As more and more in-house diagnostic testing options become available to veterinary practices, owners and managers increasingly face the question of whether to invest in point-of-care equipment or continue sending samples to a reference lab. While some of the advantages of in-house laboratory equipment are obvious, others are less so. Let’s take a look at some common questions about these tools — and what the experts have to say.
How Do In-House Diagnostics Benefit Pets and Clients?
Perhaps the most obvious benefit to in-house diagnostics is being able to help sick pets earlier, says Fred Metzger, DVM, DABVP, medical director of VCA Metzger Animal Hospital (vcahospitals.com/metzger) in State College, Pennsylvania, who jokes that he’s been called the “godfather of in-house testing” after two-and-a-half decades of speaking and writing about the practice.
Dr. Metzger says veterinarians should be running a minimum database — hematology, serum chemistry profile, and urinalysis — for every sick patient they see in the clinic. “Those are the tests that should be run in house, because they’re going to guide your decision on what to do next,” he says. “That may be imaging, it may be another test you send to a reference lab, it may be pet food, it may be pharmacy. It really drives everything.”
Not only does this make good use of clients’ time in the clinic, it also means treatment can get started sooner — based on scientific results, not guesswork, Dr. Metzger says. And by the way, he adds, a sick patient is any animal the owner thinks is sick, including the cat that “ain’t doing right” or the dog that’s “not himself.” Running an in-house minimum database on these patients provides structure and intent to an appointment that otherwise might be a bit aimless if the physical exam doesn’t yield significant findings.
Of course, in-house testing might also mean the difference between life and death in emergency and critical care cases. If a patient comes in with diabetic ketoacidosis on Saturday night, you don’t have time to wait for results to come on Tuesday before intervening.
But blood work is important even if a patient is not apparently sick, Dr. Metzger says. He recommends that the minimum database be included in well-patient protocols too. After all, “animals cannot hide their objective data,” he says, quoting his mentor and former Purdue professor Dennis DeNicola, DVM, Ph.D.
“An animal can come into the practice looking perfectly normal because you’re chasing them around in a white coat scaring the hell out of them,” Dr. Metzger says. “They can hide a lot of things, even limping. But they can’t hide their creatinine. They can’t hide their hematocrit. They can’t hide their glucose. The only way they can hide it is if we don’t run it.”
However, this is where a reference lab comes in. Since these pets are more likely to be healthy and time is not necessarily of the essence, Dr. Metzger suggests sending these tests out since they can be bundled with other screens to save the client money. “In-clinic labs and reference labs work together,” Dr. Metzger says. “They always have.”
How Do In-House Diagnostics Benefit My Practice?
Dr. Metzger likes to show clients their pets’ abnormal lab results so that they can see in black-and-white (and red) that something is wrong with their pet. This is the “broken car part” approach — if you go to an auto shop for an oil change and the mechanic pulls out a dirty air filter and shows it to you, you’re much more likely to buy a new one. You’ve seen proof with your own eyes.
It’s no different with your in-house lab, Dr. Metzger says. You’re giving clients tangible evidence that pets are healthy or sick, which drives compliance. More pets get the care they need, and your practice’s bottom line benefits. Plus, sharing this information reinforces the value of your services.
Another reason to test in-house, Dr. Metzger says, is that it’s easier to keep track of case details and maintain clear lines of communication, especially in a multi-doctor practice. “If I’m sending all the blood to a lab, and I’m seeing 10 animals in a day, it’s really hard to remember who’s who,” Dr. Metzger says. “In some cases I may not even be the one who saw the patient, but I have to call the client and tell her her dog has cancer.”
With in-house testing, Dr. Metzger works on one patient at a time, so he can remember who the owner is and what they said was going on with the patient. “It helps keep communication open and personal,” he says. “Really, it’s the only way I can keep anything straight, especially on a sick patient. And then I can immediately explain what I’d like to do next.”
What Are the Benefits of Integrating Diagnostic Equipment With Practice Management Software?
“I can’t even explain how important the integration piece is,” says Paul Camilo, CVPM, of Veterinary Consultation Services (veterinaryconsultationservices.com) in the Miami/Fort Lauderdale area.
Camilo recently went through the process of researching and purchasing both diagnostic equipment and software for a clinic he’s launching in Florida. “I ended up paying more money for my equipment because I wanted the integration,” he says. “Integration makes it easier to communicate with the client and the referring veterinarian, you can run telemedicine more easily with good integration and it saves on staff time and errors.”
Camilo, a self-described early adopter of technology, took his last practice paperless in 2005. Back then there was no integration, he says — being paperless meant scanning and attaching documents.
