Posts Tagged ‘Veterinary’

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Larry Silver

When the Doctor is Away

Posted by Larry Silver

How you keep the office running

If you as the doctor/owner are planning to be away from the office – even for a day or two – the staff has some free time, too. The doctor/owner or office manager can make lists of things that need to be done.

Make sure that if your absence was somewhat unforeseen, provisions for referring emergency cases to other doctors have been arranged for, and that patients/clients have been rescheduled.

The doctor’s absence provides an opportunity to take care of matters that could not be conveniently handled on days when patients/clients are in the office. For example, this may be the time to have the walls repainted or to have equipment repaired. Of course, the owner should be consulted before this is organized.

The staff should take care of as many tasks as possible on their own, so that an insurmountable pile of unfinished business will not be waiting for your return. Mail should be opened, sorted, and placed in priority order. If any mail comes into the office that needs to be acknowledged, the office manager should send a letter informing the writer that the doctor is away, when he/she will be returning, and that the doctor will answer the letter when he/she returns. If the doctor is going to be away for a long time, a brief summary of the mail and phone calls can be mailed or emailed to him or her, or communicated over the phone.

This is a good opportunity to perform chart purges, contact patients/clients regarding their recall appointments, activate inactive patients/clients and get them scheduled, send out letters, and work on promotional projects.

The owner and the office manager should meet prior to the scheduled absence and form a plan for what the staff should work on during that period. As unexpected absence of the doctor can occasionally occur, the owner and the office manager should determine the policy to govern such an instance which would define what the staff is to do during that time.

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Posted in Issue 09 | No Comments »

Larry Silver

Collecting money at the time of treatment

Posted by Larry Silver

By: Ken DeRouchie

I interview doctors every day as part of my research for writing articles for Solutions. We also have a number of staff surveyors constantly interviewing doctors to find out what is important to them concerning the management of their practice. Accounts receivables and collection percentages are a subject that we hear about frequently. Every doctor has a different idea about what a good collection percentage is as well as how to collect money for services rendered.

For example, I have talked to many doctors that feel obligated to let patients/clients go without paying. They feel guilty about trying to collect from a patient/client if they feel that person is in a financial hardship.

While this is quite altruistic, what these doctors must also understand is that they can’t continue to provide help to their patients/clients if they can’t afford to keep the doors of their practice open. If you provide a service, you should be compensated for it. Period. Unless you go into a situation KNOWING in advance that it is going to be a charity case, (and there is certainly room for that in any practice, as long as it is planned for) you should insist on being paid for rendering that service.

Of course this is great in theory but being able to actually collect all monies owed is another story and requires good group coordination and effort. If you and your staff are trained on how to do this from initial contact through patient discharge, including having the proper policies in place with your staff and patients/clients, your chances of collecting at the time of treatment go up exponentially. We believe that you should be collecting 98% or better of what you are producing minus insurance adjustments. If you are collecting less than 98%, you are losing net income out of your own pocket.

Let me explain. If, at the end of your fiscal year, you have enough money to pay for everything, all of your overhead is covered, your staff salaries, your mortgage/lease, equipment payments, taxes, etc., any lost income then becomes your own lost personal net income. For example: if you were collecting an average of 93% (5% lower than what should be your standard) with an annual gross income of $650,000.00 ($55k per month), this would equate to a loss of $32,500.00 per year. Over ten years this amounts to a staggering $325,000.00! And that is essentially straight out of your own pocket. This is the equivalent of you working one or more out of every ten years for free. Many doctors we survey think that “a few percent here or there isn’t that significant.” I hope the above numbers disabuse you of that idea.

With the above in mind, is it now worth it to you to spend the time to train your receptionist and/or collection/finance person on collecting properly?

Here are some tips on things you can do to increase your collection percentages.

