We have FOUR basic levels of on-site support, each time based, but we show "examples" of programs that have been done within those time frames. Please, do not prejudge Tom Cat's capabilities we tailor all consultations to practice needs!
He has 17+ books and 32+ monographs (available from the VIN Bookstore, www.vin.com) which we can start tailoring from to meet virtually any practice's needs.
1) The TIME TO SMILE AGAIN is a Denver on-site program, since it is a multi-visit local program where I need to commute. Since it requires a series of short three half-day return visits, it will not be offered in other areas unless there is a density of demand to defer travel costs. It will starts with "what will make you happy again" one-on-one discussion with the practice owner, and results in a two week action plan. The second half-day visit could include key managers, and may or may not include another action plan; this is a practice owner decision. The third half-day is an interactive team-building session for the entire practice staff. Most savvy practice owners now realize in the revised companion animal practice format, team-based veterinary healthcare delivery requires OUTSTANDING client service by the entire practice team.
The base cost for this program is $1800 USD at one site, plus all direct expenses involved in the trip (retainer of the full time fee is required to reserve the dates).
If the practice decides to expand their experience into a Short Course or a Full-year Diagnostic Consult during the three visit format, we apply the TIME TO SMILE AGAIN time fees paid against the Short Course fee ($3900) or Full-year fee of $14,600, and establish a tailored, quarterly, on-site visitation program to meet the needs of the practice (adding six more on-site consultant days to the full year support program, while quarterly establishing and expanding/extending the written transition plan tailored to practice needs and desires).
2) We offer a two day on-site program, which we call "short-course in your clinic". This two-days on-site consultation has been becoming a more popular entry into consulting support in this tightening economy. This program starts with the practice selecting a monograph subject, or a book chapter, or talking to Dr. Tom Cat and define the real IMMEDIATE need, This is a two-day on-site training visit built around ONE subject (e.g., , www.vin.com, or www.drtomcat.com or a chapter from any of our publications, www.drtomcat.com). The subject is selected by the practice, and the contact format is similar to the Partners in Progress on-site format, where the practice operates normally until 11:00 a.m., when all appointments and inpatient services are ceased, 11:15 to 12:45 is a team discussion time, lunch is provided by the practice. There is an application phase from lunch to 1:45, then we come back together for a feedback session, and by 3:00 p.m. you are back in full practice operations. We do that type schedule on both days, so you do not lose critical client contact time. The monograph or text provides the written support for a new operational plan, and we provide a 60-day follow-up support by e-mail, augmented by e-mail or fax. The base cost for this program is $3900 USD at one site, plus all direct expenses involved in the trip (retainer of the full time fee is required to reserve the dates).
If the practice decides to expand their Short Course into a Full-year Diagnostic Consult during the 60-day follow-up period, we apply the Short Course time fees paid against the Full-year fee of $14,600, and establish a tailored, quarterly, on-site visitation program to meet the needs of the practice (adding six more on-site consultant days to the full year support program, while quarterly establishing and expanding/extending the written transition plan tailored to practice needs and desires). This Short Course program also provides a building block program, used with demographics, practice valuation, and hospital design programs, if on-site assessment is desired by the client.
3) The VCI Partners in Progress
This is a three day on-site with a single practice. It centers on wellness, team-based healthcare, training program, and targets the AVMA direct-to-client initiative (started in 2004, and has been upgraded each year). Dr. Jack Walther was AVMA President at that time, and he hand-picked Dr. Tom Cat to roll out the new wellness initiative at the AVMA meeting, as well as write the balance of the total program (which has been used for the web site upgrades each year until 2011). When on-site, we utilize the lessons learned from the 2000-plus practice experiences to do the organization behavior assessments and identify new key players from your existing team . . . this program was initially designed to allow practices to self-identify colleagues with whom they want to have a synergy, so two or three practices would share the travel expenses and workshop costs. This program was built around multiple practices cooperating (2 to 4), where Tom Cat spends two days on-site with each practice involved, to get a feel for where each practice is at that time, review the medical records for continuity of care, and how the practice flows. The multiple practice visits are sequenced so the after the last practice, we have a two-day combined practice workshop at a central location. This has been a very popular format in Australia and New Zealand, where colleagues are still common and appreciated.