“To process blood work on one patient, you had to get the results from the chart, put them in the scanner, go to a computer, attach them in the correct place on the server, rename the file — there were a lot of steps, and unfortunately a lot of mistakes were made,” Camilo says. “If the average practice runs three to five diagnostic tests per day per doctor and each takes 10 minutes, just multiply that out. You’re saving a ton of money on labor [when you are truly integrated].”
When conducting research on practice software, Camilo asked prospective companies how well their systems integrated with diagnostic equipment, including in-house and reference lab results. He wanted results to populate immediately into the patient’s record and be charged automatically. “Streamlining as many of those processes as possible is going to be very beneficial and impact the bottom line,” he says.
Camilo was willing to pay a premium for this capability. “I estimate I’m paying at least 20% more for everything I’m doing because I want it integrated a certain way,” he says. “What I’ve learned is that good technology is not cheap. To be able to do things extremely well and slick, there’s an expense for that.”
What Are Some of the Newer Point-of-Care Diagnostic Options for Veterinary Practices?
While in-house diagnostics have traditionally been focused on blood work and urine, the field is expanding rapidly. Dr. Metzger is particularly excited about in-clinic cytology scanners, which have been launched by at least two companies this year.
“Traditionally, if you had a lump or big lymph node, you’d do an aspirate, make a slide, send it to a lab, wait a day or two for the pathologist to read it and hopefully the sample’s good and maybe they’ll give you an answer,” he says. “Now veterinarians collect the sample, scan it immediately in one of these scanners and get an answer in a couple hours. It’s taking in-house testing in a totally different direction.”
Other new tests available in-clinic include C-reactive protein to test for inflammation, progesterone and symmetric dimethylarginine (SDMA) for kidney function Dr. Metzger says.
Camilo is also looking forward to in-house cytology, as well as analyzers based on artificial intelligence (AI). While urinalysis driven by AI made a splash several years ago, the same technology has now come to fecal testing. “You put in the sample, spin it down, and compare it against tens of thousands of pictures in the company’s database,” Camilo says. “You get results within minutes.”
AI is also being used increasingly for radiology, Camilo says, with the technology allowing interpretation of a lateral thorax image in three minutes or less.
Both experts agree that in-house diagnostics mean better patient care, better client service, greater efficiency and practice satisfaction, and a more profitable practice. “When I talk to skeptical veterinarians I like to say, ‘If your favorite dog vomits three times in the middle of the night, are you really going to send the diagnostics out to a reference lab?’” Dr. Metzger says. “No! We want answers right away. And if we want that for ourselves, we need to offer that same capability to our clients.”
Promoting Preventive Care
The value of diagnostic screening
When Bash Halow, LVT, CVPM, was working at a veterinary hospital in Centerville, New Jersey, the practice launched an initiative to do more wellness testing for its patients. Every blood test was run in-house by a dedicated laboratory veterinary nurse, and the data from the results were collected and analyzed.
“We found that in one out of 50 blood tests for patients between the ages of 1 and 8, there was something clinically significant in the findings,” Halow says. “For seniors over the age of 8, it was one out of 17 patients.”
From that point on, everyone in the practice fully agreed on the value of wellness testing. These days, Halow, who operates Halow Consulting Veterinary Business Advisors in New York City (bashhalow.com), speaks at conferences and consults with veterinary hospitals on the value of diagnostic screening for apparently healthy patients. “Because you don’t actually know a patient is healthy unless you test,” he says.
Sure, results may not necessarily show something major like diabetes or renal failure, but trends over time can signal the need for something like a change in diet or quarterly rather than twice-yearly visits. “You’re not necessarily looking for a big bombshell, but it’s more like, ‘We’ve been monitoring this patient over the last three years, and this is a trend that’s not going in the right direction,’” Halow says.
While some practitioners argue that wellness diagnostics deplete clients’ funds so that they’re less likely to be able pay for treatments if the pet is sick or injured, Halow says the opposite is true. “Unless it’s a hit-by-car or acute trauma injury, we’re trying to get ahead of this so that in the long term they’re spending less money,” he says. “We’re doing this to mitigate the cost of illness that would really get out of hand down the line.”
For practices that want to do more preventive diagnostics, the best strategy is to get team buy-in, Halow says. And the most effective way to do that is to make sure they’re receiving wellness testing for their own pets and that you’re discussing results in team meetings. “If you share the stories of the animals tested in the last week and what results were found, the evidence for the value of it is going to be overwhelming,” Halow says.
What’s more, he says, finding problems while they’re still minor is a great way to set your practice apart. “Just think about the value of any veterinarian who’s able to do this for pets and pet parents,” he says. “That is a great way to distinguish your services from the vaccine clinic down the road. That’s being proactive with patients’ needs rather than reactive.”