First Contact:

When a new patient/client initially calls to make an appointment, the receptionist should keep it as simple as possible for the patient to arrive. Simply schedule them in as soon as possible so that they feel well serviced as their first impression. The new patient/client should be informed to arrive early to fill out paperwork so that the appointment can happen on time. Payment terms and conditions should not be discussed on the phone. You want to make it as easy as possible for the new patient/client to come in the office and not be put off by anything at the initial contact. When they get into the office you can then go over your financial policies. You should, though, ask them to bring any insurance information they have should insurance be relevant to the potential treatment. This should include the name of the company, their policy number, what is covered, what their deductible is, etc. Do not worry about having to get into the details of this over the phone and don’t make the patient feel harassed by this. You don’t want to turn the patient off before they even arrive or they may not arrive. You want the patient to feel friendly and comfortable about coming into the office but, at the same time, you want them to bring any relevant data that they can.

When they arrive:

As soon as the new patient/client comes through the door they need to be greeted warmly by the receptionist. The receptionist should then supply the new arrival with the necessary forms to fill out. Included should be a form covering your specific payment requirements indicating that payment is due at the time of treatment and/or your insurance agreements and arrangements. If insurance is involved, the form should include a place to provide what insurance they have, how much is covered, what the deductible is and most importantly, that they will be expected to pay the co-pay, deductible or anything not covered by insurance at the time of treatment. They should also be told that, unless otherwise agreed upon, you don’t offer billing but will gladly accept cash and most major credit cards. Let them know if you offer financing through companies such as Care Credit and, if they feel they will require such financial assistance, make sure they meet right away with the person in your office who handles these matters. If you don’t take care of it on the spot, you are likely to be left with a collection problem on this account. Make sure that you require their signature on this form that signifies that they have read, understood and will comply with the financial policy of your office

Once they have received treatment:

Validate your patient/client for the good decision they made to confront and handle the problem they came to you with. Let them know they did the right thing and that the investment they made was a good one. Follow up the first treatment with a quality control call, ideally from the doctor, to make sure all went well.

As treatment continues, make sure that everyone in the office continues to reinforce the good decision the patient/client made and, make the patient/client feel welcome in the office.

If you do these things you will see a turn around in your collection percentages and you will see your net income go up.

If you have specific questions for Ken DeRouchie on this article or would like to suggest a new topic for him to write about, please call 800-695-0257 ext 1664

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Posted in Issue 09 | 1 Comment »

Larry Silver

Guest column: Coping With Conflict – Part Two

Posted by Larry Silver

A Layperson’s guide to resolving conflict in the office

By Daniel A. Bobrow, MBA

President, American Dental Company

Part two in a series of two articles

In last issue’s article, we discussed models and tenets used to resolve conflict. In this part, I’ll go over the skills necessary that, once mastered, can greatly assist you in managing and resolving conflict in your office.

Active Listening

Truly listening and showing with your body language a sincere desire to know what the person is saying is vital. A person must feel that they are being heard for any resolution of any conflict or problem to occur. This can be further demonstrated by some of the points below.

Mirroring

Restating conceptually what is said to you to confirm your understanding. Care should be taken to “neutralize” statements by eliminating or changing words that are emotionally charged or are accusatory.

Pacing

Another method has to do with understanding and matching the tone and pacing of a person’s speech pattern, and, if needed slowing it down. The goal being to calm the person so a more productive conversation may take place.

BATNA

This is an abbreviation for Best Alternative To a Negotiated Agreement. It involves asking the person to consider what the best possible outcome will be if a mutually agreeable settlement can not be reached. An example of the use of BATNA is: “Joseph, I know you don’t like making reactivation calls in the evening. But you’re the only one on our staff who is capable of doing so. And you remember the mess we were in before we brought you on. What do you think will happen if we just stop doing this?” Embedded in this sentence is another technique called stroking (see below).

Reality Test

Similar to BATNA, reality testing attempts to get the person to see that his or her proposed solution is unrealistic, or at least, not optimum.

Blame Yourself, Not Others

A great way to neutralize tension during the mediation session is for the mediator to take responsibility for any misunderstandings or uncomfortable situations that might arise. For example, if a party grows impatient while the other party is speaking, you might say “I’m sorry for not giving you an opportunity to speak, Sam. Just as soon as Bill finishes, you’ll have your chance.”

