Space on your client's invoice the final frontier

One of the exceedingly few things that separate humans from the rest of the animal kingdom is our ability to use tools to accomplish our purposes. Except perhaps some sea otters dining al fresco in Pacific kelp beds, this appears to be a significant demarcation. (I've also seen great apes use sticks to dip into termite mounds for a protein treat on Animal Planet.)

INTRAVENOUS FLUID THERAPY $73.20

Thirty years ago or so, the only way to make a (Schroeder) Thomas splint was to buy a stack of a dozen six-foot-long aluminum rods, which we jammed into a hiding place in the kennels to season and collect dust in preparation for our next off-leash femur-fender kiss.

When that day came, we took off all the sticky tape from around the bundle of rods looking for just the right diameter and retaped the remaining rods. That was the easy part. Then we had to find a round object just the right diameter for the femur in question. A No. 10 tin can was often part of our inventory for this purpose, and gallon shampoo bottles or two-liter soda containers were not out of the question. I can even remember using a fat magic marker and a paper clip to make a splint for a parakeet until I mastered using a 25-gauge needle as an intramedullary pin.

We would bend the aluminum rod around a round object, twist and turn and maneuver the rod to custom fit it to each patient. Then we used a couple of pounds of cotton roll and six miles of adhesive tape to complete the project.

HOSPITALIZATION PER DAY (DOG less than 25 LBS) ... $67.80

Today, some practitioners still do it the old-fashioned way. Many others, however, buy ready-made adjustable and reusable splints of harder steel that can be set to fit a wide range of patients in a magic minute.

Let's try to use this as an analogy for preparing our estimates and invoices. We can seldom hope to remember the many details of each procedure that we perform, but we can prefab a standard that covers at least 95 percent of what we do. This standard is henceforth dubbed a bundle or a macro, depending on your computer system, but the result is that inputting one single number prints out, for estimates or invoices, the myriad of details that we often neglect to itemize, robbing our client of the unfathomable opportunity to fully appreciate the depths of their pet's care.

GENERAL ANESTHESIA PET, less than 25 LBS ... $108.15

Let's take a very simple bundle, as the computer would list it on the invoice, as an example.

Simple, isn't it? Whatever you decide for a fee or your standard maintenance, it goes as a subparagraph, and one code tells it all. Don't take the fees in these examples as recommended for your practice; that is a strict function of your demographics.

Clients getting bundles better appreciate the reasons for the fee, and you have been paid properly for an average procedure. Yes, some would need less than three flushes and others might need more; some catheters lose their caps, and others stay rock solid. It is not worth debating. Create an average and stick with it as a one-number entry. Whether or not you add or subtract the number, the skeleton is there for you to ponder just one time only, and clients will appreciate it. Needless to say, bundles are amended easily as we discover our human failings in their preparation.

ABSCESSES/DENTAL DISEASE RX ... $473.70

Want some more examples? Visit www.vethelp.us. Let's try another in the meantime.

The beauty of packages such as these is in its simplicity. In my hospital, procedure 677 spit out all of the above. No. 678 is for 26-50 lbs; 679 for 51-75 lbs, and 670 is for more than 75 lbs. I then add extractions as required, as well as No. 1244 for dental care post prophylaxis. These items include appropriate pharmaceuticals or home-care products.

Taking a half hour or so to input any bundles saves hours and prevents missed income, every single day of the rest of your practice life. Take the time ... do it right! Live well and prosper!

Thinking it through

If a veterinarian takes just five minutes to create an estimate that could be standardized like the example presented, the practice must charge $17.95 to recoup the cost of preparing the estimate, that is for a $60,000/year associate. If the owner is doing the estimate, the same five minutes equals $35.90. Repeat this three times a day, and you blew $32,956 in otherwise billable time.

For most practices, a technician performing this five-minute function still means that $9-$12 must be made up somewhere in order to fulfill the rule that paraprofessional expenses must never exceed 20 percent of gross.

Dr. Snyder, a well-known consultant, publishes Veterinary Productivity, a newsletter for practice productivity and is available for in-practice consultation. He can be reached at P.O. Box 189, Hebron, KY 41048-0189; (800) 292-7995; vethelp@insightbb.com; Fax: (859) 534-5265.