1

PRACTICE SUCCESSIN ANY ECONOMY

• MARK RUSSAK

• PAST PRESIDENT AAHA

• AMERICAN ANIMAL HOSPITAL ASSOCIATION

• NUTMEG VETERINARY CONSULTING

WHO AM I?oVet Tech USAFoCSU Graduate 1976oVMI (Veterinary Management Institute) GraduateoPrivate Companion Animal Practitioner over 35yearsoBuilt, Owned and Managed a 3 ½ Doctor AAHA Practice in Connecticut for 25 yearsoAssistant Clinical Professor,

o Mississippi State University CVM 7 Yrs.o Primary Care, Business, Communication

o Recently Retired

o Relief Vet / Shelter Volunteer/ Lecturer/ Veterinary Career Counselor

o AAHA Past President

o Board Member ICVA (formerly NBVME)

THINK BIG- FOCUS

SMALL & DREAM

OVERVIEW

oPractice Status

oBayer-Brakke Study

oTrends

oFinances/Metrics

oClient Centric/Bonding

oAction Plans

ECONOMIC STATEVeterinary Care Usage Study ◦ 10 Year Decline In Visits- (improving)

◦ Started 2004-Recession-2008

◦ Fragmentation Of Services

◦Mobile, Specialty, Spay/Neuter, Dr. Google, Internet Pharmacy, More Vets & Hospitals Etc.

◦ Inadequate Client Understanding Of Need For Routine Visits

◦Cost Of Veterinary Care

◦ Feline Visit Resistance

DISPOSABLE INCOME?

DECLINING PRACTICES

oLimited Measurement Of Client Satisfaction

oNo Real Social Media Presence

◦Owners Belief That Advertising (Marketing) Undermines His Or Her Credibility As A Veterinarian.

◦A Lack Of Referral Arrangements With OTHER Pet Service Providers Such As Groomers, Dog Walkers, And Pet Stores

DECLINING PRACTICES

oCost Perceptions

o“Veterinary Costs Are Usually Much Higher Than Expected.”

oCost Expectations: The Value Proposition

oPayment Required At The Time Of Service Only

DECLINING PRACTICES

◦Limited Use Of Business Metrics

◦Dr. Production, ACT, Profit Centers, Labor Costs, Client Visits, New Clients, Open Appointments, Receivables…

◦A majority Of Practice Owners Don’t Use Financial Concepts To Manage Their Businesses……….

….Those That Do Earn Significantly More Than Those That Don’t-

2

Why clients switch

10

Cost

Beyond your control

(e.g., move, pet dies)

Poor communication &

customer service

LOCATION DOES NOTDETERMINE GROWTH

11

Growers and Outgrowers

Decliners

SO WHAT DOES DETERMINE WHETHER YOU GROW?

o Focusing On Your Clients

o Driving Regular Preventive Care Visits

o Setting Goals And Measuring Your Business

o Communicating The Value Of YourHigher Standards

o Leveraging Technology

FOCUSING ON YOUR CLIENTS –“CLIENT CENTRICITY”

GROWERS FOCUS

oReputation/Well Known

oWord Of Mouth/Referrals'

oClient Communication

DECLINERS FOCUS

oSpecialized Care/Services

oGrowth In Area/Economy

==============================================================================================================

Practices that focus on engaging clients are

more than twice as likely to be “Growers”vs. “Decliners”

Growers Strengthen the Bonds

14

GROWTH PRACTICES

o Clients Saw The Same Veterinarian During Every Visit: Relationship Building

o Share Something With Client At Every Visit: Exam Report Cards

o Follow Up With Clients After Visits: Via. Phone / Email / Text

o Offer Care Payment Options

o Invest In Community Events

oActive Use of Social Media, such as Facebook, Twitter etc. for marketing Purposes

o Leveraging Current Technology

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Our practice management technologyand systems have evolved…

GROWTH PRACTICES GROWTH PRACTICES

oBelief That Wellness Examinations Are The Practice’s Most Important Service.

oBelief That Marketing And Advertising Are Important To The Practice’s Success.oUse Outside Client Marketing Software

oAccurate Financial Benchmarking (Metrics)

… Have At Least One Dog And/or Cat

… See Their Veterinarian Regularly

… Are The Primary Care Provider

… Don’t Work In The Pet-health Industry

SURVEY OF OVER 1,000 PET OWNERS WHO…

18

3

19

93% BELIEVE THE

BOND THEY HAVE

WITH THEIR PRACTICEIS IMPORTANT

21

“My Veterinarian is…..

