Veterinary « The Practice Solution Magazine

Posts Tagged ‘Veterinary’

Veterinary Researcher Studying Brain Tumors

Posted by Larry Silver

Veterinary Researcher Studying Brain Tumors in People, Animals

Newswise – A veterinary neurologist on faculty in the Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech has been awarded funding from the Wake Forest University Translational Science Institute to study innovative approaches for treating brain tumors in dogs, cats, and humans.

Dr. John Rossmeisl, an assistant professor in the Department of Small Animal Clinical Sciences (DSACS), is working with Wake Forest University Medical Center researchers to develop better therapeutic approaches for managing very serious forms of brain tumors called gliomas.

Rossmeisl will work closely with a cluster of scientists and physicians at Wake Forest University and with VMRCVM veterinary pathologist Dr. John Robertson, director of the college’s Center for Comparative Oncology, on the project. The veterinary college is a participating institution on a major translational research initiative at Wake Forest University funded by the National Institutes of Health (NIH).

“Gliomas are an aggressive and deadly form of brain cancer that affects dogs and people,” said Rossmeisl, who is board certified in veterinary neurology by the American College of Veterinary Internal Medicine. “Because there are so many similarities between clinical signs and pathobiology, the dog has emerged as an excellent model for studying gliomas in humans.”

Every year about 120,000 new cases of primary and secondary brain cancer are diagnosed, according to the National Cancer Institute. Much less is known about the incidence of brain tumors in domestic animals, according to Rossmeisl. Clinical signs associated with brain tumors in both people and animals can include seizures, abnormal behaviors, weakness of the limbs, loss of balance, blindness and other problems.

Gliomas arise from glial cells, according to Rossmeisl, which play numerous supporting roles for neurons, brain cells that control thought, sensations and motion. Glial cells outnumber neurons by a factor of about ten to one in the brain, and they play an essential role in creating the architecture and structure of the brain and supporting its functions.

There are several different specific types of glial cells, but two that interest Rossmeisl and colleagues most are called astrocytes and oligodendrocytes. Oncogenic abnormalities associated with each of these can lead to cancers called astrocytomas and oligodendrocytomas, according to Rossmeisl.

The most common approaches for managing these tumors involve surgical excision, radiation therapy and chemotherapy. But conventional radiation and chemotherapy affect normal cells in addition to the cancerous cells they target, so perfecting approaches that exclusively target the molecular abnormalities present in each individual’s cancer cells and spare healthy cells is a major thrust in modern oncology.

To develop more precisely targeted systems for administering therapeutic agents to cancer cells, Rossmeisl and his colleagues are attempting to further establish the molecular similarity of human and canine gliomas.
Scientists know that when astrocytomas spontaneously arise in people, they over-express three proteins: interleukin 13 receptor alpha2 (IL-13R), which is a cancer testis tumor like agent; EphA2, a tyrosine kinase receptor; and fos-related antigen 1, an AP-1 transcription factor.

Rossmeisl and colleagues working in the college’s Center for Comparative Oncology have opened a clinical trial and are currently enrolling animals from around the region that have been positively diagnosed with a brain mass consistent with the appearance of a glioma on magnetic resonance imaging (MRI).

The researchers will be studying tissue samples from affected animals in search of these proteins that are not otherwise present in normal brain tissues. Identifying these proteins could further document the dog’s suitability as a model for studying pre-clinical human disease, according to Rossmeisl, and ultimately lead to the development of more precisely targeted methods for managing these tumors.

Another portion of the work is focused on the development of powerful new cancer treatments. Through a process known as convection enhanced delivery (CED), the researchers are removing the diseased tissues and testing the application of a proprietary experimental compound. This agent is used to “bathe” the margins of the area in which the tumor was removed and it has been designed in a way that it will only bind with receptors in tumor cells expressing abnormal proteins.

“Their potential value is tremendous to humans and dogs with cancer,” said Rossmeisl. These treatments may represent a significant advancement in prolonging survival in dogs and people with these highly aggressive cancers.”

The researchers will also be looking at improved processes for performing radiation therapy on brain tumors in dogs.

“Currently, the standard of care in veterinary radiotherapy is fractional radiotherapy delivered with a linear accelerator,” explained Rossmeisl. This form of radiation therapy is typically delivered with frequent administration of relatively small doses of radiation multiple days per week over several weeks. Though it can be fairly precisely targeted, it can affect tissues unrelated to the tumor.

The grant will enable the researchers to perfect protocols for treating canine patients with stereotactic radiosurgery – more commonly known as the “gamma knife.” The gamma knife uses a specialized head-frame to target an exactingly focused beam of killing radiation with pin-point accuracy on the tumor itself. As opposed to a traditional course of radiotherapy that can take weeks, the gamma knife can accomplish the task in one session lasting a few hours.

For more information regarding the Comparative Canine Glioma Trial (CCGT) study, view the CCGT General Information Form, or contact Luann-Mack Drinkard (clinical research technician) at lmackdr@vt.edu or by phone at (540) 231-4621, or the study co-director, Dr. John Rossmeisl at jrossmei@vt.edu.

The Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM) is a two-state, three-campus professional school operated by the land-grant universities of Virginia Tech in Blacksburg and the University of Maryland at College Park. Its flagship facilities, based at Virginia Tech, include the Veterinary Teaching Hospital, which treats more than 40,000 animals annually. Other campuses include the Marion duPont Scott Equine Medical Center in Leesburg, Va., and the Avrum Gudelsky Veterinary Center at College Park, home of the Center for Government and Corporate Veterinary Medicine. The VMRCVM annually enrolls approximately 500 Doctor of Veterinary Medicine and graduate students, is a leading biomedical and clinical research center, and provides professional continuing education services for veterinarians practicing throughout the two states. Virginia Tech, the most comprehensive university in Virginia, is dedicated to quality, innovation, and results to the commonwealth, the nation, and the world.

Contact Information
Jeffrey Douglas (540) 231-7911 jdouglas@vt.edu

Tags: Veterinary, Veterinary Medicine
Posted in Issue 12 | No Comments »

NC State Offers Canine Bone Marrow Transplants

Posted by Larry Silver

Newswise – Dogs suffering from lymphoma will be able to receive the same type of medical treatment as their human counterparts, as North Carolina State University becomes the first university in the nation to offer canine bone marrow transplants in a clinical setting.

Dr. Steven Suter, assistant professor of oncology in NC State’s College of Veterinary Medicine, received three leukophoresis machines donated by the Mayo Clinic in Rochester, Minn. Leukophoresis machines are designed to harvest healthy stem cells from cancer patients. The machines are used in conjunction with drug therapy to harvest stem cells that have left the patient’s bone marrow and entered the bloodstream. The harvested cancer-free cells are then reintroduced into the patient after total body radiation is used to kill residual cancer cells left in the body. This treatment is called peripheral blood stem cell transplantation.

The machines, once used for human patients, are suitable for canine use without modification, as bone marrow therapy protocols for people were originally developed using dogs.

“It’s not a new technology, it’s just a new application of an existing technology,” Suter says. “Doctors have been treating human patients with bone marrow transplantation for many years, and there have been canine patient transplants performed in a research setting for about 20 years, but it’s never been feasible as a standard therapy until now.”

Canine lymphoma is one of the most common types of cancer in dogs, but the survival rate with current treatments is extremely low. Peripheral blood stem cell transplantation, in conjunction with chemotherapy, has raised human survival rates considerably, and it is hoped that dogs will see the same benefits.

“We know that dogs who have received bone marrow transplants have a cure rate of at least 30 percent versus about 0 to 2 percent for dogs who don’t receive the transplants,” Suter adds. “The process itself is painless for dogs – the only thing they lose is a bit of body heat while the cells are being harvested.”

Contact Information

Tracey Peake, News Services, (919) 515-6142 or tracey_peake@ncsu.edu

Tags: Veterinary, Veterinary Medicine
Posted in Issue 12 | No Comments »

Veterinary Medicine Contributes to New England Economy

Posted by Larry Silver

Veterinary Medicine Contributes $3.3 Billion to New England Economy

Newswise – Veterinary medicine contributes $3.3 billion to the economies of New England-and the region faces a shortage of as many as 658 veterinarians by 2014, according to a study released today by the Cummings School of Veterinary Medicine at Tufts University.

The study-undertaken by the UMass Donahue Institute and commissioned by the Cummings School, the only veterinary school in the six-state New England Region-reveals that veterinarians and associated staff comprise over 20,000 jobs in the area. Moreover, for every 100 veterinary medical jobs in the region, an additional 59 jobs are created in related industries, the study indicates.

Clinical practice-providing medical services for household pets, farm and food animals, and exotic animals-represents the largest percentage ($1.1 billion, or 65 percent) of direct veterinary expenditures in New England, which total $1.72 billion. Scientific research and development-which require animal health and husbandry services to test new drugs and devices and better understand animal and human health-comprises the next-largest category, with a total of 23 percent of veterinary medicine spending and 14 percent of the industry’s total employment. Laboratory animal veterinarians are responsible for the welfare of as many as 2 million laboratory animals in New England.

