How to Incorporate Ultrasound Into the Veterinary Practice – a Step-by-Step Guide

By October 18, 2018 December 31st, 2018 Ultrasound

Ultrasound has become a standard imaging modality in veterinary clinics across the United States. A powerful diagnostic tool, ultrasound can detect intra-organ growths, fluid build-up, and other maladies that are difficult or impossible to observe on X-rays. When used adjunct to radiography, ultrasound can greatly enhance your diagnostic capabilities, leading to increased prognostic confidence and improved patient outcomes.

In his recent webinar, Dr. Marc Seitz, DVM, DABVP offered crucial insight to veterinarians who are thinking about purchasing an ultrasound system. Dr. Seitz is a board-certified canine and feline specialist with a background in both general and emergency medicine. He is one of the world’s foremost authorities on veterinary ultrasound.

You can watch the entire 45-minute webinar below, or read on to learn Dr. Seitz’s answers to six frequently asked questions about veterinary ultrasound.

1. How Should I Implement Ultrasound in My Practice?

If you’re going to invest in an ultrasound system, you don’t want it to sit in a back room next to the kennels and collect dust. In order to get the most value out of your ultrasound, you will need a plan to implement the new modality in your clinic.

Rather than just saying, “I want to do echoes” or “I want to do ultrasound,” establish measurable, time-sensitive goals that encompass:

  • When you and your personnel will complete basic, intermediate, advanced, and refresher training courses
  • How you and your personnel will gradually increase usage of ultrasound
  • How you will charge clients for ultrasound

Implementation Tip: Perform “Missed Opportunity Scans”
Make sure your personnel commit to performing “missed opportunity scans.” The two biggest ones are ultrasound-guided cystocentesis and Focused Assessment with Sonography in Trauma (FAST) scans in emergency situations.

Although you might be comfortable performing blind cystos, the ultrasound will help you detect stones and masses that you would have missed. Most people can do ultrasound-guided cystos with minimal training.

About 75% of patients who are determined to be in shock are going to have a positive FAST scan. Nearly 1 in 4 patients who need emergency treatment will have a positive FAST scan. “If you treat patients who are in shock or if you work in an emergency clinic, ultrasound definitely has a role to play at your practice,” said Dr. Marc Seitz, DVM DABVP. “There isn’t a veterinary clinic that shouldn’t do ultrasound-guided cystocentesis and FAST scans.”

When you’re comfortable with cystos and FAST scans, you can take intermediate courses to learn how to use ultrasound to properly assess major abdominal organs as well as more challenging GI tract, pancreas, and lymph nodes. From there, you can take advanced courses and eventually offer full diagnostic scans, which typically bring in about $250 or more per scan depending on the location of your practice. 

  1. What Does Ultrasound Training Entail?

Like any other modality, it takes practice to grow comfortable using ultrasound. “You’re going to need training. You’re going to make mistakes. Be patient and practice. Don’t be too hard on yourself. It’s going to take time,” explained Dr. Seitz.

Bear in mind that not all training programs are created equal. When comparing your options, consider the number of instructors and their credentials. Find out how much time you will spend scanning a live animal in the lab with an instructor by your side; this is perhaps the most important factor in an ultrasound training program.

Dr. Seitz recommends that you space apart your training courses to give yourself time to practice your new skills. The slide below offers a rough outline for when to schedule your training:

Beyond formal training, you can brush up on your ultrasound knowledge by tuning in to online webinars and attending short courses and conferences. Self-directed learning, such as looking through medical literature on veterinary ultrasound, is also very helpful.

Another popular resource is the Sound Education Portal, which has free introductory and refresher ultrasound training videos, by instructors from the Academy of Veterinary Imaging. It can be found at http://education.soundvet.com

As you grow more comfortable and familiar with ultrasound, you will refer out fewer clients and be able to accept more referrals from doctors in your network.

  1. I’m Not Sure If I’ll Use Ultrasound That Often. How Can I Increase Usage in My Practice?

Beyond improving patient outcomes, ultrasound can help your clinic establish a reputation for being on the forefront of veterinary medicine—but only if you use it at every possible opportunity. Dr. Seitz offered the following recommendations to increase ultrasound usage in your practice:

  • Make sure your personnel commit to performing “missed opportunity scans” (FAST scans and ultrasound-guided cystos)
  • Write out your implementation plan, and put it in a place where you can see it every day
  • Use ultrasound adjunct to radiography to confirm suspected diagnoses
  • Perform focused scans on organs while patients are undergoing other treatments
  • Ask your personnel to remind you to use ultrasound when an opportunity presents itself
  • Put your ultrasound machine in place where it can be easily accessed—not next to the kennels in a back room
  1. What Type of Ultrasound Should I Buy, and What Will It Cost?