In recent engagements, we often do this program for a single practice in three days of on-site facilitation and training. This is what some believe is needed at their practice at this point in time. It would work as follows:
- The first day, Dr. Tom Cat watches morning operations, schedule normally please. We stop all appointments and inpatient programs at 11 a.m., to be restarted at 3 p.m., so we are only "out-of-service" for the mid-day period, At 11:15 we start, all in attendance, even doctors and managers, and facilitate, by group discussion, what drives them to be in the practice and use that personal commitment to set the tone for the wellness initiative with some guided questions and explanations. At 12:45 we break for lunch (practice buys and has it delivered AT 12:40, not before), and have them self-divide into groups for a practice "exploration" (which Dr. Tom Cat has determined to be a fruitful mission by his medical record review that morning). After they have lunch, the groups set out on their project(s), and we regroup at 1:45 p.m. for discussions. This exercise basically breaks down the paradigms and habits, and re-centers the team, and doctors on wellness care issues and team-based healthcare delivery concepts that are well defined from a combined wealth of knowledge, experience, and aptitudes.
- On the second day, again schedule normal morning operations please. We will again stop all appointments and inpatient programs at 11 a.m.,to be restarted at 3 p.m., so we are only "out-of-service" for the mid-day period, At 11:15 we start, all in attendance, even doctors and managers, practices re-assemble as a group, and the morning session is spent on reorganizational issues, as the owner and Dr. Tom Cat discussed that morning behind closed doors. This additional targeted interactive workshop is designed to zone the hospital and enhance the experiential learning. After lunch, zone teams combine and develop action plans from the previous discussions - plus any on-site issues brought with them - and at 1:45 p.m, we put their ideas on flip charts. We then guide them into using their own ideas for augmenting a pre-structured training plan for the entire team, usually in a 90-day format.
- On day three, again schedule normal morning operations please. We will again stop all appointments and inpatient programs at 11 a.m., to be restarted at 3 p.m., so we are only "out-of-service" for the mid-day period, We handle the leadership issues that have emerged concerning the new wellness Standards of Care (on the morning of day one, after my medical record review but before the meeting, we will discuss the issues I have found and I will give you templates are resources to build the first draft of the wellness Standards of Care (SOC) . . . the commitment to the SOC is ALL DOCTORS, and they will then be provided the staff for integration into the MOVH practice's orientation & training programs.
POINT OF CLARITY - the WHAT and WHY is leadership defined, which includes outcomes and measurements of success before the practice team starts anything, yet we use the staff in the zones for the HOW and WHO. The third critical element is the WHEN, which includes time lines and milestones, as well as completion dates, and it these are established by JOINT DISCUSSION and NEGOTIATION.
The e-mails, faxes and telephone calls from your team to Dr. Tom Cat are unlimited for the subsequent 90 days and are included in the flat rate fee of $5900 USD per site, plus all direct expenses involved in the trip, plus reimbursement of direct travel expenses (the engagement is "locked-in" to the time of your choosing by the submission of a retainer of the total time fee, which is applied to the final bill, sent after Dr. Tom Cat has completed the on-site visitation, with the balance due within 30 days of invoicing). This offers an economical, yet tailored, program for adding wellness programs and team-based healthcare delivery to the practice operations. What most practices have experienced is an almost IMMEDIATE increase in income, not by raising prices, but by meeting unmet needs of clients and patients. A 10% growth is usually minimum; we more often see 20 to 40%, depending on which programs are already in effect, the Standards of Care established by the practice leadership, and the KSA-A that exists (knowledge, skills, attitude and aptitude). We have had one practice do 68% more business in the following month. We have practices in their fourth year of this type program, still growing by 20% a month, but those have stayed in contact and we have added new programs each year.
AND FOR THE RECORD, we use this program to facilitate the implementation of the new (circa March 2008) VIN PRESS text, The Practice Success Prescription: Team-based Veterinary Healthcare Delivery, available as a FREE download, which is actually an integration of multiple programs in a sequential manner, using time-proven techniques and systems. Concurrently, please be aware, we DO NOT increase the practice's fee schedule to make these changes happen, we do it with healthcare delivery programs and staff leveraging of doctor time. If the KSA-A is below what the practice desires, we also integrate a zone-based, self-directed, orientation and training program, a four phased, sequenced, skill set development program, to ensure we assist in establishing a level playing field for all team members.
4) The full-year diagnostic consult - Dr. Tom Cat's 25-plus years of experience has caused our comprehensive full-year diagnostic consultation to evolve into a quarterly, eye-to-eye visit format!
A. Initial Onsite Visit - A four-day on-site diagnostic visit with Tom Catanzaro, DVM, MHA, LFACHE, including a medical record audit, fiscal assessment, and staff strength identification process. This visit shapes the development of a month-by-month, step-by-baby-step, practice training and action plan which will take the practice from where it is, to where the leadership wants it to go.
