Today's Veterinary Business

APR 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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64 Today's Veterinary Business VetPartners Corner veterinarian for vaccination, routine care or serious illness. This failure to grasp the true value of personal- ized medicine can adversely affect the health of pets and the financial health of veterinary practices. Be Pre-Emptive The area with the most need for improvement is early detection. Veterinary health care teams are very good at working up patients with clinical problems such as poly- uria/polydipsia, confirming a di- agnosis and instituting treatment. However, a goal of personalized medicine is to identify problems when they are subclinical and the pet still appears well and when the most options are often available for management or prevention. So, for example, our human physician counterparts would not be as satisfied with diagnosing diabetes mellitus in a patient; the preferred goal would be to identify the pre-di- abetic patient and then manage the condition so that it might never evolve into clinical diabetes. For us to achieve the same level of care, we need to embrace early detec- tion and not wait for animals to be clinically ill before we start routine screenings and intervention. A comprehensive history, phys- ical examination and appropriate periodic diagnostic screenings are the key components of early detec- tion. Diagnostic screenings might include genotypic testing (e.g., DNA) and phenotypic testing (e.g., laboratory findings or imaging) for heritable or otherwise predictable medical issues. Early detection is easiest if we first take the time to appreciate risk. Some animals are going to be at higher risk for specific conditions than others, based on genetics, family history, breed predisposi- tion, lifestyle, exposure and other factors. Doesn't it make sense to screen pets at risk for a variety of conditions proactively rather than waiting until the conditions become problematic? The earliest screening is typi- cally genotypic testing, which can be done as early as 1 day of age but for practical purposes is usually done at around 12 weeks (and after pet health insurance is in full effect, for pet own- ers who desire this form of risk management). With recent advances it is now possible to cost-effectively screen for dozens of ge- netic diseases with a single panel. Such panels include things like von Willebrand disease, progressive retinal atrophy, cardiomyopathy, degenerative myelopathy, MDR1 and cystinuria. A variety of laboratories, such as Orivet, Canine Health Check, Embark and Mars, provide comprehensive panels. Genotypic testing is new and exciting, but it won't uncover all risks, so phenotypic testing is need- ed for many conditions, including diabetes mellitus and orthopedic disorders, based on a pet's individ- ual risk factors. While genotypic testing can be done early in life since DNA does not change as a pet ages, phenotypic testing, such as blood work, urinalysis and radiographic studies, is usually per- formed at ages and intervals that vary with the breed and condition being detected. Diagnostic screenings can pro- vide baseline values and facilitate long-term monitoring to establish trends that might help to identify subclinical disease. Without early detection and management, many of these conditions can lead to a significant decrease in a pet's qual- ity of life. Shared Standards of Care The final aspect of personalized medicine is evidence-based man- agement. Hospitals should endeav- or to codify best practices that are common to all veterinarians in a practice and based on the most current guidelines available. These standards need to be periodically reviewed and updated as new evi- dence becomes available. Clients want veterinarians to pro- vide health guidelines in accordance with their pets' actual needs, so adopting and implementing guide- lines, protocols and evidence-based care pathways allows the veterinary practice team to satisfy this desire while simultaneously better meet- ing practice revenue objectives. A suitable starting point is to consider thorough assessments or ques- tionnaires to determine which risk factors might influence the decision-making process, using the information to establish prevention pro- tocols and early-detection opportunities, and then monitoring pets through- out their lives, modifying action plans as needed. Early therapeutic intervention has been shown to offer the best chance of successful long-term management of many conditions. Clearly distinguishing between curing a medical condition and long-term control is important when discussing the benefits of inter- vention and disease management with pet owners. The Bottom Line It doesn't take much imagination to see that personalized med- icine allows for the delivery of better medicine. With improved prevention, early detection and evidence-based treatment and monitoring, as well as closing compliance gaps, there are many more opportunities for revenue generation just by providing better medicine. In fact, the American Animal Hospital Association has suggested a significant increase in revenue is possible over the life of a pet just by providing the level of care that most veterinarians already acknowledge is needed. When will you incorporate personalized medicine into your practice? VetPartners member Dr. Lowell Ackerman is a veterinary consultant and an adjunct professor at the Tufts University Cummings School of Veterinary Med- icine. He is editor-in-chief for "Five-Minute Veterinary Practice Management Consult," and he lectures globally on medicine and management topics. Founded in 2001, VetPartners is a nonprofit association dedicated to helping the veterinary profession improve practice management standards and elevate the levels of service, expertise, responsibility and professionalism provided by veteri- nary consultants, advisers and specialists. Learn more at VetPartners Corner Editor's note: Some of the material above was abstracted from "Five-Minute Veterinary Practice Management Consult, 3rd Edition." (Continued from Page 62) Some animals are going to be at higher risk for specific conditions than others, based on genetics, family history, breed predisposition, lifestyle, exposure and other factors.

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