Before we answer this question, it is first important to ask, “How do you plan to use ultrasound in your practice?” The response might be different for a low-volume referral hospital and a high-volume veterinary clinic that focuses on preventative care.

Do you plan to perform full diagnostic scans? If you have an older ultrasound, you might be able to perform certain focused scans, but your machine will hold you back if you try to perform a full diagnostic scan.

Beyond the hardware and features of your ultrasound, it is equally important to consider the warranty and service plan. “Talk to your sales rep about what the warranty includes,” advised Dr. Seitz. “The better ones include sending a loaner the next day, which is imperative if you only have one ultrasound machine.”

The cost of ultrasound machines spans from about $20,000 to $250,000. In the $20,000 range, you can get a machine that is capable of performing FAST scans and focused exams. But if you intend to do full diagnostic scans at the general practitioner level, you probably want to invest in the $60,000 to $100,000 range.

Don’t buy a $100,000 machine if you’re only going to use it on cystos and FAST scans.

In a private practice setting, a $250,000 research-grade machine almost never makes sense. Don’t get oversold. Think about what you actually need so you can maximize your return on investment. According to Dr. Seitz, “It’s better to buy a cheap machine and pay for it that year than to buy an expensive machine and let it go unused.

5. How Do I Develop a Fee Schedule for Ultrasound, and When Should I Start Charging Clients?

If you’re new to ultrasound, you might be hesitant to charge your clients. But if you perform scans for free, you’re not going to move your practice forward, and your clients might expect not to pay for scans in the future.

So, when should you start charging? According to Dr. Seitz, the answer is simple: “immediately.” But it is important that you charge appropriately.

Don’t just charge one ultrasound price even though it’s one machine. Do you charge one price for blood work? Probably not, because just like ultrasound, your blood analysis machine has many uses in your practice.

The fees you charge to clients for ultrasound will depend on where your practice is located, but you can use the slide below as a guide:

It doesn’t take long to generate enough revenue to pay for more training (for yourself and your personnel) and a higher quality machine. When you are experienced enough to perform full diagnostic scans, you can generate $50,000 in revenue per year with just one scan per day.

Dr. Seitz offered the following tips to help you create a fee schedule for ultrasound:

  • Consider “batch” charges to generate more revenue and increase ultrasound utilization
  • Increase your cystocentesis fee to include the ultrasound
  • Increase your emergency fee to include a FAST scan
  • Charge a combined fee for abdominal radiographs and ultrasound
  • Introduce a “recheck” fee to encourage repeat scans at a reduced price
  • Talk to other doctors in your area. Explain how you’re currently using ultrasound, what you’re currently charging, and ask for feedback
  1. What Are the Most Common Mistakes Made by Veterinarians Who Are New to Ultrasound?

The single most common mistake made by veterinarians who are new to ultrasound is not having an implementation plan. How will you use your ultrasound? When will you undergo training? How will you charge clients? If you don’t know the answers to these questions, your ultrasound usage and income will be greatly reduced.

Another common mistake is not recognizing the learning curve involved. Training and practice are very important. Dr. Seitz recommends that you perform at least two or three scans each week to start, and look for opportunities to scan patients while they are undergoing other treatments. “Break out of your patterns that are preventing you from using ultrasound.”

A final mistake is working outside the capability of the machine. If your machine is more than 10 years old, it will be frustratingly difficult to perform full scans or examine GI lymph nodes.

Conclusion
Ultrasound is a powerful diagnostic modality that belongs in most veterinary practices. If you want to get the most value out of your ultrasound system, follow Dr. Seitz’s advice and create a detailed implementation plan. Consider how you and your personnel will develop your skills and expand your usage of ultrasound over time.

When comparing your options, don’t get oversold on an ultrasound with unnecessary frills that inflate the price. Your purchasing decision should be based on how you intend to use your ultrasound and the specific features you need.

By following these guidelines and sticking to your fee schedule, ultrasound will boost your revenue, improve the standard of care in your clinic, and help you develop a reputation for being on the forefront of veterinary medicine.