Real-time Care

Pre-op testing, wellness exams are fueling in-office diagnostics


Selling the benefits of in-office diagnostics? Four words just about sum it up: “convenience” and “better patient care.”

“All of us want convenience,” says Jason Hunsinger, district manager, Mid-Atlantic area, Butler Schein Animal Health. “We’re all short on time. Any time you [as a pet owner] take your pet to your veterinarian, whether he’s sick or in for a wellness exam, and you can get valuable information on the spot, that is worth its weight in gold.”

“If [a clinic] has [testing] capability in-house, they will do more testing, and that will in the end lead to more accurate diagnoses and better medicine,” says Greg Fischer, who covers southern Minnesota for Midwest Veterinary Supply. “And that’s what they’re after.”

Nor can the bottom line be ignored.

“A piece of equipment, whatever it may be, needs to pay for itself,” Fischer continues. “It behooves people like me to show how this can positively impact [the veterinary practice’s] bottom line.”

Veterinarians are facing tough competition on many fronts, including Internet pharmacies, says Tammi Lesser, marketing manager, IDEXX Laboratories. “But diagnostics is something the veterinarian can uniquely provide. And it helps patients live longer.”

Geographic differences

Hematology analyzers, chemistry analyzers, electrolytes and rapid tests have become commonplace in the veterinary clinic. “Most practices are pretty sophisticated,” says Rachel Schultz, practice consultant for the American Animal Hospital Association. Even those that still send many of their tests to an outside lab have in-house capabilities to test critically ill patients on an “I need to know now” basis. Still, Schultz has observed that rural clinics often have more comprehensive in-office labs than metropolitan ones, which have quick, convenient access to outside labs.

There are some geographical differences as well, particularly in the types of tests likely to be administered. “My industry experience comes from being in the Northeast,” says Hunsinger. Clinics in that part of the country are particularly strong in heartworm and parasite testing, he says. “Ten years ago, you saw strong follow-through in offering heartworm tests. Then it transitioned to heartworm/Lyme testing. With the prevalence of Lyme in the Northeast, people are extremely compliant.”

Pre-op testing

While many veterinarians are convinced of the need for in-office diagnostics for emergency patients, they may not believe they see enough critically ill patients to justify acquiring sophisticated lab equipment, according to those with whom Vet-Advantage spoke. Be that as it may, there’s a good chance those clinics do engage in two other clinical activities that might justify it – pre-op testing and wellness exams.

Clients don’t want to bring their pet in for pre-op testing, then return home to wait for results, then return to the clinic for a procedure, says Schultz. They’d rather all necessary testing be performed the morning of the procedure.

“The pre-anesthesia test gives you insight into the well-being of the animal,” says Lesser. It provides the veterinarian insight into the functioning of the kidney and liver, for example. If the patient is anemic, oxygen levels will be compromised, she points out. The animal’s electrolyte levels may determine how quickly it will recover from anesthesia. Bottom line is, the results of pre-anesthetic testing may result in the clinic altering its protocol, the result being a better outcome for the pet.

Pre-op testing also provides valuable baseline parameters, says Fischer. “Going forward, as that pet gets older, the clinic can refer back to the early blood work and see what their normals were.”

In the not-so-distant past, some clinics feared that if they insisted on pre-surgical blood work, clients might object to the cost and go elsewhere, says Hunsinger. But when they have made testing mandatory, they have found that they don’t lose customers, as they feared they would. “[People] know how important testing is when we go in for procedures,” he says. “Clinics have done a really good job letting their clients know why they should do it for their animals, and how important it is to establish a baseline for the pet’s future health. You’d be hard-pressed to find a practice that didn’t see value in pre-surgical blood work.”

As with so many things in the clinic, the chances of success are greater if everyone in the practice – from the front staff to the doctor – deliver the same message to the client, continues Hunsinger.  “To have any kind of testing protocol work, you need the message to be consistent, from the technician in the room to the doctor. And you need people to be confident in what they’re talking about. If they’re not, the client will see that and question, ‘Is it really worth it to pay for this service?’”

Wellness

While pre-op testing has already proven itself as a driver for in-office lab diagnostics, wellness testing is another. And those to whom Vet-Advantage spoke consider it a strong one. Annual blood work can give the doctor a good look at the well-being of the animal, says Lesser. Hematology and chemistry screens can help the doctor pick up problems, such as renal disease, before the animal presents with symptoms. The prognosis is better, because the doctor can help the client take steps, such as putting his or her pet on a therapeutic diet, that not only will improve the pet’s health, but probably save the owner money in the long run, as he or she avoids expensive treatment down the line.

Some clinics send preventive tests to outside labs, notes Lesser. “A major objection [to in-house testing] is, ‘It’s not critical that we have that information right away.’” But if the clinic can perform such tests at the beginning of a visit, the doctor can sit down, face to face, with the client before the animal leaves the building to talk about potential issues and their solutions, and schedule a follow-up visit.

“The owner gets the results of the test and satisfaction before they pay their bill,” she says. “The worst thing is when the clinic takes blood and the client is told, ‘We’ll call you if there are any problems, but if you don’t get a callback, everything’s OK.’ When they don’t get that callback, they’re wondering what they paid for.”

Some vets feel it’s important to call the client regardless of the test results. That’s good customer service, but it also eats up valuable time from the veterinarian’s day.

“We’re seeing a 40-percent increase in compliance with pet owners when [the veterinarian] can discuss test results face to face,” says Lesser. The client is more likely to understand what he or she is told, and more likely to commit and comply with the recommended course of treatment. Better that than getting the phone call to bring Fluffy back in, which means missing another day of work, etc.

Stumbling blocks

Not surprisingly, some veterinarians voice concerns about the cost of in-house testing. Not only are they concerned about the cost of acquiring analyzers and supplies, but they believe that in-house testing costs the client more money on a per-test basis than if the clinic sent the work out.

Many times, the comparison isn’t valid, says Lesser. That’s because the clinic may, in fact, be overpricing the cost of its tests. The fact is, reference labs mark up tests far less than most clinics. The solution is not to send out tests, but to adjust the price of tests done in-house, she says.

Another objection is time. Veterinarians may be concerned that in-office testing will consume too much of their techs’ valuable time.

“These pieces of equipment and these tests have made veterinary technicians smile, whether they admit it or not,” says Fischer. “The technology is proven, and because they trust it, they’re free to do other things that are important to the success of that practice.” Typically, techs perform multiple functions within their clinics. “As the technology evolves, it’s quicker, simpler and more accurate,” he says, pointing to hematology screening as an example. In the past, the tech had to look in the microscope and manually count cells, he says. “It’s tedious, and [the tech] might get pulled one way or another, or get asked to do something else. There’s plenty of room for error.”

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