Acronyms/grouped concepts Flashcards
Five key factors to evaluate hiring:
Veterinary/staff ratio Veterinary production Team members’ production Hospital flow Staff payroll percentages
Five types of interview questions
Initiative Motivational Attitude Personal Management
4 C’s of successful onboarding
Compliance
Clarification
Culture
Connection
EASE to facilitate onboarding
Encouragement
Align
Solve
End distractions
Three most common reasons staff leave
Lack of positive feedback
Lack of training opportunities
Failure of management to include the strategic vision of hospital
9 ways to enhance employee development and productivity
Shared purpose Tools to do the job Standard operation procedures (SOP) Performance standards Engage and empower Recognize and reward Physical fitness Personal focus Team focus
Two goals of appointment scheduling
Eliminate client wait time

Maximize efficiency of doctors, support staff, and the facility (eliminate downtime)
Two keys to a successful veterinary practice
Delegation and empowerment
SMART management of daily work assignments
Specific Measurable Agreed Realistic Timebound
Three common types of employee reviews
360° peer review
Self review
Job satisfaction survey
Three approaches to employee evaluations
Formal performance reviews
Coaching conversations
Corrective action discussions
Four disciplines necessary for effective performance reviews
Hold employees accountable
Teach employees to identify, deploy, develop strengths
Align performance appraisals and review systems around developing employee strengths
Design and build each role to create world-class performers
Rule of 3 regarding corrective action discussions
- If the situation is enough to catch your attention, take note
- The 2nd occurrence, take note to determine if start of a pattern
- 3rd occurrence warrants a conversation
ABCDEF Formula for Corrective Action Discussion
Awareness Behavioral expectations Consequences Decision confirmed Employee involvement Follow up
Top 3 issues that cause conflict at work
Gossip
Lack of training
Lack of communication
4-step method for successful conflict intervention
- Confront the behavior
- Talk it out
- Hold team members accountable for solutions
- Follow up and feedback
3 Steps of disciplinary procedure
- Verbal warning
- Written warning
- Final warning
> termination
8 exceptions to At-will employment
Collective-bargaining agreements
Contracts with specific length of employment
Dismissal based on race, sex, color, national origin, or religion (Title VII)
Dismissal based on pregnancy (Pregnancy Diability Act)
Dismissal based on age if over 40 (ADEA)
Dismissal based on refusal to work in unsafe condition or rights protected by OSHA
Dismissal based on personal bankruptcy (Bankruptcy Reform Act)
Dismissal because of jury duty
Types of healthcare coverage
- Fee for service
- Managed care (includes HMO, PPO, POS)
- Section 125 plans (utilize HSA, FSA)
3 types of retirement plans (regulated by ERISA = employee retirement income security act)
SIMPLE IRA = Short Incentive Match Plan for Employees Individual Retirement Plan
401(k)
SEP = Simple Employee Pension Plan
Documents to include in personnel files
Employment application, resume, interview notes, background checks
Job description
Offer of employment letter
Performance evaluations, education, training
Disciplinary documents
Federal and state mandated forms (EXCEPT I-9)

Copy of degrees, diplomas, certifications
Employee action forms such as wage, position changes
Leave of absence and attendance records
(EXCEPT FMLA)
Employee record showing date of hire, compensation rate, history of raises, promotions, demotions, emergency contact info
Store the following employee records separately:
- Payroll files
* employees name, address, SSN
* birthdate if minor
* work schedules, pay rates, wage deductions
* benefit records
* Time clock records for each pay period - I-9
- Medical records
- Any document that cannot be used in the decision for hiring, firing, promotion, or demotion
Content of job description
Position title
Summary of job including goals/objectives
List of duties and responsibilities
3 purposes of manuals
Reference tool for standards of care and practice guidelines
Training and instruction
Define standard to which employees can be held accountable
3 primary functions of patient and procedure logs
Allow convenient storage of important data
Improve quality of patient care and client service
Facilitate charge capture and auditing processes
3 types of patient and procedure logs
Hybrid logs (combination of patient and procedure logs)
Patient logs (any record showing that patients received a specific service)
Procedure logs (helps ensure tasks are completed)
DEA =
Drug Enforcement Administration
CSA =
Controlled Substances Act
Drug categories
Adulterated drugs Misbranded drugs Prescription/legend drugs OTC = over-the-counter Extra-label Generic
Components of a prescription label (federal)
- The statement “Caution: federal law restricts this drug to any use by or on the order of a veterinarian”
- Recommended route of administration
- Quantity/proportion of each active ingredient
- Names of all inactive ingredients if drug is not oral
- Identifying lot number/manufacturer
4 conditions for compounding medications
