When it comes to building a new veterinary hospital or renovating an existing facility, the first questions that come to mind typically revolve around money. How much can I afford to spend? How much can I borrow? Will I be able to make ends meet once the new hospital is open? According to veterinary financial consultant and tax planning specialist Gary I. Glassman, CPA, a partner at Burzenski & Company in East Haven, Connecticut, it’s normal—and appropriate—to ask these questions because the answers factor hugely into the future success of your project.

During a lecture at the inaugural Fetch dvm360® virtual conference, Glassman said the primary considerations before deciding to build should be the new hospital’s revenue stream and its cost structure. “Much of what is typically required for a practice to be successful is determining what kind of income will be generated and how that will change,” he said.

New hospitals need an increased revenue base to support increased occupancy costs. Two key factors support revenue generation:

 The number of invoices the hospital generates. This is controlled by the number of patients and clients served. More space in a larger facility and/or increased patient volume may lead to changes, such as adding a new associate, Glassman said.

 Controlled by the fees you charge. This is going to change based on changes to either your pricing structure or average invoice amount, he said.

Before you can increase your activity level, you’ll need to find out how many new clients you can generate and what will happen to that new client base once you move into the new hospital. In other words, does the local market support the need for a new veterinary practice, and will your new hospital be able to handle a higher volume of patients?

To answer those questions, you must understand your capacity, Glassman said. He recommends conducting a demographic survey to evaluate area veterinary hospitals and the surrounding population. Ask these key questions:

 Is there a veterinary hospital on every corner, or will there be an increase in demand because there aren’t any competing veterinarians nearby?

Is the population decreasing or increasing?

 A decreasing population base will make it challenging to gain the amount of income you need for your project.

Not sure how to increase your clientele? Marketing is key. “Buildings themselves are great marketing ploys, in that the building acts as an exquisite point for people walking by,” Glassman said. Marketing the new building can attract passersby who want to find out what your new hospital is all about. You should also monitor whether new clients are sticking with the practice or leaving after a single visit.

Activity levels are also controlled by the services you offer. For example, if your previous hospital did not offer boarding and grooming but the new facility does, this can help increase your revenue stream. But you can’t expect that revenue to change overnight, Glassman warned—you’re going to have to build it with good marketing. Any time you add new services, you need to up your marketing game, which is an additional expense.

When it comes to increasing your revenue stream, you’ll need to review your current fee levels and decide early on if they need to rise. “For 2020, we’ve indicated to practices that they should be looking at a 5% increase in fee structure,” said Glassman, who advises against increasing fees on the day you move into the hospital because clients may perceive that they are helping to foot the bill for the new building.

of your services, in addition to adding new ones. New services and practice features that can lead to increased activity levels include boarding and grooming, behavior training, dental suites, and expanded the treatment area, and enhanced surgical suites.

It’s important to keep in mind that your hospital costs will change before your revenue increases, Glassman said. The moment you enter your new building, fixed occupancy costs that are likely to be higher include mortgage payments, equipment loan payments, property taxes, utility costs, insurance costs, and maintenance service contracts. Typically, veterinary practices have some deterioration of overall financial health for the first year to 1.5 years in a new building. The key to success, he said, is in generating additional revenue relatively quickly so that you don’t need to worry so much about the higher costs.

Did you know that the IRS can help make your hospital dream a reality? There are tremendous tax incentives for you to complete your building project. The government can support and pay for your project using depreciation, said Glassman.

Generally, tax laws allow you to write off a building’s cost over its statutory life, which, according to IRS guidelines, is 39 years. But for new builds, the IRS allows owners to accelerate depreciation in a number of areas so you get a better tax deduction in the early years of building ownership. Depreciable components may not include permanent structural portions of the building or the land the facility sits on. Here are the components that do qualify:

 Cabinetry, specialty lighting and plumbing, wall coverings and trim, data equipment, property in your lab area

 Land improvements such as parking lot lighting, fencing, planting, adding sidewalks, parking lot striping, subsurface drainage

Using component depreciation requires documentation of how you are coming up with each component and the assets associated with them. Usually, engineers and accountants can assist with this process.

Articles

If you are looking to build a new veterinary hospital or renovate an existing facility, make sure you first understand the financial factors that can make—or break—your project.

