How to Increase the Quality of Your Patient Care, Increase Client

The world’s leading resource for
complete clinic management solutions
How to Increase the Quality of
Your Patient Care, Increase Client
Satisfaction, and Dramatically
Increase Profits —
All Without Adding Work or Staff!
A Brief Overview
Recently, the American Animal Hospital
Association (AAHA) completed a
landmark identify ways
veterinarians could maximize quality
care. Medical records of nearly 1,400
cats and dogs were examined, from 240
clinics in a wide variety of locations.
Many of the findings were dramatic
– and surprising.
The overriding problem: Most
veterinarians are not providing the
highest level of care...because they’re not
complying with the Standards of Care
deemed appropriate by the Veterinarians
and staff at their own clinics.
The solution: Fortunately, the study
also showed ways veterinarians can
significantly improve those levels of
©2005 RxWorks
compliance. The first step is to
clearly define the appropriate
Standards of Care for patients cared
for by your clinic.
The most successful clinics involved
all their staff in the definition of these
Standards of Care.
We believe that simply discussing the
issues raised awareness amongst the staff
and played an important educational role.
For more information, please send an email to: [email protected]
But just as importantly, their
participation in the process helped them
take ownership in the result and a special
pride in ensuring patients were cared for
Everyone likes to know they are doing
a good job, and these Standards help
all team members know that there are
expectations that they will deliver a high
level of care to all patients.
Having defined the Standards, a clinic
needs a way to manage, monitor,
measure, and enforce them. You are not
looking for a one-time effort, but a long
term solution that will consistently
deliver high quality health care to
These Standards are not rigid rules that
lock the veterinarian into a straight jacket
when it comes to the way they treat their
To be successful, the management
of the Standards must be flexible to
ensure the veterinarian can deliver the
©2005 RxWorks
appropriate care after taking any special
circumstances into account.
Standards encompass all aspects of the
clinic’s operation including enhanced
communication with clients, medical
procedures, staff training, wellness plans
and management.
The Reward: Happy and healthy patients
would be reward enough for most
Veterinarians and their staff, but the
study found an additional bonus. By
delivering a consistently high level of care,
clinics were rewarded with significantly
higher revenues and profits.
Important Notes
Real Practice, not mere Theory
This study was NOT based on some
hypothetical standard which – in theory
– should deliver higher quality of care,
but in practice would be impossible to
meet. The staff of each of the 240 clinics
actually defined the Standards that they
believed were appropriate for their clinic.
For more information, please send an email to: [email protected]
Each clinic was measured by a thorough
examination of that clinic’s medical
records to compare their actual practice
to their own Standards. This shows it is
not a lack of willingness to deliver high
quality health care, but rather the lack
of an adequate system to implement,
monitor, measure, manage, and ensure
Standards of Care.
Rigid Enforcement will not work
The enforcement of arbitrary standards
will not work because they will not be
applicable to all cases – neither will they
enjoy the long-term support of the clinic’s
staff. It is important to involve staff in the
development of your clinic’s Standards of
Care and use a flexible, comprehensive
system to manage the Standards that
allow for the unique circumstances that
may apply to a patient.
Existing Computer Software
Systems were not up to the task
Amazingly, none of the existing Practice
Management Systems in use at the 240
©2005 RxWorks
▼▼Simple to use and already we have no
idea how we managed without it.
Accuracy of billing in our first quarter has
shown a significant increase in turnover,
and keeping track of our case load is very
The senior, endocrine, urinary tract, and
epileptic clinics that we run have taken off
significantly since we can now target and
mail shot all the relevant clients.▲▲
—Forest Veterinary Clinic
▼▼The system has improved our
profitability in many ways including stricter
consistent pricing, efficient reminder
and account systems, and better time
management for staff and data evaluation
for management decisions.▲▲
—Broadway Veterinary Clinic
clinics surveyed by AAHA were up to the
task of managing Standards of Care and
the clinics’ compliance. In fact, they were
so inadequate, the medical records of the
patients had to be manually examined to
measure the clinic’s compliance.
For more information, please send an email to: [email protected]
Do you know
how your clinic
is doing?
How broad is the problem of substandard care?
