Laboratory services provided at veterinary hospitals continue to evolve. Just look at the changes over the last 40 years: Parvo used to be identified by clinical signs and nearly absent white cell count, and red blood cell counts were done by a human (using a hemocytometer). Now, blood samples are simply placed into a piece of equipment to produce the counts. Evolution can be a good thing. New tests are being developed for old diseases, and new diseases are requiring new tests. The way diagnostic lab services are provided is evolving, and it is not slowing down.

In order to successfully deal with the evolution, veterinary practices need to stay abreast of the changes and pay attention to their Circle of Care. The Circle of Care is unique for every practice, but it is based on patient care, client service, and business success; all three are intertwined in a successful practice, and only focusing on one of these can be detrimental to the stability of the Circle. Maintaining your focus on your Circle of Care will help you navigate changes in your lab services and assist you in choosing lab and/or diagnostic platforms that are valued by your clients and are profitable for yourbusiness.

Outside Reference Lab and/or In-Clinic and Handheld Point-of-Care Testing

Choosing the best option is a huge task. There are numerous companies providing in-clinic and outside lab testing options. Choosing the right company depends on factors affecting your Circle of Care, factors such as accuracy of results, turnaround time, availability of board-certified specialists to work with the primary care team, ease of use by the team, and costs. These decisions are unique to every practice.

Gordon Hardaway, DVM, owner of AAHA-accredited Hardaway Veterinary Hospital in Belgrade, Montana, offers a few tips based on what helped him choose what was best for his practice:

1. Are the necessary tests available, accurate, consistent, and verifiable at reference labs?
2. Does thecompany:
   • have excellent customer support,
   • troubleshoot problems with tests or equipment,
   • provide loaner or replacement equipment rapidly in case of breakdowns,
   • replace tests that have not run properly with accurate results, and
   • replace any products should they outdate before use?
3. Is the equipment easy and quick to use with moderate training for technicians, assistants, ordoctors?
4. Are the results easily transported into the practice management software and medical records?
5. Is the purchase or lease program self-sustaining and profitable for the volume of lab work expected in the practice?

These tips apply to both outside reference labs and in-clinic labs. Certainly, a viable testing option to consider is point-of-care testing (POCT). This form of testing is often considered “bedside testing” (think of it as cage-side and in-clinic testing). POCT is a way to perform tests conveniently and immediately. While many in-clinic bench-top instruments fall under POCT, there are numerous others that are handheld, portable devices that can be used in the exam room, in the kennel, or in the client’s home. 

When considering POCT equipment, it is important to investigate the accuracy of the test. According to Bruce Truman of BLT Technology and Innovation Group LLC, veterinarians should always ask to review the published clinical trials and validation studies. Furthermore, veterinary practices should review American Society for Veterinary Clinical Pathology (ASVCP) guidelines for the maintenance of POCT equipment to ensure quality of testing.

The evolution of lab tests is further evident with the development of telehealth platforms. POCT and digital diagnostic services will soon expedite diagnosis directly from the client’s home. According to the American Telemedicine Association, telehealth-purposed home-testing kits and diagnostic devices will evolve to “become innovative enough and low cost enough” for in-home use. This evolving change will eventually play a role in what clients expect for routinecare.

Regardless of which platform is chosen for lab and/or diagnostic testing, there are other factors in your Circle of Care to be aware of, such as whether the testing method is aligned with the business’s standard of care and whether clients value the tests recommended for theirpets.

Standard of Care Versus Perception of Value

A standard of care defines the level and type of care your veterinary practice offers. It is viewed as what a reasonably competent and skilled professional will do under similar circumstances. Does your practice have testing standards? Is it common for individuals to deviate from your standards of care? Failure to have a good standard of care leads to a failure in providing medical care to the patient and results in a loss of trust in the veterinary team by the client.

What makes a good standard of care for lab tests and other diagnostics? Kendal Harr, DVM, DACVP, clinical pathologist and quality assurance specialist at URIKA, LLC, offers these suggestions for creating standards:

1. Establish managerial responsibilities, including
   • analysis,
   • maintenance,
   • quality assurance assessment at regularintervals,
   • communication with clinicians and manufacturers,
   • assigning personnel to specific duties, and
   • creating and/or updating a laboratory notebook with this information that can easily be accessed when there is aproblem.
2. Standard operating procedures (SOPs) for each instrument should include:
   • all of the above components,
   • copies signed by personnel available in the instruments lab notebook, and
3. finally, and most importantly, each instrument requires quarterly proficiency testing, which is detailed in the ASVCP POCT guidelines.

Without proficiency testing, instrument drift and other errors will cause invalid results and, therefore, invalid diagnoses.