Want to build your dream hospital? Consider financing and cost structure first

Marketing involves finding out what pet owners want and devising and executing a plan to fulfill that need. Marketing tactics can be external (with the goal of bringing new clients to your practice) or internal (in which, the goal is introducing current clients to existing or new products or services). External marketing tends to cost more than internal marketing because it often involves some type of paid advertising.

Ideally, every marketing plan should include the following components in written form. Putting your plan in writing helps you focus on your goals, facilitates understanding and evaluation of the plan, helps ensure implementation, and gets the entire staff involved.

For the sake of this discussion, let’s assume your goal is to do more dental cleanings. This is an internal marketing plan because all aspects are completed by your team. But regardless of what you want to accomplish for your hospital, the marketing plan components outlined here will serve you well.

Your marketing objective must be specific and measurable. Simply “doing more dental cleanings” is not a measurable goal. In this example, performing 1 more cleaning per day is a measurable and attainable goal.

The target audience for your marketing messages is usually either existing or new clients, depending on your objective. In this case, targeting existing clients whose pets have periodontal disease makes the most sense. Targeting prospective clients involves a separate external marketing plan.

In general, your competitors are other veterinary practices within a 5- to 10-mile radius of your clinic. Although it seems like most procedures and services can be “shopped” by pet owners, and some practices in your area may offer lower dental fees, clients who are loyal to your practice likely won’t shop around.

Your budget, or the cost of implementing your plan, is a major factor in identifying a marketing strategy. Ideally, you should set aside a certain sum annually for marketing, and this is where that money is spent. In this example, your budget is $10 for printing 100 client handouts. Keep in mind that this figure does not include costs for staff time spent planning and running the program.

Your strategy is what you will do to accomplish your marketing objective. In this example, your practice manager and/or an associate veterinarian will create a 1-page handout explaining why it is important to treat dental disease in pets. Technicians will give the handout to pet owners during wellness visits after reviewing each pet’s oral health.

The timing is how long it takes to execute your strategy and how long it will run, and execution involves who will oversee the plan and how it will be accomplished. Here, the plan starts 1 week after distribution of handouts begins. The practice technicians will recommend forward-booking dental treatments at time of the wellness appointment. If no appointment is booked, they will send a follow-up communication (call, text, or email) 1 week later, and again 3 weeks after that for those who have not booked a dental appointment.

This marketing plan will be executed over 3 months to its test effectiveness. For some plans, the timing is open-ended. In this example, if the strategy is effective and you reach or exceed your goal, you may choose to continue using the strategy indefinitely.

Measuring effectiveness and return on investment

The practice manager will keep track of every dental cleaning completed for 3 months and determine whether there has been an increase based on this marketing strategy.

Calculate your return on investment (ROI), or how much money you earn as a result of your efforts, based on net profit (money earned minus amount budgeted). ROI can be determined daily, weekly, monthly, or annually, depending on the timeline for your plan and how much effort you want to expend. In this case, it makes sense to measure ROI monthly.

Because the objective in this marketing plan is specific, it can be measured easily to determine whether it was effective in reaching your goal. If you don’t achieve your goal, review it to determine whether it was truly attainable. If it is a worthy goal, you may need to increase your budget or change your strategy, timing, or execution.

In this scenario, if you book just 1 additional dental cleaning in the next 3 months (an obvious failure, based on the stated goal), and your average fee per cleaning is $400, you have still made an extra $390 ($400 for the 1 extra cleaning minus the $10 for handout printing, again not including staff time to implement and run the plan). Although this is a poor response, the practice still earns a net profit because the plan is inexpensive to institute.

Now, here’s your homework. Within the next week, come up with a plan for marketing a service your practice provides. Talking with your staff about potential marketing efforts is important, because marketing is a team effort that likely will require more effort on their part than on yours. But when you focus on the needs of your patients and clients, and map out a solid plan that incorporates the benefits, you’ll soon begin to improve the quality of care you provide while also boosting your bottom line.

Shawn P. Messonnier, DVM, owns Paws & Claws Holistic Animal Hospital in Plano, Texas, and serves on the 

 Editorial Advisory Board. He has written multiple books on marketing as well as holistic veterinary medicine.

A marketing plan is simply a blueprint for what you want to accomplish and how you will do it.

How to develop a marketing plan for your veterinary practice

“What if 2020 was the moment we have all been waiting for?” This is the question Bash Halow, BA, CVPM, LVT, posed to attendees at the inaugural 

® virtual conference. “What if it is a moment to clear the playing field and change the game entirely?”