B. Second Quarter Onsite Visit - A two-day on-site visit during the second quarter starts with a staff behavior profiling exercise, to now identify individual work style behaviors. It is also when the practice management/leadership has often started to revert, and we can recharge their commitment and behavior. This moves into assessment of "the plan" progress, to ensure that small hurdles from the first quarter don't grow to insurmountable mountains as your team progresses. This provides the opportunity to review "lessons learned," adjust the action plan as needed and conduct any staff training desired to help along the change process. In practices that have "stayed on track", it is a time to identify program managers and hopefully, zone coordinators. This second visit is also motivation for the practice NOT to defer or ignore the change process required to increase practice success!
C. Third Quarter On-site Visit - A two-day on-site visit during the third quarter allows continued in-service training and revision of the action plan. By this stage, we are polishing the tracking methods of program managers and their back-up, identified from the staff, based on their interest areas. Again, utilize this visit to bolster your change process and smooth the pathway to personal, professional and practice growth.
D. Action Plan Extensions Following Each On-site Visit - After each on-site visit, and after we jointly review the accomplishments and lessons learned of the previous months, we provide a Action Plan "extension", providing new programs, and adjustments in healthcare delivery and management as needed, to provide whatever help is needed to construct your "practice enhancement plan" for the year(s) to come.
For many practices, this comprehensive, personalized form of diagnostic consultation and support program can offer the answer to their practice dilemmas. The most common enemy of veterinary practice is "tradition" and "If you Always do what you have Always done, you are going to Get what you have always Gotten". Our foundation is quality veterinary healthcare delivery, as well as developing the caring leadership skills of key practice players, and our task as consultants is to use our diversified experience to build a plan that fits your practice philosophy and staff strengths. Every practice is unique; each has different combinations of staff and clients and each has been started and built by the sweat of an individual vision. In traditional veterinary terms, the practice is our patient, the ownership is our client. We must diagnose the "ills" of the situation, and clearly state the "needs" of an integrated treatment and wellness plan for the patient; the client must approve the plan before we can initiate treatment.
Once the initial treatment plan (the draft action plan) is established with you and your team, the subsequent support via e-mail, augmented as needed by phone and fax, will be instrumental in assisting the practice team growth and change of old habits. As with most complicated cases, rechecks are essential to ensure the treatment is progressing as desired, this is why we now REQUIRE the quarterly eye-to-eye contact for full-year consultations to ensure a healthy patient care program is evolving.
Any of our consultation programs will be tailored to your practice and most often, they require a commitment to change by every member of your practice team, including the doctors. Your practice has gotten where it is today with the skills and knowledge of the practice leadership; assistance is being requested because they ownership has identified a need for someone outside the organization to facilitate the needed changes to new horizons and operations - that means EVERYONE has changes to make in the transition process. Veterinary healthcare delivery starts by ensuring that the front door swings, is enhanced by client-centered service and patient advocacy, and evolves as a quality-based system of integrated programs and procedures.
- When looking at practice operations, unlike some short-sighted management consultants, we DO NOT automatically address your fees as the first action.
- We instead focus on the quality medical programs that are the basis of professional medical practices.
- We help you to develop your most valuable (and usually under-used) asset, your staff!
- We support your evolution by giving you the ideas and tools needed to progress, help you distinguish your practice from your competition, and support your efforts by providing ongoing support with this dynamic service.
- In any Succession Planning process, or realigning new leadership when a new partner is added, we focus on the practice health as our primary client, and attempt equitability for all (buyer and seller). . . in reality, this is the only way to bring on a new partner. Just as individual beings with unique personalities have common elements, most practices share a set of common systems which are assessed during the first visit and incorporated into the Full-year Action Plan.
- Medical Records are the continuity of care for the practice. Written Standards of Care will be facilitated if needed. Most practices need to improve or streamline their system of documented communication, so our diagnostic consultant performs an audit.
- Human Resources - Our task is to identify the strengths of each individual and build upon those characteristics for the good of the practice.
- Fiscal Audit - We determine the historical strengths and weaknesses and prepare a draft budget based on your program assessment (what you offer clients). This helps to quantify the healthcare delivery commitments and goals of the practice and gives you tangible items with which to track your progress.
- Internal Promotions & Healthcare Delivery Programs - Clients' perceptions are based on the pride the staff shows in the practice's programs and procedures. Internal promotions involve the healthcare delivery team knowing the programs and includes improved communications, an in-service training program, and sharing the "why."
- New programs and added substance are phased in over the coming year with "baby steps," so no one staff member is overwhelmed by the change process.
On the Full-year Diagnostic Consultation, if you decide during the very important first four days that you do not want to continue the consult or the outlined transition, you must discuss it BEFORE Dr. Cat leaves your practice! If you cancel the consult at that time, you will only incur our expenses, without any time fees. If you move forward with the consultation, the consult fee, minus retainer, is due and payable upon receipt.