- Vet believes there is a legitimate need to alter the approved drug to adequately medicate patient
- Current VCPR
- Patient has a medical condition that requires prescribed medication
- Vet determines that a compounded drug is needed
FDA oversees
Pet food
Pet dietary supplements
Animal biologic (vaccines, bacterins, diagnostic kits)
EPA oversees
Pesticides relating to pets
3 types of Ethics
Social
Personal
Professional
4 branches of Veterinary Ethics
- Descriptive (Study of ethical views of veterinarians/professionals regarding behavior and attitudes; what is right and wrong)
- Official (Standards set by professional organizations)
- Administrative (set by regulatory agencies/VBOG)
- Normative (The search for correct principles of good and bad)
4 types of moral problems in veterinary medicine
Peers
Clients
Animals
Society
Elements of informed consent
Consent given freely
Treatment and diagnoses explained in understandable terms
Risks, benefits, prognosis must be stated if treatment/diagnostics proceed
Prognosis if no treatment selected must be stated
Alternative treatments, including risks, benefits, costs discussed
Client given an opportunity to ask questions and get answers
4 elements to consider applying law of unjust enrichment
- More valuable animal = greater chance of financial recovery
- More emergent needs = more leeway to provide emergency care
- That attempted to reach owner prior to medical care
- The extent of emergency care required to stabilize the patient was reasonable
4 A’s to rise above moral distress
Ask if distress is present
Affirm commitment to address
Assess readiness to act
* if struggling, consider 4 R’s:
> Relevance
> Risk
> Rewards
> Roadblocks
Act
Aspects of SOPs for ethics/law
- Develop policy regarding shredding of confidential info
- Develop liability release form for volunteers, interns, students
- Follow a VMA for updates regarding Fairness To Pet Owners and compounding regulations
- Develop medical record standards that are defensible
- Develop standards to handle client communication, conflict, and complaints
- Ensure protocols meet state requirements daily, not just when inspected
Two types of law
- Civil law
- Tort law
- Contract law - Criminal

3 (or 4) elements of a contract
- Offer
- Acceptance
- Consideration (parties promise something they weren’t legally obligated to do or not do)
(4) . Intent to contract
3 situations that may question capacity to contract
- Minors - Have the right to avoid or disaffirm contracts made when of minor age
- Mental disability
- Intoxication/substance abuse - was sober party aware of intoxication or took advantage of it?
Federal employment posters required
Families first coronavirus response act paid leave notice
Fair labor standards act and minimum wage
Equal opportunity provisions of the law
FMLA
OSHA job safety and health protection requirements
Employee polygraph protection act
Uniformed services employment and re-employment rights act
Right to join/form unions and associations
State required posters
Cash-based accounting
Recognizes revenue when cash received and expenses when paid
Accrual-based Accounting
Recognizes revenue when earned and expenses when incurred
Accounting methodologies
Cash-based
Accrual-based
Hybrid of both
Key financial statements
Income statement a.k.a. P&L
Balance sheet
Cash flow sheet
Income statement a.k.a. P & L
Compares current year to prior year
Expenses stated as % of revenue
Balance sheet
Summarizes assets, liabilities, and equities at the time of the statement
Cash flow sheet
Shows cash generated minus cash flowing out and total cash at end of period
3 steps to analyze P&L’s
- Compare percentages
- Ask questions of the percentages
- Implement change
Financial reporting elements
Timeliness Accuracy Simplicity Sufficiently detailed Analytical
Financial analysis perspectives
Safeguarding assets
Pricing fee/structure
Cost evaluation
Procurement of capital (financing/investors)
Incremental performance
Accountability via departmentalization
(split into profit centers)
Profitability analysis
Return on capital analysis
Common KPI’s
Total revenue, total transactions by month
Average transaction charge by month
New clients and lost clients per month
Revenue, transactions, and average transaction charge per DVM per month
Revenue by category
Accounts receivable by aging classification (30, 60, 90+ days)
Payroll methods
Manual payroll
Automated in-house processing
Third-party payroll services
Requirements for wage/tax reporting
Obtain EIN
Obtain I-9 for each employee
Confirm each employee completed a W-4
Calculate and deduct employees’ income tax
Make required deposits of withheld taxes
File form 941 (employer quarterly federal tax return)
File form 940 (employer annual federal unemployment tax return)
Prepare and distribute W-2s by January 31
Prepare W-3 (transmittal of wage and tax statement) to file with W-2s to IRS
All taxes should be automatically deducted from the practice checking account to ensure payments are on time
Information to provide to collection agencies
Client’s full name, address, and telephone numbers
Total balance due on account
Client’s occupation if known
Client’s employment address
Client’s drivers license number
Copy of client’s information sheet and signature of client guaranteeing payment
