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  News from the Maryland Veterinary Medical Association                                               Fall 2009

Hospital Bundles Increase Perception of Value

by Dr. Gerald M. Snyder, Veterinary Productivity, Inc.

What has more value in your client’s mind… a “Fecal” or an Intestinal Parasite Screening?” What picture does the single word “hospitalization” bring to mind. Paint a more favorable picture for all concerned by using the language that reflects the depth of your care. Here are some examples.

Hospitalization Fee/Day
(an invoice bundle)

  • Ward Occupancy (Charge your usual overnight boarding fee).

  • Doctor’s treatment plan and supervision (1.0 x office exam). (Add 40% additional for intensive care)

  • Plus Nursing care/medication administration (0.4 x office exam). (Drug fees are not included.)

  • Plus Hospitalized pet medical waste disposal (0.1 x office exam)

Many practices today tend to hospitalize less, often to avoid client expense. Most of these pets are not going to get the care they need at home and, coincidently, empty hospital wards are overhead without revenue. This guideline may help avoid confusion among associates and staff. The premise of our guidelines is simple.
Most clients simply are incapable of properly treating ill pets at home.

Hospital Category #1
These pets lives are threatened. Hospitalization is necessary for saving the pet’s life.

Hospital Category #2
These pets are really ill. Rehydration and rapid blood levels of antibiotics are imperative. After 2-3 days, the pet owner could opt to maintain the pet by oral medication at home. These clients need to be asked the straightforward question … Are you willing and able to administer oral medication every 8-12 hours? If parenteral fluids are needed, that question becomes more complicated.

Hospital Category #3
Pets with gastrointestinal diseases where oral medication is unlikely to be tolerated, and could exacerbate the condition. Clients should be told that while oral medication is possible, vomiting or diarrhea may occur and the pet would be better treated in the hospital. Better your run than their carpet.

Hospital Category #4
Boarding Plus (oral medication administration). These pets could be given injectible starter doses of medication and sent home for treatment except that the pet owner cannot be relied upon, is not capable of, or just does not want to administer the drugs. Whether a week of pills to an unmanageable junk yard dog or by an infirm pet owner, the owner is offered the option of “Boarding Plus”, an enhanced boarding service for the boarding fee plus an additional $19.70 charge per day for administration of BID meds. Pharmacy charges are always additional.

Hospital Category #5
Day Care Only Drugs & fluids to be administered BID for the pet goes that goes home each night, and returns in the morning. (Separation anxiety on the part of the pet is real and can sometimes hinder the best efforts of the practitioner. Elavil™ etc. usually ameliorates pet’s separation anxiety Now, if we could only treat the owners.
Medicating boarders & day care patients involves bringing the pet to your treatment area twice and returning it to the wards twice. Medications must be located, administered and recorded. An additional $20/day is barely adequate to pay for this function. All of the levels of care below do not include any medications.
All of the fees below are included not as a recommendation but as a minimum for comparison.

Level 1 Hospitalized Patient Care/Day - $147.60
(Fee are hypothetical only)
• Emergency Care - Life Threatening
• Doctor’s inpatient examinations
• Doctor’s treatment planning
• Daily nursing care
• Ward occupancy
• Hazardous waste disposal

Level 2 Hospitalized Patient Care/Day - $117.60
Intensive Care Guarded Prognosis
• Doctor’s inpatient examinations
• Doctor’s treatment planning
• Daily nursing care
• Ward occupancy
• Hazardous waste disposal

Level 3 Hospitalized Patient Care/Day - $82.60
• Doctor’s inpatient examinations
• Doctor’s treatment planning
• Daily nursing Care
• Ward occupancy
• Hazardous waste disposal

Boarding Plus Patient Care/Day - $51.90
• Doctor’s inpatient examinations
• Doctor’s treatment planning
• Daily nursing care
• Ward occupancy
• Hazardous waste disposal

Day Care Plus - $34.30
• Daily accommodations
• Sanitize morning and evening
• Exercise by staff
• Meal preparation
• Daily monitoring

General Surgical Anesthesia (Bundle) - XX.80
(3 x health Maintenance Exam)
• Pre-anesthetic Physical Examination
• Induction of Anesthesia (Injection)
• Operating Room
• Endotracheal Intubation
• Cardiac Monitoring (EKG Monitor)
• Respiratory Monitoring (Respiratory Monitor)
• Continuous Blood Pressure Monitoring
• Anesthesia Level Monitoring
• Sevofluorane or Isofluorane Anesthesia
• Water Circulating Body Temperature Warming Blanket
• Endotracheal Extubation
• Recovery Room
• Recovery Room Attendant
• Post Surgical Observation and Monitoring

Complete Blood Count - $XX.70
• Specimen Collection
• White Blood count
• Red Blood Count
• Packed Cell Volume
• Differential Cytology

Radiographic Study - $162.67
(3 x health Maintenance Exam)
• Radiograph - initial view
• Radiograph - perpendicular view
• Hazardous waste disposal

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© 2009 Maryland Veterinary Medical Association

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