The study also highlights a growing critical need for veterinarians in the region. According to Bureau of Labor Statistics (BLS) data, the study found that the region will have 1,036 vacancies for veterinarians by 2014, both through new job creation and retirement of an aging workforce. With an average of 60 percent of Cummings School graduates remaining in New England, trends suggest that 378 of the school’s graduates will enter the region’s workforce, leaving unfilled 658 new vacancies for veterinarians.

What’s more, the study suggests that the region faces a flood of retirements among food animal veterinarians. Over a quarter of the region’s more than 100 specialized food animal veterinarians will reach retirement age by 2014. With current levels of food animal graduates, the Cummings School will be positioned to replace only half of these vacancies. Overall, 43 percent of New England veterinarians are over age 50; by contrast, 56 percent of livestock veterinarians are over age 50. Until 2014, the study suggests, food animal veterinarians will retire at nearly twice the rate of their companion animal colleagues. With the critical role that food animal veterinarians play in protecting the nation’s food supply, this shortage is especially alarming.

“This study confirms the importance and economic impact of veterinary medicine in Massachusetts and New England,” said Deborah T. Kochevar, DVM, PhD, dean of the Cummings School of Veterinary Medicine at Tufts University. “Cummings School is proud to serve the citizens of this region by educating veterinary professionals, advancing biomedical research, and serving as a clinical and public health resource for animals and their owners.”

The study was supported by the Veterinary Medical Associations of Massachusetts, Connecticut, Maine, New Hampshire, Rhode Island and Vermont, the New England Veterinary Medical Association and InTown Veterinary Group. Hill’s Pet Nutrition, Inc., was the study’s lead industry sponsor.

“In order to best understand the health of the animals in New England, we need to understand the industry that cares for them,” said Dr. Christine Jenkins, Director of Academic Affairs at Hill’s Pet Nutrition, the study’s lead industry sponsor. “This study does just that-and we hope it sheds light on the growing need for veterinarians in the workforce to ensure the care and safety of animals in the region.”

The study also revealed interesting findings in each state of New England. Among them:

Massachusetts has New England’s biggest veterinary scientific research and development sector, with more than 5 percent of the state’s veterinarians specializing in this area. The state is the fifth-largest in the nation for research animals registered under the Animal Welfare Act and veterinarians support the work of a vital life sciences industry in the state. With 8,000 employees statewide and a total economic impact of $1.3 billion in 2006, veterinary medicine is an essential part of the state economy.
In Connecticut, $83 is pumped back into the state’s economy for every $100 spent by the veterinary industry, a multiplier of 1.83. For every 100 jobs in the industry, another 55 jobs in Connecticut are supported. Connecticut boasts a total veterinary economic impact of nearly $1 billion in 2006, the second largest in the region.
Maine has the nation’s sixth-highest rate of pet ownership, with 70 percent of households (376,000 homes) owning one or more pets. The veterinary industry represents an economic impact of more than $290 million in the state.
New Hampshire residents spend the second-most in the region on veterinary clinical services per capita, at $94. The state also ranks second in median wages for veterinarians, at $78,180. Every $100 of veterinary industry spending in the state supports another $74 of economic activity in the state.
In Rhode Island, veterinary medicine employs an estimated 1,110 people, including 189 veterinarians. The industry invests an estimated $81 million on payroll, operating expenses and capital projects, including over $69 million in veterinary clinical practice, $5 million in scientific R&D and $6 million in academia.
Vermont has both the highest rate of pet ownership in the region and the nation-74.5 percent-and the region’s highest per capita spending on veterinary clinical services ($97). Additionally, the state boasts the region’s highest rate of veterinary practice ownership (52 percent of clinical practice veterinarians are self-employed).

Several leaders from the biomedical industry in Massachusetts spoke out in support of the study’s findings. “In order for the biomedical and medical device fields to continue to thrive in Massachusetts, we must maintain a very high standard for ethics and care in our research divisions,” said Kevin O’Sullivan, President and CEO of Massachusetts Biomedical Initiatives. “As such, veterinarians are our greatest resource, and provide a crucial element for the growth of the biotech sector.”

“The economy of Massachusetts is intrinsically linked with the growth of the biotechnical, pharmaceutical, and medical device sectors-and without a ready supply of veterinarians to oversee the clinical trials for these industries, the growth would be stifled,” continued Thomas J. Sommer, President of MassMEDIC. “The Commonwealth has a great resource in the Cummings School of Veterinary Medicine-not just as a excellent training ground for the next generation of veterinarians, but also as an economic incubator for small biomedical start-ups. This study brings the contributions of the Cummings School and of veterinarians in general to light.”

“The Cummings School of Veterinary Medicine is an essential resource for the Massachusetts life sciences super cluster,” said Robert Coughlin, President of the Massachusetts Biotechnology Council. “The close proximity of this global leader in veterinary medicine is another reason why so many companies and institutions find Massachusetts the best place in the world to do business.”

About the Cummings School of Veterinary Medicine

Founded in 1978 in North Grafton, Mass., the Cummings School of Veterinary Medicine at Tufts University is internationally esteemed for academic programs that impact society and the practice of veterinary medicine; three hospitals that treat more than 28,000 animals each year; and groundbreaking research that benefits animal, public, and environmental health. The school has secured more than $23 million in NIH funding to build a level-3 Regional Biosafety Laboratory for work with infectious disease organisms, the anchor tenant of a life sciences industrial development known as Grafton Science Park.

Tags: Veterinary
Posted in Issue 12 | No Comments »

Extending Credit

Posted by Larry Silver

Tips to Control Your Accounts Receivable

Following are some guidelines to assist you in determining to whom you wish to extend credit and how to go about collecting on those accounts.

* Assess the patient/client’s credit worthiness before extending any sort of credit. Have them fill out a “credit application” (see sample in the Form section,) and verify the information supplied.

* Always charge for any credit extended, using a monthly percentage or a flat service fee.

* When extending credit of any kind, have the patient/client sign an agreement covering the terms of the credit. Ensure that they fully understand and agree to the terms of payment.

* Monitor all accounts monthly so that you know who may be delinquent. Take immediate action on any account over 30 days past due. The older an account gets, the more difficult it will be to collect. Call the patient/client right away and make arrangements to bring the account current.

* Flag past due accounts by putting a red self-adhesive dot on the upper right corner of the patient/client’s chart folder. In this way it is easier for any staff person to see that the patient/client has a past due account and it will be more likely to get addressed.

* Each day review the schedule for the next day so that you will be prepared to see any patients/clients whose accounts need addressing. Confer with the receptionist on anyone who will need to be seen after their appointment, or from whom the receptionist would collect over-the counter.

* If a patient/client you had planned to collect from has forgotten his/her checkbook or does not have the agreed upon amount, the receptionist should contact the accounts manager or the office manager so that the matter can be addressed.

* Patients/clients with delinquent accounts, who are not making an attempt to handle it, should be sent to a collection agency. Again, this should be done as soon as possible before the account gets too old to realistically expect payment.

* Ensure that statements are accurate and are being mailed out every month on time and without fail. Utilize appropriate labels on the statements such as: Thank you for your payment.”

Tags: Dentistry, Extending Credit, Optometry, Veterinary
Posted in Issue 10 | No Comments »

THE GOVERNMENT HELPS OUT ON NEW EQUIPMENT PURCHASES

Posted by Larry Silver

Taking Advantage of the IRS Section 179 Write-Off

Written by Brad Beck, Vice President Bank of America Practice Solutions

What did you think the chances were that a banker would not start anything that is printed on paper without a disclaimer? Well if you took the safe bet you were right and here it is: I am not a CPA and therefore not certified to give tax advice. What you will read in this article are my thoughts based upon my experience in the equipment and practice finance industry. Any decisions you make about equipment purchase, and the tax benefits associated with those purchases, should be made only after careful consideration with your tax advisors. With that disclaimer out of the way, let me proceed with some information that may be helpful for you.

State-of-the-art technology and equipment has become more important than ever in a modern, competitive Health Care Office, whether you are a Dentist, Veterinarian, Optometrist, M.D., etc. The cost of technology has increased, and continues to increase, in the economic environment in which we live. Purchasing equipment is a difficult decision for many reasons but, somewhat fortunately, the government has decided to make the decision making process a little easier by giving large incentives to encourage purchases over the next few years. These incentives also help on many levels to stimulate the economy. Unlike most complicated tax legislation we see, in this case the government has gone out of their way to make the tax benefits to purchasing equipment very easy to understand.

Let’s clarify the language first. What is IRS Section 179? This refers to a small business tax incentive bill that Congress passed this year that allows small business owners a significant tax break on purchases of equipment. A taxpayer can elect to expense up to $125,000 in equipment purchases in 2007. This legislation, passed on May 24, 2007 is retroactive to purchases made since January 1st of this year. This is up from $112,000 that was previously set for this year and up from the $25,000 that it was previous to that! So this is a significant change in a tax advantage. The equipment must be used in the active conduct of a trade or business, which is just a fancy way of saying you must use the purchase in your practice. (A boat may be a valid tax deductible purchase for a fisherman but not for a Dentist!).

