Targeting changing vaccine protocols


The hard truth: You've been your own worst enemies when it comes to vaccinations. (And the only reason we can say that is that we lived those days in practice, too.) In the 1970s and '80s many veterinarians derived a substantial percent of their total incomes from vaccinating dogs and cats. They marked vaccinations up tremendously over their costs and, at the same time, didn't charge clients a separate exam or office call fee. Practices told clients that the exam or office call was "included in the cost of the vaccines."

By Roger F. Cummings, CVPM, and James E. Guenther, DVM, MBA, CVPM

The hard truth: You’ve been your own worst enemies when it comes to vaccinations. (And the only reason we can say that is that we lived those days in practice, too.) In the 1970s and ’80s many veterinarians derived a substantial percent of their total incomes from vaccinating dogs and cats. They marked vaccinations up tremendously over their costs and, at the same time, didn’t charge clients a separate exam or office call fee. Practices told clients that the exam or office call was “included in the cost of the vaccines.”

This trend started to change in the ’90s, with many practices separating the cost of the vaccines from the exam or office call charge. Yes, some pet owners resisted at first, saying they just wanted the shots, not the exam. Yet, with perseverance, veterinarians and their team members have educated clients about the value of wellness exams. And over time, more pet owners have come to understand that veterinarians’ time, knowledge, and skills have much greater value than the “shot.”

Now, with relatively new position statements from the AVMA and AAHA on vaccinations—and changes in many states’ legal requirements for vaccinations—many of you need to modify your approach. This change likely means that you’ll provide fewer vaccines or administer some vaccinations less frequently, depending on each pet’s risk and needs.

Clearly, deciding the medical issues is a major industry debate. But your work’s not done when you’ve decided on your patients’ needs. There are management decisions to make, too.

Making a clear decision

The first issue is for all the doctors in the practice to agree on a vaccination standard. Clients need to hear the same story each time they visit, no matter who they talk with.

The decision about the medical issues is critical, of course. And, as with all medical decisions, you need to focus on what you believe is best for the pet. At this point, you must set aside all thoughts about the income. After all, this is what you do in all other cases; you recommend what’s best for pets, not what’s best for practice revenue.

Once you and the other doctors in your practice decide on vaccine standards, you need to hold a staff meeting to review the protocol with the healthcare team. In the end, you want everyone to believe in, understand, and be able to communicate the benefits of your approach to pet owners.

During this meeting, team members will ask the same questions clients will ask them, so be prepared to offer believable, understandable, and valuable answers. Your team members will pass these answers on to clients, so saying something like, “because I said so” or “because I know what’s best” just won’t cut it.

Instead, explain why you’re changing your approach and work with your team to develop a way to communicate your reasons to pet owners. For example, you might say, “Based on recommendations from AAHA and the AVMA, our doctors reviewed our past approach to vaccinations. We decided that making these changes gives our patients better care.”

The key here is that when pet owners call the practice and ask, “What vaccinations does my dog or cat need?” they expect a direct answer, not pregnant pauses or “You’ll have to ask the doctor.”

Of course, you still need your team members to prepare and educate pet owners about vaccinations. So in this case, you might ask staff members to say something like, “The quantity of vaccinations that pets need has changed. Depending on the age and breed of your pet, the doctor will help you decide which vaccinations will best meet your pet’s needs.”

Yes, some pet owners will ask to buy only vaccinations, without the annual exam or office call. So you also need to discuss your policy about giving vaccines without a comprehensive exam. In fact, I think you should include a thorough discussion of the importance of wellness exams as you discuss vaccination protocols with your team. Then talk about how to explain the cost of vaccines and your requirements for an exam or office call, so pet owners appreciate the value of both.

In the end, your vaccination protocol, just like every other service, needs to benefit the pet, the client, and the practice. If your approach doesn’t, revisit it and make sure there are tangible and intangible benefits for all parties.

Considering the financial impact

Historically, the vast majority of practice visits have been initiated because the client received a notice that vaccinations were due or because the pet was sick. And in many practices today, the vaccination reminder is the one thing that drives visits from healthy pets. So changing your vaccine protocols could have a significant affect on practice finances.

How big a hit will you take? Discuss these questions with your team members to find out. And keep in mind, if you’ve already changed your vaccination recommendations, you can still complete this initial analysis by reviewing computer reports or medical records that were completed before the change.

