How to Increase the Quality of Your Patient Care, Increase Client
The world’s leading resource for complete clinic management solutions How to Increase the Quality of Your Patient Care, Increase Client Satisfaction, and Dramatically Increase Profits — All Without Adding Work or Staff! 2 A Brief Overview Recently, the American Animal Hospital Association (AAHA) completed a landmark study...to identify ways veterinarians could maximize quality care. Medical records of nearly 1,400 cats and dogs were examined, from 240 clinics in a wide variety of locations. Many of the findings were dramatic – and surprising. The overriding problem: Most veterinarians are not providing the highest level of care...because they’re not complying with the Standards of Care deemed appropriate by the Veterinarians and staff at their own clinics. The solution: Fortunately, the study also showed ways veterinarians can significantly improve those levels of ©2005 RxWorks compliance. The first step is to clearly define the appropriate Standards of Care for patients cared for by your clinic. The most successful clinics involved all their staff in the definition of these Standards of Care. We believe that simply discussing the issues raised awareness amongst the staff and played an important educational role. For more information, please send an email to: [email protected] 3 But just as importantly, their participation in the process helped them take ownership in the result and a special pride in ensuring patients were cared for appropriately. Everyone likes to know they are doing a good job, and these Standards help all team members know that there are expectations that they will deliver a high level of care to all patients. Having defined the Standards, a clinic needs a way to manage, monitor, measure, and enforce them. You are not looking for a one-time effort, but a long term solution that will consistently deliver high quality health care to patients. These Standards are not rigid rules that lock the veterinarian into a straight jacket when it comes to the way they treat their patients. To be successful, the management of the Standards must be flexible to ensure the veterinarian can deliver the ©2005 RxWorks appropriate care after taking any special circumstances into account. Standards encompass all aspects of the clinic’s operation including enhanced communication with clients, medical procedures, staff training, wellness plans and management. The Reward: Happy and healthy patients would be reward enough for most Veterinarians and their staff, but the study found an additional bonus. By delivering a consistently high level of care, clinics were rewarded with significantly higher revenues and profits. Important Notes Real Practice, not mere Theory This study was NOT based on some hypothetical standard which – in theory – should deliver higher quality of care, but in practice would be impossible to meet. The staff of each of the 240 clinics actually defined the Standards that they believed were appropriate for their clinic. For more information, please send an email to: [email protected] 4 Each clinic was measured by a thorough examination of that clinic’s medical records to compare their actual practice to their own Standards. This shows it is not a lack of willingness to deliver high quality health care, but rather the lack of an adequate system to implement, monitor, measure, manage, and ensure Standards of Care. Rigid Enforcement will not work The enforcement of arbitrary standards will not work because they will not be applicable to all cases – neither will they enjoy the long-term support of the clinic’s staff. It is important to involve staff in the development of your clinic’s Standards of Care and use a flexible, comprehensive system to manage the Standards that allow for the unique circumstances that may apply to a patient. Existing Computer Software Systems were not up to the task Amazingly, none of the existing Practice Management Systems in use at the 240 ©2005 RxWorks ▼▼Simple to use and already we have no idea how we managed without it. Accuracy of billing in our first quarter has shown a significant increase in turnover, and keeping track of our case load is very straightforward. The senior, endocrine, urinary tract, and epileptic clinics that we run have taken off significantly since we can now target and mail shot all the relevant clients.▲▲ —Forest Veterinary Clinic ▼▼The system has improved our profitability in many ways including stricter consistent pricing, efficient reminder and account systems, and better time management for staff and data evaluation for management decisions.