IMPROVING ACCESS TO IMAGING DIAGNOSTICS FOR FARM ANIMAL VETERINARY PATIENTS IN RURAL SOUTHERN VERMONT

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: OTHER GRANTS
• Reporting Frequency: Annual
• Accession No.: 1020705
• Grant No.: 2019-70024-30325
• Cumulative Award Amt.: $125,000.00
• Proposal No.: 2019-04144
• Project Start Date: Sep 1, 2019
• Project End Date: Aug 31, 2022
• Grant Year: 2019
• Program Code: [VSGPR]- Veterinary Services Grant Program Rural Practice Enhancement Grants

Recipient Organization
CLOVER ACRES LIVESTOCK VETERINARY SERVICES, LLC
2762 SHUNPIKE RD
MOUNT HOLLY,VT 057589614

Performing Department
(N/A)

Non Technical Summary
As a self-employed veterinarian, Dr. Johnson provides preventative care and treatment for cattle, sheep, goats, camelids, poultry, swine, and horses on farms in the four counties of southern Vermont, including the VT131 VMLRP shortage area. Clover Acres Livestock Veterinary Services (CALVS) is the only veterinary practice covering this expanse of small farmsteads and commercial dairies. CALVS cannot adequately meet farmers' needs in this large area due to insufficient assets and income to invest in critical equipment. Dr. Johnson's most critical needs are for an ultrasound, a radiograph machine, and a truck capable of carrying the added equipment. The diagnostic equipment will result in more specific treatment plans, more judicious use of antibiotics and other medicines, and ultimately greater food safety. An ultrasound machine with high resolution and interchangeable probes is useful for pregnancy diagnosis in all farm animal species as well as soft tissue, abdominal, and thoracic injuries. Radiograph machines are used for urolith diagnosis, pre-purchase exams, penetrating objects and fractured bones. This equipment will be purchased as soon as funds are available and put into use immediately. Replacing Dr. Johnson's 12-year-old truck will allow continued mobile veterinary services for years to come and enable Dr. Johnson to invest step-wise in building an office and haul-in clinic on her home property. The grant will increase the quality of CALVS service and enable investments that will make CALVS a long-lasting resource for farmers in southern Vermont.

Animal Health Component

100%

Research Effort Categories

Basic

(N/A)

Applied

100%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
305	3440	1081	20%
305	3510	1081	10%
305	3820	1081	20%
305	3610	1020	10%
305	3610	1081	10%
305	3820	1020	10%
305	3810	1081	10%
305	3810	1020	10%

Knowledge Area
305 - Animal Physiological Processes;

Subject Of Investigation
3610 - Sheep, live animal; 3510 - Swine, live animal; 3440 - Meat, dairy cattle; 3820 - Goats, meat, and mohair; 3810 - Horses, ponies, and mules;

Field Of Science
1081 - Breeding; 1020 - Physiology;