Ask “Harmless” Questions

Ask “leading” questions: especially when the parties seem to have reached an impasse, ask “safe” questions that get the parties talking again. For instance, you might say “Whose turn is it to get lunch today? I’m starving!” or “By the way, did I remember to thank you both for helping me juggle those four patients this morning? I owe you for that one!”

Stroking

Let the parties know that they’re doing a great job in the mediation, and you really appreciate their willingness to sit down and talk things over. It’s too bad more people are not willing to talk and listen.

The goal of all the above techniques is to get people to see for themselves why resolution of the conflict is in everyone’s interest, including theirs. If someone feels that they are being manipulated, or that a solution is being forced upon them, the parties to the conflict will be less likely to adhere to the proposed agreement. Remember that agreement is not the sole criterion of success. In fact, if either party feels the agreement is “forced on them,” it may do more harm than good.

An Ounce of Prevention

One way to deal with conflict is to create an environment where it is less likely to arise. One way to do this are to anticipate the kinds of conflict between staff members, doctors, and patients, then implement systems and training to prevent these situations from arising. Examples include:

“Personality Conflicts” between staff

Implement some form of compatibility assessment into your employee screening procedure, as well as for current employees. Doing so can help you understand who is most suited for working with whom. Employ active listening and caucus tools (see part 1, last issue).

“Trust is an essential ingredient of a productive and profitable environment,” says Dr. Ira S. Wolfe, DDS, president of Success Performance Solutions. “The willingness of people to exchange ideas and collaborate is thwarted when people are selected and promoted on the basis of skills and experience alone. ” People have to be able to get along with their co-workers in order to have a winning team environment. Wolfe’s SMARRT management process encourages and facilitates matching people who are compatible with the job, the team, and the practice culture. There are also testing procedures that help choose the right person for the right job and assesses their potential compatibility with other staff. Find some technique, test, or company who has experience and proven results in this area to help you with this. Doing this properly will result in less conflict and stress, and higher practice productivity.

Patient Complaints about being kept waiting

Implement a policy of notifying patients in advance if the doctor is running late. Promote a “no waiting policy” as part of your mission statement or declaration of principles. When the occasional complaint does occur, be prepared to use disarming verbiage such as “The doctor asked me to apologize to you for not being able to see you. He is busy with a procedure that has proven more involved than we anticipated. He assures me he will do everything he can to see you as soon as possible. Is that acceptable to you Mr. Jones?” Doing so before the complaint arises in the first place is a great way to show your sincere concern for your patient and respect for their time.

Staff Member refusing to implement changes or “grow with the practice.”

Caucus with that person employing the techniques covered above. Through good communication and active listening you can get to the source of this team member’s unwillingness to work with the team. In many cases, you may discovering something more fundamental going on that has farther reaching implications for the practice.

Another way of preventing conflict is to hire, then educate and motivate staff members to recognize the value of the work they do, and the value of the practice to its patients and the community. Involvement in charitable groups, for instance, can give the practice team a sense of shared pride, and serve to put in perspective the disagreements as self-indulgent exercises that neither the practice nor staff members can afford.

As I am writing this, I am experiencing a poignant example of potential for conflict. I am working on my laptop on a return flight from a conference I’d attended. A rather ample gentleman was seated in front of me. As he reclines his seat, my laptop is thrust into my abdomen. I struggle in vain to position the laptop in a way that will not restrict my breathing. Out of desperation, I at last say, “excuse me sir, I’m sorry to distrub you, but I wonder if it would be possible for you to bring your seat back up just a little bit and still remain comfortable. I realize these seats were not designed with the use of a laptop in mind, but it would be a great help if I could continue working on this article as I am under somewhat of a deadline.” He was immediately accommodating.

In addition to my choice of words, the fact that I had earlier helped this same gentleman avoid a bump to his head by pointing out the open overhead cargo bay no doubt set the stage for his cooperation. As to what I said, I was careful not to use accusatory or demanding language that suggested blame or that I was entitled to anything. I also showed a respect for his comfort, and directed the cause for the situation to the design of the seats. Finally, I offered a reason why I needed to continue my work.

Final Thoughts

Remember, an agreement needs to last, especially if between staff members.