▲▲ —Broadway Veterinary Clinic clinics surveyed by AAHA were up to the task of managing Standards of Care and the clinics’ compliance. In fact, they were so inadequate, the medical records of the patients had to be manually examined to measure the clinic’s compliance. For more information, please send an email to: [email protected] 5 Do you know how your clinic is doing? How broad is the problem of substandard care? The AAHA study used the term “compliance gap” to illustrate the difference between the Standards of Care defined by each clinic and the current reality. While the disparity is significant, perhaps even more stunning is the level of erroneous perceptions among veterinarians; most think their clinics are doing much more and much better than they actually ©2005 RxWorks are, and most veterinarians also resist measures that could improve the situation because they mistakenly believe their clients do not want additional advice. For instance, 68% of senior patients did not receive an appropriate canine screening. Less than half of all dogs took their heartworm preventive therapy. And a mere 18% of cats were being fed the appropriate feline therapeutic diet. The chart on the following page reveals the details: For more information, please send an email to: [email protected] 6 Patients Not in Compliance (Average Practice) Number of National Non-compliance Patients Not In Compliance Percentage Area of Compliance Average Practice Census Heartworm Testing 1,800 dogs 17% 306 Heartworm Preventive 1,800 dogs 52% 936 Dental Prophylaxis2 25% prevalence = 869 dogs and cats 65% 565 Canine Therapeutic Diets3 28% prevalence = 504 dogs 81% 408 Feline Therapeutic Diets3 25% prevalence = 419 cats 82% 344 Canine Senior Screening 35% senior = 630 dogs 68% 428 Feline Senior Screening 35% senior = 586 cats 65% 381 Core Vaccines 3,475 dogs and cats 13% 452 1 Table data taken from page 12 of the AAHA study The Path to High-Quality Care, Practical Tips for Improving Compliance. NOTE 1: The AAHA did not include data for preanesthetic testing because the data varied depending on individual clinics’ protocols. NOTE 2: For approximately 19% of the patients studied, there was no grade for dental disease reported in the chart. Based on the ages of these patients, a significant portion of those patients with no grade noted were likely to have had grade 2, 3, or 4 dental disease. NOTE 3: The rate of prevalence of canine and feline therapeutic diets is only for those seven conditions that the AAHA studied. There are many other conditions that are treatable with therapeutic diets that, if included in the study, would have resulted in even lower compliance rates. Yet the vast majority of veterinarians don’t realize their clinics compliance levels are so poor. The compliance gap for dental prophylaxis, for instance, is 153%; while actual compliance is only 35%, veterinarians overestimate it to be 54%. Take a look at the chart on the next page to see how your clinic’s compliance levels might compare: ©2005 RxWorks For more information, please send an email to: [email protected] 7 Estimated and Actual Compliance Rates Area of Compliance UNDERestimated Compliance OVERestimated Compliance Weighted Average Overestimate: 51% Heartworm Testing Estimated Compliance Rate 73% Actual Overall Estimated Compliance Actual Ratio Rate 83% 88% Core Vaccines 77% 87% 88% Pre-Anesthetic Testing 66% 69% 97% Senior Screening 43% 34% 128% Heartworm Preventive 70% 48% 147% Dental Prophylaxis 54% 35% 153% Therapeutic Diets 59% 21% 192% Overall 1 67% 64% 105% Table data taken from page 68 of the AAHA study The Path to High-Quality Care, Practical Tips for Improving Compliance. NOTE 1: Overall average weighted by the number of patients eligible for each service/product. Clearly, even small increases in compliance will result in significant improvements in patient outcomes. There’s another real benefit for veterinary clinics: enhanced compliance results in greater profits...since needed care that’s not being provided will be provided. And the good news is, clients are a lot more willing to cooperate than most veterinarians expect; the study showed 90% of clients want to know about all the health care options for their pets, regardless of cost...the vast majority are ©2005 RxWorks willing to pay for senior screenings... and 90% also want their veterinarians to make follow-up calls after appointments. For instance, a typical clinic (staffing the equivalent of 2.2 full-time veterinarians, with 3,475 active patients) that sees a mere 10% increase in compliance will end up providing 1,287 additional treatments in one year...yielding $132,535 in increased revenues and thus $81,364 more in gross profit. The table on the next page reveals the details: For more information, please send an email to: [email protected] 8 How a 10% Increase in Compliance Affects Revenue and Gross Profit 1,2 Increase in Revenue Through Improved Compliance Increase in Gross Profit Through Improved Compliance 3 Current Overall Rate of Compliance Compliance Goal Number of Additional Treatments Per Year Dental Prophylaxis 29% 39% 158 $31,521 $29,945 Core Vaccines and Related Exams 87% 97% 337 $16,294 $15,316 Therapeutic Diets 5% 15% 202 $48,587 $12,633 Senior Screenings 33% 43% 119 $13,483 $9,843 Heartworm Preventive 48% 58% 180 $11,988 $5,994 Preanesthetic Testing 63% 73% 111 $6,072 $4,190 Heartworm Testing 83% 93% 180 $4,590 $3,443 $132,535 $81,364 Compliance Area Total Improvement 1,287 