The dollar amount allowable to expense from Section 179 changes yearly according to inflation. The equipment purchase becomes a direct savings on your taxes due based upon your marginal tax rate. Any purchase amount that exceeds the 179 deduction amount of $125,000 for 2007 will go to normal depreciation schedules. That may sound complicated, but it is actually very simple. Below are two real world examples of the math which should explain it better.

I hope the above real world examples give you a grasp of the concept of the Section 179 tax benefits. If equipment purchases are in your near future, and you have not already used your “179″ benefit this year, you should give thought to purchasing and installing the equipment before the end of the year.

Before you all run to your sales reps and place equipment orders, there are a few points and limitations you should be aware of:

* This tax benefit is available from January 1, 2007 through December 31, 2010.

* As noted above, the “179″ write off is limited to $125,000 yearly (adjusted to inflation yearly).

* There is a phase out provision for 2007: If you purchase over $500,000 worth of equipment there is a dollar for dollar reduction of the $125,000 write off. As an example, if a Doctor purchases $550,000 worth of equipment, $50,000 of the $125,000 potential write-off would be lost and only $75,000 would be able to be directly written off and the rest would be depreciated as normal. Or, as another example, if a doctor purchases $625,000 in business assets this year, the Section 179 is completely phased out and there is no benefit.

* The practice must have taxable income to qualify and be used, but any write off not able to be used can be carried over and used in the following year.

* Business asset purchases (equipment) must be “Placed into Service”

In order for an equipment purchase to qualify as “Placed in Service”, the equipment must be delivered and installed and ready to perform its function. It must be available and capable to perform its function. It does NOT have to be paid for in full. The purchaser must be obligated to pay, which means they must have executed a contract to pay, or created a liability (loan) to pay, or actually paid for it.

This tax deduction will be in effect through 2010, so you should be planning accordingly. What happens January 1st, 2011? Section 179 reverts back to $25,000 and the phase out starts after $200,000. So at $225,000 in equipment purchases there will no benefit to the Section 179 write off. Using one of the examples above, a $300,000 equipment purchase in 2007 will give a savings of $56,000 (with a 35% tax rate), but that same $300,000 purchased in 2011 gives a savings of only $28,000. That’s a difference of $28,000. I’m sure you all can think of something to do with $28,000 other than give it to Uncle Sam (maybe that boat that the fisherman was able to write off under Section 179!).

Now as I say to my two sons, you have to make your own decisions in life and in business. In the end, if you have no need for new equipment this year, then this information may be irrelevant right now. But, if you do have a need for new equipment and don’t take advantage of this, you could be wasting money. The world will not stop turning but, like I said, we all have things we can do with some extra tax savings.

I hope this information is helpful and gives you some food for thought that you should discuss with your CPA.

Brad Beck Vice President Bank of America Practice Solutions

brad.beck@bankofamerica.com

800-214-6087

Tags: Dentistry, IRS Section 179, NEW EQUIPMENT PURCHASES, Optometry, Veterinary
Posted in Issue 10 | No Comments »

Motivating Employees at Your Practice

Posted by Larry Silver

By Dr. Amy Shroff, VMD

The success of any business depends on its employees. Figuring out what motivates them is the tricky part. Motivation, like employees, is highly individualized – what drives one person may not mean nearly as much to someone else. While some people excel with a pat on the back, others look for financial rewards and others still seek power or equity in a company.

In our fifty-person practice, I have learned there are seven key elements which motivate employees. Recognizing which employees fall into which categories is what makes for a happy and productive staff.

Fulfillment: Employees who fall into this category are motivated by the successful completion of a project. They are often self-motivated, if the job is challenging enough;

Power: These employees receive satisfaction when they can lead and direct;

Affiliation: People who enjoy interacting with coworkers like social aspects of the workplace and do well on teams;

Autonomy: This group wants independence and freedom. Setting their own schedules is the key to harmony;

Recognition: This is universal. Positive feedback on specific tasks is essential for everyone. No matter how busy the day seems, taking a few minutes to praise someone for a job well done makes an enormous difference in overall staff morale;

Safety and Security: A predictable work schedule, job stability and benefits drive this cluster;

Equity: Across the board, an environment that encourages interaction and feedback will help employees communicate their needs. For instance, an organized office system with a written policies and procedures manual, compensation guidelines and access to information ensures compliance and equity for all.

Whether the practice is large or small, strong leadership is critical. The ideal person is someone with patience and insight that can shape and guide the practice. In the high- stress world of veterinary medicine, this is a tough role. The leader must be in charge but approachable, respect each employee, and know their names and their position.

The majority of the employees in the veterinary practice setting usually fall into the Generation X (30s) or Generation Y (20s) age groups. When surveyed, I found these employees seek a work environment that’s fun, offers opportunities for growth, and provides competitive salaries, interesting new projects and excellent benefits as well as the chance to learn and develop new skills. They also wish to travel and attend conferences. And yes, they really want flexible work schedules.

Both these groups have grown up with computers and are more receptive to information found online. That can have its drawbacks. Because our hospital is open round the clock, we all work different shifts. I can go for weeks without seeing some of our staff. Often those questions that would be asked and answered in person need to be addressed via email. As valuable a tool as this may be, it is essential not to lose sight of the impact of face-to-face conversations. Important information is conveyed through voice and body language. Learn to read your employees so you can react and motivate them appropriately.

The P Word

Recognition was addressed above, but is worth taking a closer look at effective ways to use praise.

Be specific when praising an employee. For instance, take some time with the person to cite a certain task. It could be one that made the practice more efficient or helped a client or patient. Make it a point to do this in front of the employee’s peers whenever possible. Sometimes, we buy lunch for the office and make an announcement about a job well done.

Supervisors can easily keep track of good deeds if they always have a list of employees. They can check off the names of those recognized each day. Leaving a voicemail message for a job well done is another effective way to send someone a high five. Or, deliver hand-written notes on special occasions to make everyone stand out.

A supervisor or team leader can also use praise to improve poor performance. If an employee is handling the majority of their tasks well but lacking in one or two areas, sit down with the person and have a conversation. Praise them for what works and discuss changes to smooth out the rough spots.

Moving On Up

A raise isn’t necessarily always the answer. Providing opportunities for advancement stimulates many of us. Employees wear many hats in veterinary practices and quickly find out what they like best and can move in that direction. By offering staff training, opportunities to sharpen skills and career guidance, employees will work harder and smarter.

Show You Care

Make sure your employees have the tools they need to do their job. A functional and emotionally supportive work environment including appropriate lighting, ergonomic workstations, and Internet access with use of VIN or VSPN makes everyone’s job easier. Insure all diagnostic equipment is serviced regularly and fixed immediately if something malfunctions. Have enough supplies on hand to conduct training sessions. The small things do make a difference: quiet meeting rooms, interoffice e-mail, voicemail and even business cards say you value everyone’s role.

It is important for all employees to be part of the decision-making processes whenever possible. Our practice has grown and evolved since it began. To better define our hospital, employees were asked to review our collective and write individual mission statements for each department. Then, a new one was developed based on everyone’s input. This exercise was an excellent team builder.

We reward employees who generate ideas that can be implemented. Audio CDs, gift certificates, contributions to a person’s favorite charity are typical. We have even sponsored baby and wedding showers.

Along with the usual Christmas bonus, we also provide bonuses and appreciation for Veterinary Technician week as well as birthday bonuses.

Each department receives a monthly cash incentive if they gross above their target number. Bonuses are given to full as well as part-time employees and allocated based on number of hours worked.

It is important to reward hourly workers for taking a shift on a non-scheduled day, coming in early or staying late. If someone is called in for an additional shift in my hospital, they receive a monetary bonus. All employees working holiday shifts are provided lunch or dinner as well as double time pay. The goodwill and increased productivity this policy fosters more than makes up for the expense incurred.

Share Information

Employees need to understand where company dollars are spent if they are going to help a practice grow. By distributing cost information at regular meetings, our staff is always aware of what is going on and often makes suggestions to cut expenses.

Employees are the single most important investment any veterinary hospital can make to ensure profitability and success. Before you ask them what they want, understand what motivates you. If you know the answer, setting an example for your staff to follow will be easy.

Dr. Amy Shroff is owner and chief of staff at the Veterinary Emergency & Specialty Center of New England (VESCONE) in Waltham, MA. www.vescone.com.

Tags: Dentistry, Dr. Amy Shroff, Motivating Employees, Optometry, Staff Management, Veterinary, VMD
Posted in Issue 10 | No Comments »

Search Engine Marketing for Doctors

Posted by Larry Silver

Article 1 of 4 part series

By Lisa Thayer,

GoldfishNetwork.com

Surveys show that over 80% of internet users find new web sites by using search engines.

The question that seems to be on everyone’s minds today is “How do I get my website top placement on the search engines?” If you have a website, you may have found other websites above yours when you have looked for your site in Google. In order to answer the previous question, I need to give you a little background on the way search engines work.

There are two primary ways (out of many) that your website gets to the top of search engines: one is to pay for placement, the other is to market and design your website so that it rises up through the page ranks “organically” in search engine results.

