Is your practice really 'alive'?

What is happening in your practice; what is going on that would let staff, clients, patients and the neighborhood know that the practice is alive and thriving?

We could work on the historical average client transaction, but the newstandard for profit is rabies ratios. In short, the rabies ratio is a convenientmethod to determine how much is earned per patient. And a practice thatis "alive" has a rising rabies ratio.

Do some or all of the following and your gross veterinary revenues willincrease by $50 per patient per year. It is assumed that most practicesdo many of these things on a regular basis. If you are already doing allthe following, then consider this column a review.

* Item 1: Three Visit Rule. It is so easy to treat ear infectionsover and over. It is too easy to drain anal sacs over and over. And of course,it is really easy to treat allergies over and over. An arthritis case canbe treated over and over. The Three Visit Rule goes like this: if you seethe same patient three times in a row for the same condition without reallyresolving or making progress, revisit the diagnosis and therapy plan. After,or at the third visit, review the diagnosis and the therapy plan for anupdate, a literature review or call a colleague. Maybe the time has comefor another culture or a Lecroix Zepp surgery. Perhaps anal gland removalis necessary. Perhaps another strategy is needed for allergies or the arthritisis cauda equina and the time has come for decompression.

To get out of ruts, take a critical and new look at old patterns andgood things happen.

* Item 2: Is Your Premise Alive? Take a walk around the clinicand the grounds. Is it dead, sluggish and boring? Perhaps the time has cometo prune the trees, put in a planter, paint the shutters, put in a parkbench, solar lighting or add a yard sculpture-even if it is just a snowmanfor now.

Be ready for spring with flowers and/or planting a theme tree in memoryof something. A new mailbox, repaving the parking lot and adding new stripescan refresh the outside clinic area. Even if all this is happening in thepractice now, a new flower arrangement, a new mirror, a new piece of artand perhaps a new dress code for the front staff to look sharper and moreattentive.

Something new and bright lets folks know that attentiveness is the orderof the day. Putting a smile on the premise can put a smile on clients andstaff.

* Item 3: Smiles at the Front Desk. And speaking of smiles, takea critical look at the front office. Double check to make sure every clientis greeted and sent home by a smiling staff member. Help clients to thecar with food, have the front make sure that all client questions have beenaddressed and answered.

* Item 4: Audit Records. Please note this does not say audit "books,"it says "records." And please do this everyday. Assign someonedifferent to review all inpatient medications, duties and services to makesure all is recorded in the medical record and is also on the invoice. Then,at the end of every day, compare the invoices with the medical record toensure a "match." Expect that a few weeks will be needed to cutdown the errors.

Be prepared for a bit of a surprise.

* Item 5: Rhea Morgan's Handbook of Small Animal Practice. Thisbible has just come out with the 4th edition. And what a treat it is forthe clinician. Make sure to look up at least one case a day; truly onecase a day is all it takes, especially if it is something you already dopretty well. A fresh look at the differential, diagnostics and therapiesmight stimulate some new thoughts.

Take Cushing's for example. Over the past few years, the ideas aboutdiagnostic tests, sensitivity and specificity has changed. This presentschallenges and messages for those listening.

* Item 6: Individualized and Written Home Care Instructions forEveryone. It is still happening; most folks forget most of what we presentto them before they get home. Even our best clients forget some of our bestsuggestions. And guess what? How can they follow instructions when theyhave forgotten them?

There is a stinger here. The written home care instructions must be presentedto the client in the peace and quiet of the exam room, not at the frontdesk. It must be a separate document than the invoice.

* Item 7: Conference Room.As the years have gone along, more andmore practices have begun incorporating a conference room in their floorplan. The challenge now is to use it more.

The deal is this: make sure all cases that are going to be $200 or moreare presented to the client family in the room without the pet there todominate the dialogue. Present the treatment plan in this room, have anX-ray viewer and visual aids present. Ensure client comfort with a warmenvironment and comfy chairs for all. If it is a release conference, reviewwhat happened and why their pet received the care that was indicated.