Information together for budgeting
Last 3 years of PNL and productivity statements
All lease and loan documents
Fee schedule
List of operational changes expected in the next few years and potential effects on revenue/expenses
List of major capital expenses expected in next few years
Employee roster and recent years’ W-2s
4 stages of the business cycle
Expansion
Prosperity
Contraction
Recession
6 steps of budgeting
- Determine desired financial results
 - Analysis of financial statements
- Normalizing the revenue and expenses
- Budgeting revenue
- Budgeting expenses
- Combining budgeted revenue and expense and making adjustments
4 expense categories
Personnel/labor
Variable expenses/cost of goods sold
Occupancy/facility
Fixed/administrative
Steps to normalize revenue and expenses
- Remove any one time, non-recurring items from the financials used to create the budget
- Use an average of the last three years to normalize non-recurring expenses
Budgeting revenue considerations
Patient volume
Fee schedule
ATC
Budgeting expenses by adding the last three years’ growth rate to base expense figure; only works if
Practice is established
Expenses were stable over past 3 years
Practice will continue to operate similarly in the following year
Adjustments to bring profit closer to target
Increase revenue
Decrease expenses
Lower targeted profits (initial may have been unrealistic)
4 (5) P’s of Marketing
Product Place Price Promotion (Position)
Redefined marketing elements
Emotion Value Virtual Exceed expectations Experience
SMART goal (Marketing)
Specific Measurable Achievable Realistic but challenging Time-dependent
Pricing advantage strategies
Unique
Value added
Value based
Volume
Managing online reviews
- Take time to investigate complaint, talk to staff, and create planned response
- Response should include empathy, invitation to discuss; attempt to reach client
- Promote positive reviews
- Create a positive culture that helps avoid client experiences that cause negative reviews to begin with
SWOT analysis
Strengths
Weaknesses
Opportunities
Threats
Successful marketing plan
Gather data (SWOT analysis, client surveys, employee feedback, etc.)
Define goal
Implement a strategy
Create a written action plan
Execute the plan and measure results
6 C’s of client relationship management
Consistency Compassion Customer service Convenience Competence Cost
3 R’s of client retention
Recall
Reappointment
Reminder
Roles of inventory management
Inventory manager Inventory researcher Inventory purchaser Department lead(s) Inventory receiver(s) Inventory document or end tracker Inventory counter Bookkeeper
5 steps to get inventory under control
- Print your code or product list and edit (delete inactive, update classifications, remove duplicates)
- Reprint the list -  Double check again
- Create a list of unconsolidated products and consolidate inventory (only carry one or two products of the same type such as 2 heartworm preventatives)
- Count inventory
- Begin to enter/receive inventory efficiently and accurately as it is delivered to clinic
Inventory variance evaluation
- Add beginning and ordered/received quantity for the selected item
2. From #1, subtract the number sold in the same period
- Compare that number to the physical inventory count at the end of that period
- Those numbers should match
- If they don’t match the difference is the variance
- Any variance is an indication of weakness or problem, although a 1-4% variance on high turn items is acceptable
POMR
Problem-
Oriented
Medical
Records
SOAP
Subjective
Objective
Assessment
Plan
SOMR
Source-
Oriented
Medical
Records
Two types of insurance
- Liability - covers other people, pets, property
* malpractice -  Property - covers own property
4 elements for a malpractice suit
- Establish duty to practice within standard of care (established VCPR)
- Breach of duty - failure to act in accordance with standard
- Proximate cause - connection between negligent act of practitioner and harm to the patient
- Damages - harm to patient or client as a direct result of negligent act
5 scenarios in which a veterinarian can discontinue treatment
Animal recovers
Practitioner completes all agreed-upon treatment
Animal dies
Client terminates VCPR
Responsibility for treatment was transferred to another practitioner with client consent
Phases of the business life cycle
Introductory (vision, innovation, energy)
Growth (efficiency, discipline, talent development critical)
Maturity (manage risks, problem solved, search for growth opportunity)
Decline (decrease demand for services; revisit strategic plan for revitalizing practice)
Phases of strategic planning
Formulation
Development
Implementation
Evaluation
Guardian ad litem
Person appointed to protect interests of a minor/incompetent person or an animal
Statute of frauds
Requires production of written memo before courts will enforce certain types of contracts
Parol evidence
Signed a written contract present including a clause that the document represents the entirety of the contract - additional oral testimony altering or contradicting terms not permitted
Law of agency
Involves a person who has been authorized to act on behalf of another
Promissory estoppel
The party has relied on a promise of another party, and the party relying on the promise incurs substantial detriment due to lack of fulfillment of promise
