Reversing the decline in patient visits

Companion animal practices in the United States have opportunities to increase patient visits, according to new survey results, despite a decline in the frequency of visits that began before the current economic downturn.

Fifty-one percent of a sample of companion animal practices reported a decrease in patient visits in the past two years, while 34 percent reported an increase, according to the second phase of the Bayer Veterinary Care Usage Study.

The Bayer study's second phase, like the first phase, examined both the problem as well as potential solutions.

"The time and energy spent building clinic traffic—that is, patient visits—are worth it," said John Volk, senior consultant at Brakke Consulting Inc. "There are pets out there, especially cats, that need better care. And their owners tell us they're willing to provide that care if you tell them what to do."

Bayer Animal Health, Brakke, and the National Commission on Veterinary Economic Issues released the results of the Bayer study's second phase July 18 at the AVMA Annual Convention.

Earlier in the day, a coalition of organizations—including the AVMA and American Animal Hospital Association—had announced the new Partnership for Preventive Pet Healthcare to help practices reverse the decline in the frequency of pets' veterinary visits (see JAVMA, Sept. 1, 2011).

Looking at the problem

Various studies have identified decreases in how often pet cats and dogs see a veterinarian and how many cats and dogs each practice sees.

Before the current economic downturn, surveys by the AVMA of roughly 50,000 U.S. pet owners in 2001 and 2006 found a decrease in mean number of veterinary visits per year both for cats and for dogs.

The AVMA surveys also revealed that total number of veterinary visits by cats decreased between 2001 and 2006, even as the number of pet cats increased. Total number of veterinary visits by dogs increased, however, alongside an increase in the number of pet dogs.

More recently, an AAHA survey found decreases in total veterinary visits for dogs and cats in a sample of nearly 4,000 U.S. companion animal practices. From 2009-2010, dog visits decreased by 0.6 percent, and cat visits decreased by 1.7 percent.

"With the recent economic crisis, things certainly got worse and aggravated," said Dr. Cristiano von Simson, Bayer director of veterinary technical services. "Since we can't change anything in the economy ourselves one by one, every veterinarian, are there other trends and other things that we can work on and improve the number of visits, improve the health care for those pets?"

The first phase of the Bayer study included a literature review, interviews with U.S. veterinarians and pet owners, and a survey of U.S. pet owners. The results, which came out in January, highlighted six factors as contributing to the decline in the frequency of veterinary visits.

Environmental factors that were identified were the recession, fragmentation of veterinary services among more providers, and an increase in the use of the Internet as a source of animal health information. Client-related factors were a belief by some pet owners that routine checkups are unnecessary, cost concerns, and the difficulties of taking cats to the clinic.

The second phase of the study consisted of an online survey of about 400 owners of companion animal practices in the United States. The results revealed that many practices have seen a decrease not only in patient visits but also in revenues. Forty-two percent of practices reported a decrease in revenues from 2009-2010, although 47 percent reported an increase.

"There is a tremendous amount of unused capacity in the companion animal world," Volk said. "We have a tremendous amount of open spots on the appointment book."

Practice owners reported filling a mean of 61.7 percent of available client appointments during the first three months of 2011.

"We did identify four things that were common amongst practices that were seeing increases in visits, and I think we can consider these foundational elements," Volk said. "No matter what else you're doing, these are four boxes that you want to check off in your practice."

Practices that saw an increase in patient visits were more likely to arrange for clients to see the same veterinarian for every visit. Owners of such practices tended to believe that wellness examinations are one of the practice's most valuable services and that marketing and advertising are a key part of the business strategy. Also associated with an increase in patient visits was active use of social media such as Facebook.

Owners of practices that saw a decrease in patient visits were more likely to think advertising undermined their credibility as veterinarians. Such practices also tended to lack referral arrangements with providers of other pet services.

Six factors

The second phase of the Bayer study explored the six factors that the first phase identified as contributing to the decline in frequency of veterinary visits.

The survey of practice owners found that 33 percent thought the recession had a substantial negative impact on their local economy, and 51 percent of practice owners reported a moderate negative impact.

Relevant to the fragmentation of veterinary services, practice owners identified a mean of 15.3 other clinics in their trade area. The list included traditional independent practices, chain clinics, specialty clinics, shelter practices and other "low cost" or "limited service" clinics, and mobile vaccination clinics.

"I think another way to look at this is not just fragmentation, but proliferation of veterinary services," Volk said.

Forty percent of practice owners completely or somewhat disagreed with the statement "The Internet has made it easier to work with my clients," although 31 percent completely or somewhat agreed.

Internet usage by the surveyed practices was variable. Seventy-seven percent of practices had a website, and 43 percent used Facebook.

Relevant to routine checkups, 26 percent of practice owners completely agreed and 46 percent somewhat agreed that they view wellness examinations as the most important service that the practice performs.

Almost all practice owners recommended at least annual examinations for dogs and cats. The earlier survey of pet owners found that 85 percent had taken their dog to the veterinarian within the past year, but only 60 percent had taken their cat to the veterinarian within the past year.