Table data taken from page 24 of the AAHA study The Path to High-Quality Care, Practical Tips for Improving Compliance. NOTE 1: Calculations include only the areas the AAHA studied, with the exception of diets, which, for the quantification of the opportunity, the AAHA expanded beyond the diagnoses studied. NOTE 2: Revenue and gross profit were calculated using data compiled from a variety of sources, including The Veterinary Fee Reference. NOTE 3: Gross profit is defined as revenue, less the direct costs of providing the care – including drugs and supplies – but not staff time. So clearly, the potential for ◆The KPMG Megastudy — The Current and Future Market improvement is tremendous. for Veterinarians and Veterinary Medical Services in the The question now becomes, how can United States — found that most clinics have the capacity veterinary clinics make it happen? to increase services by 10–20% without adding staffs. ©2005 RxWorks For more information, please send an email to: [email protected] 9 6 Steps to Increasing the Quality of Your Patient Care The AAHA Study recommended 6 basic steps to improving healthcare…through increasing compliance levels. clinic’s annual revenue by $60,243 per veterinarian. ➊ Measure current compliance: Of all the clinics surveyed, not a single one registered complete compliance. The first step toward improvement is to discover your starting point. helps to assign a specific staff member as the champion on compliance, so it doesn’t fall through the cracks (which is likely to happen if you have not allocated responsibility for the tasks). ➋ Involve staff: Clinics that involved ➎ Measure and track results: Practice the staff in compliance issues achieved significantly higher levels of compliance than those that did not. teams that measure compliance simply achieve higher compliance rates. If using software to measure and track, keep in mind that you’ll need a program that is not merely for creating bills and recording transactions, but one that is based on Problem Orientated Medical Records. ➌ Set compliance goals: Remember, these are quality-of-care goals — not financial goals. Make them realistic (not 100%) and specific. Baby steps are the way to go. Build on your clinic’s successes. Although your goals are based on quality of care, remember just a 10% increase in compliance can increase the average ©2005 RxWorks ➍ Implement the new protocols: It ➏ Celebrate victories: Post the goals on a chart (like a giant thermometer), and when you reach certain levels, bring in For more information, please send an email to: [email protected] 10 pizza or ice cream. Reward the results! The report’s bottom line: Making a conscious decision to improve patient care, and then managing and measuring that level of care, will make a difference...for thousands of your patients. But how do we actually do it? Every clinic has its hectic days and you will quickly realize that managing the Standards of Care for your clinic is a complex task that is well beyond both manual systems and existing computer systems. Remember, the study found none of the existing Practice Management Systems used by the clinics in the study were up to the task. With thousands of patients, hundreds of standards, different veterinarians and staff providing the care, the complexity is just too great. RxWorks is prepared to go out on a limb and say no system, manual or computerized, will be able, on its own, ©2005 RxWorks to successfully manage Standards of Care and a clinic’s compliance. That is a pretty amazing statement from a software company, but it is true. So what is the answer? RxWorks has spent the last two years working with some of the world’s leading practice management consultants to solve this puzzle. Each part of the solution has been road tested with a range of clinics. Feedback was gathered from the Veterinarians, Practice Managers and Support Staff. The solution was refined and tested, refined and tested again, over and over again. In many cases, we had to go back to the drawing board and start all over. At times it was very tempting for us to cut corners and release the system, but we knew this task was too important. If we could help you dramatically improve the quality of healthcare delivered to patients, we could make a big difference to the For more information, please send an email to: [email protected] 11 quality of life of so many animals and the people who love them. We also knew that, although many veterinarians put their love for animals before their own need for adequate financial reward, we could show them how – by caring better for their patients– they would be better able to reward themselves and their staff. The road to financial success is not just increasing fees and creating concerns in the minds of your clients, but caring better for their animal friends. A Man & Machine Combination The answer was not a software program, but a solution encompassing both people and technology. veterinarians, and organizational behavior experts. Typical questions that needed serious