1. Benchmarking Metrics to Improve Medical Care & Financial Performance

2. Benchmarking Within Your Practice for Consistent SOC & Fees Consistent Service, Medical Care & fees? VSG initial meeting Fee Case Study metrics tool Using tool to benchmark the practice staff’s adherence to the practice’s Standards of Medical Care Using tool to benchmark the practice staff’s adherence to the practice’s fee schedule Using tool to quantify the financial effect of “compliance gap” “Compliance Gap” Medical care and Fee differences between doctors within same practice for the same case presentation.

3. http://www.veterinarystudygroups.com

4. Case Study Methodology for SOC & Fee Compliance Review Outline a relatively straight forward medical/surgical problem Request at least 3 doctors prepare invoices at 3 end points with no collusion Initial workup Surgery and post op 12 hour care Hospitalization 48 hours to resolve medical issues Practice manager enters services with fees into master spreadsheet The final result is an invoice from each provider in your hospital entered into a master spreadsheet for each stage of the problem’s resolution. This allows the medical director and practice manager to compare the application of the practice’s fee schedules and the suggested level of patient medical care between doctors in the same practice.

5. Pyo Case Study A six-year-old intact, 20-pound female Schnauzer was presented for signs of anorexia of 36 hours, lethargy, vomiting of 12 hours duration and PU/PD. She was in season approximately 4 to 6 weeks ago. Her physical exam and vital stats were unremarkable other than febrile, a tense abdomen which made palpation difficult, scleral injection & 5 percent dehydration. She was an early morning unscheduled urgent care visit. Client authorizes whatever is medically best for the patient.

6. Diagnostic Plan at Initial presentation Examination unscheduled urgent care exam CBC, Chemistry Profile, or CBC/Chem profile (if you bill them together) Electrolytes (if not included with Chem Profile above) Urinalysis lab fee (Cysto or catheterization collection) Urine culture & Sensitivity Submitted X-ray of the abdomen (2 views) Film (2 views) Interpretations of two views Abdominal ultrasound if available

7. Findings of Diagnostics X ray: uterine enlargement Ultrasound: large tubular hypoechoic mass in abdomen Chem profile: increased BUN 120, creatinine 3.3, moderate leukocytosis and neutrophilia with a left shift and a mild macrocytic normochromic anemia Urinalysis: 1.014 SG, 300 proteinuria, +2 white blood cells (WBC), and RBCs TNTC. TDx: pyometra, uremia, dehydration, anemia, renal disease, possible UTI

8. Case Study Initial Workup (1) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

9. Case Study Initial Workup (1) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

10. Case Study Initial Workup (1) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

11. Case Study Initial Workup (1) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

12. Day One Work Up (1) High to Low % Difference$ Difference% Difference$ Difference 249%$ 70927%$ 208 233%$ 1,05226%$ 168 131%$ 48418%$ 165 125%$ 48018%$ 113 105%$ 33115%$ 112 80%$ 43714%$ 116 78%$ 49712%$ 88 69%$ 4069%$ 76 55%$ 3237%$ 131 45%$ 2523%$ 26

13. Case Study – Pyo Surgery (2) Fees shown are for illustration purposes only *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

14. Case Study Pyo Surgery (2) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

15. Case Study Pyo Surgery (2) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

16. Case Study – Pyo Surgery (3) (cont’d) Fees shown are for illustration purposes only *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

17. Case Study Pyo Surgery (2) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

18. Case Study Pyo Surgery (2) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

19. Pyo Surgery & Same Day Post op Care (2)- High to Low % Difference$ Difference % Difference$ Difference 102%$62217%$143 68%$36216%$ 82 48%$66315%$120 43%$29414%$183 29%$20312%$ 57 28%$2789%$ 48 24%$1358%$ 74 23%$1608%$ 95 20%$4388%$ 86 19%$1946%$ 53

20. Case Study – Post Op Care (4) *fees shown are for illustration purposes only & are not suggested fees nor actual fees charged

21. Post-Op Care Differences 2 Days Post-op (3) High to Low % Difference$ Difference % Difference$ Difference 299%$541 46%$162 202%$595 44%$142 155%$533 40%$259 128%$518 28%$115 124%$221 17%$101 113%$365 13%$130 76%$211 12%$127 58%$347 12%$127 57%$262 12%$95 51%$223 8%$63

22. Total Case Study Fees High to Low (not including overnight fees) % Difference$ Difference % Difference$ Difference 82%$1,991 13%$305 63%$1,026 13%$300 52%$696 13%$232 49%$643 12%$256 27%$601 10%$150 25%$512 10%$287 24%$548 8%$427 24%$535 5%$72 21%$348 4%$142 16%$331 2%$59

23. Case Study Summary High to Low

24. High Low Summary 100 Practices

25. Pyo Case Total Fees Invoiced Average of the last 100 VMG practices: 26% difference high to low total fees within practice Differences range from 1% to 82% difference “Disparity Gap”

26. What Does This Mean to Practice Financially

27. Same SOC - Different Estimate How can associates in the same practice make similar treatment recommendations yet have totally different invoice amounts? Fee schedule compliance? Leadership?

28. Same History, PE & Diagnostic info Yet Different Recommendations Why do some associates come up with quite a different diagnostic and treatment plan given the same presentation history and lab findings ? Standards of Care? Leadership?

29. Take Home There is a significant variation in standards of care and charging within most practices Establish SOC with group input Simplify your fee schedule “KISS” Capture 50% of fee disparity in your hospital

30. Consider This… If you don’t address the issues that lead to differing fee presentation & levels of care within your hospital… How does this impact medical outcomes in your hospital? What is the client’s perception regarding a consistent level of care? What does it mean to the associate’s income? What does it mean to your bottom line?

31. What are You Going to Change?