The AAHA study used the term
“compliance gap” to illustrate the
difference between the Standards of
Care defined by each clinic and the
current reality.
While the disparity is significant, perhaps
even more stunning is the level of erroneous perceptions among veterinarians;
most think their clinics are doing much
more and much better than they actually
©2005 RxWorks
are, and most veterinarians also resist
measures that could improve the situation
because they mistakenly believe their
clients do not want additional advice.
For instance, 68% of senior patients
did not receive an appropriate canine
screening. Less than half of all dogs took
their heartworm preventive therapy.
And a mere 18% of cats were being fed
the appropriate feline therapeutic diet.
The chart on the following page reveals
the details:
For more information, please send an email to: [email protected]
Patients Not in Compliance (Average Practice)
Number of
Non-compliance Patients Not In
Area of Compliance
Average Practice Census
Heartworm Testing
1,800 dogs
Heartworm Preventive
1,800 dogs
Dental Prophylaxis2
25% prevalence =
869 dogs and cats
Canine Therapeutic Diets3
28% prevalence = 504 dogs
Feline Therapeutic Diets3
25% prevalence = 419 cats
Canine Senior Screening
35% senior = 630 dogs
Feline Senior Screening
35% senior = 586 cats
Core Vaccines
3,475 dogs and cats
Table data taken from page 12 of the AAHA study The Path to High-Quality Care, Practical Tips for Improving Compliance.
The AAHA did not include data for preanesthetic testing because the data varied depending
on individual clinics’ protocols.
For approximately 19% of the patients studied, there was no grade for dental disease reported
in the chart. Based on the ages of these patients, a significant portion of those patients with
no grade noted were likely to have had grade 2, 3, or 4 dental disease.
The rate of prevalence of canine and feline therapeutic diets is only for those seven conditions
that the AAHA studied. There are many other conditions that are treatable with therapeutic
diets that, if included in the study, would have resulted in even lower compliance rates.
Yet the vast majority of veterinarians don’t realize their
clinics compliance levels are so poor. The compliance gap for
dental prophylaxis, for instance, is 153%; while actual compliance is
only 35%, veterinarians overestimate it to be 54%.
Take a look at the chart on the next page to see how your clinic’s
compliance levels might compare:
©2005 RxWorks
For more information, please send an email to: [email protected]
Estimated and Actual Compliance Rates
Area of Compliance
Weighted Average
Overestimate: 51%
Heartworm Testing
Actual Overall Estimated
Core Vaccines
Pre-Anesthetic Testing
Senior Screening
Heartworm Preventive
Dental Prophylaxis
Therapeutic Diets
Overall 1
Table data taken from page 68 of the AAHA study The Path to High-Quality Care, Practical Tips for Improving Compliance.
NOTE 1: Overall average weighted by the number of patients eligible for each service/product.
Clearly, even small increases in
compliance will result in significant
improvements in patient outcomes.
There’s another real benefit for veterinary
clinics: enhanced compliance results in
greater profits...since needed care that’s
not being provided will be provided.
And the good news is, clients are a lot
more willing to cooperate than most
veterinarians expect; the study showed
90% of clients want to know about all
the health care options for their pets,
regardless of cost...the vast majority are
©2005 RxWorks
willing to pay for senior screenings...
and 90% also want their veterinarians to
make follow-up calls after appointments.
For instance, a typical clinic (staffing the
equivalent of 2.2 full-time veterinarians,
with 3,475 active patients) that sees a mere
10% increase in compliance will end up
providing 1,287 additional treatments in
one year...yielding $132,535 in increased
revenues and thus $81,364 more in gross
profit. The table on the next page reveals
the details:
For more information, please send an email to: [email protected]
How a 10% Increase in Compliance Affects
Revenue and Gross Profit 1,2
Increase in
Increase in
Gross Profit
Compliance 3
Rate of
Number of
Per Year
Dental Prophylaxis
Core Vaccines and Related Exams
Therapeutic Diets
Senior Screenings
Heartworm Preventive
Preanesthetic Testing
Heartworm Testing
Compliance Area
Total Improvement
Table data taken from page 24 of the AAHA study The Path to High-Quality Care, Practical Tips for Improving Compliance.