Halow, owner of Halow Consulting in New York and member of the Editorial Advisory Board for dvm360®, said the uncertainty of 2020 could benefit local veterinary hospitals. “Because we run small businesses and have small teams that are intelligent and engaged, we can be more nimble to the constant changes we are going to see over the next couple of months,” Halow said. “What if this is a recipe for us to come out on top?”

Halow encouraged attendees to consider how the coronavirus disease 2019 (COVID-19) pandemic may affect their hospitals going forward. “COVID-19 and its challenges don’t have to be hobbling for us,” he said. Halow shared his thoughts on the top trends for 2021.

“I was not too keen on telemedicine until 3 months ago,” Halow said. But the pandemic—and participating in virtual visits with his own medical providers—reshaped his opinion. Practice owners need to consider that clients now expect telemedicine as an option. Ignoring this could prove detrimental to future success (see “Bonus tip: A necessity, not a trend”).

“Stop thinking of telemedicine as being in lieu of a physical exam,” he said. “You are not going to get the same information from a telemedicine consult that you would from a physical exam, but there are still a lot of things telemedicine can do.”

Being able to view how a patient behaves in its home can provide unprecedented insight. For example, if a feline patient is exhibiting behavioral issues, a virtual visit allows the veterinarian to see where the cat eats and sleeps, where the litter box is located, and the overall condition of the home. These details can provide diagnostic clues not available during an in-office examination.

. When a physical examination is necessary, Halow said telemedicine can assist in pre-appointment triage. Use the virtual setting to collect the patient’s medical history and learn more about current concerns. This is an opportunity, he added, to leverage team members who may be immunocompromised or not comfortable working in an office setting, while making better use of the veterinarian’s time.

. When a client calls to cancel an upcoming appointment, suggest they turn it into a telemedicine consult instead. The veterinarian may still interact with the client and learn about the patient, Halow said. Then, based on what they hear, they may develop a plan. “More likely, what they’ll do instead of concluding the service then, the plan will include a visit with follow-up diagnostics where the physical exam can be conducted.”

How should hospitals charge for virtual consultations? Halow is confident practice owners can determine this once they establish that they can comfortably provide telemedicine. Clients expect to be charged for telemedicine visits because it is a use of the veterinarian’s time. “This meeting would be a great beginning to additional diagnostics,” he said. “And it would be a middle ground to find out how the patient is doing.”

“Two-way texting, especially in the age of social distancing and curbside service, allows your entire hospital to engage in 2-way dialogue with your clients via text messages in real-time,” Halow said, calling the service essential for hospitals. Not only do these programs let the client guide the service experience via their smartphones, but the providers (eg, VitusVet, Weave, Vet2Pet, PetDesk, InTouch Communications) supply additional resources that practices can pass on to clients, including bill paying, accessing medical records, and viewing diagnostic results.

“Think of these two-way texting tools as a way to take all of the things you are already doing and putting it through one platform,” he said.

“Staff shortages are not going away anytime soon, so onboard technology that shoulders some of your team members’ most time-consuming tasks,” said Halow. “Online scheduling has finally arrived and it’s so much better than the old way of merely requesting a time slot, with platforms that allow clients to book their own appointments directly in real time. The service has been shown to decrease appointment phone traffic by 60% and gives clients the immediacy and convenience they’ve come to expect. Now you don’t have to fret about another client care representative shortage,” he said. “You can work with the team members that you have, improve service, and take the payroll savings to the bank.”

“Clients are bigger advocates for their communities and locally sourced products and services now than they ever were,” Halow said, adding that hospitals should use this to their advantage.

Practices have been told they need to match prices for big box and online stores, but it has resulted in offices that are drowning in inventory. There is such a thing as too many options.

“I want you to distinguish yourself in these 2 ways,” he said. When clients talk about the many choices available to them for their pets, veterinary practices should say, “Yes, we’ve already seen all of the choices that are out there and we’ve picked the one that is right for you and your pet.” Be confident that your office has the item that the specific pet needs. “That should be the pitch you make to them,” he said.

Halow said it is also advantageous to remind clients that when they shop locally, the money they spend at your practice is reinvested into the community. “If we are looking for people’s help to lift us out of this economic recession, it will happen because all of us help our individual communities,” he said. “Make the case for that.”

