Today's Veterinary Business

DEC 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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12 Today's Veterinary Business Business Business WORKFORCE The cost of labor is one of the toughest expenses to manage but is a significant area of opportunity for increasing profits. When comparing the top 20 percent most-profitable hospitals against global averages, the most-prof- itable hospitals spend 6 percent less in labor. Six percent might not seem like much, but it is 6 percent of gross revenue. And that 6 percent directly impacts your hospital's bottom line. Based upon the global average, total labor, including taxes and benefits, for both DVMs and non-DVMs should be 40 percent of gross revenue. If your hospital's total labor costs are above this amount, you have opportunities to streamline. When DVM compensation is tied to an annual contract, you will need to focus on non-DVM compensation to effect changes in labor in the short term. This means that the real art to compensation is how to pay and utilize non-DVM staff. So where should you start? Though it might sound daunting, simply being intentional about how you view and manage labor is the first step. It doesn't have to be complex, but being thoughtful and planning ahead can have a sig- nificant impact on profitability. Here are five ways you can more effectively manage labor: Have the Right People Doing the Right Jobs One of the keys to effective management of labor is making sure you use your human re- sources wisely, and that means making sure the right team members are doing the right jobs. For In the midst of the day-to-day flurry of wagging tails and purring patients, it's easy to lose sight of strategies that can help keep a veterinary hospital healthy and running smoothly. Developing a plan to effectively manage labor costs is one strategy that can help do just that. By Terry O'Neil, CPA, CVA Being creative with employee schedules and developing a team-oriented culture can lead to a more profitable practice. 1 5 ways to better manage labor Semintra ® (telmisartan oral solution) 10 mg/mL For oral use in cats only Angiotensin II Receptor Blocker Brief Summary: Before using SEMINTRA, please consult the product insert, a summary of which follows: Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian. Description: SEMINTRA (telmisartan oral solution) is a clear, colorless to yellowish viscous solution containing 10 mg/mL telmisartan. Indication and Usage: SEMINTRA is indicated for the control of systemic hypertension in cats. The initial dose of SEMINTRA is 1.5 mg/kg (0.68 mg/lb) orally twice daily for 14 days, followed by 2 mg/kg (0.91 mg/lb) orally once daily. The dose may be reduced by 0.5 mg/kg (0.23 mg/ lb) increments to a minimum of 0.5 mg/kg (0.23 mg/lb) orally once daily to manage SEMINTRA- induced hypotension. SEMINTRA can be administered directly into the mouth, or next to or on top of a small amount of food. Do not mix into food. SEMINTRA should be administered using the dosing syringe provided in the package. The dosing syringe Žts onto the bottle and has 0.1 mL incremental marks. The dose should be rounded to the nearest 0.1 mL. After administration close the bottle tightly with the cap. Rinse the dosing syringe with water and let air dry. If the cat vomits within 30 minutes of dosing, the cat may be re-dosed. Information for Cat Owners: Adverse reactions can occur with use of SEMINTRA. The most common adverse reactions reported during the Želd studies included vomiting, diarrhea, lethargy, weight loss, anemia and dehydration. Contraindications: Do not use in cats with a hypersensitivity to telmisartan. Human Warnings: Not for human use. Keep out of reach of children. SEMINTRA is an angiotensin II antagonist/angiotensin receptor blocker (ARB). Pregnant women should avoid contact with SEMINTRA because substances that act on the renin-angiotensin- aldosterone system (RAAS) such as angiotensin receptor blockers (ARBs) can cause fetal and neonatal morbidity and death during pregnancy in humans. Precautions: SEMINTRA can cause mild anemia or non-regenerative anemia. Cats should be monitored for anemia when initiating treatment with SEMINTRA. SEMINTRA may cause inappetence and weight loss in some cats. Cats should be monitored for weight loss when initiating treatment with SEMINTRA. Use with caution in cats with a history of vomiting, inappetence or weight loss. SEMINTRA has not been evaluated in cats with systolic blood pressure >200 mm Hg. The safe use of SEMINTRA in cats with hepatic disease has not been evaluated. SEMINTRA is metabolized by the liver. The safe use of SEMINTRA has not been evaluated in cats less than 9 months of age, or in cats that are pregnant, lactating, or intended