Calculations include only the areas the AAHA studied, with the exception of diets, which, for
the quantification of the opportunity, the AAHA expanded beyond the diagnoses studied.
Revenue and gross profit were calculated using data compiled from a variety of sources,
including The Veterinary Fee Reference.
Gross profit is defined as revenue, less the direct costs of providing the care – including drugs
and supplies – but not staff time.
So clearly, the potential for
◆The KPMG Megastudy — The Current and Future Market
improvement is tremendous.
for Veterinarians and Veterinary Medical Services in the
The question now becomes, how can
United States — found that most clinics have the capacity
veterinary clinics make it happen?
to increase services by 10–20% without adding staffs.
©2005 RxWorks
For more information, please send an email to: [email protected]
6 Steps to Increasing the
Quality of Your Patient Care
The AAHA Study recommended 6 basic
steps to improving healthcare…through
increasing compliance levels.
clinic’s annual revenue by $60,243 per
➊ Measure current compliance: Of
all the clinics surveyed, not a single one
registered complete compliance. The first
step toward improvement is to discover
your starting point.
helps to assign a specific staff member
as the champion on compliance, so it
doesn’t fall through the cracks (which is
likely to happen if you have not allocated
responsibility for the tasks).
➋ Involve staff: Clinics that involved
➎ Measure and track results: Practice
the staff in compliance issues achieved
significantly higher levels of compliance
than those that did not.
teams that measure compliance simply
achieve higher compliance rates. If
using software to measure and track,
keep in mind that you’ll need a program
that is not merely for creating bills and
recording transactions, but one that is
based on Problem Orientated Medical
➌ Set compliance goals: Remember,
these are quality-of-care goals — not
financial goals. Make them realistic (not
100%) and specific. Baby steps are the
way to go. Build on your clinic’s successes.
Although your goals are based on quality
of care, remember just a 10% increase
in compliance can increase the average
©2005 RxWorks
➍ Implement the new protocols: It
➏ Celebrate victories: Post the goals
on a chart (like a giant thermometer), and
when you reach certain levels, bring in
For more information, please send an email to: [email protected]
pizza or ice cream. Reward the results!
The report’s bottom line:
Making a conscious decision to
improve patient care, and then
managing and measuring that level
of care, will make a difference...for
thousands of your patients.
But how do we actually do it?
Every clinic has its hectic days and you
will quickly realize that managing the
Standards of Care for your clinic is a
complex task that is well beyond both
manual systems and existing computer
Remember, the study found none of the
existing Practice Management Systems
used by the clinics in the study were up
to the task. With thousands of patients,
hundreds of standards, different veterinarians and staff providing the care, the
complexity is just too great.
RxWorks is prepared to go out on a
limb and say no system, manual or
computerized, will be able, on its own,
©2005 RxWorks
to successfully manage Standards of Care
and a clinic’s compliance.
That is a pretty amazing statement from a
software company, but it is true. So what
is the answer?
RxWorks has spent the last two years
working with some of the world’s
leading practice management consultants to solve this puzzle. Each part of
the solution has been road tested with a
range of clinics.
Feedback was gathered from the
Veterinarians, Practice Managers and
Support Staff. The solution was refined
and tested, refined and tested again, over
and over again.
In many cases, we had to go back to the
drawing board and start all over.
At times it was very tempting for us to
cut corners and release the system, but we
knew this task was too important. If we
could help you dramatically improve the
quality of healthcare delivered to patients,
we could make a big difference to the
For more information, please send an email to: [email protected]
quality of life of so many animals and the
people who love them.
We also knew that, although many
veterinarians put their love for animals
before their own need for adequate
financial reward, we could show them
how – by caring better for their patients–
they would be better able to reward
themselves and their staff. The road to
financial success is not just increasing
fees and creating concerns in the minds
of your clients, but caring better for their
animal friends.
A Man & Machine Combination
The answer was not a software program,
but a solution encompassing both people
and technology.
veterinarians, and organizational
behavior experts. Typical questions that
needed serious consideration were:
What had they seen work in practice?
What made people willing to change?
What makes people take ownership
of new systems and pride in the
What motivates the staff that makes up
the typical veterinary clinic?
