From the Editor

Hello and thanks for taking the time to stop by The Practice Solution Magazine. My name is Ken DeRouchie and I am the newly appointed editor of the magazine and this is my first From The Editor article.

Ten years ago, in 2002, I helped launch this magazine and bring it from concept to fully functioning web magazine. In the past 10 years I’ve also been a contributing writer in every issue.

I’d like to give you a little of my history. In July of 1990 I came to work for Silkin Management Group and have been an analyst for the company ever since. I spend much of my day talking to doctors from all over North America about the challenges they are facing in private practice. I help them pin point the causes of these issues and give them recommendations and solutions to these problems.  (For more information about Silkin, visit the website at

I also have a background in writing so, combining my experience working with doctors and my past writing,  It was a natural progression for me to get involved with the magazine.

In this issue of the magazine we have addressed problems ranging from staffing, employee conflicts, case acceptance, net profit as well as other topics.  I hope that we have offered some sound advice to you that will help you with some of these issues.

In past issues of this magazine there has been a mix of practice management related articles as well as articles about clinical issues impacting doctors and patients alike. In this issue and future issues I plan to focus on just practice management aspects that impact practice owners.

I welcome your feedback and would love to hear from you. Feel free to email me at or feel free to call me at 800-695-0257.


Ken DeRouchie
Editor – The Practice Solution


Making Financial Arrangements

Ensuring Your Office Gets Paid 
It is the responsibility of the accounts manager to sit down with the patient/client and work out the best financial arrangement within the framework of the policies of your office. Bear in mind that the ideal plan would be one that facilitates the most immediate payment for service rendered. One would not offer a plan that stretched payments out over a long period of time unless there was no other option that the patient could afford. Firm financial arrangements must be made with patients/clients.

It is most advisable to have only one person discussing payment options with your patient/client and this should rarely, if ever, be the doctor. The doctor should present his case recommendation, and if necessary, briefly outline the general payment options, but without getting into the actual financial arrangements (it is always best if the accounts manager is the only person discussing money with patients/clients).

Once the doctor has presented his treatment plan, he should then tell them that his accounts manager will make the actual arrangements. He should then leave the room and quickly acquaint the financial person with the case, including how soon the first appointment (or several appointments) should be; how much time he will need scheduled for the appointment(s); the total fee for the services the patient/client has accepted.

The accounts manager would then meet with them privately to make the financial arrangements. They should begin by seeing to it that the first appointment is scheduled, and then introduce the topic of finances. A good approach is, “How do you want to pay for this today?”

The accounts manager would strive to secure payment in full, but if necessary, would go over the other options that are available, illustrating with dates and amounts.

Don’t force a person into a hasty decision. If he/she needs time to review his/her finances, then simply write down the total fee and the methods of payment available. Schedule another conference to complete the financial arrangements.

Once the accounts manager and the patient/client have decided on a method of payment, the “agreement” should be summarized in writing, with dates and amounts and have the patient/client sign it. Give a copy to the patient/client.

It is advisable to then send a letter to the patient/client after the meeting, congratulating them for going ahead with your services and outlining the financial agreement again, offering assistance if they have any questions.

Always discuss fees and payment options in a very clear manner with the patient/client before providing any services. It is important to work with them so they have financial arrangements that they feel they can abide by. They will feel better about being your patient/client when they know that you have really worked with them, and that together you have made an agreement which is workable.

Publicize any new payment plans that you institute. You can put a sign in your reception area that says “Ask About Our Payment Policies”. You could also mail statement stuffers which include payment information for your patients/clients. Put together a practice brochure that explains your payment policies. Instruct your front office staff to discuss new payment plans with every person at his/her next appointment (only if appropriate).

The accounts manager’s job does not need to be difficult, time-consuming and frustrating if it is done in an organized and efficient fashion. Two of the most important factors are:

  1. Having firm financial policies
  2. Making sure that the patient/client understands and agrees to his/her obligation

Veterinary Foundation Offers Grants To Cover Costs

Veterinary Foundation Offers Grants To Cover Costs Of Care After Hurricanes

The American Veterinary Medical Foundation (AVMF) is urging veterinarians to apply for grants of up to $2,000 to cover costs incurred by Hurricanes Katrina and Rita.

Eligible applicants are licensed veterinarians, although requests from licensed veterinary technicians and others providing medical care for animals will be considered. Applicants need not come from storm-ravaged areas, but may include those from otherwise unaffected areas who are incurring out-of-pocket expenses from providing veterinary medical treatment, care and supplies to animal victims of the storms.