Keywords

mobile veterinary rural service enhancement

radiograph

truck

ultrasound

Goals / Objectives
SummaryDr. Johnson's goal is to develop an economically sustainable practice that can meet the needs of the large animal owners in this shortage area. She has already taken steps to achieve this goal, by developing her customer base and purchasing a centrally located, one-acre property with a small house and garage that can be converted to an office and a haul-in clinic. For the next three years, her specific goals are to purchase imaging equipment, replace her 12-year-old truck with a more recent and suitable vehicle, develop her office and a facility to board small ruminants, and hire an office manager with veterinary technician skills. Achieving these goals in three years will help her increase her client base and income to the point where she will be able to hire an associate veterinarian and/or build a more significant haul-in clinic.Year 1 (Sept. 15, 2019 to September 14, 2020)Dr. Johnson will purchase imaging equipment and a replacement truck as soon as she receives grant funds. The ultrasound and radiograph will be used immediately. While being trained to use this equipment, Dr. Johnson will practice pregnancy exams by offering free services to their owners. Through marketing, she expects to quickly acquire pregnancy diagnosis work from new clients with small ruminant dairies including farmers who have asked for this service in the past. The first year, she expects to use the ultrasound during 85 farm visits, the majority of which will be routine pregnancy exams.She expects to generate $10,600 in equipment usage fees alone in the first year, with additional revenue due to an increase in billable hours. These estimates are based on an assumption that 40% of clients will pay for ultrasound use and 10% for radiographs. Dr. Johnson also assumes that the business will continue to gain six clients a month, although equipment purchases are likely to accelerate growth.Year 2 (Sept. 15, 2020 to September 14, 2021)Dr. Johnson will begin using the ultrasound to evaluate calf and small ruminant pneumonia. A conservative projection is that imaging equipment fees will increase to approximately $12,800 in addition to another increase in billable hours.With the equipment purchased in year one and the resulting increased income, she will be able to start building an office and boarding facility--a fenced-in area and shed where CALVS can board small ruminant patients in need of daily injections. In order to maximize billable hours, she will hire an office manager who can double as a veterinary technician.Dr. Johnson projects gross revenue for this year to be approximately $120,000. This reflects revenues for the imaging equipment, the increased rate of client growth, and an officer manager.Year 3 (Sept. 15, 2021 to September 14, 2022)Dr. Johnson will begin using the ultrasound for equine lameness diagnosis, equine pregnancy diagnosis, and evaluation of uterine health. She projects revenue this year from imaging equipment fees to reach $15,700. Her goal for total revenue this year is $160,000.

Project Methods
Annually in January• Analyze imaging equipment use and adjust 3-year forecast projections.• Evaluate mileage and strategize scheduling to reduce overall mileage. Ensure farm call fees cover mileage and truck expenses.Year 1• Purchase imaging equipment and a replacement truck.• Start using equipment immediately, including hands-on training by equipment suppliers.• Market new services online through blog articles and social media.• Use the ultrasound during 85 farm visits.• Attend 2nd session of "Manage Your Rural Practice for Success Workshop," AABP's 3-day intensive class, in February. Develop next steps for business plan.• Generate $10,600 in equipment usage fees and additional revenue of $12,600 in associated billable hours. Generate reports of this data from veterinary software already in use.Year 2 • Begin using the ultrasound to evaluate calf and small ruminant pneumonia.• Generate $12,800 in equipment usage fees with additional revenue of $15,000 from associated billable hours.• Start building an office and boarding facility.• Hire an office manager.• Achieve gross revenue of approximately $120,000.• Accept more ride-along veterinary students.Year 3• Continue education to advance imaging skills and put additional services into practice, e.g. ultrasound for equine leg injuries or fetal sexing of calves• Generate approximately $15,700 in equipment usage fees with additional revenue of $18,700 from associated billable hours.• Achieve gross revenue of approximately $160,000.Year 4 and beyond: Consider hiring a veterinary associate and/or acquiring a neighboring 83-acre property in order to develop a substantial haul-in clinic and farm-animal education facility.Ongoing• Continue to evaluate budget and projections for each new year.• Adjust marketing and continuing education plan as needed in order to continue expanding services to new and existing clients.• Service equipment as needed to keep it in excellent working conditions

Progress 09/01/19 to 08/31/22

Outputs
Target Audience: Nothing Reported Changes/Problems:Changing Practice Management Software also changed the integrated reports available, requiring a different strategy to obtain the data for this final report. There was also a time lag for getting records up-to-date in the new software, such that the data wasn't readily available for this report until business slowed down in the winter of 2023, hence the late final reporting date. What opportunities for training and professional development has the project provided?Dr. Johnson completedcontinuing education courses from the 2021 NY State Veterinary Conference and from the AASRP concerning imaging of camelids and small ruminants. Additionally, the practice shift to more sheep and goat medicine overall, led to Dr. Johnson providing three fecal egg count workshops for clients in 2022, with demand for more such workshops in 2023. With this important information, clients are making more informed husbandry decisions, using chemical dewormers more strategically, and they are looking forward to incorporating additional preventative health measures. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Dr. Johnson achieved a Year 2 goal this year: She purchased and installed a tiny house building to use as an administrative office. That space has offered administrative efficiency, with all equipment and reference materialsin one place, with easy access to her veterinary truck. Dr. Johnson switched veterinary practice management software this year to improve client communication - sending automatic reminders and end-of-month account statements. This switch enables her to do more data entry on-the-joband reduces the need for an office manager. Gross revenue for this project year was $104,000.Revenue generated directly from imaging was about 10% of the year's total revenue, or $10,600. All income is less than set forward in the project goals. However, despite not achieving the expected year 3 gross revenue, the ultrasound equipment has yielded increased job satisfaction and created a desired shift to practicing more sheep and goat medicine overall. Also, client numbers continue to grow, averaging about 9 clients per month for the first 6 months of 2022.