PET OWNERS ARE INTERESTED INPREVENTIVE CARE

22

Believe discussing disease

prevention is important

Discussed preventive

care with veterinarian at last checkup visit

23

8 out of 10 interested in monthly payment preventive care plans

No difference in interestbased on income

PET OWNERS ARE OPEN TO “FORWARD BOOKING”

6 out of 10will say “yes” to

Forward Booking

24

Zoe’s bi-annual checkup

Closing the gap in Forward Booking

25

Average % of clients Forward Booked

U.S. Dental

Practices

U.S. Veterinary

Practices

5%80%

Source: AAHA State of the Industry 2013

DRIVING PREVENTIVE CARE – “FORWARD BOOKING” EXAMPLE

80%

Average % of clients for whom next

appointment is “Forward Booked”

U.S. Dental

Practices

~

~10%

U.S. Veterinary

Practices

~ 5%

~$350M

Projected increase in U.S. veterinary

hospital preventive care revenue

Pet owners want to be informed

27

Researching pet health

online before or after visit

Receiving suggested online

resources from veterinarian

4

30% reduction in Dr. Google when you simply recommend an online sourcePercent of pet owners that consult “Dr. Google” before or after visit

28

70%

48%

Veterinarian doesn’t recommend “trusted”

online resource

Veterinarian does recommend “trusted”

online resources

-30%

Source: Survey of 500 pet owners with regular veterinarians, 12/2013. Data on file with IDEXX.

Pet OwnershipExplaining the value of diagnostics

29

Always follow recommendation

for routine blood testing

Would probably agree

to testing if value made clear Explains Things In A Way I Understand1.

Shares Test Results With Me2.

Treats Me As A Partner3.

Provides Guidance On Preventive Care4.

MOST IMPORTANT TO STRENGTHEN THE BONDS

30

VERY BAD P.R. “IT’S NOT ABOUT THE NAIL” CORE VALUE=COMMUNICATION

Communication Is A Core Relationship Skill And Developing It To A Professional Level Of Competence Is

A Key To Success In Business (And Life!)

DIALOGUE IS KEY

• Clinical Outcomes Result From Mutual Understanding And Shared Agreement

• Common Ground Is Achieved Through Dialogue

• Who’s Doing All The Talking

Feedback

Response

Message

SHARED DECISION MAKING

Decisions Are Made Within A Collaborative Partnership

o Using Best Available Evidence

o Taking Client Perspectives Into Account

o Encouraging Client Inputo Creating A Dialogue

Shared Decision-making Requires Relationship

Coulter, 1999; Stewart et al, 2003

REALITY CHECK Interruptions In 55% Of Visits: 72% Of Clients Did NOT

Complete Their Response

Veterinarians Interrupt Clients Within: 15.3 Seconds (Dysart Et Al, 2011)

Physicians Interrupt Patients Within: 18 Seconds (Beckman & Frankel, 1984), 23 Seconds (Marvel Et Al, 1999), 12 Seconds (Rhoads Et Al, 2001)

5

PRACTICE, PRACTICE, PRACTICE

Four Core Skillso Non-verbal

Communication

o Open-ended Questions

o Reflective Listening

o Empathy

CORE SKILLSo Non-verbal-

o Body Language:

o Open-ended Questions:

o Who, What, When, Where, Why, How.

o “Tell Me What Concerns You Have About Molly? “

o “How Would You Describe Jake's Daily Activities? “

o Reflective Listening:oRepeat Of Clients Words, Summary & Interpretation

- “So Friskie Threw Up Twice Last Night?”

- “Given Your Recent Experience With Snowball, I’m wondering If That’s What You’re Worried About With Frisky?”

o Empathy:oWalk In Someone Else's Shoes

- “I Can See How Hard It Is To Make This Decision…I had to do the same thing”

- “It Sounds Like You Did All That You Could For Barney”

ALWAYS Check In With Client -Open Ended Questions:

o What Are Your Concerns?

o What Else Can I Do

For You And Fido Today?

o NOT - Do You Have Any Questions?

ENDING VISIT!OH, BY THE WAY…

Not eliciting the clients concerns at the beginning of the appointment increased the

odds (4x) of a concern arising during the closing segment of the interview.

Dysart, Coe, Adams, 2011

WATCH YOUR WORDS

VETERINARY TEAMS WHY VETERINARY TEAMS?

oDeveloping High Performing Teams In Practice Is Important Because They Are Crucial To The Quality And The Delivery Of The Hospital’s Veterinary Services

oThe Client Usually Has More Interaction With The Staff Than With The Doctors.

oVeterinary Services Are Provided By People And The Provider Is Inseparable From The Service Itself

THE VETERINARY TEAM…. KEY TO PRACTICE SUCESS

Mark RussakPast President

American Animal Hospital Association

6

THE VETERINARY TEAM

o Hire For Attitude-Train For Skillso Hire Slowly…Fire Quickly

o Leverage The Team

o Professional Attire

o Personal Appearance/Groomingo Name tagso Business Cardso Flexible schedulingo Cross Training

THE VETERINARY TEAM

▪Empower & Train For Decision Making

▪Continuing Education

▪Encourage Creativity

▪Celebrate Together

▪Laugh A lot

▪Thank You’s

▪Compensate Fairly▪Profit Sharing ▪Pet Insurance

PRACTICE CULTURE

oFoster A Culture Of Mutual Respect

oQualities Of Leadership Such As Honor, Respect, Integrity, And Focus Are Visible At All Levels Of Management.

oOwners Constantly Ask Themselves And Their Staff Members What They Can Do To Improve.

