Improving pet care by getting clients in the door (Proceedings)

Part of the reason technicians, doctors and other team members choose to work in the veterinary field is because they care about pets and want to see them get the care they deserve. Unfortunately, results from the recently released Bayer Veterinary Care Usage Study indicate many pet owners don't understand the need for what is generally accepted as routine care.

More than a few reports have shown that the economic recession of 2007 to 2009 had a negative impact on the number of patients seen at many companion animal veterinary practices in the United States. There is also substantial evidence that the erosion in the number of patient visits began well before the start of the recession. The prospect that the number of dog and cat visits to veterinary clinics was decreasing at a time when the pet population was increasing raised concerns about whether pets were getting adequate veterinary care, as well as what impact this decrease might have on the economic state of the veterinary profession, and whether the trend toward fewer veterinary visits was reversible.

The Bayer Veterinary Care Usage Study was designed to confirm the decrease in the number of patient visits that has occurred over time, to identify factors responsible for this decrease, and to identify specific actions that companion animal practitioners could take to encourage more frequent veterinary visits for dogs and cats in order to reverse the trend. The study was a collaborative effort between Bayer Animal Health, the National Commission on Veterinary Economic Issues and Brakke Consulting, Inc. and included in-depth interviews with companion animal practice owners, qualitative interviews with pet owners and a robust, statistically valid national online quantitative survey of pet owners.

The study identified six factors that have contributed to the decrease in visit numbers. Three are considered to be environmental factors:

     • 2007 to 2009 US recession—The recession and resulting unemployment had negative impacts on spending for veterinary services, exacerbating the decline in visits that had already been occurring

     • Fragmentation of veterinary services—There were more points of care and a wider variety of veterinary services available to pet owners; while this didn't contribute to the total decrease in veterinary visits; it meant that pet visits were spread out amongst more practices

     • Proliferation of Web usage—Pet owners frequently consulted Web sources regarding pet health issues, rather than calling or visiting their veterinarians

There were also three client-driven factors as follows:

     • Inadequate understanding of the need for routine care, particularly examinations—Many pet owners primarily associated veterinary care with vaccinations (i.e., shots) and because their pets did not require vaccinations as frequently, visited their veterinarian less often

     • Cost of veterinary care—Many pet owners expressed shock at the size and frequency of price increases at their veterinary clinics and did not find value for the price paid

     • Feline resistance—Because many cats aggressively resist being put in carriers and transported to the veterinary clinic and show signs of stress during veterinary visits, many cat owners deferred taking their animal to the veterinarian

While the recession and the fragmentation in the veterinary market are difficult to deal with at the practice level, there are many things everyone working in a veterinary practice can do to reverse the other four factors causing declines in veterinary visits.

The use of the Internet by pet owners is the first area practices need to focus on. A key finding from the study indicated that pet owners depended less on their veterinarian for veterinary medical information than they used to because of the ready availability of information via the Internet. In the online survey, 39% of pet owners agreed with the statement that they look online first if a pet is sick or injured and 15% agreed with the statement that because of the Internet they rely less on their veterinarian. Anyone who has worked in a practice for very long knows that this is true and that clients often can't distinguish good Internet information from bad. So what can practices do to communicate better with clients via the Web and make sure clients go to reliable sources? Listed below are some key tactics:

     • Establish your own internet presence via your website, Facebook and other places where pet owners go

     • Provide interesting, updated content about the regular care pets need and common accidents and illnesses

     • Provide your clients with a list of veterinary websites you trust for good quality information

     • Link to these sites from your own website

     • Collect and update email addresses and regularly send your clients information about the care their pets need

     • Set up a system to monitor postings about your practice on the internet and learn how to appropriately deal with negative information

Another key area to focus on is client education. Practices have been working on this for years but we have a long ways to go; many clients still don't understand the need for routine care and the impact that has on their pet's overall health.

In the Bayer study online survey, 36% of pet owners agreed that were it not for shots, they would not take their pet to the veterinarian. Similarly, 24% agreed with the statement that routine checkups were unnecessary. The willingness to forego routine examinations was more pronounced among cat owners than among dog owners. According to the online survey, only 60% of cat owners had taken their animal to the veterinarian in the past year, whereas 85% of dog owners had done so. Among those who said that they were taking their pet to the veterinarian less often now than in previous years, 63% of dog owners and 68% of cat owners said they did not see a need to take their pet to the veterinarian as often; that is, they saw no need for an annual examination.

Pet owners also perceived that some animals needed routine veterinary care less frequently than others. For example, study respondents with pets that lived primarily indoors were less likely to have taken their animal to the veterinarian in the past year. Likewise, pet owners with older animals were less likely to have taken their animal to the veterinarian in the past year. The idea that older animals need less care than younger ones obviously makes no sense; yet many pet owners appear to believe that.

Consider the following actions to educate your clients about the need for regular veterinary care:

     • Develop standards for care within your practice and turn them into a mantra similar to "twice a year dental cleaning" or the USDA "Five a Day" fruit and vegetable campaign

     • Set up systems to communicate this information to every client that walks in the door—assign roles to individual staff members, use checklists, posters, and handouts

     • Educate clients about WHY exams and wellness care are so important—prevention of future problems, longer life for pet, happier/healthier pet now

     • Educate clients about WHAT the exam includes and how this helps you help their pet—one of the best ways to do this is through communication of everything you do—"I'm taking Fluffy's temperature now; its normal" or "I'm looking at Fluffy's teeth—they have some plaque on them—let's set up an appointment to clean those so her breath will be good and an infection in her mouth won't lead to other problems"

     • Develop client friendly communication materials in multiple media formats—people take in information differently (hearing, reading, seeing) so provide information in different formats—brochures, your website, podcasts, posters & models

     • Provide your clients with a list of veterinary websites you trust for good quality information and link to these sites from your own website

     • Collect and update email addresses and regularly send your clients information about the care their pets need

     • Train doctors and staff members to talk in a pet-owner friendly manner about common recommendations and conditions—make sure you're all communicating the same message

     • Expand your reminder system to include more clients and more types of reminders—use benefit and value oriented language

     • Use multiple formats for reminders and communications: email, texts, phone calls, mail

The third area to focus on is related to price. Pet owners have definitely noticed the rising cost of veterinary care. As one pet owner in the Bayer study focus groups said, "All of a sudden, the price just skyrocketed. You could go when it was 60 bucks, now I can't get out for less than $150."

