Protocols Shmotocols

By Mark J. McGaunn, CPA/PFS, CFP®,  McGaunn & Schwadron

When I worked as a 911 paramedic, we worked under a strict set of physician-developed protocols that would allow us the expediency of providing patient care in routine, and more importantly, critical situations. We laughed at Johnny and Roy in the 70′s TV show “Emergency” because they had to call for orders just to establish IV access. Medical control physicians granted us great latitude because of our assessment skills and seeing the end results. So if a needle chest decompression or cricothyroidotomy was required, a medical control physician would 99.9% of the time grant what we wanted to do, because they knew we had followed the protocol up to that point, and we were talking really fast into the radio!

More importantly, we used the protocols as a guide so every one of the 50 Worcester EMS paramedics knew what the other would do on every type of patient encounter. And that’s key in any multi-doctor veterinary practice from receptionist to DVM. I doubt that a new captain would get on an airplane traveling from Boston to Frankfurt if the co-pilot refused to perform a checklist prior to takeoff or run through annual simulator training. Plain common sense stuff.

I believe that if all veterinarians use standard, written protocols to treat their patients, there will be:

•more consistent patient outcomes,

•better communication between same-practice care providers,

•mechanisms in place to gauge the quality of a pet’s treatment, and

•a meaningful basis for financial incentives based on better patient outcomes (as I dislike pure production-based compensation models)

just like there is in the human medicine arena. I really think practices and consultants in general get giddy if they can apply statistics to value financial performance, but the real, and barely-mentioned, key is to judge how good a practice is at its core reason for being-medicine. Protocols first, measure second.

There are standard setting organizations in human medicine promulgating protocols to treat acute ischemic stroke (Kansas Stroke Coalition) and ST-wave elevated myocardial infarction (Vermont Department of Health/UVM College of Medicine). But in veterinary medicine, there appear to be loose recommendations from AAHA on dental health and other guidelines, but they really haven’t made it down to the pet owner level in widespread form. The “trickle down” versus “trickle up approach”, even though I’ve seen a few AAHA posters at New England airports. And from my listening to veterinarians, few feel that they need AAHA’s help, which I think ignores AAHA’s resources already in place. There’s even a disparity in vaccination protocols from practitioner to practitioner, with some seeking alternative guidance from a variety of sources (VIN opinions, drug companies, conference speakers, etc.). Much work is needed on all fronts. Here’s what we should do to start at the practice level:

•Develop appropriate sets of protocols by consensus and evidence to cover the top 10 reasons why pets (i.e. canine, feline, avian, etc.) visit your practice. Expand later.

•Make sure protocols make sense and periodically revise if there is a recognized need.

•Install an audit or monitoring system that tracks whether each protocol is working. Yes, it sounds like a compliance review, but that’s what it is!

•Have your practice manager be an integral part of the process by having client forms or EMR capability, training, scheduling, and staffing working at 110% so that your decision to have protocols doesn’t come to a screeching halt.

No, by instituting protocols you won’t become a robot. You still have to fall back on hands-on, old-fashioned patient assessment and diagnosis skills to succeed according to Jeff Werber, DVM. And your reward-consistent delivery of medicine to a group of patients who will show you your success by a bunch of right-sided wags!

Mark J. McGaunn, CPA/PFS is the Managing Member at McGaunn & Schwadron, providing strategic tax, financial planning and business consulting services in the greater Boston and New England area.

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