Before I begin to discuss pay-for-placement online marketing, I have to get on my soap box and make a special announcement: If you glean nothing else from this article, remember this – having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. A baseline is the point at which you begin a marketing campaign so you can compare the effectiveness of the campaign.

Programs such as Google’s AdWords and AdSense or Yahoo’s Sponsored Search are good examples of paying for placement. Each search engine has their own individual fee structure. The price you pay to advertise in this manner depends on the “keywords” you choose and the competition for those placements. Keywords can be thought of as the words a person would type into the search box on search engines. They can consist of words, phrases, or alphanumerical terms. If you are spending your marketing budget on keyword ads, you need to choose your keywords carefully.

Using keywords that are overly broad such as “best dentist USA” can result in bringing more traffic to your website, but if you only have dental offices in California, that search probably won’t result in a new patient. Conversely, choosing keywords that are overly specific might bring in too little traffic, like “veterinarians who graduated from Purdue in 1983″. Keywords are so important in fact, that selecting keywords has become an industry all its own.

The two top search engines used by the general public are Google and Yahoo. Google and Yahoo also supply some of the smaller search engines such as AOL, My Space Search, Netscape, Alta Vista, etc. with their search results. In fact, if you added up the huge market share of Google it would account for almost 70% of all searches!

As previously mentioned, having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. You obtain a baseline by having your web designer add a tracking program/ code to your website. We set up Google Analytics on all of our client’s websites.

Google Analytics (GA) is a free service offered by Google that generates detailed statistics about the visitors to a website. Its main highlight is that a webmaster can optimize his/her marketing campaigns through the use of GA’s analysis of where the visitors came from, how long they stayed on the website and their geographical position. Users can define and track conversions, or goals. Goals might include sales, lead generation, viewing a specific page, or downloading a particular file. By using this tool, marketers can determine which ads are performing, and which are not, as well as find unexpected sources of quality visitors.

Many of my clients have asked, “Wait a minute…why is Google Analytics free?” The simple answer is that Google knows that if you have the information to make informed online advertising decisions, you will be more likely to advertise. And, since Google is the giant of the search engine world, chances are they will be able to earn your business.

Next time, I’ll discuss spiders and crawlers and bots…oh my!

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients across the U.S. Lisa can be reached at 503-783-0440 or by e-mail: Lisa@GoldfishNetwork.com

Tags: Dentistry, Optometry, Search Engine Marketing for Doctor, Veterinary
Posted in Issue 10 | No Comments »

Root Canals Just as Effective as Dental Implants

Posted by Larry Silver

Dentists Emphasize Saving Natural Teeth and Patient-Specific Considerations

For patients torn between the best way to treat a compromised tooth, the choice just got clearer. A recent systematic review comparing two of the most common treatment options – root canals and dental implants – found virtually equal success, or survival rates, between both treatments. However, despite this similarity, it was concluded that the priority should always be to preserve the natural tooth before extracting and replacing with an implant. Root canal treatment saves more than 17 million teeth a year.

The results of the treatment analysis were published by The International Journal of Oral and Maxillofacial Implants, the official publication of the Academy of Osseointegration, an organization committed to advancing dental implants. The Academy also published a consensus statement developed by experts from several dental disciplines that supports the comparison’s findings and stresses the importance of patient-specific considerations.

There are several notable differences between the two procedures. Dental implants require extracting the tooth followed by multiple surgeries to insert a metal post in the jaw and affix a porcelain crown to the post. These surgeries often can take three or more visits to complete, and can be timely and costly. During root canal treatment, the source of tooth pain – inflamed pulp – is removed and the inside of the tooth is then cleaned, filled and sealed. Today, most root canals can be completed in one visit and are virtually painless.

Since the comparative analysis uncovered no significant differences in the success rates between the two options, the researchers emphasize that treatment decisions must be based on factors other than outcome, such as case complexity or the patient’s individual health and preferences. To assist dental professionals and their patients in determining the most appropriate treatment, the American Association of Endodontists (AAE), the national association representing root canal specialists, released a position statement on treatment planning when considering a root canal or dental implant.

According to Dr. Shepard S. Goldstein, AAE president and Framingham, Mass. endodontist, the position statement is meant to be used as a guide when deciding how to best treat a compromised tooth. For example, when a patient has diabetes, there are certain factors that the dental professional must consider when determining treatment.

“The recommended treatment must be safe, mindful of the patient’s wishes, and should aim at preserving the natural tooth when possible,” said Dr. Goldstein. “The AAE hopes that this guidance can help ensure that each patient receives the best treatment based on his or her unique case.”

Dr. James A. Abbott, an endodontist from Santa Rosa, Calif., says many of his patients have had to choose between a root canal and a dental implant. “Most patients want to keep their natural tooth,” says Dr. Abbott. “When I explain the details of both treatments and how the tooth can be saved with a root canal, the choice is simple.”

The AAE position statement also is intended to assist dental professionals in evaluating the various risk factors and other implications associated with each of the treatment choices. Risk factors can include smoking, bone quality and estrogen level – for example, women with lower estrogen levels may encounter more treatment failures with implants. According to the AAE statement, it is crucial that the patient’s health and specific oral care needs be the most important considerations when weighing treatment options.

The American Association of Endodontists, headquartered in Chicago, represents more than 6,900 members worldwide, including approximately 95 percent of all eligible endodontists in the United States.

SOURCE: American Association of Endodontists

Tags: Dental Implants, Dentistry, Root Canals, Veterinary
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Collecting Past Due Account

Posted by Larry Silver

Working With Your Patients/Clients

Collecting on past due accounts is a function that the Accounts Manager will find herself having to do. Any contact with a patient/client, even under these circumstances, should be kept on a friendly, professional and dignified basis. This will promote respect for the office and its business practices.

Always remember the following points with regard to your patients/clients:

* Most people have good intentions, and want to cooperate with agreements they have made.

* Although a person’s account may be overdue, most people still have a good intention to take care of it.

* Most people prioritize their bills, and will first pay those that they feel are most pressing.

* Most people with past due accounts will pay those bills where someone is actively requesting them to pay.

Bearing in mind the above, your role is to arrange to be one of the creditors that your patients/clients will not delay paying. The following points may be helpful in this regard:

1. Bill promptly every month.

2. Ensure that your bills are accurate.

3. Ensure that you have the original signed financial agreement from your patient/client.

4. Contact the patient/client as soon as you realize the account has been delinquent.

5. When you speak with the patient/client, let him/her know that you believe he/she is able to make payment.

6. Let the patient/client know that you expect to be paid, and refresh their memory on the signed agreement.

7. Allow the patient/client his/her self-respect; never back him/her into a corner, insult or badger the patient/client.

8. Explain to the patient/client that you want to help him/her work it out so that he/she can maintain the agreement that he/she made with your office.

9. Be prepared to offer some options to the patient/client that he/she may not have considered.

10. Be willing to really communicate with the patient/client so that a true understanding and agreement can be reached.

11. If absolutely necessary, utilize the credit reporting associations. Let the patient/client know that you are planning to do so and that this will go on their credit rating.

12. As a last resort, utilize the services of a collection agency, and let the patient/client know that you plan to do so

Tags: Collecting Past Due Account, Dentistry, Optometry, Veterinary
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Veterinary Advisory: Canine Influenza Virus

Posted by Larry Silver

University of Florida researchers report that outbreaks of canine influenza virus, which causes an acute respiratory infection, have been identified in dogs in shelters, humane societies, boarding facilities and veterinary clinics in Florida, predominantly in Broward, Dade, Palm Beach and Duval counties.

This highly contagious virus is a newly emerging respiratory pathogen in dogs and causes a clinical syndrome that mimics kennel cough. Canine influenza virus infections are frequently mistaken for infections due to the Bordetella bronchiseptica/parainfluenza virus complex.

CLINICAL SIGNS:

Because this is a newly emerging pathogen, all dogs, regardless of breed or age, are susceptible to infection and have no naturally acquired or vaccine-induced immunity.

Virtually 100 percent of exposed dogs become infected. Nearly 80 percent have clinical signs.

There are two general clinical syndromes the milder syndrome and a more severe pneumonia syndrome. The milder disease syndrome occurs in most dogs.

In the milder disease, the most common clinical sign is a cough that persists for 10 to 21 days despite therapy with antibiotics and cough suppressants. Most dogs have a soft, moist cough, while others have a dry cough similar to that induced by Bordetella bronchiseptica/parainfluenza virus infection. Many dogs have purulent nasal discharge and a low-grade fever. The nasal discharge likely represents a secondary bacterial infection that quickly resolves with treatment with a broad-spectrum, bactericidal antibiotic.

Some dogs develop a more severe disease with clinical signs of pneumonia, such as a high fever (1040F to 1060F) and increased respiratory rate and effort. Thoracic radiographs may show consolidation of lung lobes. Dogs with pneumonia often have a secondary bacterial infection and have responded best to a combination of broad-spectrum, bactericidal antibiotics and maintenance of hydration with intravenous fluid therapy.

FATALITY RATE:

Fatal cases of pneumonia have been documented, but the fatality rate so far is low, at 1 percent to 5 percent.