Publications

Progress 09/01/20 to 08/31/21

Outputs
Target Audience: Nothing Reported Changes/Problems:Dr. Johnson changed how she charges for radiographs halfway through year 2. She had been charging $45 per view, but it seemed like an arbitrary number and limited the scope of a study of any particular body part. Given that this is digital radiography and the cost is more related to hours rather than individual pictures, Dr. Johnson decided to bill $180 per hour for on-farm radiography work. With a cooperative patient, the cost is much more manageable and valuable for clients. If the patient is uncooperative, Dr. Johnson still makes enough money to cover the associated office time required to formalize the images and upload them for sharing. This will simplify reporting as well, because Dr. Johnson will simply report number of hours and the resulting income associated with radiography. What opportunities for training and professional development has the project provided?Dr. Johnson is keen to review continuing education courses from the 2021 NY State Veterinary Conference and from the AASRP concerning imaging of camelids and small ruminants, but has not had time to review these lessons yet. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?It is difficult to project how coronavirus will affect the year to come in terms of construction expense (office outbuilding), employee safety and health (coronavirus variants and vaccine efficacy), and increased local demand for livestock veterinary care. No further marketing of imaging equipment is planned, Dr. Johnson will rely primarily on word-of-mouth advertising and offering imaging when valuable for an animal's diagnosis and care plan. Clients are immensely reassured to know that imaging is an option, even if we don't decide to use it. Dr. Johnson will save specifically for a construction project and work with her CPA to add a part-time employee, if a good fit can be found. In the meantime, Dr. Johnson plans to switch veterinary software for sure this winter, enabling timely data entry. Dr. Johnson will also participate in continuing education related to imaging when and where feasible and relevant.

Impacts
What was accomplished under these goals? Clover Acres Livestock Veterinary Services business has grown substantially in the past year, grossing $93K, which is more than $20,000 more than year 1 of the project. The increase in revenue is largely due to the availability of imaging equipment. In terms of actual equipment fees, the increase was minimal: about $2500 this year compared to $570 in year 1. Income from the associated 20+ billable hours translates to $2400, for a total direct revenue benefit of $4900, just 25% of the increased revenue overall. Acquisition of new clients has dropped from about 9 per month in 2020 to 4 per month in 2021, but total invoices written have increased, suggesting improved client retention, as was projected in the grant proposal. Moreover, average income generated per invoice has increased from $195 to $233. New client acquisitions have dropped largely because Dr. Johnson started to refuse after-hour emergencies from people that do not have an existing Veterinary-Client-Patient-Relationship with CALVS, thereby encouraging all clients to provide preventative care for their livestock.