A number of resources are at your disposal if you would like to learn more about how alternative dispute resolution (ADR) can help you achieve more harmonious relations in your practice. Which are appropriate depends on factors such as the number of staff members and the types of conflict you experience. I invite interested readers to contact me if they would like to learn more about these powerful techniques.

Daniel A. Bobrow, MBA is president of the American Dental Company, a Chicago-Based Consultancy serving the dental profession. He has mediated and arbitrated various cases. He is also Executive Director of Climb For A Cause, a non-profit Foundation whose mission is to provide health care treatment and education to people in need worldwide. He may be reached at 312-455-9488 and

Dbobrow@AmericanDentalCo.com or

Director@ClimbForACause.org.

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Posted in Issue 09 | No Comments »

Larry Silver

AMA Joins AVMA Initiative to Strengthen Medicine

Posted by Larry Silver

AMA Joins AVMA ‘One Health’ Initiative to Strengthen Medicine by Working Together

The American Veterinary Medical Association (AVMA) announced today that the American Medical Association (AMA) has adopted a resolution calling for collaboration on a One Health Initiative.

The two national, medical organizations will work collaboratively on areas of mutual medical interest, such as pandemic influenza, bioterrorism risks, and biomedical research.

The AVMA One Health Initiative will take another major step forward at the AVMA Convention in Washington, DC, when the AVMA will announce the members of a One Health Initiative Task Force. The new AVMA One Health Initiative Task Force will be charged with developing strategies to promote collaboration among the various health science associations, colleges, government agencies and industries.

Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention (CDC) said, “This is fantastic news. I am sure I speak for all of CDC in voicing my complete enthusiasm and support for the One Health Initiative. I appreciate the leadership that the AMA and AVMA are providing in creating this powerful network of health protection.”

AVMA President, Roger K. Mahr, DVM, who has championed the One Health Initiative at the AVMA, testified before the AMA in support of their participation in the Initiative.

“The convergence of animal, human, and ecosystem health clearly dictates that the ‘one world, one health, one medicine’ concept must be embraced. Together, we can accomplish more to improve health worldwide than we can alone,” Dr. Mahr testified.

“New infections continue to emerge and with threats of cross-species disease transmission and pandemic in our global health environment, the time has come for the human and veterinary medical professions to work closer together for the greater protection of the public health in the 21st Century,” said AMA Board Member Duane M. Cady, MD.

The AVMA One Health Initiative Task Force will be comprised of twelve thought-leaders representing various health science professions, academia (including two students), government, and industry.

The AVMA and its more than 75,000 member veterinarians are engaged in a wide variety of activities dedicated to advancing the science and art of animal, human and public health.

SOURCE American Veterinary Medical Association

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Posted in Issue 09 | No Comments »

Larry Silver

Project Could Help Pets Serve As Disease Watchdogs

Posted by Larry Silver

A national surveillance network that uses the medical records of companion animals could help prepare for a wide variety of emerging disease threats to humans and animals, including avian influenza, according to veterinary scientists at Purdue University’s School of Veterinary Medicine.

The National Companion Animal Surveillance Program was originally designed to alert people to potential anthrax or plague outbreaks. New findings on tests of the program are detailed in the current edition of Vector-Borne and Zoonotic Diseases, a medical journal that focuses on diseases transmitted to humans by vectors such as mosquitoes or directly from animals.

Larry Glickman, a professor of epidemiology in the School of Veterinary Medicine, designed the National Companion Animal Surveillance Program in collaboration with Banfield, The Pet Hospital, a nationwide chain of veterinary hospitals. Between 2002 and 2004, tests were conducted on more than 10 million pet records to determine how the database could be used to monitor disease outbreaks.

“We discovered we can use analytical techniques to target specific geographic areas where vaccines need to be developed,” Glickman said. “This early warning will become critical to stop the spread of avian flu virus and other diseases that might affect humans. The quicker we can identify the problem in the more than 150 million dogs, cats or pet birds that live in approximately 40 percent of all households in the United States, the greater the probability we can contain a disease before it spreads to humans.”