Supporting local businesses is a growing nationwide trend, Halow said. “Know that your message is likely to fall on very receptive ears.”

Looking ahead, Halow predicts that more and more clients will need financial assistance to provide the lifesaving veterinary care their pets need. Lines of credit for the veterinary industry have been a game-changer, he said, noting that CareCredit and VetBilling.com are among the most popular.

Halow said some pet insurance companies, such as Nationwide, now cover the cost of virtual visits as part of their coverage plans. “One of the ways to incentivize clients to acquire pet insurance is to say that you offer virtual visits and that the insurance company covers the cost of those visits.” It’s a win-win for all parties, he said.

Above all else, Halow said, practices need to consider what pet owners want. “Your job should be listening to their needs and finding a way to offer your services in such a way to meet those needs.”

Amanda Carrozza is a freelance writer and editor in New Jersey.

The year may be coming to a close, but it has brought lasting changes affecting how veterinary hospitals must operate to succeed in 2021.

Top trends in veterinary practices for 2021

If it seems as though you’re seeing otitis cases all the time, you probably are. According to Ashley S. bourgeois, Dvm, DACvD, a dermatologist at Animal Dermatology Clinic in Portland, Oregon, and dvm360® editorial Advisory board member, otitis is the second most common reason dogs are brought to a veterinarian.

Although the condition can be chronic or acute, chronic presentations are more common, she said at the inaugural Fetch dvm360® virtual conference. And because chronic or recurrent presentations are typically multifactorial, a thorough history to identify all causal and contributing factors is extremely important. During her session, bourgeois outlined the causes of otitis and discussed the components involved in making the diagnosis.

Bourgeois started by breaking down the complexity of causation, particularly for chronic cases. Predisposing factors, primary and 

secondary causes, and perpetuating factors all play a role in this dynamic. Predisposing factors alone do not cause otitis, but they do increase the risk for the development of infections. Examples of predisposing factors include abnormal ear conformation and topical reactions. When combined with 1 or more primary causes, infection and otitis can occur.

Primary causes of otitis include conditions such as atopic dermatitis, food allergies, and endocrinopathies. If primary causes are not identified and managed, recurrent episodes will likely occur. bourgeois emphasized the significant impact of these primary causes, even in asymptomatic patients. Despite not having clinical evidence of otitis, at least 1 study showed that atopy alone alters the microbiome of the ear. Secondary factors (eg, yeast and bacteria normally present in the ear canal) do not cause pathology in a healthy ear. but in the presence of other primary factors, these secondary factors can lead to overgrowth of microorganisms and infection.

Perpetuating factors (eg, fibrosis, stenosis, calcification) are often irreversible and include changes in anatomy and physiology in response to recurrent otitis. These irreversible factors prevent the resolution of otitis and often are an indication for surgical intervention.

The diagnostic approach and historical assessment should include a thorough review of potential primary and secondary factors, as well as predisposing and perpetuating factors. Try to determine whether the problem is acute or chronic and whether there are any inciting factors or other signs of primary disease such as allergies.

During the physical examination, it is important to evaluate the pinnae as well as the ear canals. Note as many details as possible so that you can track these findings on serial exams and monitor for progression or resolution. Note the type and location of inflammation, the presence and appearance of any discharge, and the presence and location of any ulcerations or proliferative tissue. Note the state of the tympanic membrane, and palpate the tissue of the ear canals, noting any fibrosis or calcification.

A proper otoscopic exam is imperative, bourgeois said, and if the patient is not cooperating, use sedation as needed. For otoscopy, she recommends using a bright light source and at least 10 times magnification. Video otoscopy has many advantages, including the extremely bright light source, the ability to use photos and videos for owner education and documentation, and the ability to manipulate instruments more deeply into the ear canal. The video otoscopy systems allow for constant irrigation (eg, flushing and aspiration), which can be advantageous when performing ear flushes or myringotomies. Additionally, small tears in the tympanum can go unnoticed with hand-held otoscopy, but with video otoscopy, you can see small bubbles emanating from the tear. 

Regardless of the type of otoscope used, bourgeois advises using the largest size otoscopy cone possible. A 3-mm cone is the most commonly used size, she said, but the variability in patient size among dogs and cats necessitates having multiple sizes available.