Your standard of care serves as a road map for the veterinary team. It provides guidance on what is an accepted medical practice for the industry based on scientific data. It also provides protocols to evaluate other members of the veterinary team, detailing the quality of care that must be provided to patients. Ultimately, it provides consistency throughout your team. Failure to meet the standards of care places the individual at risk for legal action in addition to destroying the strength of your Circle of Care, since patient care is compromised, client trust is broken, and team performance is jeopardized.

Some standards of care are not accepted by the client. Compliance may be low for certain recommended lab tests. What do clients value when it comes to lab tests and other diagnostics? Is it price? Convenience? Solving a problem? Clients want good treatment outcomes at a reasonable cost. Their perception of value is unique to each person (i.e., one man’s junk is another man’s treasure). To help clients value a recommended test, help the client understand the medical issues facing their pet and allow the client to be involved in the care provided to their pet. Nan Boss, DVM, owner of AAHA-accredited Best Friends Veterinary Center in Grafton, Wisconsin, has created successful partnerships with her clients by incorporating the following actions when discussing labtests:

1. When possible, tie testing to a specific procedure or disease, for example, anesthetic safety, monitoring for medication side effects, or early diagnosis of common disorders, such as kidney disease in cats. “Here’s what I am looking for, and this is why it’s important.”
2. Make sure clients know that if you find a disease or problem, there will be treatment available. Many clients assume that if you find liver or kidney disease, there wouldn’t be anything you could do for it anyway.
3. Use the word “need” instead of “recommend,” such as “We need to do annual blood screening in order to detect common age-related problems early.”
4. Lastly, give the clients the test results in writing with an explanation for each individual test. They deserve something tangible for the money they spent and to understand it.

Boss has created the chart below to give to clients to explain the tests being performed and incorporates an easy-to-understand section that details the results and the nextsteps.

These excerpts from Best Friends Veterinary Center’s “Canine Blood Test Results” provide some information for the client to take home. It gives the team the chance to discuss results with the client, and it provides a clear framework for actions needed moving forward. Now the client knows what was tested, why, and when the next test is needed, and why. It reduces the chance that a client will ignore the follow-up, which often translates to “They just want more money out of me.” The client now knows and is an active partner in delivering the care the pet needs.

Pricing Structure

Not all pricing of lab tests can be calculated in the same way. In addition to costs of medical waste and other supplies, pricing also depends on the perception of value to the client. Additionally, negotiating special pricing for high-volume testing is possible with any of the outside lab providers.

What is perception of value pricing? Take, for example, a woman who feels a lump in her breast. A fine needle aspirate and/or biopsy of the lump is not invasive and results in minimal discomfort; however, the desire for a result carries a high value to the female patient. Pricing can be calculated not only on the cost of materials but also on the value assigned to the test by the patients. This can be correlated to the veterinary fine-needle aspirate. It is not invasive and has low discomfort and low supply cost. The fee for the lab test is more than simply covering the cost of materials. Recognizing low-value versus high-value tests is important for calculating the pricing structure of your services.

In regard to pricing for high-volume tests, certainly negotiate for lower costs of materials, but also consider the cost–benefit ratio of charging less while doing more tests. Adding to the pricing dilemma is the complexity of the testing procedure (high volume and low complexity versus low volume and high complexity) and whether the test is urgent for trauma or surgery. Complexity can include everything from what sample is needed, how the sample is obtained, and processing of the sample up to operating the labequipment.

Do not forget the “hidden” costs; they, too, must be factored into the pricing structure. This includes tests that require calibration of the lab equipment each time a test is run or controls that must be run at the same time as the testing of a sample as well as maintenance. These added costs of consumables or perishable supplies and reagents are often forgotten about because they are part of the routine testing procedure.

Your business plan should include details on how to manage lab pricing. Even tests that are outsourced to a reference lab should be priced with the business plan in mind. It is important to realize the implications of a number of different factors in your pricing structure, such as wages, supplies, maintenance and repair, administrative costs (ordering and stocking), reporting (data processing and documentation), contacting the client, and overhead (facility) costs. Value is another important factor, especially the value associated with how long it takes to get results (hours versus days). Reading through the list of these additional factors, one can see the importance of efficiency and having a strong lab management system in place. Even simplifying the process for receiving data and documenting results in the medical record plays a role in cost–benefit ratio of lab tests.

Evolution

Diagnostic lab equipment and tests are services provided every day in your practice. How these services perform can have a positive impact on all aspects of your veterinary practice, from patient care to staff morale and from client compliance to practice profitability. Delivering optimal diagnostic testing can be easily overlooked in your day-to-day operations if you fail to identify viable platforms for your business, fail to implement consistent protocols, ignore what clients value, and treat the pricing of tests as one size fitsall.

Your team plays a vital role in delivering effective diagnostic testing for every patient, every client, every time. Diagnostic testing, although considered a medical offering, is a value-added service that benefits both patient and practice.