consideration were: ● What had they seen work in practice? ● What made people willing to change? ● What makes people take ownership of new systems and pride in the outcomes? ● What motivates the staff that makes up the typical veterinary clinic? ● How do we explain this concept? ● How do we educate the staff of clinics who have many years practical experience and well-established habits? ● What would motivate a 55 year-old veterinarian to make the changes necessary to deliver higher levels of patient care? ● Why should a part-time receptionist care? ● How do we help the veterinarian confidently involve support staff in RxWorks’ role in the solution is the technology. The real challenge is in the people component. For this we leaned heavily on leading practice management consultants, hospital administrators, practice managers, experienced ©2005 RxWorks For more information, please send an email to: [email protected] 12 delivering high-quality health care? The questions went on and on and we are sure that you can come up with even more. In some cases it seemed we were not getting the same answer to the same question from anyone. But we pressed on and the more we refined the solution, the more we addressed the varying concerns. When we got a component right, truly right, it often solved many of the concerns simultaneously. The plan to achieve increased compliance has many components and is not an all or nothing solution. It is a flexible menu that allows clinics to choose the elements that suit their individual situation. The solution includes: ➊ Seminars and Training Courses that explain the importance of Standards of Care to clinic staff and their role in the delivery of high quality health care. ➋ Manuals explaining how a clinic can define their Standards of Care with short cuts to speed the process and tips to boost the likelihood of success. Health Care Indicators on the patient screen track compliance. Charging the client for relevant items automatically set the LAST and DUE date. Overdue indicators automatically generate reminders and trigger Health Care Prompters whenever staff deal with this patient. ©2005 RxWorks For more information, please send an email to: [email protected] 13 ➌ Accredited consultants who can work with the clinic’s staff to define their Standards of Care. ➍ Training courses that show clinics how to measure, manage, monitor, and get acceptance of their Standards of Care with tips on how to ensure a lasting improvement and not just a flash in the pan. ▼▼ Now, at last, I have a system that actually does improve my efficiency, organize my day logically, simply and actually extends my capacity as a veterinarian. I find I have to spend less time on accounts and paperwork but I have more usable information about the health of my practice. ▲▲ —Roehampton Veterinary Clinic ➎ Consultants who can hold your hand through the entire process...and who are equipped with sophisticated data mining tools to regularly monitor your clinics progress and pinpoint areas for improvement. ➑ Content that can give your clinic ➏ Software that actively manages ➒ A value equation that shows your clinic’s compliance with your Standards of Care. Looking through a rearview mirror at historical reports is not enough; help is needed at the point when care is being delivered. ➐ Seminars that address the issue of enforcement. How do you find the right balance? Not too rigid, not too flexible, but just right. ©2005 RxWorks a head start in its Standards of Care objectives. There is no need to start at ground zero, much work has already been done that you can leverage off. the return on your investment, both medically and financially, has justified the time and money you have invested. ➓ Practice Management Software that supports a clinic’s goals. It is not a specific feature or function, but a total package that kicks in throughout the relationship your clinic has with its patients and clients. For more information, please send an email to: [email protected] 14 How Our Comprehensive Software Solution Can Help Your Clinic The RxWorks solution can be a key to your success in improving compliance, since it has been developed specifically to support these new initiatives. Not only does RxWorks provide you with the world’s leading Practice Management Software for veterinarians, we have also organized a combination of training, consulting and content partners who support your goals of implementing and improving Standards of Care in your clinic. ©2005 RxWorks Together, we address the advice, training and support required for day-to-day activities, management reporting, implementation and medical and business strategic management. You select from our menu of support services, those that are appropriate for you. Obviously it is beyond the scope of RxWorks’ resources (and business model) to deliver all of the needed components. So, we built relationships with independent veterinary management For more information, please send an email to: [email protected] 15 consultants and trainers who are accredited by RxWorks. These