In addition, the AVMF will consider partial funding for storm-damaged structures and equipment used to provide veterinary care of animals.

“Veterinarians across the country have volunteered their time, expertise and resources to treat animals injured and displaced by these terrible storms,” said Dr. Tracy Rhodes, DVM, chairperson of the AVMF. “These grants will help to reimburse veterinarians for the costs associated with this care.”

Funding for the awards is provided through the AVMF Animal Disaster Relief and Response Fund. Established shortly after Hurricane Katrina struck the Gulf coast, the fund was developed with the goal of raising $1 million for disaster relief efforts in the areas ravaged by the storms. The American Veterinary Medical Association Executive Board allocated $500,000 in matching funds to help meet this goal.

A grant application form is available online at Forms are to be submitted to the applicant’s state veterinary medical association, which may not be the location where the expenses were incurred. State associations will then submit the forms to the AVMF for review and consideration.

The AVMF advances the care and value of animals in society by raising and distributing funds in support of animal disaster relief and animal health studies. Established by the American Veterinary Medical Association in 1963, the AVMF is based in northwest suburban Chicago. For more information about the AVMF, visit or call (847) 925-8070, ext. 6689.

The AVMA, founded in 1863, is one of the oldest and largest veterinary medical organizations in the world. More than 72,000 member veterinarians are engaged in a wide variety of professional activities. AVMA members are dedicated to advancing the science and art of veterinary medicine including its relationship to public health and agriculture.

From: American Veterinary Medical Foundation website

Project Could Help Pets Serve As Disease Watchdogs

A national surveillance network that uses the medical records of companion animals could help prepare for a wide variety of emerging disease threats to humans and animals, including avian influenza, according to veterinary scientists at Purdue University’s School of Veterinary Medicine.

The National Companion Animal Surveillance Program was originally designed to alert people to potential anthrax or plague outbreaks. New findings on tests of the program are detailed in the current edition of Vector-Borne and Zoonotic Diseases, a medical journal that focuses on diseases transmitted to humans by vectors such as mosquitoes or directly from animals.

Larry Glickman, a professor of epidemiology in the School of Veterinary Medicine, designed the National Companion Animal Surveillance Program in collaboration with Banfield, The Pet Hospital, a nationwide chain of veterinary hospitals. Between 2002 and 2004, tests were conducted on more than 10 million pet records to determine how the database could be used to monitor disease outbreaks.

“We discovered we can use analytical techniques to target specific geographic areas where vaccines need to be developed,” Glickman said. “This early warning will become critical to stop the spread of avian flu virus and other diseases that might affect humans. The quicker we can identify the problem in the more than 150 million dogs, cats or pet birds that live in approximately 40 percent of all households in the United States, the greater the probability we can contain a disease before it spreads to humans.”

Authors of the research paper were Glickman; George E. Moore, Nita W. Glickman and Richard J. Caldanaro of Purdue’s School of Veterinary Medicine; David Aucoin of VCA Antech; and Hugh B. Lewis of Banfield, The Pet Hospital.

Researchers collected data from 80,000 companion animals treated weekly at more than 500 Banfield hospitals in 44 states. Additional data included reports from VCA Antech Diagnostics, a nationwide network of laboratories used by more than 18,000 private veterinary practices.

Medical records were transferred to Purdue, where they were stored and converted for analysis with the help of COMSYS Information Technology Services, a consulting firm located in Houston.

Based on the data, researchers found:

o A clear pattern of association between flea and tick infestation in pets compared to the incidence of Lyme disease in humans, with a two-month lag and peak rates occurring during warmer months. This information allows veterinarians to anticipate unusual occurrences of diseases that are transmitted from animals to humans and design treatment methods. Public health officials also could be alerted so they could provide timely information to the public and spray affected areas for ticks. In addition, specimens such as these can be used for profiling a broader variety of diseases that are potentially transmitted to humans by fleas and ticks, such as Rocky Mountain spotted fever.

o A 3.3 percent increase in the number of positive tests from 2002-2004 for a disease called canine leptospirosis. Leptospirosis can be transmitted from dogs to humans. The disease is currently the leading cause of acute kidney failure in dogs and also can damage the liver. Most animals and humans recover from leptospirosis if it is diagnosed early and treated with antibiotics. This research will help develop early warning signs and aid in the development of vaccines that target emerging new strains of leptospirosis. The data also documents an increase in the disease over the past 10 years, probably related to increasing contact between dogs and wildlife such as raccoons, Glickman said.

o A correlation between the number of cases of influenza-like illness in cats and similar symptoms in humans in the Washington, D.C., area where Banfield has numerous hospitals. This pattern suggested common environmental causes of influenza in cats and people. The finding illustrates the importance of the ability of Purdue researchers to track diseases by geographic area and to detect statistical clusters of events in companion animals that could signal the introduction of new viruses into the United States, such as avian influenza virus due to bird migration or bioterrorism.

