ABSTRACT: As professional members of a veterinary practice, nurses are idealty placed to use their knowledge, skills and experience to contribute to the financial well-being of their organisation. By using their skills, they can assist the veterinary surgeon in health assessments, which can discover the early onset of disease, often overlooked, and ensure that products dispensed and services rendered are charged properly.

Veterinary nursing is a profession in its own right. Many practices are now recognising this and it is a progressive move for the profession as a whole. However, with this added recognition comes additional responsibility – a responsibility to the profession and a responsibility to the practice.

With added recognition comes additional responsibility

If you are truly to embody the role of a professional in your veterinary practice, you need to take on part of the responsibility for its development and success, and you can do this by using your professional knowledge, skills and experience to improve its profitability.

Nurses are more than just members of the practice who add value to the services performed by the veterinary surgeon. They can be – and should be – allowed to be real contributors to the financial performance of the practice.

Using powers of observation

Patients often have conditions other than the one for which they are presented to the practice in the first place. Many seemingly healthy pets some into a practice for routine examinations and boosters, yet have undiagnosed health problems which may need some form of veterinary attention. While some of these may have been relatively minor, some were the early signs of chronic and degenerative diseases that could alter the patient’s quality of life and lead to a shorter life span.

As a professional nurse, you occupy an ideal position to help your patient and the practice, through spotting the early onset of disease. This can be done by discussing issues with the owner, whether casually or when admitting or discharging a patient coming into the hospital.

The problem with degenerative disease is that it is usually slowly progressive. Because it advances slowly, owners often aren’t fully aware of how dramatically their pet has changed – many will have become used to the signs or learnt to accept some of the noticeable issues. So it is important not to be judgemental.

Still others think that some of their pet’s changes are just a part of growing old’. As a professional you know that old age isn’t a disease. Furthermore, you are aware of the power of nursing intervention in addressing such conditions as pet obesity and benefiting pets’ lives through weight reduction programmes.

Vets are often too busy with the primary reason a patient has come into the practice to notice all the subtle changes in a pet, and clients are often reluctant to discuss some conditions with the vet for fear either of ridicule or of receiving bad news. A nurses constant exposure to the patient gives you a valuable insight that vets and owners will appreciate.

Nurses have made a valuable impact by discussing with owners the risks of obesity, which is often very easy to spot and obvious to all but the owner. As a qualified nurse, however, you are able to identify and comment on many other issues as well. For instance:

•   When walking in-patients, are you spotting subtle lameness that needs further investigation?

•   When grooming a patient, are there lumps that may have been missed by owners? Remember, no one can diagnose a lump by sight or feel – the only definitive diagnosis is by means of clinical pathology tests, such as cytology or histopathology, and it is the vet’s province to decide upon this course of action.

•   When performing your own physical examinations, are you able to spot early gingivitis? Over 85 per cent of all dogs over the age of three have periodontal disease, and half of those require immediate attention; the other half will require attention within the following six months.1

•   When looking after a patient in the hospital, have you spotted a change in toileting habits or water intake other than what you would expect?

These are just examples of how nurses should be using their training and knowledge to help their patients. Using this knowledge also helps the practice generate revenue. It isn’t why you do what you do, but it is a beneficial consequence.

This helps create a win-win situation that can help practices grow:

•   The client wins because the pet that they care about (they wouldn’t have brought it to you otherwise) is being cared for and the potential problem is being treated sooner, leading to a more favourable outcome.

•   The patient wins because its quality of life is maintained, it isn’t exposed to unnecessary pain, and early intervention is often much more beneficial for chronic conditions than remedial treatment

•   The practice wins because it exists to provide healthcare for pets.

If everyone in the practice has the same outlook and approach, it will continue to generate the revenue it needs to grow and prosper.

A proactive approach to leakage

Leakage is a term that is used to describe a fee that should have been charged, but isn’t. This can happen in a number of different areas – lab work performed and not charged, additional procedures carried out during an operation and not charged, and drugs dispensed as packs instead of individual items. The list goes on and the veterinary nurse can play a significant role in preventing leakage as it happens, in even the most efficiently run practices.

There is a statistical principle called the Pareto Principle – otherwise known as the 80/20 rule – which states that a 20 per cent sample of a population will have an 80 per cent effect on the whole. In other words, 80 per cent of a practice’s overall revenue will come from about 20 per cent of the procedures it conducts. In order to make a difference in revenue, focus your attention on the procedures that the practice does the most.

In a typical small animal practice, this would include procedures such as consulting, dispensing, lab work and routine surgery. Leakage can occur because a practice is too busy, because the urgency of the procedure doesn’t allow for immediate record keeping, because charging codes are confusing or not comprehensive, through human error, or by intention.

There will be some leakage that you cannot control – for instance, in the consulting room does every worming tablet given actually get charged?

There will be some leakage that is intentional. So, staying with the wormer example, can you charge the client for a second tablet if, as part of your service you administer the tablet and the cat promptly spits it out?

Consider laboratory procedures. If tests are sent out in a rush at the end of the day to catch the last post, charges may be missed; or a blood sample may be reserved for additional tests that are subsequendy run and not charged; additional tests may be suggested by the lab and may be agreed to without a charge being made.

Use your knowledge of what results mean and
make sure there is a charge on the computer when the results come in. Look through the lab invoices to spot areas of recurrence to see where any problem may lie.

Setting up a code on the computer, especially for complicated surgical procedures, can be tricky. You often have limited text options, and what may seem obvious at the time may be obvious only to the person creating the code. Misunderstanding or missing codes for regular – if infrequent – procedures can lead to incorrect charging and leakage through misunderstanding.

For example, the person who has created the code may think it is obvious that charging PDS additionally is implicit; the person charging the procedure may assume it is included. Use your experience to see where charging differences exist and address them.

Summary

Generating revenue for your practice is a positive contribution that you can make and is not something to be embarrassed about or from which to shy away. In a caring profession such as ours, we don’t – and shouldn’t – advocate treatment where it isn’t needed. Early intervention, however, is almost always best for the pet and is a bonus for the practice. Practices need to charge for what they do; otherwise they will have no resources to invest back into the business and will need to charge higher prices across the board to make up for the shortfall. Nurses are well placed to make a contribution to their practices, and accepting this responsibility is an important part of being a professional. 

Author

Ray Girotti MBA CVPM

Ray is the hospital manager for North Downs Specialist Referrals, a multi-disciplinary referral centre in Surrey. He has an MBA and the Certificate in Veterinary Practice Management (CVPM). He has over 15 years’ experience in veterinary practice management and, prior to this, worked in and around veterinary practice for over eight years in a variety of nursing and commercial roles.

To cite this article use either

DOI: 10.1111/j.2045-0648.2012.00192.x or Veterinary Nursing Journal Vol 27 pp 264-266

References

1. JOHNSTON. N. (1995) The Economics and Marketing of Veterinary Dentistry. [No. 5. February 1995] The Veterinary Business Journal

Further reading

BELL. D„ McBRIDE. P. and WILSON. G. [1994] Managing Quality. Butterworth-Hememann, Oxford. MCCARTHY, J. B. [1992] Basic Guide to Veterinary Hospital Management American Animal Hospital Association. Lakewood.

SHERIOAN. J. P. and McCAFFERTY. O. E. [1993] The Business of Veterinary Practice. Pergamon Press, Oxford

• VOL 27 • July 2012 • Veterinary Nursing Journal