Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate American College of Healthcare Executives
Sample "Starting Point" for Horizontally-Integrated Wellness Surveillance Program
Puppy Wellness
Heartworm and Flea/tick Prevention
6, 9, 12 weeks (9 and 12 could be nurses consult in some jurisdiction)
12-system Physical (nurse asymmetry exam each time)
DHPP (distemper, hepatitis, parainfluenza, parvo virus) each visit
Bordetella (1 x @ 8 weeks or older)
Fecal - float and Giardia SNAP if from shelter or Pet Store
Deworming (CDC Strategic deworming program)
15 weeks
2-system Physical
DHPP (distemper, hepatitis, parainfluenza, parvo virus)
+/- Complete the paper work and draw blood for the following week surgery
Rabies, 1 year (tag additional)
Fecal
Puppy Wellness
16 week JPS screening for breeds predisposed to hip dysplasia
4-6 months female or male
Nurse asymmetry exam upon admission
Risk Level 1 (PCV, TP, BUN minimum Panel pre-surgery)
Spay / Neuter
Microchip
*some practices provide pet population "credits" to reduce spay/neuter cost IF the client has stayed on the program for the four previous visits.
9 months
Nurse asymmetry exam - 12-system Doctor Physical is anything is atypical
Bordetella
Fecal
13 months
Rabies, 3-year
DHPP (1st annual then w/extended DOI vaccines, every 3 years)
^ Use age chart (Idexx or Pfizer) as client handout, add genetic predisposition web site above age chart using folder label
19 months
Nurse asymmetry exam - 12-system Doctor Physical is anything is atypical
Review changes in dietary needs
Review dental hygiene
Bordetella
Fecal
Starting at 2 Years of Age
Canine Life Cycle Consult (1 of 2 Semi-Annual)
12-system Physical
Rabies tag additional if three year vaccine and one year tag law
Bordetella
Fecal - Float & Giardia SNAP
Heartworm test
Urine sample - ERD
Canine Life Cycle Consult (2 of 2 Semi-Annual)
12-system Physical
DHPP (w/extended DOI vaccines, only once every 3 years)
Bordetella
Young Adult Panel (Chem-6) - or - Over-40 Panel (Chem 12)
Fecal - Float & Giardia SNAP
Legend
^ Use age chart (Idexx or Pfizer) as client handout
# Geriatric screening starts at ~ 70
Diagnostic Intensity means X-rays "needed" for limping animals, rales, static gut, late grade 2+ mouth or later and similar SOC.
Diagnostic Intensity means when there is an atypical laboratory value, it is assigned to a nurse to follow, get sequential blood/urine samples, and continue until atypical condition is resolved, or doctor determines it is "typical" for this specific animal.
Every Need ([ ] or CR-_) Statement has "two yes" alternatives, then client response: W-D-A-X
Kitten Wellness
Heartworm and Flea/tick Prevention
6, 9, 12 weeks (9 and 12 could be nurses consult in some jurisdictions)
12-system Physical (nurse asymmetry exam each time)
PRC (panleukopenia, rhinotrachi, Calci virus) each visit
Felv vax (for 2 separate visits)
Felv/ Fiv test ( 1x)
Fecal - float & Giardia SNAP if from shelter or Pet Store
Deworming (CDC Strategic deworming program)
15 weeks
12-system Physical
PRC (panleukopenia, rhinotrachi, Calci virus)
Rabies
Fecal
4-6 months female or male declaw optional
Nurse asymmetry exam upon admission
Risk Level 1 (PCV, TP, BUN minimum Panel), FIV test (lab work)
Spay / Neuter / declaw
Microchip
*some practices provide pet population "credits" to reduce spay/neuter cost IF the client has stayed on the program for the four previous visits.
13 months
Rabies, 3-year
^ Use age chart (Idexx or Pfizer) as client handout, add genetic predisposition web site above age chart using folder label
19 months
Nurse asymmetry exam
PRC (1st annual then every 3 years)
Review changes in dietary needs
Review dental hygiene
Starting at 2 Years of Age
Feline Life Cycle Consult (1 of 2 Semi-Annual)
12-system Physical
Rabies tag additional if three year vaccine and one year tag law
Fecal - Float & Giardia SNAP
Urine sample - ERD
Feline Life Cycle Consult (2 of 2 Semi-Annual)
12-system Physical
PRC (1st annual then every 3 years)
FELV (only if exposed or at risk)
Fecal - Float & Giardia SNAP
Young Adult Panel (Chem-6) - or - Over-40 Panel (Chem 12)
PLUS - Thyroid Screen starts at about age 7
Legend
^ Use age chart (Idexx or Pfizer) as client handout
# Geriatric screening starts at ~ 70 on age chart
Diagnostic Intensity means X-rays "needed" for limping animals, rales, static gut, late grade 2+ mouth or later and similar SOC.
Diagnostic Intensity means when there is an atypical laboratory value, it is assigned to a nurse to follow, get sequential blood/urine samples, and continue until atypical condition is resolved, or doctor determines it is "typical" for this specific animal.
Every Need ([ ]or CR-_) Statement has "two yes" alternatives, then client response: W-D-A-X
We have met the enemy and it is us. The client cannot reasonably decide on the merits of different healthcare delivery issues; that is a graduate veterinarian's responsibility. When the medical records do not match the invoice(s), it is pure fraud from an auditor's standpoint. There cannot ever be "forgotten care" or "forgotten charges", or even falsified information (e.g., "45 minutes anesthesia" and "30 minute surgery", being invoiced as "30 minutes of surgery and anesthesia"). We are required by the respective practice acts to have full and accurate records and disclosure to the animal steward on patient and professional "needs". The client has the right to allow the animal access the needed care or not, but at no time are we as healthcare professionals allowed to hide the actual healthcare facts or needs from the client.
"Compliance" to inviolate Core Values and inviolate Standards of Care is internal to the practice, and not a client issue. Compliance starts from the providers and is reinforced by the staff and providers; when there is a consistency in the expected Standards of Care, the subsequent continuity of care become easier as well as more beneficial to patient, client, staff, providers, and business.
Reality Check#8
Some veterinarians will read the above, and state they don't need to do it; they can remember it all. This translates to: "I do not want to share accountability", "I do not believe in team-based healthcare delivery", and in many cases, "I will work 24/7, 365, and never whine about the hours."
The above are falsehoods, since no one wants to be tied to the practice 24/7, 365, yet many veterinarians do not want to change their sloppy medical record habits, much less their sloppy standards of care, so they offer excuses.
Integrating a wellness surveillance program is exactly what your clients want; make the decision to serve them, or not. Make it an overt decision.
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