Be proud of the care given to patients, show the client the X-rays, theintensive care area, the dental models and, yes, dress and look like a professional.

* Item 8: Email. Most of our clients have email. And the goodclients are going to have some afterthought questions. During the conference,we can put their mind at ease-when they get home and some questions popup ­ by encouraging them to email the staff, and let them know theycan expect an answer within 24 hours, seven days a week.

If they don't have email they might have a FAX. Provide a blank FAX sheetfor them to FAX questions to you and respond by FAX. We can respond to aFAX at our convenience within moments of its arrival during business hours.

Many good clients have many good questions but they don't want to botherthe staff. Put them at ease and make it easy for them to communicate withyou without the telephone snafus.

* Item 9: Conservative, but Visible Sign. Look at the clinic sign.Go out a take a drive around the neighborhood. Drive by the clinic a fewtimes. Is the sign visible, is it appropriate to the services provided withinthe clinic, does the sign need painting, a new light, or replacement?

If the sign is perfect, maybe enhance it with a birdhouse on top. Makeit interesting. During holidays add some cheer to the sign. My favoritegag is to have Santa Claus "smashed" into the sign on a broomstick.

* Item 10: X-ray Work-Up. Take a good look at your radiology department.How do the films stack up? Get an outside opinion. The truth is many filmsfrom many clinics would enjoy a facelift with new cassettes, a processor,new film or, yes, a new machine. How about just retooling the techniquechart? One chart for soft tissue (low mas) and one for bone (hi mas). Andmaybe even separate technique charts for dogs, cats, birds and other exotics.

The good news is that little things can really improve the diagnosticquality of the films which just might prompt you to take more films.

Worried about more radiation? Sorry, the reality is that many practicesand their patients would benefit from more and better films.

* Item 11: A Mentor. It does not matter how old, or how young,or even how skilled we might become or success that we have encountered.To get to the next level a mentor is really an aid these days.

"Spam" is not only found on the Internet. It plagues everydaylife as well. Sometimes it is hard to know what to do.

The way to learn is to listen, listen, listen. We also need to talk toclarify our own thought processes. Talking in the mirror is good practice.An outside, objective ear is also good for objective input.

* Item 12: Echo 1 More a Week. Most of us have access to ultrasoundthese days, by referral, in-house or by the traveling ultrasound clinician.Yet no matter how many patients we echo, the range of skill and the broadeningof the mind with more access and increased numbers of cases add to the enjoymentof life in practice.

The Handbook of Small Animal Practice is only one place to get an ideafor echoes, as the differential provided with each case situation most certainlywill get the creative mind flowing to, "I wonder what this would looklike...?"

* Item 13: Candy. Some of us are really shy and just cannot breakthe ice. And sometimes we are thinking or trying so hard to do such a goodjob we forget that smoke coming out of our ears can intimidate clients.

The fun for me is this little known fact -"Visiting a veterinaryoffice has been shown to cause a chocolate deficiency." And guesswhat? Hardly anyone argues.

The key here is to get good candy - Mini-Snickers, Reese's Peanut ButterCups, Hershey's and Mini Kit Kat go down nicely.

Those who know me well know that I am and have been painfully shy. Candyhas been the ice breaker that opened up the world for me. Try it, you'lllike it.

Another little-known philosophy is, "Make it fun and they will come."Admit it. Going to the doctor, the dentist, the lawyer or the accountantare just not fun.

The "make it fun" rule applies to everything: family activities,professional meetings, house warming, open houses and going to the veterinarian.

Make sure there are toys for the kids, interesting reading, hot coffee,tea and pastries at the front counter.

The fun goes for the pets as well. Treats are really popular for dogsand catnip for cats. Silly discovery: human animal crackers are quite thehit with dogs and birds.

Put some of these ideas to work. If you already are doing them, workon making them better.