The full-year diagnostic consultation is supported with monthly review of procedures and fiscal data, sent to Dr. Tom Cat via e-mail, assessed, and responded to via e-mail, with phone calls as needed to elaborate. The e-mails, faxes, and/or phone calls from your team to ours are unlimited. Until our six-month fee schedule review, this program is offered at a flat rate of $14,600 USD per site, plus reimbursement of direct travel and trip expenses (the engagement is "locked-in" to the time of your choosing by the submission of a retainer of the 50 percent of time fee, which is applied to the final bill, sent after Dr. Tom Cat has completed the on-site visitation, with the balance due within 30 days of invoicing). This program offers the best tailored program for a practice desiring evolutionary growth, in operational effectiveness and/or liquidity.
Addendum - We do offer "specifically tailored programs", which can be for industry or practices. It is done by discussing the wants and needs, and developing an approach that seems realistic. The costs are highly variable, dependent upon preparation efforts, support services desired, and on-site commitments. For practices which have used our on-site services previously, the fee starts at $1800 USD per day. For first time practices or industry, it is dependent upon the scope and duration of consulting advice desired.
WE TAILOR OUR SERVICES TO MEET YOUR NEEDS. The above four formats are provided for time/fee/scope of services concepts. We can adjust subject matter within the time spans to meet your needs. For instance, pre-architect hospital design services are often included, based on your practice's flow and operational desires, and Tom Cat's assessment expertise.
DISTANCE LEARNING VCI® PROGRAMS
We have three basic levels of off-site support which we start tailoring from:
1. Floor Plan development and/or review -
Usually pre-architect, but in some cases, during the architectual process, when communications do not seem to be getting a practice what it wants. After 2000 hospitals and three architectural texts, Dr. Tom Cat is very skilled at capturing the essence of what veterinarians request - and within budget. For a $750 retainer, we initiate the engagement, provided whatever floorplan drawings appear applicable, and start an e-mail exchange. If we are requested to come on-site for an interactive floor plan development, we add the short course fee to the desk audit fee, to achieve the rates.
2. Desk Audit -
This may be most anything you choose, since it is a "pull" support engagement. For a $750 retainer, we initiate the engagement, provided whatever Monographs appear applicable, and start an e-mail exchange. Once the $750 retainer is obligated from e-mails, Monographs, floor plans, or other reports, we start to bill after the fact. Applications include:
Fiscal and productivity reviews - Usually from veterinary software summary reports and previous P&L documents, a baseline, trends, and/or program-based budget can be reviewed/developed and tracked.
Mentoring - Often used by start-ups, new managers, or new owners to bounce ideas off someone who has authored 17 books, 32-plus Monographs, over 2000 hospitals visited, and years of experience in most organizational behavior environments. This is just a way to have a consultant available who knows and understands the practice's stresses and the occasional angst of practice operations.
Demographics - In the Blackwell Publishing (Wiley & Sons) text, Beyond the Successful Veterinary Practice: Succession Planning & Other Legal Concerns, we shared the only published valuation formula for practices, which includes a demographic assessment, with parameters shared within the text and evolved over time. We can do general single site assessments ($695), marketing assessments ($1295), and can do multi-site assessment desk audits (fee increases with each site). If we are requested to come on-site to assess "the lay of the land", we add the short course fee to the desk audit fee, to achieve the rates.
3. Pre-paid Telephone Support -
This usually utilizes the spreadsheet from the electronic tool kit in the Profit Center Management Monograph (or the new 2010 AVA Veterinary Chart of Accounts, which Tom Cat helped mentor, or the new 2017 AAHA Chart of Accounts), and can be done quarterly or monthly, to provide mentoring to programs, standards of care, and financial accuracy in tracking the veterinary business trends. This is predominantly an e-mail exchange process, sometimes supplemented with telephone exchanges when speed bumps are hit.
Monthly - The prepaid annual fee is $3500.
Quarterly - The prepaid annual fee is $1000.
ADDITIONAL/SPECIAL VCI® PROGRAMS
Since Dr. Thomas E. Catanzaro, DVM, MHA, LFACHE, is highly credentialed and well published, as well as a respected speaker and industry facilitator, we receive requests for many special services, such as seminar speaker, expert testimony, and feasibility reviews.
These are handled on a case-by-case basis by Dr. Tom Cat personally, and the following are a few examples:
Dr. Tom Cat's CV is over 53 pages. It can be requested as a review document to a specialized engagement.