Veterinary Practice Act
State’s commonwealth law codified into regulations that describes what licensed and non-licensed practitioners can do/cannot do, describes acceptable medical standards
The law of unjust enrichment
Created to avoid unjust enrichment of one part at the expense of another
(eg owner receives emergency care at the vet’s expense)
Contract law
Agreement establishes an obligation
Negligence
Exists when someone fails to do what a reasonable person of similar skills would have done (eg Comparing a general practitioner to another general practitioner) and results in damages
EEOC
Equal Employment Opportunity Commission
-enforces laws prohibiting employment discrimination; applies to employers of 15 or more (for at least 20 weeks)
IRCA
Immigration Reform and Control Act
-reserve jobs for American citizens and legal immigrants; established I-9 requirements; applies to most employers
FLSA
Fair Labor Standards Act
- any employee working more than 40 hours in one week must be paid overtime unless exempt;
- regulates employment of minors;
- applies to all practices,
- enforced by US Department of Labor
Title VII of the Civil Rights Act of 1964
Cannot discriminate hiring, promotion, wages due to race, color, religion, sex, or natural origin;
-enforced by EEOC
Sexual Harassment Law of 1964
Addresses gender based, sex based discrimination;
-defines sexual harassment and holds employers responsible
PDA
Pregnancy Discrimination Act of 1978
-cannot discriminate based on pregnancy, childbirth, or related medical conditions; -applies to workplaces of 15 or more
ADA
Americans with Disabilities Act of 1990
- employers must make a reasonable accommodations for applicants and employees with disabilities unless accommodations impose undue hardship on business operations;
- applies to employers of 15 or more and individuals on payroll at least 20 weeks per year
ADEA
Age Discrimination in Employment Act of 1967
- employers cannot discriminate based on age for persons 40 years or older;
- applies to employers of 20 or more
FMLA
Family and Medical Leave Act of 1993
- eligible employees entitled to 12 work weeks of job-protected, unpaid leave during a 12 month period due to health condition, addition of new child to family, care of spouse/child/parent;
- applies to employers of 50 or more employees who work 20 weeks or more; -employees eligible if they work 1250 hours during 12-month period immediately preceding the commencement of leave
Worker’s compensation
Protects employees involved in work related injuries;
- applies to all employees;
- states have specific laws pertaining to collection of damages
FUTA
Federal Unemployment Tax Act
-employers must pay tax to fund unemployed workers with financial support in the event of temporary, involuntary unemployment
FICA
Federal Insurance Contribution Act
-employee and employer pay to fund Social Security and Medicare
ERISA
Employee Retirement Income Security Act of 1974
-employees in qualified benefits programs; outlines obligations, rights, rules, communication surrounding these benefits
COBRA
Consolidated Omnibus Budget Reconciliation Act
- qualified individuals allowed to extend health coverage on a self-pay basis for 18-36 months after termination;
- applies to employers of 20 or more and who leave under certain circumstances
HIPAA
Health Insurance Portability and Accountability Act
-protects employees’ health insurance coverage when they change jobs, limits pre-existing conditions, prohibits discrimination based on health status; -applies to all
MHPA
Mental Health Parity Act
- consistent benefits between medical/surgical and mental health benefits;
- all eligible employees
EPPA
Employee Polygraph Protection Act of 1988
- prohibits most employers from using lie-detector tests during or before employment;
- some exceptions such as security guards
FDCPA
Fair Debt Collection Practices Act
- limits what debt collectors can do in attempt to collect;
- cannot harass, use oppressive tactics or abusive treatment
Tax Act of 2003/Section 179
Increased amount of eligible property that can be written off in the first year
Tax Act of 2003/Section 168k
Additional deduction of 50% of remaining balance of equipment purchased that is above the maximum value for Section 179
MACRS
Modified Accelerated Cost Recovery System
-Established formulaic table to calculate depreciation by the IRS
PPACA
Patient Protection and Affordable Care Act of 2010
-Mandatory health coverage or pay penalty, certain services must be covered by health insurance
CCPA
Consumer Credit Protection Act of 1968
-protects employees from dismissal due to having wages garnished, limits amount of garnishment per week
FACTA
Fair and Accurate Credit Transactions Act of 2003
-amended FCRA to reduce risk of identity theft by regulating how consumer information is handled
NLRA
National Labor Relations Act of 1935
-protects rights of employees to engage in collective bargaining/unionizing
OSHA
Occupational Safety and Health Act of 1970
-instituted to provide standards for workplace health and safety
USERRA
Uniformed Service Employment and Reemployment Rights Act of 1994
-protects service members’ and veterans’ employment rights, including protecting jobs while deployed