• How many doses of each individual vaccine did you administer in the past 12 months? For example, your medical records might show:

2,000 rabies vaccines at $10 each = $20,000

2,000 distemper and parvovirus combination vaccines at $15 each = $30,000

• How many office calls or exam fees were generated in conjunction with the vaccines administered in the past 12 months? For example, your medical records might show:

2,000 annual exams at $35 each = $70,000

• Will the same number of clients bring their pets in for the distemper and parvovirus combination vaccine in the year they are not due for a rabies vaccination? In our experience, most wellness visits are still driven by reminders and vaccinations. So without thorough client education about the need for regular exams and good follow through with reminders, you’ll probably see a significant drop in the number of wellness visits.

Now project the affect your changes in vaccination recommendations will have on practice revenue. For example, if you charged $35 for an annual exam, $10 for an annual rabies vaccination, and $15 for an annual distemper and parvovirus combination vaccination, the total would be $60. If you decided to give the rabies vaccination one year and the distemper and parvovirus combination the second year, your income per annual canine vaccination would drop only $15 the first year.

Of course, when pets get vaccinations most also receive other services or are prescribed additional medications. So you may not earn the same incremental income if you see the pet less frequently.

Whether you estimate a revenue drop of $10,000 or $100,000, you’ll need to think about how to adjust for the loss and continue to spur revenue growth. Of course, one option is to raise fees, and many practices will and should do this. Yet it’s often difficult to raise fees enough to maintain or increase income if you’re providing fewer services or seeing fewer clients. And even practices that have moved to providing three or four vaccinations, with one given each year during the annual exam, will probably see a decline in healthy pet visits if they don’t implement other marketing and educational programs.

A solution: Promote better health

Most practice management consultants agree that few practices have thoroughly analyzed the financial implications of changing vaccination protocols. And fewer practices yet have implemented programs to increase revenue from other medical services. What types of programs or services should you consider? Consider these examples:

• checking thyroid levels of dogs and cats receiving thyroid medications

• checking phenobarbital levels of patients receiving phenobarbital

• recommending appropriate deworming for dogs and cats. (The Centers for Disease Control and Prevention recently reported an increase in visceral larva migrans in children. Shouldn’t we recommend deworming at least twice a year?)

Thanks to “The Path to High-Quality Care,” a compliance study published by AAHA in July 2003 and supported by a grant from Hill’s Pet Nutrition, we know that often pets don’t receive the preventive care veterinary teams recommend. So although pets are living longer than they did in the past because of improved nutrition and disease prevention, we have a tremendous opportunity to better their lives by improving compliance with basic medical recommendations.

To take advantage of this opportunity, each practice needs to analyze its clients’ compliance and implement programs and systems that reinforce recommendations and improve client education about pets’ needs. And every practice may find different tools that help.

For example, like other practitioners who’ve started reviewing their patient records, Dr. Eddie Garcia, director of the Veterinary Medical Clinic in Tampa, Fla., was amazed at how many services patients weren’t receiving. To correct the problem, Dr. Garcia recently appointed a long-term, experienced team member to be “patient care coordinator” in his practice.

This staff member reviews all patients’ medical records before clients arrive for their appointments. She notes in the record or on a checklist what preventive measures doctors or team members need to discuss with clients.

The coordinator also follows up after the visit to schedule a progress examination, the pet’s next annual visit, or one or more of the preventive measures the doctor recommended. And she makes sure the doctor records issues that need to be discussed with the client during the next visit and checks that the practice team charged for all services rendered. Finally, the coordinator has the authority to return the record to the doctor if it doesn’t meet the standards the practice team set.

Yes, we know doctors review medical records. But, in reality, most veterinarians still don’t spend enough time reviewing patient records specifically for compliance issues. And it’s fairly uncommon to find a veterinary team that consistently educates pet owners about the steps they can take to keep their pets as healthy as possible. Some good news: An experienced staff person can more than offset the costs of his or her salary and benefits by raising clients’ compliance.

Target change, and thrive

Today everyone’s bombarded with information, and no one feels they have enough time to do all the things they want or need to do. Given this new reality, you and your team members need to find new ways to communicate with and to pet owners about their pets’ critical healthcare needs.

A simple postcard vaccination reminder no longer has the power it once did when it comes to bringing pet owners to the practice. To make up the difference in response, team members need to take more responsibility. They need to call clients to follow up; remind them of appointments; and schedule the dental procedure, progress exam, or other recommended care.

Yes, this approach takes time. But we need to build personal ties with clients if we’re going to help them help their pets. And spending more time connecting with and educating pet owners is essential to maintain the financial health of the practice, too. Just as we change our medical recommendations to offer better care for pets, we need to rethink our service approach to help clients keep their four-legged family members healthy.

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