Authors of the research paper were Glickman; George E. Moore, Nita W. Glickman and Richard J. Caldanaro of Purdue’s School of Veterinary Medicine; David Aucoin of VCA Antech; and Hugh B. Lewis of Banfield, The Pet Hospital.

Researchers collected data from 80,000 companion animals treated weekly at more than 500 Banfield hospitals in 44 states. Additional data included reports from VCA Antech Diagnostics, a nationwide network of laboratories used by more than 18,000 private veterinary practices.

Medical records were transferred to Purdue, where they were stored and converted for analysis with the help of COMSYS Information Technology Services, a consulting firm located in Houston.

Based on the data, researchers found:

o A clear pattern of association between flea and tick infestation in pets compared to the incidence of Lyme disease in humans, with a two-month lag and peak rates occurring during warmer months. This information allows veterinarians to anticipate unusual occurrences of diseases that are transmitted from animals to humans and design treatment methods. Public health officials also could be alerted so they could provide timely information to the public and spray affected areas for ticks. In addition, specimens such as these can be used for profiling a broader variety of diseases that are potentially transmitted to humans by fleas and ticks, such as Rocky Mountain spotted fever.

o A 3.3 percent increase in the number of positive tests from 2002-2004 for a disease called canine leptospirosis. Leptospirosis can be transmitted from dogs to humans. The disease is currently the leading cause of acute kidney failure in dogs and also can damage the liver. Most animals and humans recover from leptospirosis if it is diagnosed early and treated with antibiotics. This research will help develop early warning signs and aid in the development of vaccines that target emerging new strains of leptospirosis. The data also documents an increase in the disease over the past 10 years, probably related to increasing contact between dogs and wildlife such as raccoons, Glickman said.

o A correlation between the number of cases of influenza-like illness in cats and similar symptoms in humans in the Washington, D.C., area where Banfield has numerous hospitals. This pattern suggested common environmental causes of influenza in cats and people. The finding illustrates the importance of the ability of Purdue researchers to track diseases by geographic area and to detect statistical clusters of events in companion animals that could signal the introduction of new viruses into the United States, such as avian influenza virus due to bird migration or bioterrorism.

“We wanted to show that these animals could be used as sentinels of infectious agents and perhaps predict the occurrence of diseases in humans,” Glickman said. “The long-term goal is to partner with other providers of companion animal health care and animal laboratory data to create a comprehensive system that will be a national resource to further the practice of evidence-based veterinary medicine and veterinary public health. We think there is no comparable human-surveillance system in the country.”

In ongoing work, the Purdue researchers are investigating ways to monitor cats for avian influenza. In collaboration with Banfield, they have developed an early-warning system for the occurrence of canine influenza that is caused by a virus that appears to have jumped recently from horses to dogs. If a dog comes to a Banfield clinic with a predetermined set of clinical signs, the computer screen flashes in the hospital and information appears that advises the practitioner what samples to collect from the dog for virus identification. A similar real-time surveillance system could be used to identify the avian influenza virus in pet birds or cats, Glickman said.

“The avian flu virus could be the ‘black plague’ of veterinary medicine, but we can be proactive through early detection and vaccine development,” Glickman said. “A reporting system such as this for companion animals will allow us to educate veterinarians and help the public. It also will demonstrate what is possible in human medicine with development of a more centralized and coordinated health-care delivery system.”

The research was funded in part by the Centers for Disease Control and Prevention.

Writer: Maggie Morris

Sources: Larry Glickman

Purdue School of Veterinary Medicine

http://www.vet.purdue.edu

From: Purdue University, Medical News Today

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Posted in Issue 06 | 2 Comments »

Larry Silver

Veterinary Foundation Offers Grants To Cover Costs

Posted by Larry Silver

Veterinary Foundation Offers Grants To Cover Costs Of Care After Hurricanes

The American Veterinary Medical Foundation (AVMF) is urging veterinarians to apply for grants of up to $2,000 to cover costs incurred by Hurricanes Katrina and Rita.

