What you need to know about equipment selling categories

Editor’s Note: The following is the final part of Vet-Advantage’s series of articles on equipment selling. Products are broken up into categories, with explanations on the medical necessity of the product, as well as selling points for reps and why veterinary clinics will benefit from the equipment.

Anesthesia
Anesthesia units, which come in wall, stand and tabletop configurations, are essential to a veterinary practice. Unlike in human health, veterinarians can’t perform procedures without putting the animal under anesthesia. This is for the protection of both animal and clinician, as animals aren’t cooperative during even minimally invasive procedures, whether it be dental treatments such as teeth cleaning, or the removal of a growth such as a cyst.
Anesthesia units are often a forgotten piece of equipment in a veterinary clinic. That’s because the core part of the machine is built to last. Reps should observe each piece of equipment; often there are opportunities for replacement parts in rubber seals and gaskets, and manufacturers often have replacement kits and online demos of how to replace those parts and do leak tests. Eliminating leaks saves the vet clinic money on oxygen and gas cylinders, thus you’re adding value to the customer relationship.

Autoclaves
Steam sterilization, through autoclaves, is the most effective way to sterilize veterinary instruments before use. Autoclaves are a priority in infection control. The heat and pressure from the autoclaves sterilizes instruments, eliminating bacteria and other pathogens, and reducing the risk of accidental infections and biohazards.
Autoclaves improve efficiency. The type of autoclave a practice invests in can have an impact on workflow. For instance, some autoclaves come with automatic shutoff systems, eliminating one step for practice personnel to worry about. Reps should inquire as to the age of the autoclave and whether it’s up-to-date on routine maintenance. Biological indicators can check to see if it is still properly cleaning. A breakdown with an autoclave is a breakdown in infection control.

Centrifugal parasite testing
Centrifugation is the recommended method to process fecal samples for detection of parasites by the Companion Animal Parasite Council (CAPC). Processing fecal samples by centrifugal floatation has emerged as the leading technology due to its improved sensitivity over traditional (gravity) floatation. Not only has centrifugation become a preferred method among veterinary parasitologists, but in addition there are multiple published papers that indicate this methodology has a significantly higher yield of parasites than the traditional floatation. 
Given the zoonotic potential of many parasites, accurate diagnosis is critical to the health of pets and pet owners, says Pam Pasakarnis, Vice President, Sales and Marketing, Iris Sample Processing (StatSpin). Between 20- to 25-million companion animal fecal exams are performed per year in United States.
Bringing this lab work in-house makes sense for veterinarians for many reasons. Veterinarians sending samples to a reference laboratory might be paying $8 to $12 per fecal sample. Some of the large reference labs are doing thousands of samples per night and many processing errors could occur, giving both false positive and false negative results. If the veterinarian brings the process in house they can have same-day results with greater control over the quality of the results and save the $8 to $12 – which can add up. This method is also more accurate than the simple floatation methods, says Pasakarnis, which also gives false negative results, and the pet can be treated sooner and with more confidence in the results. 

Chemistry analyzers
Chemistry analyzers allow veterinarians to run blood work in-house. Veterinarians get test results more quickly than they would sending their tests out to a lab, so they are able to make a diagnosis, recommend treatment options and possibly begin treatment right on the spot. Nearly every test that veterinarians used to refer to labs can be run on an office chemistry analyzer. These include blood chemistry tests, electrolytes, urine-protein creatine ratios, bioacids, T4 and cortisol.
Reps should encourage vets to look at their diagnostics capabilities as that of an integrated system that is designed to work together and to connect with practice management software, reference laboratories, digital imaging, pathology, and consultants, says Gary Eaton, director of sales channels, IDEXX. ÒIf the vet is buying components separately, they will be leaving on the table major improvements in workflow, speed, acquisition expense, client experience/satisfaction, compliance, and better medicine.”
More vets want to link their in-house lab to their billing and invoice system to ensure tests are properly billed. Reps should call on their manufacturer reps to fully understand how a particular analyzer interfaces with the customer’s computer system.
The more diagnostics veterinarians offer their patients, the more opportunities they discover to provide better care and services, setting their practice apart from others.
Chemistry analyzers range in price from $5,000 to $20,000, depending on the testing capability and degree of automation. Customers may hesitate to make a substantial purchase. But, now more than ever, they should be investing in their practice to provide patients and clients with the best standard of care. In addition to the issue of cost, your customers may object to the training involved if they purchase a new system. Reps should remind them that newer analyzers offer greater automation and are very user-friendly.