Cytology is a mainstay in both diagnosis and monitoring for treatment response. Do not rely on your eyes to diagnose what material is present, bourgeois cautioned, as the true diagnosis can 

sometimes be surprising. rely on cytology to determine the type of microorganisms and inflammation present. otoscopy can guide you to the most appropriate locations for sampling.

The scoop or rotate technique using a cotton-tipped applicator is an effective way of obtaining samples. For this method, insert the cotton-tipped applicator gently into the canal, but not so far as to contact the tympanum. At the junction of the horizontal and vertical canal, rotate or scoop the applicator, and then roll that material onto a slide. If too many clumps are on the slide, then spread some material onto another slide. repeat this sampling as necessary. bourgeois uses standard Diff-Quik stain, without prior heat fixation, dipping each slide 5 to 8 times in each stain and blotting 

in between to avoid cross-contamination of stains.

Cytology is simple, inexpensive, and available in the clinic. In this way, it can be an effective monitoring tool and inform clinical decision making. For example, the duration of antibiotics required
to clear an infection varies from patient to patient, so the use of serial cytology can indicate whether an infection is truly resolved and that diagnostic result can help inform whether treatment can be discontinued.

You may also wish to submit a culture and sensitivity, but recent data have shown that the accuracy and inter laboratory agreement of culture and sensitivity data are poor. That said, culture and sensitivity information can be very important when systemic treatment is required, such as for patients with otitis media, where mixed infections occur, where there is suppurative inflammation with little bacteria, or when patients have failed to respond to previous therapy. In chronic cases, you may wish to request an extended sensitivity panel to include polymyxin b or tobramycin. Keep in mind that the presence of biofilm will reduce the ability to culture organisms and reduce the efficacy of treatment.

When a culture is required for otitis media, pass a sterile plastic catheter connected to a sterile syringe filled with 0.5 to 1.0 ml of sterile saline into the middle ear ventral to the malleus. If the tympanic membrane is not yet ruptured, perform a myringotomy at the caudoventral aspect of the tympanum. Inject the saline and aspirate back. Culture the aspirate. Be sure to obtain this sample from the middle ear (not the external canal) for otitis media cases.

Although flushing is also considered a treatment, Bourgeois emphasizes that it is very important diagnostically to clean and flush the ear canal. There may be 

evidence of primary causes under the debris in the canal. It is essential to flush out any debris thoroughly to assess the ear canal and tympanic membrane accurately. visualization of the ear canal may also be improved by using cerumenolytics and resolving proliferative tissue using corticosteroids. These adjunctive measures are important because medical treatment is more effective when the ear canal is open and clean. 

Perform the flushing procedure as follows:

Anesthetize the patient. Not only does this make the procedure more tolerable for the patient, but if there is a tear in the tympanic membrane the patient will require deep aspiration from the bullae, lest irrigation fluid drains from the bullae through the eustachian tube and into the pharynx, causing aspiration. Use sterile water or saline for irrigation.

Pass infant feeding tubes (red rubber catheters) down the ear canal.

Flush and aspirate repeatedly until the canal is clear.

Use polypropylene catheters (stiff, rigid catheters) for myringotomies to drain fluid from or infuse medications into the middle ear. B

ourgeois recommends cutting the catheter at a bevel and using the sharp point to create the myringotomy. It is important to remember that cats have septum bullae that make accessing the bullae difficult when flushing the middle ear or delivering medication locally. Patients may exhibit transient Horner syndrome after ear flush procedures. This should not be a deterrent for performing these procedures, she said, as untreated otitis cases also may develop Horner syndrome.

Where imaging is necessary, computed tomography (CT) is the most informative modality. radiographs are of limited value due to superimposition of structures. CT scans can accurately detect osteomyelitis or fluid in the bullae and also help determine if medical management is likely futile, such as in cases where the ear canals are completely stenotic and bullae are severely affected. For bullae evaluation, magnetic resonance imaging is not often necessary unless there is concern about an underlying neurologic disorder.

Bourgeois emphasized that otitis is a multifactorial inflammatory disease of the ear canal and pinnae. otitis commonly becomes chronic due to inadequate control of the primary cause or perpetuating factors. Serial cytology is of great value in diagnosing and monitoring otitis. Finally, ear flushing
is important in diagnosing, treating, and evaluating infections and has a role as maintenance therapy in preventing recurrence of otitis.