How do we explain this concept?
How do we educate the staff of clinics
who have many years practical experience and well-established habits?
What would motivate a 55 year-old
veterinarian to make the changes
necessary to deliver higher levels of
patient care?
Why should a part-time receptionist
How do we help the veterinarian
confidently involve support staff in
RxWorks’ role in the solution is the
The real challenge is in the people
component. For this we leaned heavily
on leading practice management
consultants, hospital administrators,
practice managers, experienced
©2005 RxWorks
For more information, please send an email to: [email protected]
delivering high-quality health care?
The questions went on and on and we
are sure that you can come up with even
more. In some cases it seemed we were
not getting the same answer to the same
question from anyone.
But we pressed on and the more we
refined the solution, the more we
addressed the varying concerns. When
we got a component right, truly right,
it often solved many of the concerns
The plan to achieve increased compliance
has many components and is not an all
or nothing solution. It is a flexible menu
that allows clinics to choose the elements
that suit their individual situation. The
solution includes:
➊ Seminars and Training Courses
that explain the importance of Standards
of Care to clinic staff and their role in the
delivery of high quality health care.
➋ Manuals explaining how a clinic can
define their Standards of Care with short
cuts to speed the process and tips to boost
the likelihood of success.
Health Care Indicators on the patient screen track compliance. Charging the client for relevant
items automatically set the LAST and DUE date. Overdue indicators automatically generate
reminders and trigger Health Care Prompters whenever staff deal with this patient.
©2005 RxWorks
For more information, please send an email to: [email protected]
➌ Accredited consultants who can
work with the clinic’s staff to define their
Standards of Care.
➍ Training courses that show clinics
how to measure, manage, monitor, and
get acceptance of their Standards of
Care with tips on how to ensure a lasting
improvement and not just a flash in the
▼▼ Now, at last, I have a system that
actually does improve my efficiency,
organize my day logically, simply and
actually extends my capacity as a
veterinarian. I find I have to spend less
time on accounts and paperwork but I
have more usable information about the
health of my practice. ▲▲
—Roehampton Veterinary Clinic
➎ Consultants who can hold your
hand through the entire process...and
who are equipped with sophisticated data
mining tools to regularly monitor your
clinics progress and pinpoint areas for
➑ Content that can give your clinic
➏ Software that actively manages
➒ A value equation that shows
your clinic’s compliance with your
Standards of Care. Looking through a
rearview mirror at historical reports is
not enough; help is needed at the point
when care is being delivered.
➐ Seminars that address the issue of
enforcement. How do you find the right
balance? Not too rigid, not too flexible,
but just right.
©2005 RxWorks
a head start in its Standards of Care
objectives. There is no need to start at
ground zero, much work has already
been done that you can leverage off.
the return on your investment, both
medically and financially, has justified
the time and money you have invested.
➓ Practice Management Software
that supports a clinic’s goals. It is
not a specific feature or function, but a
total package that kicks in throughout
the relationship your clinic has with its
patients and clients.
For more information, please send an email to: [email protected]
How Our
Can Help
Your Clinic
The RxWorks solution can be a key to
your success in improving compliance,
since it has been developed specifically to
support these new initiatives.
Not only does RxWorks provide you with
the world’s leading Practice Management
Software for veterinarians, we have also
organized a combination of training,
consulting and content partners who
support your goals of implementing and
improving Standards of Care in your
©2005 RxWorks
Together, we address the advice, training
and support required for day-to-day
activities, management reporting,
implementation and medical and
business strategic management. You
select from our menu of support services,
those that are appropriate for you.
Obviously it is beyond the scope of
RxWorks’ resources (and business model)
to deliver all of the needed components.
So, we built relationships with
independent veterinary management
For more information, please send an email to: [email protected]
consultants and trainers who are
accredited by RxWorks.
These experts provide your management
with the advice and support that you
need to be as effective as possible in
achieving your Standards of Care goals.
For the information technology-based
activities, we use on-site, internetbased and group training courses and
seminars, to help you get the most
benefit out of RxWorks’ comprehensive
Because RxWorks has engaged in the
ongoing collaboration with working
veterinarians that we’ve mentioned,
we improve standard tools and add
new ones as they become relevant to the
practice of veterinary medicine.