Cryosurgery
Cryosurgery allows veterinary clinics to freeze and remove common lesions such as papillomas (warts), sebaceous adenomas, skin tags, sarcoids, granulomas, follicular cysts, fibroids, histiocytomas, and distichia.
Most veterinary clinics are using the scalpel removal method, which requires anesthetic, surgically removing the lesions, and sutures. Treatment with cryosurgery is faster, less painful, and more effective.
Veterinarians charge an average of $85 per treatment for cryosurgery, which varies if they opt to use anesthesia for unruly animals, says Ashley, Lindsey, VP of Marketing, CryoSurgery Inc. Cryosurgery kits such as Verruca-Freeze¨ are available in starter kits and replacement canisters, offering flexible purchasing options for budget conscious practices.

Dental scaling
Dental scaling enables the veterinarian to remove the patient’s plaque (the accumulation of food particles and bacteria), as well as calcium, phosphorus and other minerals, which accumulate over plaque to form calculus.
Veterinarians tend to prefer ultrasonic scalers (the same instruments used in human dentistry), which rely on an electronic generator. There are two types of ultrasonic scalers: magnetostrictive and piezoelectric. Magnetostrictive ultrasonic scalers employ a pulsing magnetic field applied to a metal stack, which flexes to move its tip in an elliptical pattern. It generates heat, requiring fluid for cooling the handpiece and gum tissues. Piezoelectric ultrasonic scalers employ pulsing voltage applied to ceramic crystals, which move the tip in a reciprocating pattern. This causes the patient’s gum tissues to heat, requiring fluid for cooling.
Many experts believe that, dollar for dollar, ultrasonic scalers are one of the best investments that veterinarians can make. The instrument costs between $1,000 and $3,000, depending on whether it comes with extra drills and polishers, both of which are often essential for practicing good dentistry. But, once veterinarians add ultrasonic scalers to their practice (typically one per operatory table), they rarely need to replace them. Usually, the cost of maintaining the instrument involves replacing the scaler tip periodically when it breaks down – generally a $100 cost.
Ultrasonic scalers generally last at least five years, and many veterinarians use them about 500 times each year. At $200 a teeth cleaning, that adds up to revenue their practices can’t afford to forego. And, even more importantly, better oral care means better patient care.

Dental imaging/X-ray
Using dental digital imaging helps the practitioner detect pathologies under the gum that are not visible during a routine oral examination. Revealing hidden procedure opportunities enables the practitioner to improve patient care, says Jennifer Healey, Assistant Marketing Manager, ALLPRO Imaging/Air Techniques, Inc.
Veterinarians are getting more serious about oral care and early detection of problems, and for good reason. At 2 years old, 80 percent of dogs and 70 percent of cats have periodontal disease; 60 percent of cats over 6 years of age have resorptive lesions; and 83 percent of extracted teeth have a fractured root left behind.
Adding dental digital imaging enables staff members to independently complete revenue generating imaging procedures. Dental imaging procedures help to grow the veterinary practice and its level of care. Oral pathology in companion animals is common, yet often overlooked without radiographs. Radiographs are an essential component of dental treatment, but 75 percent of clinics do not offer radiology services.

Lasers
Price point is often an obstacle to overcome with veterinarians. But laser procedures can generate new revenue streams for veterinary hospitals and create more time for procedures already done, including declawing, cyst removal and neutering.
Laser surgery seals blood vessels to reduce hemorrhaging and also nerve endings to reduce pain. This also leads to a quicker recovery, and because laser surgery is often done in smaller areas than surgeries with a traditional scalpel, the risk of infection is decreased, as is swelling.
Lasers can be used in pain management and therapy treatments. Whereas high-level lasers (Co2) destroy cells and tissues, low-powered lasers (diode) help modulate cellular activity in tissue, thereby facilitating tissue repair and cell growth in skin, tendons, ligaments and muscles. Low-level laser technology also helps maintain cartilage use during periods of inactivity, as well as manage chronic pain.

Lighting
Medical lighting serves a number of different applications, including operating rooms, treatment and exam-room lighting. Each area has its own need, says Keith Black, Dealer Relations / Exhibits Coordinator, Medical Illumination. ÒIn all cases, lighting enables the doctor or technician to clearly see what it is that they’re doing. In a lot of ways, it’s not a medical requirement as much as it is a human requirement.
Veterinarians need proper lighting to perform their job effectively. The lighting has to be white so that you have the proper color rendering; cool so it doesn’t overheat the patient and doctor; and proper lighting also means having a mechanism to properly position the light.
Lighting is going Ògreen.” Black says that advances in lighting technology allow for lights to maintain their whiteness and coolness, but Òthey’re also more energy efficient.” LED lightsources provide much cooler light output than traditional sources, cooler overall emission of ambient heat from the fixture, higher color temperatures and the most noticeable feature – LEDS have much longer lifespans. Metal Halide (high intensity discharge) bulb system lights take it a step further with the highest level of efficiency to be found in surgery lights today. These new technologies help reduce cost of ownership over the lifespan of the equipment.
Reps selling lighting should do some research into their customers’ needs. For instance, higher-end OR lighting may be appropriate for a 24-hour facility with surgeons, but not needed for a small practice that performs basic procedures. Reps can also include lighting in the ÒHow is your supply ofÉ” questions, Black says. By keeping veterinarians current on replacement bulbs for their existing lighting they avoid costly shipping charges to overnight replacements. And it opens the door to prospect for new sales.

