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Fatten up your revenue


Team retention, good medical recommendations, and consistency will help your practice to beef up income.

There are occasions when you congratulate yourself for tightening your belt a notch or two—you've worked extra hard at the gym to work off those second and third helpings at the Thanksgiving table, for example. But looking at your practice's profit and loss statement is not a time to be feeling lean.When it comes to practice revenue, an ever-expanding bottom line is a good thing.

We tracked down a couple of practices that have hit on ways to keep their coffers full. They're the highest-priced hospitals in their communities, but their clients wouldn't think of going anywhere else. Why? Read on to find out. Then consider how you can implement these three strategies in your own hospital—whether you're the practice owner setting clinic policies, an associate looking to increase your production, or a manager responsible for tracking practice finances.

1. Find and hold on to the best team members

"The biggest difference between us and the guy down the road is our staff," says Dr. Brent Cook, co-owner of Kingsbrook Animal Hospital in Frederick, Md. "Clients come to us because they know Nora; they know Eileen."

Dr. Cook and his partner hire only licensed technicians, and they make a conscious effort to "let them be technicians, not animal restrainers," he says. Receptionists observe exams and

surgeries so they can speak with clients knowledgeably. And when a client comes in for an appointment, a team member hands that person

The bottom line

a business card. That team member is the client's contact for all communication with the hospital. "That way when they call, they can just ask for Nora instead of having to explain their pet's situation every time," Dr. Cook says.

Furthermore, when clients are facing a particular health challenge with a pet, the doctors select a team member who's been through a similar situation to talk to them about it. "Whether it's a cat urinating in the house, a splenic mass, or a tooth abscess, we see these things every day as doctors," Dr. Cook says. "But clients have never been through it before. If someone can say, 'I've been in your situation and I know it's difficult,' they feel much better."

In addition to superstar talent and a focus on empathy, the practice owners' attitude is key to a great team. Luanna George, LVT, hospital administrator at Orchard Park Veterinary Medical Center near Buffalo, N.Y., says her owners' thoughtfulness is one of the biggest factors affecting team loyalty. "The partners here are three of the kind-est people I've ever known, and they really do put the staff first," she says.

Revenue review

The result? Incredible staff longevity. One team member has been at the practice 40-plus years, and two others more than 30 years. Employees with a 10-year history at the hospital are not uncommon—George is one of them.

Now, while it's one thing for us to recommend that you find good team members, we know it's easier said than done for many practices. How do Kingsbrook and Orchard Park do it? "Many of our team members find us," Dr. Cook says. "They've heard about us and want to work for us."

Which brings us to the next point.

2. Aggressively recommend the best patient care

Both George and Dr. Cook emphasize that a top reason their team members are so dedicated—and clients are willing to pay top dollar—is that their practices recommend only what's best for the patient. "We are the patient's advocate," George says. "It's posted all throughout the hospital and on our Web site. We talk about it at staff meetings. The doctors discuss it during rounds."

Dr. Cook's practice is similar. "We recommend the best, no matter what it costs," he says. "That includes referring a lot—TPLOs and ultrasounds, for example—to specialists. Our staff members want the best for their own pets. So they in turn are able to recommend top-level care to clients—it's what they would do. Money doesn't come up in conversation nearly as much as what's best for the pet."

Dr. Brent Cook

In order to add value to the high-level medical care—and the top-level fees that go with that care—both practices go for the "wow" factor with clients. Kingsbrook doctors get on the floor to examine most patients and talk directly to pets. "We say, 'Hey, Buffy, how are you? Your ears look good,'" Dr. Cook says. "Clients love it. They mention it in our surveys all the time."

Orchard Park, which offers specialty and emergency services as well as community care, has a liberal 12-hour visitation window. And some clients with hospitalized pets will "camp out" for the entire 12 hours, George says. "I think it probably makes paying our hospitalization fees easier if clients can be with their pets," she says. "They understand the value when they see the effort we put into the pet's comfort and care."

3. Cultivate consistency in all areas of the hospital

According to consultant Denise L. Tumblin, CPA, a Veterinary Economics Editorial Advisory Board member and author of Benchmarks 2007: A Study of Well-Managed Practices, differences in the way doctors and team members approach practice—clinically, financially, and in areas such as client communication—will harm a hospital. These differences can lead to confusion, soured relationships, client misunderstandings, and, ultimately, shortcomings in patient care. And all of these problems undermine a practice's attempts to fatten up revenue.

To maintain consistency, the doctors at both Orchard Park and Kingsbrook meet regularly to talk about their practice. "We need to make sure we're running one hospital out of this building, not four," Dr. Cook says.

Luanna George

He and the other doctors use a method they learned from Tumblin. The practice manager picks 10 cases from one doctor, plus the invoice from each of those transactions, and gives them to another doctor. The second doctor has a week to read the charts and see why the pets came in, what the doctor found, and what he or she recommended, and then compare that to the invoice to see what was charged.

At the next meeting, the doctors discuss the findings. "We only get through a couple of cases, but they stimulate discussion of consistency issues we didn't know existed," Dr. Cook says. Here are some of the benefits of the exercise:

• Builds confidence. Say a doctor is charging for a level 1 exam but spending enough time to charge for a level 2 exam. If he or she learns that the other doctors are charging level 2 rates successfully, the first doctor will feel more confident charging appropriately the next time.

• Spurs idea sharing. Kingsbrook just hired a new associate, and these discussions have helped her build on her training. "Our new doctor might say, 'You would recommend all these tests? That's going to cost $600,'" Dr. Cook says. "We'll say, 'Yeah, but if the client doesn't do it, it's going to cost $900 next month.' You can see the light bulb go on."

• Uncovers gaps in patient care. Comparing cases also helps the Kingsbrook doctors discover differences in protocols. "We'll ask, 'Why does one doctor have 12 cases of Giardia when no one else has any?'" Dr. Cook says. "Or 'Why does Dr. Davis have 12 knee X-rays when the rest of us have two?' And Dr. Davis is right there, so he tells us." Tools to help you do this at your practice are available in Benchmarks 2007: A Study of Well-Managed Practices. To learn more, visit industrymatter.com and search for "Benchmarks."

So if your revenue is looking waifish, take a look at your team, your recommendations, and your consistency (or lack thereof). Consider whether the ideas presented here might work for you, and prepare to watch your earnings swell.

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