OH THOSE CRAZY CATS!

oMetrics Are A Set Of Measurements That Quantify Results

oYou Can't Manage What Isn't Measured

WHY METRICS???

FINANCAL BENCHMARKING

o Profit CentersoRevenue By Category

o New Clients Per Month

o Open Appointments

o Receivables

o Inventory Levels

o Average Patient Transaction (APT)

FINANCAL BENCHMARKING

o Gross Income Per Month: Hospital, Doctor

o Average Transaction Charge Per Veterinarian

o Number Of Medical Transactions Per FTE DVM Per Month

o Labor Costs

REVENUE BY CATEGORY

oLab 18-22%

oDental 5%

oImaging 6%

oAnesthesia 6%

oSurgery 8%

oOffice Visits 12%

oMed Exams 15%

oInjectable 46%

© 2015 SNOWGOOSE VETERINARY MANAGEMENT CONSULTING

7

Well Managed Metrics RULE THE EXAM ROOMoNever Allow Client to See or Hear Pain

“Pain Is Inevitable

...Suffering Is Optional”

oDiagnostic & Care Plan Compliance KeysoNever Pre-Judge

o Best Options First- Plan A,B,C?o What YOU Would Do For YOUR PETo NEVER, NEVER, NEVER - Recommend

o What the Patient Needs & Deserves!

o Fido NEEDS…..

MONEY TALK

oComfortable Financial / Medical Communication

oPlain Language-No Jargon

oRisk / Benefits/ Teamwork

oPatient Care Plans (Estimates)

o$$ Updates Daily

FOOD FOR THOUGHToPet Spending Has Increased…………. o While Vet Care Spending Has Lost Ground-

Improving?

o ¼ + Of Pet Owning Public Spends $0 = Opportunity!

o Good Medicine Is Good For The Bottom Line

o “The Reason We Practice Is Not Profit……but We Can’t Practice Without It”

o Pre-anesthesia Testing

o Pain Medication

o Full Dentistry

o Full Diagnostics

$375/pet/year

REVENUE BOOSTERS

◦ Same DVM Each Visit◦ Standards & Protocols = DVM Consistency=Client

Trust◦ Assessments: Nutritional, Parasites, Dental, Behavior-

EVERY PATIENT EVERY TIME! ◦ BP, Breed Screens, Thorough Exams◦ Missed Charges

◦ Follow Up ◦ Reinforce > Recall > Recheck> Remind

◦ Medical Progress Exams = Recheck◦ Forward Booking, Text Reminders, i-cal etc.

CLIENT CENTRIC / BONDING

Clean Animals

High Tech & Current Image◦ Digital Camera Pictures-

Procedures

◦ Personal Client Videos-Virtual Tours

◦ Facebook, Blogging, Tweeting, Practice Apps, Practice You Tube Channel, Client G-Mail, Google Voice

Clients are an

investment…

not a liability

CLIENT CENTRIC / BONDING

Stand Out From The Crowd

oExotics

oBehavior Counseling

oAlternative Medicine

oPuppy Classes

oWeb Site-Pet Portals

oSurveys

CLIENT CENTRIC-BONDING

◦ Internet Pharmacy

◦ Pet food & Rx Delivery

◦ Pet Pick Up and Delivery

◦ Hospital To Car

◦ Communication… Texting- Sx/DO

8

CLIENT CENTRIC-BONDING

Above & Beyond

o Comfort Room

o No Charge Nail Clips, Euthanasia

o In Home Euthanasia

o Hospice Service

o Sympathy Notes-Tribute Donations

o Virtual Memorials

KEYS TO EXCELLENCE

Nurture A Winning Team◦ Staff Make The Hospital

◦ People Are Your Organization’s Most Important Resource;

