Today's Veterinary Business

OCT 2018

Today’s Veterinary Business provides information and resources designed to help veterinarians and office management improve the financial performance of their practices, allowing them to increase the level of patient care and client service.

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54 Today's Veterinary Business Leadership and heartworm checks were done on a client's pet. The bill totaled $190, and the client paid with cash. Even though Susan did not process the transaction, she was watching what occurred. Later in the day, Susan went into the client's record and did what is called a negative transac- tion. She created another invoice but entered negative 1 for the quantity of each service. The total invoice came to minus $190. Susan then took $190 out of the cash drawer, put the money in her pock- et and shredded the receipt. Everything seemed fine in the end-of-day and deposit reports, but Susan had stolen $190. How would you uncover the embezzlement? The answer lies in the itemized audit trail. The report would show the positive transac- tion in the morning and the neg- ative transaction in the afternoon. This report must be reviewed by the practice owner each day. Doing so takes a minute or two, but it is absolutely necessary. Pay particular attention to any negative transac- tion and, even if you know why it occurred, inquire with your manag- er and receptionist anyway. Sometimes, the knowledge that someone is examining the reports will prevent embezzlement. Fee Exception Reports The other document a manager and practice owner must review is the fee exception report. This report will tell you if anyone charges less than the stated fee in the computer. You can prevent this by not allowing fee changes in your software program. So, let's say you have a hospi- talization service code and your fee is $75. If someone enters $50 for the service, the fee exception report will show the $25 variance. The manager or practice owner can then investigate. The best practice is to set up the practice management software so that no one other than the own- er is able to alter a fee. Determining a practice's fee schedule is the prerogative of ownership. In my opinion, an associate veterinarian or, for that matter, anyone else in the practice other than the owner does not have the right to alter the fee schedule. If an associate doctor is supposed to charge $100 for a service but she decides to charge $50 instead, and if the owner did not give permission, I believe that the associate just "stole" $50 from the veterinary practice. An associate veterinarian has no right to vary from the fee sched- ule unless the practice owner gives permission. This policy should be stated in the employment contract and a violation can be cause for termination. Don't Be the 1 in 10 Many embezzlements occur because a practice has not im- plemented appropriate internal controls. In failing to do so, these practices are almost asking for embezzlement to happen. Hospital owners, you cannot put the responsibility on your practice manager, accountant or anyone else. You are responsible for getting involved in the process, reviewing the end-of-day reports and keeping a vigilant eye for signs of impropriety. Hopefully you will not be the 1 in 10 that is victimized. Practice Smarter columnist Mark Opperman is president and founder of Veterinary Management Consultation Inc. and co-author of "The Art of Veterinary Practice Management, Second Edition." The Nurse's Role At some point, a senior pet's health begins to deteriorate. Quite often, geriatric patients experience pain, decreased mobility, cognitive disor- ders, hearing and sight loss, irreg- ular eliminations or incontinence, and appetite or dietary issues. A veterinary nurse who has devel- oped a strong bond with the client and patient is in a great position to assist these patients through increasingly difficult times. Helping clients understand the aging process and providing infor- mation and resources is essential. Nurses can talk with the owner of an aging pet to learn about her main challenges, frustrations and concerns. They can provide com- fort and support solutions and make recommendations based on specific needs. They can ensure that visits to the hospital are as easy and stress-free as possible. The nurse can assist in areas such as these: • Veterinary visits: Help the patient into the hospital as needed. Many of them might have mobility issues. • Medications and at-home treatments: Demonstrate how to administer drugs or treatments, and develop reasonable and easy regi- men schedules. • Mobility: Recommend solutions for slippery surfaces. The answers could be rugs, yoga mats, booties and other non-slip options. • Lifting and climbing: Recommend and demon- strate harnesses, slings, ramps and furniture steps. • Hearing or vision impair- ment: Recommend gates, lights and environment modifications. • Diet: Recommend food ap- propriate for a specific need Getting Technical columnist Sandy Walsh is a practice management consul- tant, speaker, writer and instructor for Patterson Veterinary University. or condition. These might in- clude soft or easily digestible diets and, if the veterinarian approves, a therapeutic diet. • Elimination: Discuss comfort and treatment options such as diet modifications, medica- tions, potty pads, diapers and hygiene products. • Future visits: Forward-book- ing is important to ensure continued care as frequent visits become more likely. Schedule the next visit each time the pet comes in. When the End Is Near Despite your having provided the best care, the time will come when hospice and other end-of-life services become necessary. Con- versations about the pet's comfort and quality of life and, ultimately, euthanasia will be needed. At this point, the client already will be grieving the inevitable. Help her on the difficult journey. Share information on the options avail- able to her and how everything works. Hold her hand and hold the pet's paw as they approach the final stage. As hard as these moments might be, there is no better patient advocate than the veterinary nurse. It's what we do best. Continued from Page 52 Leadership PRACTICE SMARTER An associate veterinarian has no right to vary from the fee schedule unless the practice owner gives permission.

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