Dr. Packer is an associate professor of neurology/neurosurgery at Colorado State University College of Veterinary Medicine and Biomedical Sciences in Fort Collins, and is board certified in neurology by the American College of Veterinary Internal Medicine. She is active in clinical and didactic training of veterinary students and residents and has developed a comparative neuro-oncology research program at Colorado State University.

A look at the causes of and diagnostic best practices for this ubiquitous and often vexing condition.

Otitis: the keys to diagnosing this multifactorial inflammatory disease

Many young doctors contact our office to find out how and where they can secure a new employment contract or position after leaving a bad work situation (for example, a hospital has cut salaries or a corporation has made undesirable management changes).

I’ve often found clients to be surprised by my advice. We may have an exchange about the validity and enforceability of their noncompete or nonsolicitation agreement, but the discussion often takes an unexpected turn toward the prospect of becoming a practice owner.

Conversations can vary depending on a client’s situation. A young, reasonably experienced client with good credit history is likely to do well in a critical timing situation. Rather than changing jobs because circumstances accelerated a decision that was likely to happen eventually, it may be time to consider practice ownership as the next career step.

When I graduated from law school, family farms were being sold at auction routinely because of confiscatory estate tax rules. For a time, there was virtually no estate tax at all. Now the taxation law has landed somewhere in between. (This does not provide much comfort to the farm families who went into bankruptcy.)

Similarly, situations regarding business and individual income taxes are constantly changing. That’s why practice owners need to remain vigilant to take advantage of the financial incentives provided under the Internal Revenue Code (IRC).

Depreciation is central to the real estate industry. We veterinarians can use it to our advantage, but we must carefully consider timing.

Depreciation is an accounting concept that is part truth and part fiction. Depreciation allows a taxpayer to deduct from taxable income an established portion of the value of something used in a trade or profession. The available deduction in a given year is calculated based upon the business property’s useful life and when that item is placed in service.

Those 2 terms are where the challenge lies. When an item is placed in service and how long it remains useful are characteristics we manipulate to our advantage—within the law—through judicious timing.

We have a friend in the Internal Revenue Code (IRC), which in some instances, keeps us from having to worry about useful life. Though it is not as powerful today as it once was, IRC Section 179 is designed to help businesses acquire and employ business property tax efficiently. However, Section 179 helps best when it is appropriately timed.

Section 179 allows a business to ignore the amount of time a piece of equipment or other physical items can be expected to last. Instead, the entire price of the equipment can be deducted (written off) from business income in a single year, regardless of its useful life.

Veterinary practices used to purchase a Mercedes or Land Rover for the clinic’s use and deduct the entire $50,000 from the practice owner’s taxes. Eventually, this practice was curtailed.

However, while Congress eliminated much of the luxury car use of Section 179, there were other, substantial expansions. Now, the Section 179 single-year depreciation regulations permit a single-year deduction of qualifying equipment of amounts approaching $1 million.

Effective use of the Section 179 rules requires close review by a practice owner or partnership, as well as a certified public accountant (CPA), to determine:

What other relevant tax matters will play into the use of the Section 179 code provisions

Let’s look at a couple of examples to help drive these points home.

 is an equine facility with several racetracks and breeders as clients. That hospital might want to accelerate or decelerate its invoicing so that one individual year sees $100,000 more in income than the previous or subsequent year. The single “high taxable income” year would be the best time to purchase that $100,000 ultrasound machine the practice wants. (The practice should ignore the ultrasound salesman’s tax advice and scrutinize any “buy-now” incentives that may pale by comparison with what Section 179 can do in terms of dollars saved.)

 has a partner who constantly tries to convince the others that the practice needs new diagnostic equipment. The partners look at last year’s tax return and don’t see net income sufficient for 

 use of Section 179 if the current year unfolds similarly. That practice needs to focus on increasing its efficiency and revenue, so that if they buy the equipment, there will be 

 against which they can make full use of Section 179. If that just isn’t possible, the timing for a large equipment purchase is wrong.

Beware of the vendors’ “offers and recommendations”

Section 179 is relatively straightforward, but has many nuances that need to be discussed with the clinic’s CPA prior to making any large equipment purchase.

Just as important is fully understanding the claims and offers made by salespeople. For example, a digital radiograph system may be purchased outright, leased, or purchased at a discount (with a 5- or 6-year minimum supply or product purchase commitment).

Don’t let a salesman pressure you into signing a contract before you can analyze the deal, giving consideration to how Section 179 could help to make price and other issues work in your favor.

