Don't blame ailing revenue on recession

Recently, our office has received an increased volume of calls asking the universal, paranoid practice owner question: "How are other practices doing this quarter?" The query reflects the doctor's concern that perhaps something is afoot other than external factors such as couch-potato clients watching the war in Iraq on Fox television; or, perhaps, the fact that multiple layoffs at local industries could be impacting; or, perhaps, fear of SARS is keeping clients at home.

The fact of the matter is, most practice owners are reluctant to pointa finger at some uncontrollable outside force threatening practice revenues.

Rather, most become suspicious that practice internal controllable factorsare at play. As one practice manager said: "I am worried we are doingsomething wrong."

Many times, this fear of doing something wrong is related to fee schedules.Maybe the practice's fees are too high. Maybe clients are seeking serviceselsewhere. Maybe veterinarians have priced themselves out of the market.

Fee structures to blame?

Wait a minute. There are many other issues you should consider beforejumping to the conclusion that fee structure is the internal issue at play.Most practices have extraordinarily reasonable fee structures, comparedto the expertise and quality veterinary care provided. Most evidence suggeststhat tremendous elasticity in veterinary fee structures exists and thatmost practices have quite a bit of latitude for judicious fee increaseson various services before complaints will arise.

Beyond failure of the reminder system, because someone forgot to printthem, post them or the computer software failed to print all of the reminderstruly due, what else should you be thinking?

The answer is clear: Who is answering the practice's telephone? If businessis down, perhaps the message potential clients hear when they call is acomplete turnoff. Is someone turning them away before they even have a chanceto see you at the exam room table?

Some practitioners have reported the worst possible situation: a surly,unhappy receptionist or technician picks up the phone and slams it downwithout even finding out who is calling. This person is so busy and overwroughtthat she cannot bear the thought of making another appointment. When thephone rings, they choose to ignore it or simply hang up on the caller.

Are you listening?

Usually, the situation is not quite that bad, but have you really listenedto what your employees say when a call comes in? Perhaps a bit of phoneespionage would be in order.

Recently, we had the opportunity to secretly conduct staff reviews viaphone espionage for several clients. What we found astounded us, especiallygiven the high standards to which these practices aspire. Staff trainingand continuing education is ongoing. Regular meetings ensure everyone isup to speed on client queries that may arise.

Some of these practices have trained practice managers at the helm whoreally take it personally when an employee does not do as good a job asshe thought the individual was trained for.

In one practice, income for the first quarter of 2003 has been significantlydown from last year. When calling, my assistant, Sue, posed as a pet-ownerinquiring about services for two of her cats. One had blood in the stool.The other was a kitten requiring vaccines, spay and a declaw. The mistakesmade by the receptionist included:

· She did not inquire as to whether the caller was a new or existingclient.

· At no time was any effort made to establish an appointment,for one cat or the other.

· The correct fees for various procedures on the kitten were incorrectlyquoted.

· The receptionist expressed a strong opinion that the surgicalprocedures were "very expensive".

· The receptionist expressed no interest in nor did she ask anyquestions about the ill kitten.

· The receptionist did not ask for the caller's name, telephonenumber or any other information that would potentially lead to an appointment.

More calls

In another espionage call to a different hospital in a different state,Sue posed as a pet owner seeking information about vaccinations and spay/neuter.Although the hospital employee was cheerful and pleasant, just as in theother consults we performed, the following problems were noted:

· Too much scientific information was provided that flew overthe head of the caller.

· Confusing and misleading information was given that was notin accord with hospital policy.

· The technician vowed with absolute authority that vaccine procedureswould cause no harm whatsoever to the pet.

· No effort was extended to obtain any information about the caller,or offer to establish an appointment.

· We observed mediocre presentation skills about the various qualitysupport care services provided at the point of surgical procedure, suchas pain management, pre-anesthetic laboratory testing, and comprehensivephysical examination.

Make it happen

We could give you a few more examples, but let's move to suggestionsand solutions. First, please ensure every employee who might be answeringthe telephone understands this message: Any caller who has taken the timeto find the practice's telephone number and make the call has a problemthat he/she wants solved. It is your duty to help that client get the informationand professional attention needed through an established appointment.

The second issue is to make sure your employees understand that thereis no way they can fail when dealing with a telephone call. One reason appointmentsmight not be made for callers is because the employee is afraid to makea mistake. All of us deal, from time to time, with questions we cannot answer.Each employee needs to understand that an excellent phrase to state withconfidence and authority is this: "That is a good question. I don'tknow the answer, but I will find out for you. Please give me a phone numberto call you, and I will get back to you promptly."

Or, alternatively: "That's a good question. Let's schedule an appointmentso you can speak to the doctor who can resolve the issue for you. Is 2:00tomorrow afternoon a good time for you?"

Practice makes perfect

Here are a few standard questions your employees should be practicedat using:

If the caller is not known or the name is not recognized, the receptionistshould ask: "Are you an existing client, or are you new to our practice?"

If an existing client, the staff member should politely ask for the client'sfull name and name of pet.

If the caller is a potential new client, then at some point, the receptionistmay want to say at an appropriate point in the conversation: "Sinceyou have not been to our practice before, let me tell you a little bit aboutus."

When issues of fee-shopping occur, use this phrase as suggested by Dr.Wayne North, consultant: "For all of these services, we charge only$______."

Each employee with phone answering responsibilities should clearly understandat what point a caller problem indicates urgent or non-urgent care. Foran excellent training reference and flow chart to assist in a variety ofcalled-in medical dilemmas, consider "The Veterinary Receptionist'sTraining Manual" by Drs. Jim Wilson and Carol McCormick, AAHA Press(phone: 800-252-2242).

If a caller refuses to schedule an appointment, but has been lookingfor information, try the following: "May I send you some additionalinformation about our practice?" Or, if your practice maintains a currentand active Web site, "If you would like more information about theservices we provide and also access to excellent articles about pet care,you can visit our Web site at ___________."

Don't take employees' effective response to incoming calls for granted.Many employees have not had adequate training that allow them to "closethe sale". Many employees need booster shots to practice through role-playingeffective phone techniques. For every telephone call a practice receives,there is an opportunity to establish a long-lasting relationship with aclient.

No employee should ever lose sight of the responsibility for giving theclient the opportunity to establish a bond with the practice. This responsibilityto the client and pet can only be met by making the appointment at the pointthe individual calls.