INCUBATION/SHEDDING PERIOD:

The incubation period is two to five days after exposure before clinical signs appear. Infected dogs may shed virus for seven to 10 days from the initial day of clinical signs. Nearly 20 percent of infected dogs will not display clinical signs and become the silent shedders and spreaders of the infection.

DIAGNOSIS:

There is no rapid, real-time test for diagnosis of dogs with an acute influenza virus infection. Current diagnostic tests rely on detection of antibodies to canine influenza virus, which are detected as early as seven days after onset of clinical signs. Paired acute and convalescent serum samples are necessary for diagnosis of recent infection. The convalescent sample is collected at least two weeks after the acute sample. There are many situations in which collection of an acute sample is not feasible. In this case, testing of a convalescent sample will indicate whether the dog was infected at some time in the past. Serology tests not only indicate if a dog was infected, but also serve to alert veterinarians that the virus is present in their community so they can take precautions with dogs presenting for kennel cough.

In addition to serology, the lungs and distal trachea from dogs that died of pneumonia can be tested for influenza virus by PCR analysis and virus culture.

PREVENTION:

There is no vaccine for canine influenza virus at this time. This virus is spread by aerosolized respiratory secretions, contaminated inanimate objects and even by people moving back and forth between infected and uninfected dogs. This is an enveloped virus that is most likely killed by routine disinfectants, such as quaternary ammoniums and 10 percent bleach. Because the virus is highly contagious and all dogs are susceptible to infection, veterinarians, boarding facilities, shelters and pet stores should use isolation protocols for dogs that have a kennel cough.

WHAT VETERINARIANS CAN DO:

Veterinarians can submit serum samples for canine influenza antibody titers. Paired acute and convalescent samples are preferable for confirmation of infection, while single samples collected after seven days of clinical disease are also useful. In addition to determining infection, these samples will contribute toward virus surveillance in Florida. Currently, there is no fee for this testing. The turnaround time for results is less than two weeks. Please see the “”Serum Collection and Shipping”" form for further instructions.

Veterinarians may also submit fresh (no formalin or freezing) lung and tracheal tissues from dogs that die from pneumonia. Canine influenza virus culture and PCR analysis will be performed on these tissues. Virus recovered from these samples will greatly contribute toward development of vaccines and diagnostic tests.

Contact Dr. Crawford in the Department of Small Animal Clinical Sciences at the University of Florida College of Veterinary Medicine for sample submission or for more information via phone (352) 392-4700, ext. 5731; fax (352) 392-6125; or e-mail crawfordc@mail.vetmed.ufl.edu.

SOURCE: Maryland Veterinary Medical Association and Paul Knepley, DVM, Director of the Bureau of Animal Health and Diagnostic Services at the Pennsylvania Department of Agriculture.

Tags: Canine Influenza Virus, Veterinary
Posted in Issue 10 | No Comments »

Cruel Deaths in Mexico a Result of…

Posted by Larry Silver

Closing U.S. Horse Processing Plants

Efforts to shut down horse processing plants in the United States have led to increased abandonment and neglect of horses in this country and the inhumane death of horses in Mexico, according to the American Veterinary Medical Association (AVMA).

Dr. Mark Lutschaunig, director of the AVMA Governmental Relations Division, says that the AVMA, far from being pro-horse slaughter, opposes bills banning slaughter because there are no provisions to take care of the more than 100,000 horses that go unwanted annually in the United States.

“If they think that by passing one of these bills they’ll get rid of the problem of unwanted horses, they’re simply fooling themselves,” Dr. Lutschaunig said.

Efforts by groups calling for an end to horse slaughter, such as the Humane Society of the United States (HSUS), have led to the closure of the three remaining processing plants in the United States. Now, as the AVMA has repeatedly warned, horses are being abandoned in the United States or transported to Mexico where, without U.S. federal oversight and veterinary supervision, they are slaughtered inhumanely.

“The reality is, the HSUS has done nothing to address the real issue here, and, in fact, by seeking to ban horse slaughter, they have made things significantly worse,” said Dr. Lutschaunig. “If they really wanted to do something productive to improve the welfare of horses, they would address the issue of unwanted horses in the United States.”

Even if a bill passes banning the transport of horses for slaughter, it would be nearly impossible to enforce. Such a law could easily be circumvented by transporting and selling horses as “working” or “pleasure” horses, only to have them end up in an unregulated foreign slaughter facility.

“The AVMA does not support horse slaughter,” Dr. Lutschaunig said. “Ideally, we would have the infrastructure in this country to adequately feed and care for all horses. But the sad reality is that we have a number of horses that, for whatever reason, are unwanted. Transporting them under USDA supervision to USDA-regulated facilities where they are humanely euthanized is a much better option than neglect, starvation, or an inhumane death in Mexico.”

SOURCE: American Veterinary Medical Association

Tags: AVMA, Horses, Veterinary
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Veterinary Cardiologist Discovers Gene for Heart Disease

Posted by Larry Silver

WSU veterinary cardiologist Kathryn M. Meurs discovered a mutant gene in the Boxer breed that causes a type of heart disease that can be fatal in animals and humans. The disease is called Boxer cardiomyopathy. The more formal term is arrhythmogenic right ventricular cardiomyopathy or ARVC.

© 2009 Newswise — Washington State University veterinary cardiologist Kathryn M. Meurs has discovered a mutant gene in the Boxer breed that causes a type of heart disease that can be fatal in animals and humans.

Well known in the Boxer breed community, the disease is called Boxer cardiomyopathy. The more formal term is arrhythmogenic right ventricular cardiomyopathy or ARVC.

This is same type of heart disease that caused the sudden death of 1950s college and pro football great Joe Campanella at age 36, as he played handball with the new head coach of the Baltimore Colts, Don Shula.

In Boxers, the disease can be fatal and frequently occurs when the animals exercise or become excited. Occasionally, they perish from the disease while at rest, too.

“Dr. Meurs’ discovery of both the gene and its location is a tremendous achievement in the cardiology of humans and animals,” said Bryan Slinker, dean of WSU’s College of Veterinary Medicine, and a recognized cardiac disease researcher. “This achievement not only helps Boxer breeders avoid this disease but it also provides an extraordinary advancement to the study of human heart diseases resulting from electrical conduction defects and the resulting heart muscle changes that occur.”

The disease is well known in Boxers because the breed has the highest incidence of this form of heart disease. ARVC is also known to be an inherited disease and breeders sometimes avoided breeding to certain lines of Boxers yet were never completely sure if those lines had an increased risk of disease. Additionally, the disease tends to vary in severity between different dogs; key indications that the disease had a dominant genetic origin.

Meurs began looking at the disease as an extension of her work with inherited heart disease in cats and dogs. This work is somewhat similar to her work with breeds of cats that also suffer heart disease and for which she has also discovered mutant genes. Her lab developed a molecular probe for these mutations so that cat owners now have a mechanism for screening for the disease and breeding away from it.

Using an extremely powerful gene screening mechanism based on a massive computer chip at the Broad Institute at MIT with investigators Kerstin Lindblad-Toh and Evan Mauceli, Meurs looked at thousands of regions of boxer dogs’ DNA simultaneously. The samples were collected with participation by members of the American Boxer Club and the American Boxer Charitable Foundation and were segregated into groups of dogs with the disease and those with no evidence for the disease.

Once computer analysis identified a specific region of interest, Meurs’ lab evaluated thousands of DNA sequences in affected and unaffected dogs and identified a gene mutation in a gene that normally codes for the production of a key cellular adhesive protein. Subsequent studies done by WSU veterinary cardiologist, Sunshine Lahmers, demonstrated that the cellular adhesive proteins were located at the junction between cells in the heart.

Theoretically, the conduction defect is in some way responsible for a rapid, irregular heart beat that does not pump blood efficiently. When blood is not pumped efficiently, there may not be enough circulation maintained in the brain and other organs. This can lead to fainting episodes or even sudden cardiac death.

Over time, the right, lower chamber of the heart, called the right ventricle, begins to be infiltrated by a fibrous fatty tissue and often has decreased contractile ability. This change in the heart’s tissues can spread to the wall between the heart chambers and even the left ventricle.

The structural changes that result in functional impairment is the hallmark sign seen when a post mortem examination is performed on the animal’s heart. Under the microscope, the normal muscle appears solid and dense. The affected heart muscle tissue is riddled with holes where the fibrous fatty tissue has infiltrated stretching it like unorganized lace.

Meurs’ laboratory is now near obtaining a patent on her discovery and is perfecting a genetic testing probe for the gene mutation that will be used as a clinical screening device. Shortly, Boxer owners will have the ability to take a simple cheek swab of their dog and know whether or not it carries the mutant gene. Cost of the screening is expected to be about $70 and available within the next 1-2 months.

“In many cases, after the disease is diagnosed it can be managed with medication for a long enough period of time in a dog’s life that other diseases such as cancer will be the cause of death,” said Meurs. “The medications are not very expensive and there are generic forms available, too. Average monthly costs are probably less than $100.”

Meurs said that, with her lab’s service, Boxer owners and breeders will be able to identify dogs with the mutant gene and are likely to breed away from the disease.

