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Changing Vaccine Protocols

Excerpts from August 2004 issue of http://www.vetmedpub.com/ve/

We present this because it is never "outdated" because it contains valuable information and because it shows how long the veterinary profession has been aware of the risk or  ineffectiveness of vaccines.  It also points out the problems with the customer and the need for actually reviewing the patient's file before treating...... Editor

Excerpts from August 2004 issue of http://www.vetmedpub.com/ve/ Article entitled:
Targeting Changing Vaccine Protocols
By Roger F. Cummings, CVPM, and James E. Guenther, DVM, MBA, CVPM

“The hard truth: You’ve been your own worst enemies when it comes to vaccinations. (And the only reason we can say that is that we lived those days in practice, too.) In the 1970s and ’80s many veterinarians derived a substantial percent of their total incomes from vaccinating dogs and cats. They marked vaccinations up tremendously over their costs and, at the same time, didn’t charge clients a separate exam or office call fee. Practices told clients that (it) was “included in the cost of the vaccines.”

“This trend started to change in the ’90s, with many practices separating the cost of the vaccines from the exam or office call charge. Yes, some pet owners resisted at first, saying they just wanted the shots, not the exam. Yet, with perseverance, veterinarians and their team members have educated clients about the value of wellness exams. And over time, more pet owners have come to understand that veterinarians’ time, knowledge, and skills have much greater value than the “shot.”

“…with relatively new position statements from the AVMA and AAHA …and changes in many states’ legal requirements for vaccinations—many of you need to modify your approach. … you’ll provide fewer vaccines or administer some vaccinations less frequently, depending on each pet’s risk and needs. Clearly, deciding the medical issues is a major industry debate…. There are management decisions to make, too.”

“… The decision about the medical issues is critical, of course. And, as with all medical decisions, you need to focus on what you believe is best for the pet. At this point, you must set aside all thoughts about the income. After all, this is what you do in all other cases; you recommend what’s best for pets, not what’s best for practice revenue.”

“…you need to hold a staff meeting re….the protocol. ….you want everyone to believe in, understand, and be able to communicate the benefits of your approach to pet owners. During this meeting, team members will ask the same questions clients will ask them, so be prepared to offer believable, understandable, and valuable answers. Your team members will pass these answers on to clients, so saying something like, “because I said so” or “because I know what’s best” just won’t cut it.”

The observations are mindful of the public’s right to know and understand. The article continues “ …. you might say, “Based on recommendations from AAHA and the AVMA, … We decided that making these changes gives our patients better care.” Of course, you still need your team members to prepare and educate pet owners about vaccinations. So in this case, you might ask staff members to say something like, “The quantity of vaccinations that pets need has changed. Depending on the age and breed of your pet, the doctor will help you decide which vaccinations will best meet your pet’s needs.”

They acknowledge “… some pet owners will ask to buy only vaccinations, without the annual exam or office call” and suggest the vet discuss the new policy with the team, including “the importance of wellness exams as you discuss vaccination protocols.” They advice vets “… explain the cost of vaccines and your requirements for an exam or office call, so pet owners appreciate the value of both. In the end, your vaccination protocol, just like every other service, needs to benefit the pet, the client, and the practice. If your approach doesn’t, revisit it and make sure there are tangible and intangible benefits for all parties.”

“Historically, the vast majority of practice visits have been initiated because the client received a notice that vaccinations were due or because the pet was sick. And in many practices today, the vaccination reminder is the one thing that drives visits from healthy pets. So changing your vaccine protocols could have a significant affect on practice finances.

“How many doses of each individual vaccine did you administer in the past 12 months?
For example, your medical records might show:

2,000 rabies vaccines at $10 each = $20,000 2,000 distemper and parvovirus combination vaccines at $15 each = $30,000 How many office calls or exam fees were generated in conjunction with the vaccines administered in the past 12 months? For example, your medical records might show: 2,000 annual exams at $35 each = $70,000”

The writers ask “Will the same number of clients bring their pets in for the distemper and parvovirus combination vaccine in the year they are not due for a rabies vaccination? …. So without thorough client education about the need for regular exams and good follow through with reminders, you’ll probably see a significant drop in the number of wellness visits.”

“Now project the affect your changes in vaccination recommendations will have on practice revenue. For example, if you charged $35 for an annual exam, $10 for an annual rabies vaccination, and $15 for an annual distemper and parvovirus combination vaccination, the total would be $60. If you decided to give the rabies vaccination one year and the distemper and parvovirus combination the second year, your income per annual canine vaccination would drop only $15 the first year….. Of course, when pets get vaccinations most also receive other services or are prescribed additional medications. So you may not earn the same incremental income if you see the pet less frequently.”

“Whether you estimate a revenue drop of $10,000 or $100,000, you’ll need to think about how to adjust for the loss and continue to spur revenue growth. Of course, one option is to raise fees, and many practices will and should do this. …… A solution: Promote better health …. What types of programs or services should you consider? Consider these examples:

• checking thyroid levels of dogs and cats receiving thyroid medications
• checking phenobarbital levels of patients receiving phenobarbital
• recommending appropriate deworming for dogs and cats. (The Centers for Disease Control and Prevention recently reported an increase in visceral larva migrans in children. Shouldn’t we recommend deworming at least twice a year?)”

The article goes on to discuss a 2003 study “supported by a grant from Hill’s Pet Nutrition” which shows that pets live longer nowadays but suggests “… we have a tremendous opportunity to better their lives by improving compliance with basic medical recommendations.”

They suggest “… each practice needs to analyze its clients’ compliance and implement programs and systems that reinforce recommendations and improve client education about pets’ needs.” An example of a vet who “recently appointed a long-term, experienced team member to be “patient care coordinator” in his practice” is given.

The system suggested is “reviews all patients’ medical records before clients arrive for their appointments. She notes in the record or on a checklist what preventive measures doctors or team members need to discuss with clients.” And “The coordinator also follows up after the visit to schedule a progress examination, the pet’s next annual visit, or one or more of the preventive measures the doctor recommended. And she makes sure the doctor records issues that need to be discussed with the client during the next visit and checks that the practice team charged for all services rendered. Finally, the coordinator has the authority to return the record to the doctor if it doesn’t meet the standards the practice team set.”

The observation is made that “..most veterinarians still don’t spend enough time reviewing patient records specifically for compliance issues. And it’s fairly uncommon to find a veterinary team that consistently educates pet owners about the steps they can take to keep their pets as healthy as possible. Some good news: An experienced staff person can more than offset the costs of his or her salary and benefits by raising clients’ compliance.”

Admirably, the writers suggest “…we need to build personal ties with clients if we’re going to help them help their pets. And spending more time connecting with and educating pet owners is essential to maintain the financial health of the practice, too. … we need to rethink our service approach to help clients keep their four-legged family members healthy.”

The remainder goes on to matters of staff, training, and mentoring. It is very interesting and you may see the veterinary practice in a new light by going to the equally interesting website to explore.

Vets are not rushing to inform owners about newly released but long-understood vaccination protocol. It has been suppressed for over a decade and it is only through the efforts of determined, selfless, ethical practitioners and researchers that the facts have finally escaped into the public domain.

Editor: We thank Kris Christine for bringing this article to our readers.