Building up practice

“Explain things in a way I understand.”

“Share test results with me.”

“Treat me as a partner.”

“Provide guidance and ways to make preventive care easy.”

These are among the factors that dog and cat owners say strengthen their bond with their veterinary practice, according to the AAHA State of the Industry 2015 report.

The American Animal Hospital Association released the report during its yearly conference, March 12-15 in Tampa, Florida. Numerous sessions explored practice building. Keynote speaker Greg Bell, author of “Water the Bamboo,” shared his message about nurturing growth.

One management track focused on growth through client retention. The idea is that a practice’s clients are like water flowing into a bucket full of holes, and the practice can plug some of the holes via management procedures.

Earlier in March, AAHA announced it had begun voluntary accreditation of internship and mentorship programs at AAHA-accredited hospitals (see article). During the conference, Dr. Tracey Jensen assumed the office of president (see article), and the association gave the AAHA-Accredited Practice of the Year awards (see article).

The conference drew a total of 3,713 attendees, including 1,158 veterinarians, 248 veterinary technicians, and 67 veterinary and veterinary technician students. The association’s membership encompasses about 3,600 AAHA-accredited practices and 1,900 nonaccredited practices.

Starting small

Speaking during the opening session, Bell related that he begins every day with this question: “What is going well?”

He asked each member of the audience to think of one thing that was going well and share it with another audience member, leading to lively discussions. Bell said, “An attitude of gratitude can help you tremendously.”

In “Water the Bamboo,” Bell writes that bamboo farmers water seeds for years with no growth. Then, giant timber bamboo can grow more than 90 feet in 60 days. Bell’s five lessons from the bamboo farmer are patience, courage, self-discipline, persistence, and belief.

“Everything starts small,” he said.

The bond between client and practice

Dr. Mike Cavanaugh, AAHA chief executive officer, presented the State of the Industry 2015 report in a special session. The association has produced the annual report with Idexx Laboratories Inc. for the past three years.

Practice revenues increased a mean of 5.1 percent from 2013-2014, averaging across thousands of AAHA-accredited and nonaccredited animal hospitals. The number of active patients, or patients with at least one transaction during the year, increased a mean of 0.9 percent. Patient visits increased a mean of 1.4 percent. Visits were up a mean of 1.9 percent for dogs, but down a mean of 0.4 percent for cats.

Twenty-four percent of hospitals saw revenues increase more than 10 percent, with active patients increasing a mean of 9.0 percent at those hospitals. Fifty-one percent of hospitals saw revenues increase 0 to 10 percent, with active patients increasing 0.3 percent. Twenty-five percent of hospitals saw revenues decline, with active patients decreasing 5.4 percent.

The 2015 report included results from a January 2015 survey by Idexx of 1,001 dog and cat owners who visit a veterinarian regularly. Ninety-three percent of respondents believed the bond they have with their practice is important to their pet’s health.

The survey revealed that, among the reasons that clients stayed with their current veterinarian, the veterinarian explaining things in an understandable way was important to more pet owners than reputation, cost, or level of medical advancement. Dr. Cavanaugh said, “The level of medicine you provide won’t be appreciated if you can’t make it understandable and relevant to pet owners.”

Sixty percent of pet owners had switched their veterinarian sometime in the past. Six in 10 switched for reasons beyond the veterinarian’s control, such as moving or the death of a pet. One in 10 switched because of cost, while three in 10 switched because of communication or customer service issues.

Other findings from the survey include the following:

• Three in 10 pet owners said they “always” agree with their veterinarian’s recommendations for blood work. Eight in 10 who don’t always agree would probably say yes if the veterinarian explained the value of the test.
• Six in 10 pet owners research their pet’s health online before or after veterinary visits, but only three in 10 pet owners currently receive recommendations from their veterinarian for trusted online resources—which reduces the use of search engines for pet health research by 30 percent, according to a previous Idexx survey.
• Nine in 10 pet owners view discussions of preventive care as important to their pet’s health, but only six in 10 pet owners recall having these discussions at their pet’s last checkup.
• Six in 10 pet owners said they are willing to book their next appointment before leaving the building, and nearly half of pet owners said they prefer to do so as long as they receive a reminder. The preferred reminder method for upcoming appointments was receiving something in the mail.
• Eight in 10 pet owners indicated interest in payment plans for preventive care, and income did not determine the level of interest.

Client retention via practice management

The daylong track on growth through client retention covered data integrity, reminders, and schedule mastery. The speakers were Jason Wernli and Scott Harper of allyDVM Inc., a company that provides software and advisory services for veterinary practices.

Wernli and Harper have found that, from the angle of practice management, client retention is generally the most important driver of practice growth and generally the easiest to influence. In a March 11 national sample of 133 typical practices among those allyDVM Inc. serves, the client retention rate was 74 percent over a 12-month period for clients active in the past 18 months.

“As we tighten up our retention protocol by going after missing reminders, other pets past due, correcting data, we are plugging holes in the bucket,” Wernli said.

The integrity of client and patient data is key to client retention, Harper said. Of primary importance are keeping clients’ contact information clean and current and ensuring that reminders are properly configured for each patient.

Harper said practices can assign staff and use software to keep data clean. When calling with a reminder of an upcoming appointment, a staff member can take steps such as asking for the client’s email address or recommending that the client schedule appointments that are due for other pets.

In the allyDVM sample, practices had email addresses for 59 percent of clients, although 9 percent of the addresses were invalid. These practices also had cell phone numbers, listed as such, for 59 percent of clients.

The sample revealed opportunities in the area of reminders, by looking at pets that had an appointment or transaction in the past 24 months. The mean number of medical reminders per pet was 4.3 for pets with at least one reminder for medical services and products including examinations, vaccinations, and medications. Twenty-five percent of pets had one or fewer reminders. Forty-three percent of medical reminders were past due, and 59 percent of pets had at least one reminder past due.

Wernli noted that practices can issue medical reminders and reminders of upcoming appointments not only through postcards and phone calls but also through email and text messages. Practices should send medical reminders well ahead of the due date. Issuing reminders electronically first is less expensive than starting with a postcard if the practice’s communications system is able to shut off delivery of reminders once the client has scheduled an appointment.

Booking the next appointment before the client leaves the building has a number of advantages, Wernli said. Rescheduling appointments as necessary is easier than getting clients to schedule appointments after leaving the practice. Forward booking can result in a reduction in reminder costs, a more consistent appointment schedule, the ability to right-size staff, and better compliance with preventive care.

In the allyDVM sample, the no-show rate for appointments was 9 percent, going by the definition that the client is a no-show and the practice cannot fill the slot. Harper suggested overcommunicating to remind clients of upcoming appointments and rescheduling no-shows as soon as possible. Practices can examine their no-show and walk-in rates, then decide whether to institute a policy of some overbooking.

Harper advised not giving up on seemingly lost clients. He said practices can recapture many of these clients by sending additional medical reminders three to six months after the patients are past due.

Related JAVMA content:

Report highlights growing practices (May 15, 2014)

Revenues rise with patient visits (May 15, 2013)

Veterinary visits increase slightly (May 15, 2012)