Written By: Dr. Jennifer Fletcher, Animal Hospital of Dauphin County
As veterinarians, we have two main goals: keeping pets healthy and their owners happy. We examine animals and administer vaccines to protect them from infectious disease, but all too often we find ourselves treating dogs and cats for chronic conditions that require lifelong medications and monitoring. The move toward preventive medicine is becoming more imperative as the cost and standard of care rises. The cornerstone of moving your practice towards preventive medicine is a wellness program. By creating a comprehensive plan and thorough training of our staff to embrace “wellness,” we now have a foothold in moving our practice towards preventive medicine. We implemented our program two years ago at the Animal Hospital of Dauphin County and have seen many benefits of transforming the way we approach wellness in our patients.
Establishing a comprehensive plan
The first step in establishing our wellness program was determining the components of the program. Every practice may take a different approach but we elected to streamline the wellness exam, provide stage-specific blood panels at a discounted price, administer lifestyle specific vaccines, discuss current diet and recommend year-round flea/tick and heartworm prevention. We tried to keep it as simple as possible for our clients so they would not feel overwhelmed or confused by the choices that we offer. With time being a limiting factor in the exam room, becoming efficient with recommendations and discussion of wellness was one of our greatest challenges.
For the wellness exam, we utilized our electronic medical record to start our recommendations before the client even enters the hospital. Our veterinarians will research the medical record of each wellness patient on the schedule that day and pre-load the patient list with the vaccines, blood testing and preventive products they recommend based on the patient’s lifestyle and medical history. We also created Feline Wellness and Canine Wellness exam templates. These templates include questions our technicians ask our clients in the exam room. These questions cover current problems or concerns, diet (what brand of food and how much they are feeding), flea/tick/heartworm prevention if they currently use it, at home dental care, lifestyle of the pet (boarding, grooming, etc. for dogs and indoor only, indoor/outdoor, outdoor only for cats), and infectious disease testing (heartworm, tick-borne, FIV/FeLV). Through training and discussions at staff meetings, the technicians transformed these questions into a dialogue with clients rather than peppering them with questions. Finally the technician opens the computer invoice and discusses wellness bloodwork and other recommendations the veterinarian has made.
For wellness bloodwork, we created a set of blood panels that include a CBC, chemistry, and a fecal float but may also include thyroid testing and a urinalysis based on the age of the patient. We are able to offer these panels at a discounted price to our clients through an agreement with our external laboratory. We propose annual wellness bloodwork for all patients and infectious disease testing yearly in dogs and based on lifestyle of the cat.
Changing your message — vaccines to wellness
The next aspect we changed about the way we practiced was our message to our clients. We no longer ask owners to set up their “vaccine appointments,” but instead, to have them schedule their “wellness exams.” The word wellness definitely alerted a change in our clients. The most commonly asked question was, “What do you mean by wellness?” Through interactive staff meetings based on communication techniques, we trained our staff to use this opportunity to explain that we want to not only administer vaccines but also ensure their pets’ overall health status by discussing weight, diet, parasite preventives and any other concerns the client may have. About one year after instituting our program, our clients now call to set up their wellness exams. By changing one word, we also changed how our clients saw the value of their annual or semi-annual appointment.
First and foremost, everyone on the staff must be on board with the program and believe in the value of wellness and preventive care. The best way for staff to feel a part of the program is to be participants themselves. We encouraged our staff members to have wellness bloodwork performed on their own cats and dogs. We embraced the “practice what you preach” mentality.
We also used the opportunity of our staff pets’ bloodwork to educate receptionists and technicians about what the values mean. The more your staff knows about their own pets’ health, the more they can convey this to the client. Our clients especially take what we do for our own pets into consideration when making decisions for their animals. There is no stronger recommendation than one you would make for your own dog or cat.
Introducing the wellness program to the clients
For the most part, our hospital had always been recommending preventives and lifestyle-based vaccinations. With the introduction of the wellness program, we made it more visible to the client with visual aids and a consistent message. Our emphasis on wellness to our client starts with the receptionists scheduling and confirming the appointment; it is then reiterated in the exam room by the technicians and doctors and is again, reinforced by the receptionists and technicians with follow up calls. By doing this, the client feels the entire practice is on board with recommendations and is more likely to participate.
When our receptionists schedule and call to confirm the appointment, they remind the owner to bring a fecal sample (as all of our wellness bloodwork panels include a fecal float). In the exam room, we have posters explaining wellness bloodwork and show what each panel includes, the cost of the panel and the discounted savings to the client. It’s a great visual tool and shows the client the value they are receiving. Finally we use our EMR system to our advantage to create callback reminders for vaccines (if starting a series and needing boosters) and dental recommendations. The receptionists call owners reminding to set up their technician appointment for the booster vaccine or to ask them if they would like to set up the dental cleaning procedure that the doctor recommended at their exam. The follow up calls have increased client compliance and show our clients are commitment to wellness in their pets.
Especially in the first year of our wellness program, our clients felt slightly overwhelmed or unprepared for the cost of the wellness bloodwork. Because of this, we allow clients to set up appointments with our technicians within 3 months of the wellness exam to take advantage of the blodowork prices and to have infectious disease testing performed without another exam by a doctor. Many clients enjoy this option as it allows to discuss it with family members at home or to spread out cost over two visits.
Showing clients the value — sharing stories of success
Our hospital has certainly seen the value of the wellness program along with our clients. Not only have we established “baseline” bloodwork values for patients who appear healthy, we have also detected early or subclinical disease in a number of patients. We have diagnosed early stage chronic renal failure where a diet change is the only treatment needed, instead of discovering it when the patient is severely azotemic and clinically ill. Additionally, we have revealed hyperthyroidism and diabetes mellitus before patients have developed hypertension, heart murmurs, weight loss and ketosis. By far one of the most rewarding examples of the success of wellness bloodwork was a case in which we diagnosed thyroid cancer in a dog whose only clinical sign was a three pound weight loss. We relay these stories of success with all of our clients in the exam room. We emphasize how animals can “hide” disease and that early detection is the key in the management of most chronic conditions. By detecting disease early, we can increase a patient’s quality of life for longer and most likely for a lower cost to the client as well.
Overall, the wellness program at our hospital has been a win-win situation. Our patients are receiving a higher standard of care and their owners are becoming an active participant in their pet’s health. Many hospitals already recommend and perform many components of a wellness plan, but making it visible and valuable to the client is the key. A straight-forward comprehensive plan will help move your practice towards success with preventive medicine.