“We wanted to show that these animals could be used as sentinels of infectious agents and perhaps predict the occurrence of diseases in humans,” Glickman said. “The long-term goal is to partner with other providers of companion animal health care and animal laboratory data to create a comprehensive system that will be a national resource to further the practice of evidence-based veterinary medicine and veterinary public health. We think there is no comparable human-surveillance system in the country.”

In ongoing work, the Purdue researchers are investigating ways to monitor cats for avian influenza. In collaboration with Banfield, they have developed an early-warning system for the occurrence of canine influenza that is caused by a virus that appears to have jumped recently from horses to dogs. If a dog comes to a Banfield clinic with a predetermined set of clinical signs, the computer screen flashes in the hospital and information appears that advises the practitioner what samples to collect from the dog for virus identification. A similar real-time surveillance system could be used to identify the avian influenza virus in pet birds or cats, Glickman said.

“The avian flu virus could be the ‘black plague’ of veterinary medicine, but we can be proactive through early detection and vaccine development,” Glickman said. “A reporting system such as this for companion animals will allow us to educate veterinarians and help the public. It also will demonstrate what is possible in human medicine with development of a more centralized and coordinated health-care delivery system.”

The research was funded in part by the Centers for Disease Control and Prevention.

Writer: Maggie Morris

Sources: Larry Glickman

Purdue School of Veterinary Medicine

From: Purdue University, Medical News Today

AMA Joins AVMA Initiative to Strengthen Medicine

AMA Joins AVMA ‘One Health’ Initiative to Strengthen Medicine by Working Together

The American Veterinary Medical Association (AVMA) announced today that the American Medical Association (AMA) has adopted a resolution calling for collaboration on a One Health Initiative.

The two national, medical organizations will work collaboratively on areas of mutual medical interest, such as pandemic influenza, bioterrorism risks, and biomedical research.

The AVMA One Health Initiative will take another major step forward at the AVMA Convention in Washington, DC, when the AVMA will announce the members of a One Health Initiative Task Force. The new AVMA One Health Initiative Task Force will be charged with developing strategies to promote collaboration among the various health science associations, colleges, government agencies and industries.

Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention (CDC) said, “This is fantastic news. I am sure I speak for all of CDC in voicing my complete enthusiasm and support for the One Health Initiative. I appreciate the leadership that the AMA and AVMA are providing in creating this powerful network of health protection.”

AVMA President, Roger K. Mahr, DVM, who has championed the One Health Initiative at the AVMA, testified before the AMA in support of their participation in the Initiative.

“The convergence of animal, human, and ecosystem health clearly dictates that the ‘one world, one health, one medicine’ concept must be embraced. Together, we can accomplish more to improve health worldwide than we can alone,” Dr. Mahr testified.

“New infections continue to emerge and with threats of cross-species disease transmission and pandemic in our global health environment, the time has come for the human and veterinary medical professions to work closer together for the greater protection of the public health in the 21st Century,” said AMA Board Member Duane M. Cady, MD.

The AVMA One Health Initiative Task Force will be comprised of twelve thought-leaders representing various health science professions, academia (including two students), government, and industry.

The AVMA and its more than 75,000 member veterinarians are engaged in a wide variety of activities dedicated to advancing the science and art of animal, human and public health.

SOURCE American Veterinary Medical Association

Optometry Awards Contact Lenses With Seal of Acceptance

World Council of Optometry Awards UV Absorbing Contact Lenses With Global Seal of Acceptance

The World Council of Optometry’s (WCO) Global Seal of Acceptance for Ultraviolet Absorbing Contact Lenses was awarded to Johnson & Johnson Vision Care, Inc. The announcement was made at the annual meeting of the American Optometric Association in Boston.