Yet RxWorks remains supremely simple to
use. Each module is fully integrated into
the system, so you can access whatever you
need with two clicks of the mouse!
RxWorks is the veterinary software of
choice for over 1,500 clinics in 14 countries.
©2005 RxWorks
“It is by far the best system on the
market,” says Dr. Richard Edwards of
the Alphabet Veterinary Centre.
5 Ways You Can
See Results
RxWorks software can help veterinarians
address the 5 basic medical components
of a compliance-improving effort:
➊ Vaccinations: In RxWorks, charging
for the initial vaccination will automatically set a reminder date in the patient
record for when the booster should be
done. This is typically included in a
reminder system – so the system will
send out a reminder of some sort.
➋ Parasite prevention: Flea control,
intestinal worm and heartworm
prevention all require regular treatment...
provided in sets. (For instance, flea
control is sold in 6 packs that will last
6 months.) The software tracks the date
when the next set is needed...and alerts
the clinic staff, so they can in turn notify
the client.
For more information, please send an email to: [email protected]
➌ Diet: The computer notes the kind of
Your staff can use the software to :
food being fed and a date when next bag
should be bought -- for easy notification.
➊ Communicate the compliance
➍ Health checkups: Regular checks
for healthy animals (like Healthy Pet or
Wellness exams), physical exams, fecal
checks, and dental exams can be set as
automatic reminders.
➎ Screenings: Senior screenings,
wellness plans, and geriatric plans are
scheduled, along with pre-treatment
screenings (like blood screens prior to
5 Steps to Increasing
Client Satisfaction
As clients comply with best-practice
recommendations, their pets will be
healthier -- so naturally, they’ll be happier
customers. RxWorks software provides
the communication tools that make this
possible, and the program is so automatic
you won’t need to add staff to accomplish
your goal of strengthening the client/
practice bond.
©2005 RxWorks
status among staff and prompt them
to communicate with clients: Personto-person staff contact with clients is
crucial in improving compliance and
the client/practice bond, — so RxWorks
provides immediate access to all needed
information in one screen. And when
the visit is being completed, RxWorks
checks all the details and if the Standards
of Care items have not been addressed,
asks for a reason why.
A critical part of the communication is
for all staff to give a consistent message
to the client explaining the Standards of
RxWorks has tools to help you define
the message and then help all of your
staff deliver consistent information
that encourages the client to accept the
needed treatments.
➋ Measure your compliance rates:
You can then review your compliance
For more information, please send an email to: [email protected]
rates using the reports provided by
RxWorks and equally important, see
the reasons why your Standards are not
being accepted by your clients.
➌ Target Clients with pets that need
to meet your Standards of Care:
Client communication isn’t limited
to reminders, though; clinics can also
develop targeted informational and
promotional mailings.
For mailings, RxWorks has superior
ability to identify and select clients and
patients by any of the information in the
database...then easily mail-merge to create
individual letters, emails, or postcards.
➍ Set reminders and send them to
clients: A key benefit of RxWorks is its
powerful reminder process.
The AAHA study showed clients do
At the end of a visit the consulting Veterinarian must make a choice either to invoice an item that
will reset the Health Care Indicator or else to select a reason why the indicator is being ignored.
©2005 RxWorks
For more information, please send an email to: [email protected]
want to be reminded of procedures that
will benefit their pets’ health, and they
welcome continued reminders. RxWorks
can set up to 4 scheduled reminders at
specific time intervals.
When the patient receives treatment,
RxWorks resets the reminder date for the
next treatment. If the client misses a date,
a second reminder will be sent and if they
miss the second date, a third will be sent...
and so on.
Plus, the form of the reminder can
change: You can choose to send a card as
the first, an e-mail as the second, a letter
for the third, and a phone call for the
fourth, or any other combination.
➎ Measure response to your
reminders – are they as effective as they
could be in achieving your goals for
Standards of Care ? RxWorks automatically measures client response for each
reminder level, so the clinic can see which
type of reminder works best...and finetune for even better results. This is one
more important component in helping
©2005 RxWorks
you achieve your Standards of Care goals.