experts provide your management with the advice and support that you need to be as effective as possible in achieving your Standards of Care goals. For the information technology-based activities, we use on-site, internetbased and group training courses and seminars, to help you get the most benefit out of RxWorks’ comprehensive functions. Because RxWorks has engaged in the ongoing collaboration with working veterinarians that we’ve mentioned, we improve standard tools and add new ones as they become relevant to the practice of veterinary medicine. Yet RxWorks remains supremely simple to use. Each module is fully integrated into the system, so you can access whatever you need with two clicks of the mouse! RxWorks is the veterinary software of choice for over 1,500 clinics in 14 countries. ©2005 RxWorks “It is by far the best system on the market,” says Dr. Richard Edwards of the Alphabet Veterinary Centre. 5 Ways You Can See Results RxWorks software can help veterinarians address the 5 basic medical components of a compliance-improving effort: ➊ Vaccinations: In RxWorks, charging for the initial vaccination will automatically set a reminder date in the patient record for when the booster should be done. This is typically included in a reminder system – so the system will send out a reminder of some sort. ➋ Parasite prevention: Flea control, intestinal worm and heartworm prevention all require regular treatment... provided in sets. (For instance, flea control is sold in 6 packs that will last 6 months.) The software tracks the date when the next set is needed...and alerts the clinic staff, so they can in turn notify the client. For more information, please send an email to: [email protected] 16 ➌ Diet: The computer notes the kind of Your staff can use the software to : food being fed and a date when next bag should be bought -- for easy notification. ➊ Communicate the compliance ➍ Health checkups: Regular checks for healthy animals (like Healthy Pet or Wellness exams), physical exams, fecal checks, and dental exams can be set as automatic reminders. ➎ Screenings: Senior screenings, wellness plans, and geriatric plans are scheduled, along with pre-treatment screenings (like blood screens prior to anesthesia). 5 Steps to Increasing Client Satisfaction As clients comply with best-practice recommendations, their pets will be healthier -- so naturally, they’ll be happier customers. RxWorks software provides the communication tools that make this possible, and the program is so automatic you won’t need to add staff to accomplish your goal of strengthening the client/ practice bond. ©2005 RxWorks status among staff and prompt them to communicate with clients: Personto-person staff contact with clients is crucial in improving compliance and the client/practice bond, — so RxWorks provides immediate access to all needed information in one screen. And when the visit is being completed, RxWorks checks all the details and if the Standards of Care items have not been addressed, asks for a reason why. A critical part of the communication is for all staff to give a consistent message to the client explaining the Standards of Care. RxWorks has tools to help you define the message and then help all of your staff deliver consistent information that encourages the client to accept the needed treatments. ➋ Measure your compliance rates: You can then review your compliance For more information, please send an email to: [email protected] 17 rates using the reports provided by RxWorks and equally important, see the reasons why your Standards are not being accepted by your clients. ➌ Target Clients with pets that need to meet your Standards of Care: Client communication isn’t limited to reminders, though; clinics can also develop targeted informational and promotional mailings. For mailings, RxWorks has superior ability to identify and select clients and patients by any of the information in the database...then easily mail-merge to create individual letters, emails, or postcards. ➍ Set reminders and send them to clients: A key benefit of RxWorks is its powerful reminder process. The AAHA study showed clients do At the end of a visit the consulting Veterinarian must make a choice either to invoice an item that will reset the Health Care Indicator or else to select a reason why the indicator is being ignored. ©2005 RxWorks For more information, please send an email to: [email protected] 18 want to be reminded of procedures that will benefit their pets’ health, and they welcome continued reminders. RxWorks can set up to 4 scheduled reminders at specific time intervals. When the patient receives treatment, RxWorks resets the reminder date for the next treatment. If the client misses a date, a second reminder will be sent and if they miss the second date, a third will be sent... and so on. Plus, the form of the reminder can change: You can choose to send a card as the first, an e-mail as the second, a letter for the third, and a phone call for the fourth, or any other combination. ➎ Measure response to your