Eligible applicants are licensed veterinarians, although requests from licensed veterinary technicians and others providing medical care for animals will be considered. Applicants need not come from storm-ravaged areas, but may include those from otherwise unaffected areas who are incurring out-of-pocket expenses from providing veterinary medical treatment, care and supplies to animal victims of the storms.

In addition, the AVMF will consider partial funding for storm-damaged structures and equipment used to provide veterinary care of animals.

“Veterinarians across the country have volunteered their time, expertise and resources to treat animals injured and displaced by these terrible storms,” said Dr. Tracy Rhodes, DVM, chairperson of the AVMF. “These grants will help to reimburse veterinarians for the costs associated with this care.”

Funding for the awards is provided through the AVMF Animal Disaster Relief and Response Fund. Established shortly after Hurricane Katrina struck the Gulf coast, the fund was developed with the goal of raising $1 million for disaster relief efforts in the areas ravaged by the storms. The American Veterinary Medical Association Executive Board allocated $500,000 in matching funds to help meet this goal.

A grant application form is available online at www.avmf.org/html/GrantGuide.asp. Forms are to be submitted to the applicant’s state veterinary medical association, which may not be the location where the expenses were incurred. State associations will then submit the forms to the AVMF for review and consideration.

The AVMF advances the care and value of animals in society by raising and distributing funds in support of animal disaster relief and animal health studies. Established by the American Veterinary Medical Association in 1963, the AVMF is based in northwest suburban Chicago. For more information about the AVMF, visit www.avmf.org or call (847) 925-8070, ext. 6689.

The AVMA, founded in 1863, is one of the oldest and largest veterinary medical organizations in the world. More than 72,000 member veterinarians are engaged in a wide variety of professional activities. AVMA members are dedicated to advancing the science and art of veterinary medicine including its relationship to public health and agriculture.

From: American Veterinary Medical Foundation website

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Posted in Issue 05 | 1 Comment »

Larry Silver

PROFILE: Dr. Kathleen Bartos and Lou Bartos

Posted by Larry Silver

How did Halifax Veterinary Clinic go from $0 in collections to over $1 million a year?

PROFILE

Dr. Kathleen Bartos and Lou Bartos

Practice: Halifax Veterinary Clinic

Location: Port Orange, Florida

A general small animal veterinarian, who specializes in veterinary acupuncture, Dr. Kathleen Bartos opened her clinic in July of 1990. Together with her husband Lou as office manager, the Halifax Veterinary Clinic struggled badly for the next five months. By December, they had $0 in collections. That’s right – $0.

Dr. Bartos had graduated from the University of Florida veterinary school in 1986. She worked as an associate for two and a half years and then did relief work for other veterinarians for a year and a half while attempting to build her own practice.

She thought she had the necessary tools to succeed.

But in December of 1990, on the verge of bankruptcy, she and Lou had a serious dilemma: do they invest in the practice more or do they shut down?

Due to Dr. Bartos’ strong desire to help animals, shutting down was clearly not an option.

The Bartos’ quickly decided that they needed help in managing their practice so they hired practice management consultants.

The first piece of advice they were given was to promote the practice and to promote without delay. Since it was December, they sent out holiday specific promotion and, within a month, things swiftly started changing for the better.

Within two months, the Bartos’ had received a 100% return on their investment in the program.

Fifteen years later, Halifax Veterinary Clinic produces over $1 million a year. It has its own in-house blood lab and Dr. Bartos has developed an incredible reputation as an excellent practitioner of veterinary acupuncture.

Even with their great success, The Bartos’ still use consulting services.

“It’s like going to church, if you stop going you feel like you’re missing something. And when we have new staff, we have to get them trained,” said Dr. Bartos. “It’s a successful action,” said Lou.

It may seem like the Bartos’ would have to work all the time in order to be this productive. Not true. They only work 4 days a week giving them plenty of opportunities to enjoy their hobbies of kayaking, hiking and spending time outdoors in other activities. They also have 5 cats and a dog.

At the end of the interview, Dr. Bartos had some advice for veterinarians just graduating. She said, “Don’t miss out on general practice by being a specialist, go into progressive, high quality general practices that are willing to innovate.”

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Posted in Issue 04 | No Comments »

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