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Issue: 9 - Sep 15, 2009
WELLNESS SCREENING: The Real Issue Is Compliance
By: Ronald E. Whitford, DVM
ImproMed, LLC
WELLNESS SCREENING: The Real Issue Is Compliance
Wellness is one of the current buzzwords of the medical professions. Wellness is simply another term for health and may be described more specifically as preventive health care to maintain optimum health. Screening is the other word in vogue right now. Screening is defined by Webster as a system for separating into different groups, in this case separating into normal and abnormal clinical values.
We can assume that almost everyone has heard of wellness screening and would agree that the early detection of subclinical signs provides a greater opportunity to catch problems early and either resolve the problem or make recommendations to slow down the progress of the condition. Hopefully this will lead to a better quality of life, and often times an extended life span.
Preventive health care is the only sale we need for the rest of the pet’s life. There is sufficient pathology in the current patient base of most mature practices to keep us busy for the rest of our practice careers. The problem is creating the opportunity to extensively look for any problems present. The reality is that to date very few practices have capitalized on those opportunities to any large degree. The real question can be simply stated as how do we get clients to comply with our recommendations? Needed services are of no value unless they are discovered and then marketed appropriately to gain the client’s request for compliance with those recommendations.
The foundation of gaining compliance lies in the determination of the reasons for noncompliance. Here are a few of the possibilities along with strategies for some of them:
1.       Failure of the DVM and staff to believe in the importance of wellness screening procedures. This problem is quickly resolved once wellness screening programs are instituted and you start to find hidden problems providing the opportunity to ward off serious complications for the pet.
2.       Failure of the staff & DVM to obtain a comprehensive medical history and perform a thorough (nose to tail) physical examination. If we look at the patient, it will often tell us what needs to be done. Too many veterinarians continue to rely on the high income of a quick vaccination rather than dedicating themselves to being the pet’s advocate. Many times all the client knows about their pet is what we tell them. You miss 100% of the shots you don’t take. Results of the history and physical exam often provide us with the ammunition needed to recommend additional wellness screening procedures.
3.       Poor client/pet bonding is still the problem with at least some percentage of pet owners using that practice. Most practices still have at least the occasional client wanting only a rabies shot! Many of these clients consider the pet nothing more than a piece of property and want only minimal care. However finding problems on these pets and bringing it to the attention of the owner sometimes results in a surprised request for additional services. Don’t be guilty of supervised neglect caused by prejudging the client.
4.       Lack of client education may be a reason for noncompliance, however we must remember that today’s client is more educated than ever before, but sometimes the information is inaccurate especially when associated with the internet! An uneducated market is a nonexistent market, but just be sure not to use this as the major scapegoat of noncompliance.

5.       Poor staff communication and marketing techniques may fail to provide the client with sufficient information to request the services. The biggest barrier to client education is realizing when the client does not understand what you are talking about. Clients learn by many different ways. It is important to use as many client education and marketing strategies as possible to ensure hitting the “hot button” for each client. Many clients will not ask questions for fear of appearing stupid or sadly perceiving that the DVM/staff does not have the time or care enough to ensure total client understanding.  Remember that communication is incomplete without understanding and that there are two components to communication: transmitting and receiving.
6.       The pet is not their pet. In many cases the person presenting the pet is not the primary caregiver. It is crucial that you be able to communicate with the primary caregiver for the pet. Client handouts and phone calls are the only practical ways to solve this problem. Direct communication with the primary caregiver provides the best chance of compliance with recommendations.
7.       Lack of financial resources is a major reason for noncompliance. This lack of financial sources may be real or just a matter of priorities of how the client wishes to spend discretionary income. Obviously this can be tied to bonding to the pet. I believe this is the true bottom line reason for most noncompliance. To prove this ask yourself: “If I offer to provide the recommended wellness screening services at no charge to the client, how many clients will not comply?” Therefore a major obstacle creating noncompliance can be hurdled by addressing the “limited funds” issue. Consider these strategies:
a)       Promote veterinary pet insurance. Studies prove client with pet insurance rarely refuse recommendations. Veterinary pet insurance has the ability to make high technology diagnostics affordable to the client of the next decade. With the advent of the wellness programs included with at least one insurance company, pet health insurance is indeed affordable.
b)       Establish tiered screening protocols which increase as the pet ages. The key is to start early in the life of the pet and “seed plant” the idea of wellness screening. The reason most geriatric programs have failed in the past was because of the “overnight introduction” of a very expensive protocol. Clients don’t like to make hasty decisions. People don’t often buy under high pressure, at least not more than once.
Consider an early mid-life adult screening of basic blood parameters on the first annual vaccination visit. Consider raising the cost of your preventive care wellness exam sufficient to cover the fee for ECG & glaucoma screening.    Why not make this a value added service that can be promoted to set you apart from the competition? “Our basic wellness visit includes a comprehensive medical history, thorough physical examination, and heart/glaucoma screening. From a practice management perspective, consider the potential profits from treating conditions found and using this minimum test to provide tangible evidence to the client of the need for more extensive testing. But the real opportunity for this marketing strategy is to seed plant the idea of adding routine additional screening procedures as the pet matures and begins the aging process.   
In most cases of canine annual visits, the blood is already drawn for the heartworm test. In cats, blood is often drawn for heartworm testing or leukemia testing. Therefore there is little additional time needed other than for setting up the test. Compare true costs of in-house testing versus out-sourcing. Don’t forget to add in labor requirements for in-house testing. What’s the rush to get results? A decision on where to test should be based on economics to be most cost-effective.
Note that screening tests can be used as a marketing tool because it is simply a tool for looking at normals. When this same test is done for diagnostic reasons, a much higher charge is justified. Why? The reason is very simple, charge for your skills and time for INTERPRETATION of the abnormal values. Any abnormal results on this initial screening obviously calls for more in-depth diagnostics. This strategy involves new thinking, just as many other new successful marketing strategies. The goal is 100% compliance with your recommendation of wellness screening procedures. By implementing this strategy, clients will more easily accept the higher tiered protocols you develop for the aging pet.
c)       Creative financing will generate additional compliance. “Credit with control” works well in many practices. It is beyond the scope of this article to cover all aspects of controlled credit but here are a few suggestions:
1)       Have a credit knowledgeable person in charge of the credit program and limit the number of people who can approve the credit application.
2)       Be sure all staff understand the policy.
3)       Always provide accurate written estimates.
4)       Always require deposits sufficient to cover the “hard costs” of the services provided.
5)       Require minimum monthly payments.
6)       Discontinue additional credit if payments are in default.
7)       Emphasize credit cards as the first line of credit.
8)       Hold checks are the next best thing to credit cards. One caution: do not accept “hold checks” as the deposit!
9)       Charge a monthly credit charge even on hold checks as well as appropriate interest.
10)   No money, no credit card, no checking account, no friend to loan them money, no job equals no credit.
Again, the major problem with the wellness screening programs offered today is low client compliance. Only you can determine the level of compliance you demand in your practice and how to achieve that goal.
Ronald E. Whitford, DVM
Owner and Chief-of-Staff
Dr. Whitford is a 1972 graduate of Auburn University School of Veterinary Medicine. In addition to being chief-of-staff, he is a nationally recognized speaker, writer, and consultant within the veterinary profession. His special interest in practice is surgery.