Software Functions
or a Total Solution?
From experience, sometimes painfully
gained over the past 18 years providing
practice management systems to the
veterinary industry around the world,
we feel we understand which of the
key elements of a system can really be a
benefit to a clinic.
We also know that once our competitors
see the benefits veterinary clinics receive
from the comprehensive RxWorks
solution to managing Standards of Care,
they will quickly start adding functions
on an ad hoc basis, in the hope that they
can convince you that they can deliver
similar benefits.
Don’t be fooled! Competitors cannot
recreate overnight a solution that took
2 years of research, solid development,
and fine tuning.
Without a strategic direction for
providing a comprehensive solution to
For more information, please send an email to: [email protected]
the management of Standards of Care,
their ad hoc changes are not part of a plan
that has direction and reason, other than
to play catch-up.
▼▼Our revenue has increased, the ability
Be wary of getting involved in the
“function wars” and being distracted by
superficial functionality.
amount of immediately accessible financial
All RxWorks software development is a
part of our total solution offer. We also
have the complementary services and
support that really make systems work
for you.
▼▼Clients are pleased, especially when
Remember what we said earlier in this
paper: no system, manual or computerized, will be able on its own to successfully manage Standards of Care and a
clinic’s compliance.
Our goal is to provide you with not only
the computer system, but also access to
the advice, training, implementation and
support necessary for you to be successful
in achieving your own goals.
Talk to any RxWorks Practice Advisor
©2005 RxWorks
to customize reminders, handouts and
protocols is very helpful. Target marketing
mail shots are working well, and the
reporting is very useful. ▲▲
—Dragon Veterinary Clinic
we explain how the system makes pricing
fairer and allows us to keep up to date with
methods of treatment, etc.
Takings have increased 15% per week
without a fee rise. ▲▲
—End Cottage Veterinary Clinic
and you will hear a clear strategic
direction mapped out into the future that
helps veterinarians like you deliver better
healthcare to patients and delivers you
the rewards of good practice.
It is a strategic direction that RxWorks
has a long history of fulfilling, and one
that will serve you well into the future.
For more information, please send an email to: [email protected]
Your Profits Will Respond
(Without Adding Work or Staff!)
Better patient care is the goal, of
course – yet an additional benefit of
improving compliance is enhanced
profits. Here’s how it can happen in
your clinic.
Since RxWorks software has been
developed with busy veterinary clinics
in mind, it is designed to streamline the
process of contacting clients.
Since most functions are automatic,
using the system only requires a few
minutes each day...yet will save time
(by eliminating the need to dig through
card files, stacks of paper, and one-at-atime computer documents) that will more
than make up for the quick keystrokes
and/or mouse clicks. So, no need to add
staff or other office-related costs.
Yet the study revealed a clear after-effect
of better quality care. Better care means
©2005 RxWorks
more services provided to patients,
and thus billings will rise. Specifically,
the study showed a mere 10% increase
in compliance...would result in an
additional $132,535 in profits for the
average practice, per year!
Where Can You Go From Here?
Your clinic can increase the quality of
patient care.
For more information, please send an email to: [email protected]
needed healthcare instructions for
their pets.
You can increase client satisfaction
and strengthen the client/practice
bond, too.
And you can dramatically increase
profits — all without adding work or
The AAHA study shows you the way:
Take proactive steps to improve
how your clients comply with the
Of course, a world-class software
program – created especially for
veterinarians – can make all the difference.
The program is RxWorks.
Yes, your clinic can dramatically
improve patient outcomes... and profits...
without adding work or staff.
Contact Info
+44 (0) 700 399 3377
+61 (0) 7 3251 8666
+31 (0) 6 2060 9134
+ 1 888 779 5163
+44 (0) 845 280 2626
+61 (0) 7 3252 5625
+31 (0) 13 5042 302
+ 1 702 435 7672
[email protected]
[email protected]
[email protected]
[email protected]
Mail Address
[email protected] [email protected]
P.O. Box 22
RBH Qld 4029
[email protected] [email protected]
Beekseweg 11A
5087 KA Diessen
©2005 RxWorks
6375 South Pecos Road
Suite 202
Las Vegas, NV 89120