Tags: Gene for Heart Disease, Veterinary
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Streamlining Your Collections

Posted by Larry Silver

Tips to Improve Your Performance

Patient/Client Billing

Those patients/clients who do not pay cash at the end of their appointment must be billed through the mail. Most offices receive a large portion of their monthly earnings in response to these billing statements. A person who receives a billing statement in the mail may or may not pay it fully or promptly, though. The Accounts Manager can increase the percentage of patients/clients who promptly pay their bills through the following:

* Send all bills out promptly. Most people tend to pay bills that come in closest to the beginning of the month and postpone those bills received later in the month. Determine exactly when you are going to send your bills out, and get them prepared a couple of days prior to sending.

* Make sure that bills are neat and professional in appearance. A neatly written or typed bill carries more authority than a sloppy one. Computer billing offers the most efficient and neat method of billing.

* Accuracy of your bills is very important. Itemize the services performed. Avoid repeating a charge on the bill that has already been paid. Ensure that the spelling of the name and address is correct.

* Indicate a due date on your billings. Any amounts that were previously billed, but not paid should be listed separately and the balance carried forward.

Collecting From Insurance Companies

While there is not really one best way to streamline claim processing, the following are some suggestions to avoid unnecessary delays:

* Use electronic filing wherever possible.

* Use approved insurance claim forms. Some other forms are easier to complete, but may not be processed as quickly.

* Pre-print your identification information on the forms.

* Pre-print your most frequently performed procedures on the forms. This helps to avoid typographical errors.

* Submit your findings for predetermination of benefits any time extensive service is needed.

* Have patients/clients bring their claim form with them to the first visit and have them fill out their section first.

* Mail all claims from your office if not filing electronically.

* Remind patients/clients that insurance plans are intended to help them pay for care, not to pay the entire cost for them.

* Explain clearly and concisely, prior to service, what the patients/client’s financial obligation is.

* Come to a mutual agreement about the assignment of benefits.

Working Patient/client Accounts

The Collections position involves more than just sending out bills. Often the accounts involve some work. Therefore an accurate records and a tracking system must be developed which will keep the Accounts Manager informed on when to expect payment and how much to expect.

Maintaining Accurate Patient/client Records

Your office should maintain a separate financial record for each family or individual patient/client. Financial records can take the form of a computerized account or a patient/client ledger card. In either case, the name on the account should be that of the person responsible for payment of bills.

Every financial transaction should be recorded in the correct account or ledger card. Every charge and every payment received should be recorded. This is done regardless of whether the payment is received at the time of service or not, in response to a bill sent by mail, or from an insurance company. The more details in an account, the better. This card or account becomes the source for the patient/client’s monthly statement showing charges and payments.

Using a Tickler

Since the Accounts Manager must “work” the accounts, it is advisable for her to develop a tickler system that she will use to track the accounts. There are a variety of software programs that can be used for a reminder/tickler system. What is explained below is a system that was originally designed for a non-computerized system. It is presented here to give you the basics of what you need, whether doing it with software or not.

This tickler system can be as simple as using a 5 x 7 file box. The file box should have 31 dividers, labeled 1-31, one for each day of the month. When you begin “working” an account (using the aging information that follows,) make up a tickler card with the patient/client’s name, account number, phone number, insurance information if applicable, and the date.

You will then note on the card every date and time that you have any correspondence with the patient/client and/or insurance company. You will also note exactly what was said and promised. If you have placed a call to an insurance company to find out exactly when you will receive payment on an account, note on the card whom you spoke with and when the money is to arrive. You would then place the card behind that date in your tickler file. When that date rolls around, you simply pull the card, see that money was to arrive that day, and if it doesn’t you place another call.

Each day when the Accounts Manager comes into the office, she should pull the cards behind the current day and “work” those accounts. As the day comes to an end, she would take the current tabbed date card and move it to the back of the box (the days then are constantly moving forward in the box). Any card that she was not able to get to that day must be placed behind the slot for the following day so that any necessary calls or follow-up can be made.

Monitoring Your Accounts Receivable

All accounts should be monitored using an accounts receivable aging sheet, whether this is done with a software program designed for such or not This acts as a valuable collection tool because the status of an account can be assessed along with an immediate determination of which patients/clients are not complying with the terms of payments. The accounts receivable sheet should be analyzed ten days after each billing period. Patients/clients who have not made their payments should be sent a second billing (31-60 days) with a reminder that their payment is past due. (A handwritten one, such as “your payment is beyond the time established by you to pay your account,” is most effective).

Patients/clients receiving a third billing (61-90 days) should receive a statement with a stronger memo. If payment is not made within ten days, this patient/client should receive a call and a firm arrangement must be established.

If still no payment occurs, it is advisable to create a “third party credibility” in the collection of this account. You could send a letter such as “We have been informed by our accounting firm that because your account is considerably overdue, it will be turned over to an attorney for immediate legal action if complete payment of your balance is not made immediately”. This correspondence creates the image of the account now being controlled by an outside, stronger source. The account then appears to no longer be in the hands of just the Doctor and staff, and may create greater credibility and enhance the collection process.

The most important factor in keeping your collection percentage high is maintaining continual communication between the office and the patient/client (and insurance companies). By really staying in communication, you will remain in control of your accounts, and you will enjoy greater success in receiving prompt payment for services rendered.

Tags: Dentistry, Optometry, Streamlining Your Collections, Veterinary
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Employers Pay High Price for Vision Disorders

Posted by Larry Silver

Uncorrected Vision Problems Contribute to Decreased Employee Performance

Vision disorders carry a hefty price tag for employers and result in a marked decrease in productivity costing businesses an estimated $8 billion annually, according to a new report released by the Vision Council of America (VCA). The Vision in Business report shows the staggering financial impact of vision problems on the economy, individual states and the workplace.

“Uncorrected vision problems are costing employers billions of dollars,” said Ed Greene, CEO of VCA. “Direct medical costs associated with vision disorders exceed similar medical expenditures for breast cancer, lung cancer and HIV, yet few Americans get regular eye exams or have vision coverage in their health plans.”

Both the private and public sectors of the economy are affected. VCA’s state-by-state analysis of the economic burden associated with vision disorders finds:

1. In 17 states the annual financial burden of vision disorders exceeds $1 billion, and in 15 additional states, that burden exceeds $500 million;

2. States representing the largest cost burden are: California ($5.5 billion), Florida ($3.9 billion), New York ($3.6 billion), Texas ($3.1 billion), Pennsylvania ($2.7 billion), Illinois ($2.2 billion), Ohio ($2.1 billion), Michigan ($1.8 billion), New Jersey ($1.6 billion) and North Carolina ($1.4 billion).

Vision in Business examines the prevalence and cost of vision problems as well as the role of preventive vision care in improving the productivity and efficiency of the American workplace. It also shows that job-related eye injuries, computer eyestrain and other vision problems are costly for employers and employees in a wide range of industries and occupations. Employees in professions ranging from engineers, construction workers, stockbrokers, software developers, to accountants and administrative assistants are among those most at risk for developing vision problems that affect their work performance.

Specific findings from the report include:

1. Vision problems are the second most prevalent health problem in the country, affecting more than 120 million people.

2. An estimated 11 million Americans have uncorrected vision problems, ranging from refractive errors (near- or far-sightedness) to sight-threatening diseases such as glaucoma or age-related macular degeneration.

3. There are nearly 800,000 work-related eye injuries each year, 90 percent of which are preventable.

4. Nearly 90 percent of those who use a computer at least three hours a day suffer vision problems associated with computer related eye strain.

5. Employers gain as much as $7 for every $1 spent on vision coverage.

“I see patients everyday with vision problems that could impact their work performance if not corrected,” said ophthalmologist Elaine G. Hathaway, M.D. “In addition to refractive errors, eye injuries and computer eye strain, eye diseases such as glaucoma and diabetic retinopathy can impair vision if not detected and treated early.”

VCA’s report also highlights recent research that finds the annual financial burden of major adult vision disorders exceeds $50 billion. Specifically, there is a $35.4 billion drain on the U.S. economy with an additional $15.9 billion borne by individuals with vision problems and their caregivers.

“The good news is that because of these high costs, healthy vision is increasingly being recognized as an important health issue in the workplace,” said Greene. In fact, the federal government has set a precedent by adding vision coverage to its new health plan that launched in November 2006.

“Regular eye exams are the best way to maintain employee vision health,” continued Greene. “Increased productivity and accuracy as well as higher job satisfaction are just a few of the payoffs one receives from healthy vision. Therefore, it is crucial that both employers and employees make healthy vision a priority through preventive vision care and offering effective vision benefits in the workplace.”

Tips for Employers:

1. Offer vision coverage as part of a health care package.

2. Ensure a safe working environment with mandatory eye protection as needed.

3. Encourage regular eye exams for employees.

Tips for Employees:

1. When working on a computer take a 20 second break every 20 minutes and look at something at least 20 feet away.

2. Those who wear glasses should talk to their eyecare professional about anti-reflective lenses to reduce glare, eye strain and fatigue.

3. Wear protective eyewear that meets the approval of the American National Standards Institute (ANSI), which will be clearly marked “ANSI Z87.”