Relevant to the cost of care, 56 percent of practice owners increased fees in 2010 and 2011, and 24 percent increased fees in one of the two years.

"Veterinary medicine is a low-frequency-of-purchase service," Volk observed. "You see clients typically once or twice a year, so they always think it costs a lot more than they were expecting."

With regard to their attitudes toward cats, 70 percent of practice owners completely or somewhat agreed that they go to great lengths to ensure that the experience in the reception room causes as little stress as possible for cats and their owners.

Nevertheless, 38 percent completely or somewhat disagreed that they provide each cat owner with instructions on how to make travel to the clinic less stressful.

Looking for solutions

Dr. Karen E. Felsted, NCVEI chief executive officer, emphasized that the Bayer study looked for practical solutions to reverse the decline in the frequency of veterinary visits.

The survey of pet owners found, for example, that 45 percent said they would visit the veterinarian more often if the practice offered a wellness plan billed monthly. The survey of practice owners found that only 5 percent offer such a plan, but 29 percent would be willing to do so.

"Essentially, that's a bundled group of preventative health services, the basic services that a pet needs during a year, that a pet owner is allowed to pay for over time," Dr. Felsted said. A pet owner could pay for a wellness plan in monthly installments, for example.

Among findings related to practice management, the study revealed that practice owners generally reviewed financial figures at least quarterly, but fewer reviewed client and patient numbers this often.

Eighty-two percent of practice owners completely or somewhat agreed that they would change how their practice operates if they knew doing so would increase client satisfaction, but only 20 percent completely or somewhat agreed that they routinely measure client satisfaction with after-service surveys.

With regard to client communication, the study revealed that, while 57 percent of pet owners completely agreed with the statement "My veterinarian communicates with me in language I understand," 43 percent did not agree completely. Nevertheless, 88 percent of practice owners completely or somewhat agreed with the statement "I talk my clients through the exam, explaining what I am doing in detail."

Dr. Felsted remarked during her presentation on the disconnect between how clients and veterinarians perceive the quality of communication.

"This is a critical area for improvement," Dr. Felsted reiterated after the convention. "If we expect clients to spend the money on good quality care, we simply must communicate not only what we are doing and the need for our recommendations, but the value the client receives from this as well."

The study found that 74 percent of practice owners agreed that increasing fees has become more difficult, and 49 percent agreed that clients increasingly are complaining about fees.

"We have worked on the assumption for many, many years that as long as we communicated value, clients would pay anything that we asked, " Dr. Felsted said during her presentation. "It's become very, very clear, even before the recession, that that's not an assumption we can count on any longer."

Dr. Felsted said some strategies that practices can use to improve profitability, in addition to offering wellness plans, are providing payment options and designing better marketing programs, which might include offering promotional discounts. Forty-five percent of practice owners reported providing a free initial examination for pets adopted from shelters, and 36 percent offered price matching on products.

Practices have a major growth opportunity in the number ofveterinary visits by focusing on cats, Dr. Felsted noted.

Dr. Felsted also advised that practices make sure to schedule the next appointment before the patient leaves the clinic. Four percent of practices always do so, while 35 percent often do so and 49 percent sometimes do so.

"There are things, easy things, that every single practice can do to actually reverse this trend in visits," Dr. Felsted said.

Additional information from the Bayer study is available at http://bayer-ah.com/news.cfm.

Increasing patient visits

Owners of companion animal practices who reported an increase in patient visits were more likely to do the following:

• Arrange for clients to see the same veterinarian at every visit.
• Believe that wellness examinations are one of the practice's most valuable services.
• Believe that marketing and advertising are a key part of the business strategy.
• Actively use social media such as Facebook.

Source: Bayer Veterinary Care Usage Study

Banfield's wellness plans

The recent Bayer Veterinary Care Usage Study suggested that offereing wellness plans could increase the number of veterinary visits by cats and dogs. Banfield Pet Hospital is an example of a practice group that already promotes wellness plans.

Banfield's hundreds of clinics offer Optimum Wellness Plans, annual packages of preventive care with monthly payments. Currently, about 46 percent of Banfield's feline and canine patients are on a wellness plan.

Among Banfield's patients not on wellness plans, cats averaged 1.42 visits in 2010, and dogs averaged 1.43 visits. Among Banfield's patients on wellness plans, cats averaged 3.67 visits in 2010, and dogs averaged 2.86 visits.

Dr. Jeffrey S. Klausner, Banfield's chief medical officer, said Banfield believes twice-annual examinations are key to ensuring that pets receive proper preventive care.

"Regular visits also assist in building long-lasting relationships with clients," Dr. Klausner said. "The relationship piece is an important part of preventive care—the better the relationship with a client, the more likely clients are to trust doctor recommendations.

"We've also found that wellness plan clients not only come in twice as often, they have better compliance with preventive care recommendations. For example, our data show that 45 percent of wellness plan clients have their pets on heartworm preventive, while only 20 percent of non-wellness plan clients do."