Why More Practitioners Need To Hospitalise
I think that Hamlet phrased it best – when he said;
“To hospitalize or not to hospitalize – that is the question.”
So many Veterinary practitioners don’t hospitalize pets (that really do need hospitalization), for all sorts of different reasons. However, when all is said and done, hospitalization is a hallmark of good Veterinary medicine.There are so many procedures that are performed for hospitalized pets that just can’t or won’t be available for outpatients. These include;
- more frequent and more thorough examinations,
- more reviews of the history,
- more opportunity to review laboratory and other data,
- more opportunity to perform ancillary testing (e/g/ ultrasounds, ACTH response tests etc) and
- more opportunity to accurately document and chart the progress of each patient.
The above benefits generally result in;
- increased diagnostic accuracy,
- more appropriate treatment,
- more rapid patient response and recovery,
- less patient morbidity,
- fuller recovery and
- greater profit for the practice.
This scenario is the ideal; a win-win-win for everybody.
Unfortunately, many practices and practitioners today tend to hospitalize pets less often than optimally required – often to avoid client expense.
Let’s be frank – most of these patients are not going to receive the care that they need at home. Clients do not have the medical and/or surgical skills sufficient, nor simply the time to adequately treat these patients, nor do they have the skills or training to be able to assess; response to treatment and whether their pet needs to be medically reviewed. Your clients know of this lack and most of them simply do NOT want to deal with a pet requiring treatment.
Coincidently, empty Hospital wards are overhead without income – a major expense.
Most clients are simply incapable (for whatever reason – they are NOT trained in this area – and more-over they do NOT want the responsibility) of properly treating ill pets at home.
Let’s examine in detail of some of the benefits of Hospitalisation and how you can make this procedure of increased value for your client.
- More time. How many times has a client come in for something routine and mentioned a concurrent problem – one that you simply do not have the time to delve in to at that time (running late, waiting room full, etc). Hospitalisation allows you the chance to perform a more thorough examination/investigation at your leisure.
- Client satisfaction. Sending patients home with the “Come back if s/he doesn’t get better” phrase is doing you, the patient and the client a dis-service. The client may well choose to seek more attentive care elsewhere. Many Veterinarians assume that a patient not returning or revisiting equates to a successful outcome. This could not be further from the truth.
- Observation of treatment. You can’t, without observation, confirm a diagnosis or effectively judge treatment outcome. Unless you admit and observe, you are unaware of lack of response to initial treatment. Is there underlying pathology present, or is there a misdiagnosis? Observation is the answer.
- Appropriate environment. Is the environment to which the patient is returning, one which gives adequate opportunity for ‘healing’? Are there other complications such as parasitism, poor sanitation, adequate food, shelter and warmth, are there other pets or unruly children. All these factors need to be considered.
- Less client stress. Many clients are physically, emotionally or time challenged with respect to caring for an ill pet. As such, Hospitalisation removes this burden. How can single owners (especially the old, frail, elderly, small or incapacitated), deal with a patient that needs daily ear flushings, regular bandage changes our wound treatments. The situation worsens with the size and temperament of the dog and the un-cooperation of the cat. Does a client really want to clean up vomit or diarrhoea from their house or carpet? Most clients appreciate the Peace Of Mind that they get by Hospitalising their pet.
- Greater profit. As Jay Abraham says; “When you render greater service, you generate greater charges.” That is not to say or suggest that you hospitalize pets for the fees. If you are sure that the condition will resolve successfully at home and/or if you are certain that the client is capable of looking after the pet optimally at home, then treat that pet as an outpatient. The point here is that on many occasions the client would prefer that the pet be hospitalized and because we assume and presume that the client wants the pet at home, we do not offer hospitalization as an alternative. A hallucination could be that if we were to do so (offer hospitalization for a clients’ pet), then many clients would take us up on it. The client’s financial circumstances are his or her concern and should be of no influence to you with respect to offering and recommending the best and most successful treatment available.
Next time, before you send a patient home for treatment, consider if everyone may not be better off if that patient were to be hospitalized.
Value-Added Hospitalisation Bundles
You should NEVER charge for Hospitalisation … (caught your imagination didn’t I – read on)…
A Hospitalisation charge should be a bundled fee consisting of the following components;
- Ward Occupancy (your overnight boarding fee)
- Doctor’s Treatment Plan and Supervision – formerly called Daily Doctor Exam Fee or In Hospital Exam Fee (equivalent to a consultation fee – add 40% loading if intensive care involved)
- Nursing Care/Medication Administration (0.4 x consultation fee) – medications are extra
- Medical/Hazardous Waste Disposal Fee (0.1 x consultation fee)
Depending on the Category and the Level of Care required, Hospitalisation Bundles can thus be created (and MUST be itemized in/on the invoice) – see some examples below:
Examples:Below are some suggested bundles, what they could contain and a rough guide to pricing levels or steps. Please note – these are examples only (the fees are TOTALLY hypothetical) and you will need to examine and rework the examples and the specific charges to fit your own situation. I’d like to thank Gerald Snyder for his guidance and help with these examples.
Hospitalisation Category 1: Emergency Care – Life Threatening $197.6Pets lives are threatened, hospitalization is necessary to save the patient’s life
- Doctor’s inpatient examinations
- Doctors treatment planning
- Daily nursing care
- Ward occupancy
- Hazardous waste disposal
Hospitalisation Category 2: Intensive Care – Guarded Prognosis $157.60These pets are very ill. Rehydration and rapid IV antibiotics are imperative. After 2-3 days, owners might/could opt for treatment on an outpatient basis with oral medications. The essential question here becomes: “Are you willing and able to administer oral medication every 6-21 hours?” If parenteral fluids are required then the patient is not yet ready to go home.
- Doctor’s inpatient examinations
- Doctors treatment planning
- Daily nursing care
- Ward occupancy
- Hazardous waste
Hospitalisation Category 3: Hospitalised Patient Care/Day $102.60Pets with gastrointestinal diseases, where oral medication is unlikely to be tolerated and/or exacerbate the condition commonly make up this category. Clients should be told that while oral medication is possible, vomiting or diarrhea may occur and the pet would be better served by hospitalization. Better your run than their carpet!
- Doctor’s inpatient examinations
- Doctors treatment planning
- Daily nursing care
- Ward occupancy
- Hazardous waste
Hospitalisation Category 4: ‘Boarding Plus’ (oral medication administration) $61.90These pets COULD be given a loading dose of medication by injection and then treated as outpatients at home. However the client either – cannot be relied upon, is not capable of or does not want to administer the medication. Charging the client and Enhanced Boarding Service (boarding fee plus an additional $19.70 per day for administration of medication) offers good value to these clients.
- Doctor’s inpatient examinations
- Doctors treatment planning
- Daily nursing care
- Ward occupancy
- Hazardous waste
Hospitalisation Category 5: (Day Care Plus) $34.30Medications and fluids to be administered as required for the pet that goes home each night and returns the following morning. Separation anxiety is real (for both pet and owner) and can sometimes interfere with the best efforts of the Veterinarian.
NOTE: medication of boarders and day care patients involves bringing the patient to the treatment area at least twice a day and subsequently returning him/her to the wards. Medication must be located, administered and recorded (on the patient file). An additional $20.00/day is barely enough to pay for these procedures.
- Daily accommodation
- Clean/sanitize morning and night
- Exercise by staff
- Meal preparation
- Daily monitoring