VCA urges employees to take an active part in maintaining healthy vision by scheduling regular eye exams. Permanent vision loss is not a normal part of aging, and many vision threatening conditions have no early warning signs. Eye exams can also detect other serious health problems including diabetes and glaucoma.

SOURCE: Vision Council of America

Tags: Decreased Employee Performance, Dentistry, Optometry, Veterinary
Posted in Issue 10, Latest Alt | No Comments »

Search Engine Marketing for Practices

Posted by Larry Silver

(Article 2 of 4 Part Series)

By Lisa Thayer, GoldfishNetwork.com

“Spiders and crawlers and bots…oh my!” – Two views of the same website

One of the most challenging aspects of optimizing a website is that there are two audiences to appeal to: 1) standard website users (like you and me) and 2) search engines. There are many similarities in attraction but also some very important differences.

First, let’s take a look at the top four usability issues from a human/standard user’s viewpoint:

* Ease of navigation – This is no time to be overly “creative” and make visitors guess where to find pertinent information. Sounds like a deceptively simple piece of advice but you only have an average of 8 seconds to capture your audience’s attention. After you have spent time and effort driving traffic to your website, don’t lose them by frustrating them! One navigational tool users appreciate is the addition of a “site map” or hierarchal list of the pages of your website.

* Visually attractive – If it looks like a high school student created your website, it will adversely affect your business’ public profile. If you don’t care about your professional image, the customer might also think you don’t care about the quality of your work. Keep in mind that the internet allows individuals the chance to anonymously pre-screen your business. You may truly have a solid, reputable business but if your website doesn’t have a good design with the proper aesthetics and technical capabilities, you’ll present a poor image of yourself. Unless you know how to design a website with these attributes, you should retain the services of a web designer and developer.

* Content-rich – Studies show that website visitors read websites like billboards not novels. Make sure that whoever writes the copy for your website is familiar with this very important difference in writing for the web. Place your most important content “above the fold” so that the user doesn’t have to scroll down unless they need more details. Make your website more relevant to the user by providing a set of Frequently Asked Questions (FAQ). Don’t be afraid of having a page of categorized links to other website resources but, of course, ask that they in turn link back to your website. Also, be sure to update your content as information in your industry changes as this will garner more frequent, repeat traffic.

Speed – In our increasingly fast paced society we have little tolerance for time wasters such as watching someone’s fancy animated intro or waiting for a picture to download. Use animation sparingly for maximum impact and to respect visitor’s time.

Not every website on the Internet gets the majority of its traffic from the major search engines, but you can’t afford to ignore them. Search engines processes and methodologies are quite complex and are updated all the time. The simple explanation of how search engines work is: the user types a query into a search engine which quickly sorts through literally millions (sometimes billions) of pages in its database and produces matches /results ranked in order of relevancy.

A search engine’s database is culled from a variety of sources.* Many of the larger search engines use things called web “spiders”,” crawlers” or “bot” programs that search the Internet in a methodical way to index and find new or updated data.

The most important thing for a website owner to know is that due to the use of these automated spiders some content and links displayed on a web page may not actually be visible to the search engines.

Now, let’s take another look at the top four usability issues – this time from a spider’s viewpoint:

* Ease of navigation – A spider isn’t concerned about getting lost – either you provide an easy roadmap to and through your website or it simply doesn’t exist in the spider’s mind; metaphorically speaking of course. The best way to do this is by adding a site map.

* Visually attractive – Web spiders don’t have eyes therefore even an actual picture of Bigfoot would have no effect on relevance. Search engines don’t index images; they won’t index any text your web site presents in image format. To fix this problem, you can use what are called “ALT tags” or image descriptions in your website coding.

* Content-rich – Content is also king when it comes to web spiders but beware… search engine methodologies have evolved to identify redundant text and the overuse of keywords. This means some of the tactics ethically challenged web designers used a few years back no longer fool the search engines and can actually harm your standings if overused. Search engine methodologies these days even go so far as to calculate the ratio of actual text (content) to the amount of coding. Web spiders also consider the information within three clicks of the home page to be most relevant to a search. Spiders, as well as human users, appreciate fresh content. (I will address the important issue of updating content in the next article.)

* Speed – Although search engines generally won’t penalize for the use of frames, dynamic content and multimedia files, they will have difficulty indexing them. They also don’t index pages that require registration, “cookies” or passwords.

I have seen many business owners make the mistake of designing an elaborate website and then seek out a professional SEO (Search Engine Optimization) expert. This can lead to disastrous results such as poor performance, missing your target market, and a potentially costly redesign. Before you begin your website project, make sure you clearly express your business vision, current and future marketing plan, and expectations with your web designer. (BTW- If the web designer isn’t asking you about these vital areas perhaps you should keep looking.)

*Other search engine sources include search engine advertisements, human based search engines or web directories and topical search engines.

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients in 9 states across the U.S. Lisa can be reached at (503) 783-0440 or by e-mail: Lisa@GoldfishNetwork.com

Tags: Dentistry, Optometry, Search Engine Marketing for Practices, Veterinary
Posted in Issue 11 | No Comments »

Do You Know What Constitutes Great Service?

Posted by Larry Silver

The Four Components of Great Service

Great service to your patients/clients is one of the most important factors required for building a successful practice. Under the heading of great service, you will find the following key components: convenience, communication, cost and quality, importance of your service as perceived by the patient/client.

CONVENIENCE: Consider the location of your practice. People generally select a service based on how convenient it will be for them to get to the location. Surveys and studies show that well over half of the public selects their healthcare services because of a conveniently located facility.

Are your hours structured to meet the needs of your patients/clients? Most people operate on a very hectic schedule and will actively seek out those practices that offer convenient or flexible hours. Practices that really work at ways to make it more convenient for their patients/clients to use their services will surely reap the rewards for their efforts.

COMMUNICATION: Words are not the only way in which communication occurs. Appearances and actions weigh equally as important in conveying an idea or concept to your patients/clients. Look at your staff, building, reception area, signs, business cards, letters, etc. What do these communicate to the public?

Decide exactly what it is that you wish to communicate to your patients/clients and prospective patients/clients. Then convey that in not only verbal communication, but in all of the above categories as well. Teach your staff to do the same.

COST AND QUALITY: The cost of your services is directly related to the quality of service that you deliver to your patients/clients. Your patients/clients will never feel that your fees are too high (or even really think about it for that matter), if they perceive the quality of service to be valuable. If you provide inferior or slow service, it will almost automatically make your fees appear to be too high. Again, patients/clients will take into account the amount of time they had to wait, the appearance of staff and facility and the demeanor of those servicing them.

Communication ties in with this area. Ensure that your patients/clients know what you are doing. Talk to them during the examination and explain what you are doing and why. This impacts the patient/client’s impression of the fairness of your fees. Clear and professional communication with your patients/clients helps to ensure that they go away feeling satisfied that they have received excellent value for what they paid.

IMPORTANCE: Although you may perform valuable services, it is most important that the patient/client perceives how important the service is. This presents you with a “marketing” challenge. A large percentage of the population does not visit their doctors often enough.

This only indicates that the importance of regular exams has not been conveyed effectively to the public at large (or even to some of your patients/clients).

National health educational campaigns are designed to increase the public’s perception about health and the importance of regularly visiting all of their family doctors. You cannot, however, rely solely on that type of campaign alone. It is vital that you take every opportunity to provide education to your patients/clients and to raise their “IQ” in the area of good health. The more they know, the more likely they are to use and appreciate your services and to tell others about you.

Provide a variety of brochures, put out a monthly newsletter, create your own handouts. Train your staff to educate the patients/clients. Maintain awareness in the practice that an educated patient/client is a more compliant patient/client and one who is much more likely to refer new people to your practice.

Tags: Dentistry, Great Service, Optometry, Veterinary
Posted in Issue 11 | 1 Comment »

Purpose, Product and Statistics

Posted by Larry Silver

for the Owner of a Health Care Practice

The Basics

Most doctors, when starting their practices, miss some of the basic actions that should be established prior to opening.

An owner of a healthcare practice should always, as a first step, work out the following basics: their purpose as a practice owner, the actual product of the practice, and the statistics that will measure the success of the practice.

Below are examples that you can modify and use for your own practice

Purpose of the Practice Owner

* To establish an efficient health care practice that delivers quality service to its patients and/or clients.

* To have a very solvent and viable practice that provides a high quality of life for the doctor/owner and an enjoyable place for the staff to work.

Once the purpose has been established, it is the owner’s responsibility to set the direction and the pace for the business and to demand that the valuable final products of the organization be achieved. To do that, she/he must work out what the product of the practice is. Below is an example.

Product

* A solvent, viable, expanding practice delivering high quality care and service.

* Satisfied patients and clients who have received high quality care and service.

Statistics

* Number of active patients/clients.

* Production

* Collections

* Net Income

* Solvency: amount of cash versus bills owiing

Putting the purpose, product and statistics in place will help create a strong foundation for the expansion of your practice.