“In awarding the Global Seal of Acceptance, the World Council of Optometry Global Commission on Ophthalmic Standards (WCO GCOS), which provides independent evaluation of ophthalmic related products, has determined that certain Johnson & Johnson Vision Care, Inc. contact lens brands meet established, recognized and accepted standards that are adopted by the WCO GCOS,” said WCO President Robert Chappell. “These include published standards of International Standards Organization (ISO) and American National Standards Institute (ANSI).”

The ISO and ANSI standards classify UV-blocking contact lenses into two groups based on the lens’ absorptive capacity at its minimum thickness. Class 2 UV-blockers must absorb at least 70 percent of UVA and more than 95 percent of UVB radiation. Class 1 UV-blockers must absorb a minimum of 90 percent UVA and at least 99 percent UVB radiation. Only products that meet these standards may claim to be UV blocking. All of the lenses previously received the American Optometric Association (AOA) Seal of Acceptance for Ultraviolet Absorbers/Blockers.

“Not all contact lens lines offer UV protection, and, of those that do, not all provide similar absorption levels,” explains Cristina Schnider, OD, Director, Medical Affairs, VISTAKON(R), Division of Johnson & Johnson Vision Care Inc.

Experts say the effects of UV radiation are cumulative and can do irreversible harm to all structures of the eye and surrounding tissue that are left unprotected or under-protected. Certain conditions, such as age-related cataract, may not manifest for years at which point the damage is already done and it is too late to reverse the effects of the sun. “That’s why it is important to get maximum protection beginning in childhood,” advises Dr. Schnider. “The most complete measure of UV protection can be achieved with a combination of UV-absorbing sunglasses, a wide-brimmed hat, and UV-blocking contact lenses.”

Because they cover the entire cornea and limbus, UV-blocking contact lenses offer an added level of protection when worn with UV blocking sunglasses. While many sunglasses block UV rays that enter through the lenses, most do not prevent unfiltered rays from reaching the eyes through the sides, as well as the top, and/or bottom of the glasses. Due to their inability to block these peripheral rays, some sunglasses block as little as 50 percent of all UV radiation from reaching the eyes.

“It is just as important to block these peripheral UV rays,” warns Dr. Schnider. “UV-blocking contact lenses provide added protection by effectively blocking sunlight that may enter the cornea from the top, bottom, or sides of the glasses.” Although UV-blocking contact lenses provide important added protection for patients, they should not be viewed as a stand-alone solution. Contact lenses should always be worn in conjunction with high-quality UV-blocking sunglasses and a wide-brimmed hat for maximum UV protection for the eyes.

The World Council of Optometry is an international organization dedicated to the enhancement and development of eye and vision care worldwide. Representing over 200,000 optometrists from 75 member organizations in 41 countries, WCO serves as a forum for optometric organizations to respond to public health needs and opportunities around the world. The WCO is a member of the International Agency for the Prevention of Blindness and maintains official relations with the World Health Organization.

SOURCE: PR Newswire

An Eye Disease or Systemic Disorder?

Hearing Loss Study Adds to the Evidence

Shahin Yazdani, MD, and his research team evaluated whether patients with ocular pseudoexfoliation syndrome—the most common cause worldwide of the form of glaucoma known as “secondary open angle”—had a higher incidence of hearing loss. In ocular pseudoexfoliation (also called “exfoliation”) syndrome, fibrous white deposits aggregate on the iris, lens and other parts of the eye and can block fluid drainage; this blockage increases intraocular pressure, which can damage the optic nerve. Similar fibrillar deposits have been found in the heart, blood vessels, lung, liver, kidneys and skin of patients with ocular pseudoexfoliation. In addition, pseudoexfoliation has been associated with ischemic heart disease. systemic hypertension, aneurysms, Alzheimer’s disease, and age-related macular degeneration (AMD). The researchers hypothesized that the hearing organs might also be affected after noticing hearing disability in many pseudoexfoliation patients.

The case-control study enrolled 83 patients with ocular pseudoexfoliation and 83 controls matched for age and gender. Hearing loss was significantly more prevalent in patients with pseudoexfoliation than controls —-94 percent versus 69.9 percent. Below-average hearing thresholds were also significantly more common in ears of cases versus controls, 88.4 percent and 53.6 percent respectively. As in past studies, no definitive correlation was found between glaucoma and hearing loss. The authors conclude: “The findings of the present study imply that this apparently ocular disorder may truly be a manifestation of a systemic condition that affects multiple organs throughout the body.”

Ophthalmologists are urged to consider the possibility of hearing loss in patients with ocular pseudoexfoliation syndrome and guide them to additional medical care as needed.

Source: Newswise