Similar findings were obtained with the online survey, with 53% of respondents agreeing with the statement that veterinary costs are usually much higher than expected. Furthermore, 26% agreed with the statement that they consistently looked for less expensive veterinary options and a similar percentage agreed with the statement that they would switch veterinarians if they found a less expensive one. Another section of the online survey attempted to measure pet owner satisfaction with their regular veterinary hospital with regard to various attributes. Veterinary practices scored lowest on value of services and payment options.

Pricing is a complicated issue and isn't just about the absolute dollars charged for a service. Pricing is also related to the value perceived by the client for the care provided. And even if the price and the value are acceptable to the client, if they don't have the money in their checking account, they aren't going to be able to afford the services. Therefore the availability of payment options is also critical. In addition to the recession, clients are dealing with the increasing costs of veterinary care resulting from the availability of more sophisticated medical options, the extended life span of pets which results in more routine care spending as well as an increased likelihood of the pet developing a serious and/or chronic disease and fee increases well above the rate of inflation. Even clients who are fully committed to providing quality care are looking at payment alternatives.

Payment options for clients generally fall into three categories: in-house delayed billing of various types, third-party payment plans and pet insurance.

While practice owners don't want either themselves or their staff to function as insurance sales people or credit card vendors, those who work in practices already regularly recommend to clients products and services not carried in the practice. Examples include obedience training, pet day care centers, groomers, pet sitters and a wide variety of dietary and other products. Doctors and staff take the time to understand those products enough to be comfortable with the recommendations and help clients understand the options because they think they are of value to the client in taking better care of their pets. Why is it any different with financial products that allow clients to provide more comprehensive care? Not only do pets benefit from the improved care; veterinary practices benefit because clients who have the financial ability to pay for better care help us practice the kind of veterinary medicine we want to practice and improve the profitability of the practice. A sophisticated study conducted by Veterinary Pet Insurance, one of the largest pet health insurance companies, showed that the company's clients with pet health insurance on average had 41% higher stop-treatment levels, scheduled 40% more veterinary visits, and spent twice as much on veterinary care over the life of their pet. A cardholder survey by CareCredit, one of the leading third-party medical financing companies, revealed that 71% of cardholders said that having this financing option affected their decision as to the level of treatment they can provide their pet.

In order to effectively recommend these payment options, veterinarians and their staff must first of all understand the products themselves. Recommendations to clients are most helpful when they include not only a general recommendation for a kind of product but a recommendation for a specific brand along with the reasons why the practice thinks this product is the best one and a company the practice has had a good experience with. This is no different from medical products; clients don't just want to know that their pets should be on heartworm preventative; they want to know which brand your practice recommends and why.

The last area to be focused on in this session is that of feline resistance. During the Bayer study pet owner focus groups, it became evident that cat owners found taking their animal to the veterinarian highly stressful for the animal and themselves. They indicated that their cats hid when the cat carrier appears; aggressively, physically resisted being put in the carrier; cried during the car or bus ride to the veterinary clinic; showed signs of stress and fear in the waiting area, particularly when dogs were present; displayed physical signs of tension during the examination; and acted remote and unfriendly for several days after returning home. Results of the online survey highlighted the importance of this problem. Only 83% of cat owners who responded to the survey said their animal had a primary veterinary clinic, compared with 91% of dog owners. Of those animals taken to the veterinarian, dogs had visited a mean of 2.3 times during the preceding year and cats had visited a mean of 1.7 times during the preceding year. In measuring pet owner attitudes toward taking their animal to the veterinarian, cat owners had more negative ratings than dog owners for every attribute, including such items as "Would not take my pet to the vet if vaccination not needed" and "My pet hates going to the vet".

A critical area for practices to focus on is increasing their Cat Friendly Practice quotient by taking some of the following actions:

     • Identify all the cats owned by your clients, put them in the reminder system and talk to them about the care needed

     • Train doctors and staff about cat issues and healthcare—AAFP/AAHA Feline Life Stage Guidelines are a great starting point

     • Help owners comply with veterinary recommendations—think about long acting or once a day medications rather than three times daily treatments

     • Help cat owners understand the need for care—a booklet called: CATegorical Care: An Owner's Guide to America's #1 Companion from the Catalyst Council is an excellent resource

     • Promote cat-friendly handling—train staff members who don't have experience with cats

     • Help owners learn how to acclimate their cat to a carrier & properly transport it to the practice

     • Offer kitten kindergarten classes

     • Set aside part of your reception area as cat-friendly

     • Consider separate cat and dog entrances

And don't forget to make it as easy as possible for clients to visits—anything that increases convenience increases visits:

     • Book the next appointment before the pet leaves the practice and explain why

     • Send reminders religiously—postcards, email, text messages

     • Make scheduling available online

     • Remind clients by telephone and/or email 48 hours before appointment

     • Consider extended hours

     • Let clients know you offer drop off services

Getting clients in the door is the first step to providing better care for their pets and there are many things everyone in the practice can do.