reminders – are they as effective as they could be in achieving your goals for Standards of Care ? RxWorks automatically measures client response for each reminder level, so the clinic can see which type of reminder works best...and finetune for even better results. This is one more important component in helping ©2005 RxWorks you achieve your Standards of Care goals. Software Functions or a Total Solution? From experience, sometimes painfully gained over the past 18 years providing practice management systems to the veterinary industry around the world, we feel we understand which of the key elements of a system can really be a benefit to a clinic. We also know that once our competitors see the benefits veterinary clinics receive from the comprehensive RxWorks solution to managing Standards of Care, they will quickly start adding functions on an ad hoc basis, in the hope that they can convince you that they can deliver similar benefits. Don’t be fooled! Competitors cannot recreate overnight a solution that took 2 years of research, solid development, and fine tuning. Without a strategic direction for providing a comprehensive solution to For more information, please send an email to: [email protected] 19 the management of Standards of Care, their ad hoc changes are not part of a plan that has direction and reason, other than to play catch-up. ▼▼Our revenue has increased, the ability Be wary of getting involved in the “function wars” and being distracted by superficial functionality. amount of immediately accessible financial All RxWorks software development is a part of our total solution offer. We also have the complementary services and support that really make systems work for you. ▼▼Clients are pleased, especially when Remember what we said earlier in this paper: no system, manual or computerized, will be able on its own to successfully manage Standards of Care and a clinic’s compliance. Our goal is to provide you with not only the computer system, but also access to the advice, training, implementation and support necessary for you to be successful in achieving your own goals. Talk to any RxWorks Practice Advisor ©2005 RxWorks to customize reminders, handouts and protocols is very helpful. Target marketing mail shots are working well, and the reporting is very useful. ▲▲ —Dragon Veterinary Clinic we explain how the system makes pricing fairer and allows us to keep up to date with methods of treatment, etc. Takings have increased 15% per week without a fee rise. ▲▲ —End Cottage Veterinary Clinic and you will hear a clear strategic direction mapped out into the future that helps veterinarians like you deliver better healthcare to patients and delivers you the rewards of good practice. It is a strategic direction that RxWorks has a long history of fulfilling, and one that will serve you well into the future. For more information, please send an email to: [email protected] 20 Your Profits Will Respond (Without Adding Work or Staff!) Better patient care is the goal, of course – yet an additional benefit of improving compliance is enhanced profits. Here’s how it can happen in your clinic. Since RxWorks software has been developed with busy veterinary clinics in mind, it is designed to streamline the process of contacting clients. Since most functions are automatic, using the system only requires a few minutes each day...yet will save time (by eliminating the need to dig through card files, stacks of paper, and one-at-atime computer documents) that will more than make up for the quick keystrokes and/or mouse clicks. So, no need to add staff or other office-related costs. Yet the study revealed a clear after-effect of better quality care. Better care means ©2005 RxWorks more services provided to patients, and thus billings will rise. Specifically, the study showed a mere 10% increase in compliance...would result in an additional $132,535 in profits for the average practice, per year! Where Can You Go From Here? Your clinic can increase the quality of patient care. For more information, please send an email to: [email protected] 21 needed healthcare instructions for their pets. You can increase client satisfaction and strengthen the client/practice bond, too. And you can dramatically increase profits — all without adding work or staff. The AAHA study shows you the way: Take proactive steps to improve how your clients comply with the Of course, a world-class software program – created especially for veterinarians – can make all the difference. The program is RxWorks. Yes, your clinic can dramatically improve patient outcomes... and profits... without adding work or staff. Contact Info UK Australia Nederland US Phone +44 (0) 700 399 3377 +61 (0) 7 3251 8666 +31 (0) 6 2060 9134 + 1 888 779 5163 Fax +44 (0) 845 280 2626 +61 (0) 7 3252 5625 +31 (0) 13 5042 302 + 1 702 435 7672 Email Sales [email protected] [email protected] [email protected] [email protected] Email Support Mail Address [email protected] [email protected] FREEPOST RXWORKS P.O. 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