Monitors
According to their 2009 position statement on monitoring anesthetized patients, the American College of Veterinary Anesthesiologists (ACVA) recommends monitoring the following parameters electronically: blood pressure, capnography, pulse oximetry, ECG/HR, and temperature. For good reason: According to Andrew Schultz, Director of Veterinary Monitoring for Midmark, depending on the study, up to 95 percent of anesthesia complications can be detected by monitoring equipment before the problem is recognized by a trained clinician, says Schultz. ÒThat may be just a second or two, but when a patient’s life hangs in the balance, seconds count.”
Good monitor brands aren’t cheap, so sales reps must speak with vets in terms of saved lives, reduced perioperative complications, revenue opportunities and return on investment. By outlining how a clinic can add a modest $20 fee for monitoring and pay back the cost of the monitor in a matter of weeks, you can usually overcome the price objection, and move on to more important topics such as which monitor would be right for them, says Schultz. Do they want compact and portable because it will move around the clinic from exam room to treatment areas, or will it be dedicated to a surgical suite, in which case they might prefer a larger color screen, more features and a rolling stand for security?
Capnography counts, so sell them on it. Dubbed the Òanesthesia disaster early warning system,” CO2 monitoring can alert the clinician of trouble within two breaths, so they can finish the case quicker and safer, says Schultz. The technology best suited for small and large veterinary patients alike are low-flow (<50ml/min) sidestream or solid-state (durable) mainstream systems. If they’re not ready for the additional investment, the newest monitors allow users to add CO2 at any time with ÒConnect and Go" modular solutions.
Monitors have many applications other than procedures. In fact, they can become part of the veterinarian’s routine practice, such as senior wellness exams or feline hypertension screenings, for which he or she can collect revenue. Sometimes it’s up to the sales rep to point them out. ÒIncorporating a comprehensive monitoring business plan into a vet clinic can be shown to add between $100,000 and $500,000 to the value of the practice," says Schultz.

Otoscopes/Ophthalmoscopes
Otoscopes are instruments used to examine the interior of the ear. In companion animals such as Labradores, which have floppy ears and dark moist areas inside where things can grow, it’s important for vets to be able to probe the ears to detect ear canal disease. Ophthalmoscopes are lighted instruments that examine the interior of the eye to detect eye disease and other diseases such as hypertension, which is prevalent in cats, especially those older than 8 to 10 years of age.
If veterinarians can use a device that creates a client education scenario where the client can clearly see the problem, then they’re going to have a much better chance of having the client be compliant with a treatment plan, says Dave Manley, Welch Allyn. An example of this is in ear treatment where the owner may stop after a few applications when the dog doesn’t appear to have symptoms, only to end up at the veterinarian office a few weeks later when the problem flares up again. ÒIf the vet can show the client what’s going on, obviously it’s going to increase revenue in recheck fees,” Manley says. Deep ear cleanings can bring in $200 to $300 each time for vet practices.
Otoscopes and ophthalmoscopes allow vets to spot problems before they become too serious. ÒOtoscopes are a great way to detect the early signs of eye disease,” says Manley. ÒIf you have a dog that’s having problems with his eyes it won’t manifest itself until some outward sign, like fluid draining or hemorrhaging, or the pet starts walking into walls. That’s when the vet looks into the eyes, sends him to a specialist, butby then many times it’s too late to effectively treat the animal. Early detection is the key.”
Otoscopes and ophthalmoscopes can run $200 to $500 each for the instrument head; $200 for a power handle. A typical otoscope/ophthalmoscope set of runs under $1,000. A video device such as the digital vet macroview otoscope (which runs about $1,200) has a camera that will look in the ear and show clients in real time the problem.

Ultrasound
Ultrasound imaging, or sonography, relies on high-frequency sound waves to produce pictures of organs and other body structures. Unlike X-rays, it does not use ionized radiation. The test is fast and painless for patients, yet produces vital information for veterinarians.
Because pets can’t communicate their conditions, ultrasound is useful in diagnosing problems with the heart, bladder, kidney and stomach. Emergency centers benefit from having ultrasound equipment onsite to check for internal damage if a pet has been hit by a car or suffered a collision. With ultrasound, vets are able to detect pregnancies, any complications in pregnancies and the ongoing health of the offspring for both large and small animals.
Ultrasound equipment is available in both console and portable units. Reps working with large animal veterinarians who travel to see patients would probably opt for more handheld ultrasound options. Reps servicing veterinary hospitals and emergency/surgery centers where the patients come to them would most likely opt for console models.

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