Problem: Your Average Doctor Transaction Is Low

Denise L. Tumblin, CPA, WTA Veterinary Consultants, Columbus, Ohio

ArticleLast Updated January 20183 min read
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The Problem

The target average doctor transaction (ADT) for the practice is $160 to $175, but the veterinarians’ actual ADT ranges between $125 and $155. Per the 2017 Well-Managed Practice Benchmarks Study, the ADT typically represents 3.2 to 3.5 times the examination fee.

The solutions

  • Forward book appointments for medical progress examinations, dental prophylaxis, preventive care, and follow-up bloodwork to ensure patients receive the healthcare prescribed by the veterinarians and included in the practice’s medical protocols. Be sure to charge for all examinations. Practices may neglect to charge for some examinations, including extended and medical progress examinations and those given to hospitalized patients.

  • Evaluate patient compliance with the practice’s protocols for preventive care, laboratory tests, and dental prophylaxis. Set target compliance rates for canine heartworm, fecal, and senior wellness testing as well as dental prophylaxis, and compare the targets to the actual number completed. For example, a practice has 4000 active canine patients and a heartworm testing compliance goal of 80% (ie, 3200 heartworm tests [4000 × .80]). The actual number completed was 2000 (ie, a 50% compliance rate [4000 ÷ 2000]). To bridge compliance gaps, share ideas for effectively educating clients about the necessity of care (eg, attractive, easy-to-understand educational materials that use more pictures and fewer words). Use educational apps and the practice’s website and social media to help convey the necessity of care.

  • Conduct a case review for missed charges to assess the consistency of billing for all provided patient care. Pull a random sample of 20 cases each veterinarian completed in the past 2 weeks (ie, 10 outpatient and 10 inpatient cases per veterinarian), and compare the medical record of the care provided to the client invoice. Note any services that were provided but not billed, and total the dollar value of the missed charges to assess the frequency and the type of healthcare items typically missed. To reduce the frequency of missed charges, use a charge sheet to track care when provided, and assign the responsibility of entering charges daily to the veterinary nurses. Also, ask the client service representatives to do a final review before checkout.


The ADT tells a story about the medicine and finances of a practice. A low or inconsistent ADT between the veterinarians signals a possible variation in the quality of care or the inappropriate application of the practice’s fee schedule. The ADT can also indicate ineffective utilization of the veterinary nursing team. What story does your practice’s ADT tell?