Dr. Tom Cat has over 300 periodical publications and proceedings, as well as the 17 books and 32-plus Signature Series Monographs (with companion CD tool kits) (www.vin.com or www.drtomcat.com). There exists a Dr. Tom Cat Speaker's Bureau list of past presentations, but Dr. Tom Cat prides himself in tailoring each presentation, so there is never a duplicated seminar.
Although Dr. Tom Cat does not seek opportunities for expert witness in legal cases, he does support existing clients when requested. It needs to be noted that the "expert witness" fees are for his time and knowledge, and NOT his testimony. His testimony will not be "adjusted" for the satisfaction of the person employing him. The facts of the situation will define the data, application, and testimony.
When someone seeks specialized assistance in the areas of safety and occupational health issues, we usually refer to Philip Seibert, Jr. CVT, someone who specializes in veterinary safety, someone who has published the AVMA guidelines and is currently revising the AAHA guidelines. His web link is on our cover page.
New facilities require a uniquely tailored transition plan to be started at least six months before move-in to mediate post-occupancy expense, including training to capitalize on the new facility flow. The estimated the average cost of move-in to a new healthcare facility is about 12 percent in excess of the construction cost, unless there is a pre-existing team-based transition plan implemented. With an on-site, pre-existing, team-based transition plan being implemented, the estimated average cost of move-in to a new healthcare facility is reduced to about 3 percent of the construction costs. If old habits are moved into a new facility, usually frustration and dissatisfaction will disrupt patient/client service, compounding the move-in costs.
When moving from a single owner to multiple owners, a revised style of governance is required. When moving from a single facility to multiple facilities, a revised style of governance is also required, regardless of ownership. Many specialty practices have a representational executive board, which is dysfunctional by design. Dr. Tom Cat has the published references on governance, but the simple fact is that the facilitator of effective governance will usually be discarded after the first year due to the learning curve stresses that have been encountered. We are proud that even after being "discarded" after the first governance transition year, we are often invited back after a few years when the governance board wants to go to the next level.
Many industry vendors want to become leaders in practice healthcare delivery, but they have not been in the trenches and do not have the experience to understand the variety of organizational behavior dynamics. Since Dr. Tom Cat spends most of his time consulting in the trenches, many vendors have asked him to provide insights, or mentor their field representatives, in practice relations. Other vendors have asked his counsel in product development. For example, in 1991 he was on the four-man team that redesigned the Summit X-ray machine, which was to become a veterinary profession leader in radiography hardware. He has continually offered pro-bono advice to software vendors, and in most cases, within two to three years, his predictions have come true. Blackwell Press asked him to forecast 25 years into the future for veterinary medicine and practice, and he immediately sought out Terry Hall, DVM, CFP, to co-author the text, since economics will be the pressing issue in the coming two decades. Web links to trusted professionals dealing with veterinary issues are on our web site cover page.
Practice valuation has evolved since Blackwell Press published Dr. Tom Cat's text Beyond the Successful Veterinary Practice: Succession Planning & Other Legal Issues. He immediately sought out Ed Guiducci, JD, to co-author the text, since the legal aspects required a very savvy veterinary transactional attorney who understood win-win negotiations, the pressing issue in developing multiple owner practices. This text still offers the only published practice valuation formula, yet Vet Partners (AVPMCA) has a Valuation Task Force that developed 13 Risk Factors to better define the capitalization rate. We have had a very knowledgeable representative on that task force since its inception, and currently, Michael Hargrove, DVM, MBA, does our economical, yet highly professional, off-site SNAP SHOT valuations. When there is a new leader and a change of practice culture need, Dr. Tom Cat is the one to step in and facilitate the organizational change issues. Web links to trusted professionals dealing with veterinary issues are on our web site cover page.
As you can see, Dr. Tom Cat often task organizes for special needs. He has used Dr. D. Tim Crowe for emergency and critical care issues, since that area has special professional needs, and Dr. Crowe is dual certified, as well as highly respected in the VECCS organization.
These special situations, and special needs, are easily within the scope of services offered by Veterinary Consulting International® and Dr. Tom Cat. Tom's board certification covers ten major areas of healthcare administration. And while no other veterinarian has accomplished this level of professional recognition, less than 10 percent of the 30,000-plus members of the American College of Healthcare Executives (ACHE) have been recognized as Fellow. Dr. Tom Cat was recognized as Fellow in 2000, and must re-certify for his diplomate status every three years.
ITEM OF NOTE: Dr Tom Cat now centers his time on North American practices, yet he divides his time between International clients and North American clients, following the request for whichever practice wants his services. As such, please use DrTomCat@aol.com for direct contact concerning his availability for consultation(s) at your site.