Publications

Progress 09/01/19 to 08/31/20

Outputs
Target Audience:Current livestock veterinary clients have been informed that Clover Acres Livestock Veterinary Services now has imaging equipment that is highly portable and versatile. Dr. Johnson has used the ultrasound to diagnose pregnancies in sheep, goats, and dairy cows. She has used the radiograph equipment with small ruminants and horses. Both tools have provided new clients and new farm calls to existing clients. Changes/Problems:During the interim between writing the VSGP application and putting the equipment into use, Dr. Johnson decided on an equitable ultrasound equipment fee to use across ruminant species for pregnancy checks. As a result, instead of a $90 ultrasound equipment fee per invoice, the most common ultrasound fee is likely to be $30-60, resulting in lower equipment revenue overall, but hopefully more billable hours. The charge for pregnancy checks is $5 per head, with a minimum of $30 and a maximum of $90. Dr. Johnson examined 18 sheep in one hour in March, resulting in the maximum $90 fee. That producer will likely use the service again, potentially for the whole 50 head flock, resulting in more billable hours but no more than a $90 equipment fee. There is a slight problem associated with this billing change. The report that Dr. Johnson planned on using actually shows the total quantity of uses for the equipment. So, even though the ultrasound was used at only 5 farms for pregnancy diagnosis, the report has a quantity of 46, the total number of patients it was used on. For this year of minimal uses, it was easy to count the scheduled appointments on the calendar. But for subsequent years, Dr. Johnson will need to create a report that fits the approach described in the VSGP application. When Dr. Johnson upgrades CALVS practice management software over the next couple of months, she will think about how best to input this information on invoices and identify a report that will identify the number of farm calls and clients that used these services. What opportunities for training and professional development has the project provided?Dr. Johnson received on-the-job bovine reproductive ultrasound training from a dairy veterinarian in a nearby area and received continuing education credits from the state veterinary board for that training. Dr. Johnson had planned to travel out-of-state for a 3-day course, but due to Coronavirus concerns opted for online and local training instead. For radiology, Dr. Johnson has reviewed numerous sources for patient positioning and views required for various diagnoses. With the equipment on hand, she can take radiographs to share with more knowledgeable colleagues for feedback and treatment plan suggestions. This has boostered Dr. Johnson's confidence in hands-on physical exams in addition to giving clients access to dental and lameness experts. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Dr. Johnson plans to do additional marketing of ultrasound pregnancy diagnosis in ruminants now, at the beginning of year 2, having gained confidence in her skills over the past 8 months. Dr. Johnson will also explore options to promote radiograph services, consulting with colleagues about marketing and requesting written permission from clients to share interesting images/case histories publicly. Overall, the business has grown significantly in 2020, and pending small farm agriculture continues to thrive in Vermont despite an economic recession, Dr. Johnson is making plans to build an office and a small boarding facility as planned in year two. She will likely hire a part-time employee as well, especially after seeing the efficiency benefits of having a social-distancing assistant during coronavirus- prevention lockdowns in year one.

Impacts
What was accomplished under these goals? Year 1 (Sept. 15, 2019 to September 14, 2020) Dr. Johnson purchased imaging equipment and a replacement truck as soon as she received grant funds in late January 2020. The ultrasound was first used on February 27, 2020 and the radiograph machine was first introduced on February 10, 2020 and subsequently once every 2-3 months, with a recent uptick (2-3 equine cases in one week). Dr. Johnson did not provide any free services to customers, just discounts on her hourly rate while learning how to use the equipment. The most useful time to diagnose small ruminant pregnancies is in December in Vermont. Having missed that window in the first year, Dr. Johnson only used the ultrasound at 5 farms and the radiograph was used for 3 patients in this project's first year, resulting in $570 in equipment use fees. Three of the five ultrasound farm visits would not have happened in previous years, because the express purpose for these was pregnancy diagnosis in small ruminants. At least $600 of revenue this first year came from a corresponding increase of billable hours resulting from equipment use. In response to marketing the availability of this diagnostic equipment and the demand for livestock veterinary services, CALVS has gained an average of 8 new clients each month, a 3% increase over previous years. The percentage of clients that used the above services from February through September 2020 is not worth calculating due to the seasonal aspect of ultrasound use. Also, radiograph use has seen a significant uptick since October 1, 2020 and will hopefully result in a meaningful percentage calculation in year 2 of the project. The income generated in equipment usage fees was: $570 Associated billable hours: at least $600 Client growth per month: 8 Although not specified in the project goals above, CALVS projected to produce 400 invoices in 2019 and $72,000 in revenue. The actual totals were 400 invoices, 14 of which were finance charges, and $70,287 in revenue.

Publications