Tags: Dentistry, Optometry, Product, Purpose, Statistics, Veterinary
Posted in Issue 11 | No Comments »

Steps to Safeguard Your Practice against Embezzlement

Posted by Larry Silver

Note from the editor:

In our first issue , we published an article entitled “Steps to Safeguard Your Practice against Embezzlement.”

As our research staff continues to discover that this issue is still prevalent with doctors nation-wide, we are re-visiting this same article with additional advises.

Minimize the Risk

More than likely, you’ve heard some horror story about a colleague who had a trusted employee embezzle money from him/her. There are steps you can take to minimize the risk of embezzlement.

The following procedures are recommended by an accountant and should be part of your normal routine as safeguards against embezzlement:

Cash Handling:

1. Firm policy that every patient/client gets a receipt whether they pay or not.

2. Cash handling and cash record-keeping duties need to be segregated. Have one person collect patient/client portions over the counter and another person post balances. Have a third person do bank deposits. As owner, play an active role in monitoring sales and cash if you have too few employees to fully separate the duties for handling cash and collections.

3. Each month, compare the amount of your collections that was cash. There will be some fluctuation, of course, but if it goes low one period, it is suspicious.

4. Start a patient/client sign-in sheet where patients/clients simply sign-in. Compare this on a daily basis to an over-the-counter-collections report (and day-sheet or equivalent), looking for inconsistencies such as patients/clients who are on the sign-in sheet but not listed on the day-sheet report. Spot check by phone call to patients/clients who are reported to not have paid a portion due that day. This can be done as a “quality control” call to the patient/clients. Of the questions asked one might be something like, “It’s our policy that all patients/clients who pay any cash on the day of service receive a receipt. Did you receive a receipt today for any cash paid?” Implement this policy in writing and DO IT. This will make it far more dangerous to attempt embezzlement.

5. Have a written policy to conduct unannounced checks of petty cash and other cash accounts on a regular (bi-weekly or monthly) basis. Conduct these checks without fail.

Accounts Receivables and Statements:

6. Review your accounts receivable aging report monthly. Look for changes from the last month’s report that don’t make sense. Scrutinize any balance over sixty days old as its existence normally does not make sense and minimally means a dropped ball by someone if not hanky-panky on collections.

7. Have a written policy that no balance write-offs or account adjustments are permitted without written Doctor approval. If possible, consider a ‘lock-out’ (in your computer software) to allow ONLY the owner the ability to write-off balances.

8. Spot check day-sheets against patient/client charts, ledger cards (or patient/client account records) and the schedule book at least once a quarter, looking for any discrepancies. That you do this – sporadically – should be overtly promoted to the staff.

9. Routinely check with visiting patients/clients who have balances over thirty days old – and with past-due patients/clients you are calling – to ensure they’ve received a statement from you. The idea here is to look for incidents of the collections person throwing statements out versus mailing them in order to cover a payment embezzlement.

10. Become suspicious if you find you are all of a sudden paying a lot of refund checks to patients/clients.

Accounts Payables and Purchasing:

11. Ensure all expenditures are authorized (via written request) and documented.

Safeguarding Records and Miscellaneous:

12. If using paper day-sheets, then remove these day-sheets from the office each quarter, and store them at home or in a safe deposit box.

13. Always change the locks immediately when a key-holding employee leaves employment.

14. The last thing to remember is to assume that if someone can rip you off, they will – and take steps to prevent it; and if your antenna goes up on some circumstance, you carefully check into it.

Tags: Dentistry, embezzlement, Optometry, Veterinary
Posted in Issue 11 | No Comments »

Guide For Veterinarians

Posted by Larry Silver

Includes Unusual Species Adopted Into Human Households And Potential Hazards To Human Health

Ferrets, frogs and finches are becoming more common as pets, but the list of unusual species adopted into human households now includes some of the most exotic creatures on the planet. The trade in exotic pets has become a multi-billion dollar enterprise, but expansion of the industry sometimes outpaces veterinary knowledge of how to treat the maladies that afflict these unusual animals.

The new “Manual of Exotic Pet Practice,” published by Elsevier and edited by veterinary experts at the University of Illinois and Louisiana State University, provides detailed information on all of the major exotic animal groups. The book devotes entire chapters to invertebrates, ornamental fish, amphibians, crocodilians, snakes, lizards, chelonians (turtles and tortoises), birds, marsupials, ferrets, rabbits, hedgehogs, chinchillas and guinea pigs. Rats and mice get a chapter, as do hamsters and gerbils. A final chapter offers guidance on the treatment of injured wildlife.

“We felt that there was a strong need for a general exotic pet textbook that could be used by veterinarians to manage any exotic animal that came their way,” the editors wrote in the preface.

University of Illinois wildlife veterinarian Mark A. Mitchell co-edited the book with LSU professor of zoological medicine Thomas N. Tully Jr.

The manual includes a brief history of the age-old tradition of capturing or domesticating wild animals, and a chapter on how to prepare an animal hospital for exotic pets. Each of the other chapters lists common species kept in captivity, and offers guidance on their biology, husbandry, nutritional needs, preventive medicine, common diseases, and potential hazards to human health.

Want to know how to restrain a crocodile so you can give it a proper exam” How do you know if a turtle is suffering from a vitamin A deficiency” Is the lethargic rabbit in your waiting room a victim of heat stroke or cardiac disease” Did that frog swallow something it shouldn’t have” The book offers guidance on these and myriad other potential therapeutic challenges.

Diagnostic approaches and treatment strategies are described in every chapter, and each includes information about surgery and, when applicable, special instructions related to anesthesia.

The book includes hundreds of color photographs of the maladies and injuries that sometimes afflict exotic animals, with more photos of common examination and treatment techniques. An in-depth index allows quick reference to items of interest.

“Dr. Tully and I were interested in pursuing this book because we saw a real need for an ‘all-exotics’ text for the general practitioner,” Mitchell said. “Historically, veterinary texts for exotic pets have been group-specific (for example, devoted entirely to reptiles or birds). Although invaluable, many veterinarians have expressed a desire to have a single point, primary reference to obtain clinical information on these animals. We hope this text will serve the tens of thousands of veterinarians managing exotic pet and wildlife cases as an invaluable resource to manage their patients.”

Source: Medical News Today

Tags: Veterinary
Posted in Issue 11 | No Comments »

Providing A Firm Foundation Through Written Office Policy

Posted by Larry Silver

A Way to Avoid Common Confusions in the Work Place

In order to function most effectively as a team, agreements must be known and adhered to for smooth, efficient coordination and cooperation. This is also known as “policy”. As long as people know what the rules of the activity are, and those guidelines are clearly presented as being in the best interest of the activity, the policies will be followed and a smoother operating environment will result.

Policy that is understood, agreed upon and adhered to will strengthen the practice in the achievement of the goals.

Even those “policies” that are simply in your head, and you figure “everyone knows” should be put in writing. By putting all policies in writing, problems and confusions that could otherwise surface will be curtailed and even eliminated.

It is advisable to create your “General Office Policy” to address fundamental issues that affect every practice. In addition, policies relating to specific areas of the practice should be properly documented. The practice should maintain a Master Policy Manual and each employee should have his or her own copy of the policies of the practice.

Once a General Office Policy Manual is developed, the practice will continue to generate new policies as time goes on and new issues and situations present themselves. When creating a new policy, place a copy in the Master Policy Manual and distribute a copy to each relevant staff member. Request that the staff then send written compliance to the office manager that they have read and understand the policy and that they have placed their copy in their respective manuals.

Following is a list of the types of topics that should be addressed in the General Office Policy.

Recommended Topics That Should Be Addressed In Written Office Policy

Patient Relations

Equal Opportunity Statement

Harassment

Bonding Of Employees

Terms of At-Will Employment

Orientation and Training

Definition of Full and Part Time

Work Hours

Pay Periods

Payroll Deductions

Wage and Salary Guidelines

Salary Adjustments

Fringe Benefits

Retirement Plan

Vacation

Holidays

Sick Leave

Maternity Leave

Funeral Leave

Jury Duty

Absenteeism

Tardiness

Personal Time Off

Leave of Absence

Voting

Reimbursement of Expenses

Disciplinary Measures

Staff Meetings

Continuing Education

Problem Resolution

Smoking

Breaks and Lunchtimes

Job Performance Reviews

Termination

Unemployment Insurance

Worker’s Compensation

Health and Safety Rules

Cleanliness/Maintenance

Appearance

Uniforms

Personal Data Changes

Solicitation

Office Security

Where To Park

Telephone Use

Outside Employment

Confidentiality

Dating of Patients

The material presented is not intended as a substitute for appropriate legal, accounting and governing board advice. The information and suggestions may or may not conform with all Federal, State (or Province), and Local rules, laws and regulations. Each state, county or city may have very different statutes or ordinances influencing legal employee policies. It is imperative that you have your policy manual and employment practices reviewed by legal counsel with particular expertise in the employment laws of your city, county, state or province.

Tags: Avoid Common Confusions, Bonding Of Employees, Dentistry, Equal Opportunity Statement, Harassment, Office Policy, Optometry, Orientation and Training, Patient Relations, Terms of At-Will Employmen, Veterinary
Posted in Issue 09 | 1 Comment »

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