36% of the practices. About ¼ of the responding practices involve their outside marketing company in managing their blogs and newsletters.


Video content is a part of many practice’s digital marketing; therefore, survey respondents were asked: “Who creates your practice’s video marketing content?”. About 60% of the practices do this in-house, and a wide variety of team members are involved. About 20% of the practices outsource this task to an outside marketing company, and about 20% of the practices work together with their outside marketing company to create this content. Responses were similar when asked, who manages the video marketing program.


About 50% of the respondents said their practices don’t use Google Ads. Of the 50% who do, a little over ½ of them create the ads in-house, about 1/3 outsource this task, and the rest create them jointly with their outside marketing firm.


About 29% of the respondents said their practice doesn’t have a mobile app. 51% of the practices outsourced the creation of the app to an outside marketing firm, and the others were split fairly evenly between creating the app totally in-house and sharing the creation with their outside marketing firm. About 27% leave the content management to their outside marketing firm while 26% do this in-house and 19% share the responsibility jointly between their practice team and outside marketing firm.


Digital marketing is, of course, just one component of a practice’s overall marketing plan, and it is critical that a practice look at the big picture before diving into the use of specific marketing tactics. Read the full report for big picture marketing tips.


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Practice Purchasing

Posted By Administration, Saturday, May 25, 2019

Many factors are essential to the practice of quality medicine and surgery including having an appropriate range of high-quality equipment for both diagnostics and treatment and the right medications, supplies, and food to use in-house or send home with clients. The process for purchasing and replenishing these items varies from practice to practice, and May’s Monthly Management Survey asks about that process.


No surprise, the practice owner (typically a veterinarian) makes the final decision in 75% of the purchases of medical equipment and about 55%-60% of computer hardware and software purchases. This makes sense due to the higher cost of equipment and the long-lasting impact of the decision on practice finances and medical care. The practice manager and practice team are more involved in the drugs, supplies, and food purchase decisions. Those respondents who answered “other” typically said that a combination of these team members were involved in the final decision or that others not listed here (associate DVMs, inventory manager, IT person, corporate office) were involved.


Peers are the most common initial go-to resource for all purchase categories, although practices use many resources to gather information before making a purchase. Resources listed in the “other” answers included company sales reps, VIN, VMG groups, VHMA boards, the Internet, corporate headquarters (if a corporately owned hospital), and the veterinarians in the practice. The almost unanimous resource for IT purchases was the practice’s IT consultant.


Purchases are made for different reasons, and it must first be understood what the goal of the acquisition is before gathering information and making a decision. Will the new equipment, supplies, food, or medications improve patient care? For example, the purchase of an ultrasound machine may allow for more accurate diagnoses. Will the new equipment lower the operating costs related to the provision of services? A new blood chemistry unit may lower the direct costs incurred in running a blood profile because less maintenance is required for the unit. Will the new equipment, food, or medications increase revenue? Or will it allow the practice to offer a more affordable diagnostic or treatment alternative? Often, more than one of these goals is met with the acquisition of a single piece of equipment or change in medication protocols. For example, an IV fluid pump will often reduce staff costs related to monitoring fluid administration as well as improve patient care by more accurately insuring patients receive the volume of fluids needed. Purchases aren’t usually made just to increase revenue; the revenue is a happy consequence of providing better patient care.


There is a broad range in how much financial authority managers have in purchasing. About 50% of the respondents can spend up to $1,500 without owner approval.


When asked: “What factors go into your decision making when you consider new products and services (rank the factors in order of priority)? The two factors that are ranked as 1 and 2 over 50% of the time are “User experience” and “Return on investment and value.” “Affordability” is included in the first three rankings 38% of the time and “Product support” and “Customer service” are included about 1/3 of the time.


For more details including tips on how to evaluate a new equipment purchase see the full report, VHMA’s Insiders’ Insight May 2019.


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Posted By Administration, Monday, April 29, 2019
Telemedicine is a hot topic right now and has generated a lot of controversy over whether it should be part of how veterinary medicine is practiced. Some of this controversy is due to confusion over what all the “tele-terms” really mean; however, some of the controversy is also over real issues related to whether pets can be appropriately diagnosed and treated using some of these modalities.
Telehealth, the umbrella term, is defined as follows: “all uses of technology to deliver health information, education, or care remotely.” Telehealth can include both services that require a VCPR (veterinary-client-patient relationship) and those that don’t. The definitions of the telehealth services shown below are based on the 2018 AVMA-AAHA document entitled “The Real-Life Rewards of Virtual Care.”
  • Telemedicine—the practice of veterinary medicine using technology as a communication tool (requires a VCPR)
    Teleconsulting—the use of telehealth tools by a general practice veterinarian to communicate with a veterinary specialist about the care of a patient
  • Telemonitoring—the remote monitoring of patients who are not at the same location as the healthcare provider
  • Teletriage—safe, appropriate and timely assessment and management of animal patients via electronic communication with their owners under conditions of uncertainty and urgency and where a diagnosis is not rendered
  • Electronic prescribing—the digital-based electronic generation, transmission, and filling of a medical prescription
  • Teleadvice—providing health information that does not require a VCPR to pet owners or other parties using technology

To find out where practices stand on telehealth, VHMA asked managers as part of their April 2019 Insiders’ Insight Management Survey to identify their current and future practices.

When asked “What types of telehealth services does your practice currently provide? (Electronic communication can be via the telephone, email, fax, text, video conferencing, mobile app, web-based chats, wearable monitoring devices, etc.).” Not surprisingly, the most used services are teleconsulting with specialists and electronic prescribing. Telemonitoring is not used extensively at this time, and only about 1/3 of practices are providing true telemedicine services which require a VCPR. 
When asked “What technologies does your practice use in telehealth communication?” Telephone, email and messaging lead the pack, but it is worth noting that 100% of practices didn’t select the phone as an option. That indicates some practices are very strict about the kind of information they will discuss even when a VCPR isn’t required.
A big question that comes up when discussing telehealth is can these services be charged for and how to do it? The VHMA survey asked, “Does your practice charge for the following types of telehealth services?”
Answers are all over the board, but in summary, most practices are not offering many of these telehealth services and, of those that do, few are charging for all or most of the services provided.
When asked if practices have discussed telemedicine as a business strategy, not quite 40% of the practices surveyed have discussed telemedicine as a business strategy; the majority of practices have not. However, the majority of practices have indicated they are at least thinking about telemedicine as a potential service to be offered or expanded in their hospital.
The next question asked: “In what ways is your practice thinking about expanding your telemedicine services?” Telemonitoring via pet wearable devices generated the least interest while almost 50% of the respondents indicated interest in live virtual appointments and asynchronous electronic consultations. 2/3 of the “other” comments stated their practice was not looking at using any of these options. Several others said their practices are considering telemedicine and exploring options but not yet sure how it can best be utilized.
Most managers think their team members have concerns about the legal liabilities of telemedicine. They also think their clients would appreciate the additional access to the professional staff.
Telehealth and telemedicine are in their early days in veterinary medicine, and very few practices are comfortable jumping into all aspects of it. There is a lot to be worked out. Telemedicine is becoming increasingly popular in human medicine, and it is likely the veterinary profession will feel ongoing pressure to participate. Ignoring the issue or just saying no won’t make it go away. Veterinary professionals need to shape telemedicine and telehealth in a way that works for the business side of the practice and provides quality care to our patients (does not harm).


Read the full report - VHMA Insiders' Insight April 2019


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