I almost called this article “creating estimates”. However, the word “estimate” has fallen out of favor since it supposedly conjures up images of an auto repair shop. Presenting a “treatment plan” to the owner hopefully creates more value, a sense of caring and professionalism on our part, and may help in your discussion of what is recommended for the pet. I have found that more problems result from miscommunication over money than anything else. Creating a “treatment plan book” addresses several key points:
- Staff will spend less time creating treatment plans
- There will be more consistency in treatment plans
- Any staff member will be able to create an accurate plan in seconds
- The plans are designed with a buffer of 10-20% built in. If you are really dealing with some unknowns, add an even higher buffer.
- Clients will be less aggravated, because a miscellaneous buffer to account for the unexpected will usually result in a final invoice being less than the high end of the plan.
- Always have a rule that if you do go over the high end, the owner needs to be called with an explanation. Do not wait until they are at the front desk.
- Always aim for a final invoice that is less than the high end of the estimate.
Veterinary software programs make creating bundles of services fairly simple, although time-consuming during set-up. You can find this information by looking in your software manual if you have one, using the help feature on your software, or call support for your system. If you don’t have a computer software system that will do this, you can create a physical manual. I highly recommend having a hard copy regardless, since what hospital has not experienced the joys of a down computer system??
To start, make a list of every service you offer, from spays and neuters to barium studies, exploratories and cruciate repair. Enlist the help of the doctors and the rest of the staff – I still discover the occasional service that needs to be included that I did not think of. And of course the hospital often adds procedures as time goes along.
Pick one service to start and complete, and you will soon get the hang of it. List every aspect of that service, even if there is no charge for it. It is difficult enough to make clients understand everything that goes into a procedure on their pet, so the more complete you can be, the more it will create value for the client. For example, a spay may be as follows:
Ovariohysterectomy canine 0-30# bundle
- Ovariohysterectomy
- Pre-anesthetic induction
- Inhalant anesthesia
- Hospitalization canine
- IV catheter
- Monitoring
- Pain medication injection/sx
- Antibiotic injection/sx
- Laser therapy post-surgical
- Rimadyl 25mg pain pack
- Rimadyl 75 mg pain pack
- Rimadyl 100mg pain pack
- Extract baby teeth
Once bundled, design it so that each of these items will come up on your computer screen with a box (pre-checked) in front of the item, so if not included in that particular surgery the box can be unchecked. For example, I list all of the rimadyl sizes that a patient may go home with, and I uncheck the incorrect sizes for that particular pet. You can also change quantities in the low and high columns, usually more of an issue in plans involving hospitalizations for sick pets, where there is more of an unknown as to days of stay and therefore variation in daily treatments needed. Simpler estimates for services such as abscess repair or laceration repair include a miscellaneous charge of $60-$100 to help cover medications to go home, e-collars, etc. Other estimates may need a higher miscellaneous charge of $100-$200 or more to make sure you cover unknowns. I suggest that even within a particular service bundle you make separate estimates for different levels of care, such as laceration repair minor, laceration repair major, dental cleaning routine, dental cleaning severe, etc.
You may need to create new service items that are part of bundles, if they are priced differently or at zero. For example, for our dental bundles I have a separate service item called “IV catheter with dental” listed at zero price; for tumor removal bundles the name is “IV catheter” at the regular price. The nice part is that when it comes time to invoice, you can add the bundled service and then just uncheck whatever was not done, and change quantities. Just make sure you are following the estimate you made, and hopefully your total will be less than the high end of the estimate. If you are consistently having problems with this, you need to make sure you have not missed any of the bundled items that should be included, or you need to add a higher miscellaneous charge. Creating bundles of your services to be used for treatment plans and invoicing is a great project, one that will make your staff’s life easier, in that estimate-making will be faster and can be spread around and not left up to 1-2 people to struggle through. It will also dramatically reduce the number of missed charges, which should make your employer happy. It is also a huge project, so if you decide to take this on make sure you add it to your list of accomplishments when evaluation time rolls around. If I can help anyone with this, please contact us through the forum. I would be glad to provide you with specific examples of our bundled services you can use as a guide to get started, and hopefully answer any questions you may have.