for breeding. See Human Warnings. The safe use with other anti-hypertensive medications has not been evaluated. Adverse Reactions: The safety of SEMINTRA was evaluated in a 28-day Želd study in 192 cats. Adverse reactions that occurred include vomiting 46 (24.0%), diarrhea 18 (9.4%), lethargy 13 (6.8%), weight loss 13 (6.8%), decreased appetite/inappetence 13 (6.8%), non- regenerative anemia 11 (5.7%), dehydration 10 (5.2%), retinal lesions (target organ damage) 4 (2.1%). The long-term safety of SEMINTRA was evaluated in an open label, 5 month Želd effectiveness and safety study in 107 cats that received at least one dose of SEMINTRA. Adverse reactions that occurred in this study are weight loss 37 (34.6%), vomiting 32 (29.9%), dehydration 18 (16.8%), non-regenerative anemia 17 (15.8%), anorexia 14 (13.1%), diarrhea 12 (11.2%), lethargy 12 (11.2%), decreased appetite/inappetence 11 (10.3%), heart murmur 10 (9.3%), death, euthanasia, found dead 9 (8.4%), cough 8 (7.5%), and retinal lesions (target organ damage) 6 (5.6%). Nine cats died or were euthanized during the study. Three cats had progressive chronic kidney disease that may have been affected by telmisartan treatment, concurrent disease, or inadequate control of hypertension. The other six cats died of causes unrelated to treatment (e.g. neoplasia). To report suspected adverse drug events, for technical assistance, or to obtain a copy of the Safety Data Sheet (SDS), contact Boehringer Ingelheim Vetmedica, Inc. at 1-866-638-2226. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or at http://www.fda.gov/AnimalVeterinary/SafetyHealth. Effectiveness: Effectiveness was demonstrated in a 28-day multi-center, controlled, randomized and masked Želd study in client-owned cats with hypertension, and in an open-label 5-month Želd study. 28-Day Field Study In a 28-day study, 288 cats with hypertension (systolic blood pressure [SBP] 160-200 mmHg) were enrolled in the study and randomized to treatment with SEMINTRA (telmisartan oral solution) (n=192) or vehicle control (n=96). The study population included cats with hypertension associated with chronic kidney disease or controlled hyperthyroidism, or idiopathic hypertension. The per protocol population for effectiveness was 141 SEMINTRA treated cats and 79 control cats. SEMINTRA was administered orally at 1.5 mg/kg twice daily for 14 days, then 2 mg/kg once daily until study end; the vehicle control was administered at a mL/kg volume equivalent to SEMINTRA. The two primary variables for effectiveness were comparison of the SEMINTRA and control group mean SBP (mSBP) from baseline to Day 14, and a decrease in mSBP >20 mmHg in the SEMINTRA group from baseline to Day 28. Cats with SBP >180 mmHg at Days 14 or 28 were rescued and removed from the study. There was a statistically signiŽcant difference between the mSBP for the SEMINTRA group compared to the control group at Day 14 (p=0.0005). At Day 14 the SEMINTRA group mSBP decreased by 23.2 mmHg, and the control group mSBP decreased by 7.3 mmHg. At Day 28, the SEMINTRA group mSBP decreased 23.9 mmHg compared to baseline. 5-Month Field Study One hundred-seven cats from the SEMINTRA group that had successfully completed the 28-day study were enrolled in a 5-month open-label study. At the beginning of the 5-month study most cats were administered SEMINTRA at 2 mg/kg once daily. Cats that experienced hypotension (deŽned as SBP <120 mmHg) at 2 mg/kg once daily could have the SEMINTRA dose reduced to 1 mg/kg once daily. Cats that experienced hypotension at 1 mg/kg once daily could have the SEMINTRA dose reduced again to 0.5 mg/kg once daily. Cats were evaluated for SBP, target organ damage (TOD; primarily assessed by retinal photographs), clinical pathology and adverse reactions. SBP was measured on Days 28, 56, 98, 140 and 182 and retinal photographs and clinical pathology were collected on Days 28, 98 and 182. Seventy- three (68.2%) cats completed the study (Day 182), 8 cats were removed for hypertension (SBP >180 mmHg), 2 cats were removed for hypotension, 10 cats were removed by the owner or for owner non-compliance, 8 cats were removed for new or worsening TOD, and 6 cats were removed for adverse reactions unrelated to TOD. Twenty-six cats had dose reductions to 1 mg/kg once daily to manage hypotension. Of these 26 cats, 10 had an additional dose reduction to 0.5 mg/kg once daily. NADA 141-501, Approved by FDA Manufactured for: Boehringer Ingelheim Vetmedica, Inc. St. Joseph, MO 64506, U.S.A. SEMINTRA is a registered trademark of Boehringer Ingelheim Vetmedica GmbH, used under license. © 2018 Boehringer Ingelheim Vetmedica, Inc. All Rights Reserved. Reference: Package Insert 449201-00 Revised 03/2018 09/2018

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