Christopher J. Allen, DVM, JD, is president of the Associates in Veterinary Law P.C., which provides legal and consulting services exclusively to veterinarians. He can be reached via email at info@veterinarylaw.com. Allen serves on 

There is a great deal of truth in the saying “Timing is everything.” However, there isn’t always someone to tell you when you are facing a critical timing situation.

Veterinary equipment purchases and taxes: What you need to know

I primarily manage advanced dental cases, many of them involving older dogs or cats. That’s why I tend to get overly excited about new puppy or kitten appointments, because they typically allow technicians to spend extra time reviewing everything, from vaccinations and diet to elimination training.

You might not be as thrilled to see new senior dog or cat patients, especially if they have multiple problems or comorbidities—leaving you with one 20-minute slot at the end of the day to diagnose and treat every ailment. But these animals deserve (and typically need) all the extra time and care we can give them. So, what’s the best way to welcome senior pets into your practice?

We need to get better at defining and identifying senior pets. According to the American Association of Feline Practitioners (AAFP) and the American Animal Hospital Association (AAHA), cats are considered senior at age 11 and geriatric at age 15. Senior dogs are more challenging to identify, because larger dogs age faster than smaller dogs. A giant breed might be considered senior at age 5, but a smaller breed, like a Chihuahua, might be considered senior at age 11.

Additionally, targeting patients for a senior care program is not easy. When a senior pet is identified and acknowledged, client education helps with transitioning these patients into a senior health program. Discussing life stages from an early age with clients can better prepare them for when you start using terms like “senior” and “geriatric.” As your patients reach milestones, additional, more frequent care is needed. Subtle changes may be signs of a potential disease, rather than instances of pets “just getting old.”

For new or current clients who might be unaware of senior pet problems, it is important to provide additional time for more detailed history or focused questionnaires and a thorough physical examination (likely diagnostic testing and in-depth discussion of management or follow-up steps). If your allotted time is too short, a follow-up appointment might be necessary.

When asked, most practices encourage examinations twice a year, along with diagnostic work-ups involving bloodwork and urinalysis. Blood pressure measurement is sometimes mentioned, but often forgotten, and radiographs typically are only taken if there is a specific reason. Because studies have shown that many issues can be identified in apparently healthy pets, these diagnostic tests should be used as baseline levels to detect trends or changes before clinical signs are recognized. There are several guidelines you can use to help monitor disease stages including the 

 (Cardiac Education Group), the International Renal Interest Society’s Staging of 

cognitive dysfunction syndrome evaluation tool

Several questionnaires can also help assess behavior, pain, mobility, and overall quality of life in senior pets. Providing a list of potential issues may also alert the client to a problem they may not have suspected otherwise. Helping clients become more cognizant of gradual changes can help with early detection of many health issues. Try giving clients a senior folder with pockets that can hold veterinary visit information, diagnostic results, and a section for current medications.

Encourage clients to make quarterly or monthly observations of their pets, including how much and what they are eating and drinking, their activity levels, their elimination habits, and behavioral changes. They can take sequential photographs of their pets for body condition scoring comparisons, with a lateral view and a “skyline” view. They can also take photographs of any unusual or suspicious mass or tumor (with an object next to the mass for size comparison)—this will help you determine any rapid changes and help locate the mass for removal.

All of these efforts help identify senior pets who need additional care and attention. As we look at these patients more closely and regularly, we can detect issues and diseases at earlier stages, thus helping improve their quality of life and hopefully extending their time with clients.

Having a solid veterinarian-patient relationship during these golden years can help you continue to be your patient’s advocate when it’s time for the client to make the difficult decision of euthanasia. These senior pets have often been loved family members for years and they deserve their final years to be as happy and comfortable as possible.

Heidi Lobprise, DVM, DAVDC, is a veterinary dental expert with Main Street Veterinary Hospital and Dental Clinic in Flower Mound, Texas.

When it comes to providing proper care to older dogs and cats, client education is key in helping to detect early signs of illness. 

Vetted November 2020

Want to build your dream hospital? Consider financing and cost structure first

How to develop a marketing plan for your veterinary practice

Top trends in veterinary practices for 2021

Otitis: the keys to diagnosing this multifactorial inflammatory disease

Veterinary equipment purchases and taxes: What you need to know

Welcoming and caring for senior pets