They ARE Your Organization ~Ken Blanchard

Create “Raving Fans”◦ Poor Service Has Created: Low

Expectations

◦ Promise High & Deliver High: Exceed Expectations

FACTORS INFLUENCING AVERAGE TRANSACTION CHARGE

o Fee Schedule

o Culture: Philosophy, Appointment Length

o Recommendations And Compliance/Adherence

o Client Education

o Staff Training

o Thorough Physical Examinations

o Client Centric/Service

o Client Bonding Skills

FACTORS INFLUENCING AVERAGE TRANSACTION CHARGE

o Commitment To Best Practices Recommendations

o Communication Skills

o Confidence In The Medical Recommendations

o Animal Health Care Team Support: # Of Staff, How They Are Scheduled, Skill Sets, Confidence In Doctor

o Selling An Additional Necessary Service Or Product

o Longevity/Established Client Base

WAYS TO INCREASE TRANSACTION NUMBERS

o Effective Reminder System

o Preferred Method to Contact Clients

o More Appointment Flexibility

o New Services

o Client Education

o Discuss All Diagnostic Test Results with Clients

oCompetitive Prices For Products That Could Also Be Purchased ElsewhereoPrescription Drugs, OTC products, Internet

Pricing

oOwn internet Pharmacy

oExtended business Hours

ACTION STEPS…..

ACTION STEPS…..

oUse Business Metrics

oMarketing The Practice:

oThrough Referral Programs With Other Pet Service ProvidersoProviding Referral Incentives For

Existing Clients oIncreasing Use Of Social Media

And Other Communications Vehicles

ACTION STEPS…..

o Routinely Measuring Client Satisfaction Through After-service Surveys

o Marketing The Practice Through Referral Programs With Other Pet Service Providers, Providing Referral Incentives For Existing Clients.

o Making It Easier For Clients To Schedule And Keep Appointments By Scheduling The Next AppointmentBefore The Pet Leaves The Practice

ACTION STEPS…..

Emphasize Full-year Life Stage Health Plans ◦ Explain To Owners How To Care For Their Pets & Why

& When Visits To The Practice Are Indicated

AFFORDABLE- NOT CHEAP VETERINARY CARE

Helping Clients Manage Veterinary Costs By:◦Developing Written Financial Policies And Providing

Patient Care Estimates, Payment Options & Monthly Installment Payment Plans

◦Pre-Paid Wellness Plans

◦ Third Party: Care Credit, Insurance

9

PET HEALTH INSURANCE FACTS****(North American Pet Health Insurance Association)

oInsured Pets:o Dog Owners Spend…29% More On Veterinary Care

o Cat Owners Spend….81% More On Veterinary Care

oOwners 50% More Likely To Get Insurance If Veterinarian Recommends It.

oDecision NOT About The Cost Of Insurance

oCompliance Tips:o ALWAYS Ask About Pet Insuranceo Designated Staff Member Insurance Liaisono Insure Staff Petso Website Linkso Stick With 1 Or 2 Companies

ACTION STEPS…..

oMake The Practice “Fear Free” To Reduce Stress

oEducating Cat Owners On Methods To Acclimate Their Pets To Carriers And To Make Bringing Them To The Practice Less Stressful-

o“Cat Friendly Practices”

ACTION STEPS

o Identifying Pets With Lapsed Appointments By Asking About Other Pets During Every Visit And Reinforcing The Importance Of Routine Wellness Examinations.

o Mine Your Records

o Making It Easier For Clients To Schedule And Keep Appointments Using A Wider Array Of Reminder & Recall Methods…text, ical Etc.

o Capture Missed Charges

CAPTURE MISSED CHARGES

Percentage of U.S. Lab Tests

Never Billed To Clients

17%

Estimated 2012

$450M

Increase in U.S. Veterinary Practice

Revenue Associated with Reducing

% of Lab Tests Never Billed To Client

~10%

Potential Target %

ACTION STEPS…..

PARTNERS FOR HEALTHY PETS (PHP)

o Ensure Pets Receive The Preventive Healthcare Through Regular Veterinary Visits.

o Led By AVMA & AAHA o Collaborative Alliance Of Over 100 Veterinary

Associations, Colleges Of Veterinary Medicine And Animal Health Companies

o Provides Tools And Resources That:o Help Communicate The Value And Benefit Of

Preventive Care

o Enhance The Veterinary Client Relationship

o Promote The Importance Of Annual Veterinary Checkups

PERCEPTION OF VALUE PERCEPTION OF VALUE PERCEPTION OF VALUE

10

FINAL THOUGHTS-

oBuild RelationshipsoGet Personal

oEnhance Phone Skills- Staff TrainingoSmile, Positive, Helpful

oAttitude of Gratitude!

oCommunication = Understanding = Value = Compliance

EVERY CLIENT…EVERY PET…EVERY VISITIt Is Not That We Aim

Too High And Miss

It……….

But That We Aim Too

Low And We Reach It”

~Michelangelo~

LIFE: THIS IS WHAT REALLY COUNTS!

HAVE FUN !!!!